UROLOGICAL STUDIES ON SPINAL CORD INJURY PATIENTS

Abstract

The findings of cystography, urethrography, cystoscopy and intravenous pyelography as well as complications, treatments and prognosis in 171 cases of traumatic spinal cord injury at the Bibai Rosai Hosptial (high lesion 43, middle lesion 56 and low lesion 72) are reported in this paper.
1. The patterns of retrograde cystograms were classified to 5 fundamental types which were atonic type bladder, normal type bladder, distorted type bladder, pine tree shaped bladder and contracted bladder. Within 6 months after injury, the writer found atonic bladder in more than a half of total cases, distorted type bladder in about one-fourth, normal type bladder and pine tree shaped bladder in 10% respectively. After 1 year, however, atonic bladder was seldom found; the incidence of distorted bladder increased to about 70% and that of pine tree shaped bladder to 20%. and normal type bladder remained within 10%.
After 2 years, distorted bladder in over 60%, pine tree shaped bladder in more than 30% and contracted bladder in 6% was seen.
Related with level of cord lesion, the number of atonic bladder decreased more rapidly in the high lesion group than in the middle and low lesion groups. Correlation between bladder type and bladder efficiency was not seen in the present series.
2. Trabeculation of bladder was found in 24% within 6 months after injury, in 44% at one year and 90% after 2 years. Trabeculation in the high lesion group occured more often than in the other groups between 6 months to one year. After 2 years inspite of the level of the lesion, the incidence of trabeculation was elevated to about 90%.
Elongation of bladder dome was observed in about 15% of total cases within 1 year, and its increased to 36% after 2 years.
The percentage of dilatation of posterior urethra was 37% within 1 year, then was enhanced to 50 or 60%.
Over a half of patients had sinking of bladder base within 6 months. Its percentage was gradually lowered with time. Inspite of the time elapsed since injury, it was always higher in the low lesion group than in the other groups.
Relationship between these abnormal findings of cystograms and bladder efficiency was not. observed in this series.
3. Within 6 months after injury, spastic external sphincter was observed only in the high lesion group. After 2 years, however, its incidence did not have any significant difference among these three groups (10-15%).
Relaxed external sphincter was seen in 19% of total cases without the incidental difference among each group after one year.
4. The percentage of the cases with hypofunctional kidney by IVP within 6 months, after 1 year and after 2 years was 10%, 31% and 36% respectively. Inspite of the higher incidence of marked renal hypofunction in the high lesion group, the incidence of hypofunctional kidney was almost the same in three groups.
There was no correlation between renal function and bladder efficiency: Lowering of the renal function was observed in as high as 40% of the cases with good bladder efficiency.
5. The incidence of vesicoureteral reflux was 19% of total cases and had no diffierence among each group. It was about 10% within 1 year and was elevated to 30% after 2 years. 80% of kidneys with VUR showed renal hypofunction and they became worse with time. VUR was found in 50% of contracted bladder, in about 15% of distorted type bladder and pine tree shaped bladder, but was seldom complicated with atonic and normal type bladder.
6. Calculous formation was found in 14% of total cases.
7. 59 patients out of 120 achieved satisfactory micturition without surgical treatments, and another 26 cases with various operative interventions.
8. Follow up studies on 50 cases after discharge were performed. Out of 19 cases with no residual urine on discharge, 16 cases (840) had no residual on the reexamination time, and only 2 cases claimed fever of pyelonephritis after discharge.
Out of 12 cases with residual rate of les