| 제목 |
Comparison of Detrusor-Sphincter Dyssynergia in the SCI And Non-Neurogenic Bladder:Preliminary Study |
| 소속 |
Chonbuk National University Hospital, Department of Rehabilitation Medicine1, Research Institue of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National Universitiy Hospital2, Chonbuk National University Hospital, Department of Urology3 |
| 저자 |
Sung Woon Baik1*, Gi Wook Kim1,2, Yu Hui Won1,2, Sung Hee Park1,2, Myoung Hwan Ko1,2, Myung Ki Kim3, Jeong Hwan Seo1,2† |
Objective : The urinary bladder function of storing and voiding urine is controlled by central and peripheral nervous systems. The pathophysiology of detrusor-sphincter dyssynergia (DSD) in neurogenic bladder is represented by disruption of spinobulbospinal tract between the pontine micturition center and Onuf’s nucleus. However, dyssynergic sphincter activity can be seen in non-neurogenic etiology. In this retrospective study, we aimed to find out the differences of dyssynergic sphincter activity patterns and urodynamic parameters in the spinal cord injured and the non-neurogenic dysfunctional bladder.
Method : Seventy-eight patients of dysfunctional voiding with urodynamic study reports were enrolled. They were divided into spinal cord injured group or non-neurogenic group by reviewing the medical records. We categorized the urodynamic study findings into 6 types according to dyssynergic sphincter activities. Type 1-3 belonged to true DSD and the other types to pseudo-DSD. And we also analyzed their urodynamic parameters such as bladder capacity, compliance, detrusor leak point pressure, peak detrusor pressure (PdetQmax), post-void residual urine volume and electromyographic activity of the sphincter.
Results : About 16% (8 patients out of 48 patients) of non-neurogenic group and 86.7% (26 patients out of 30 patients) of cord injury group showed dyssynergic sphincter activity, respectively. There were significant differences in bladder capacity (t=2.537, p<0.05) and compliance (t=3.364, p<0.05) between true DSD patients and pseudo-DSD patients. There were significant difference in peak detrusor pressure at maximal urinary flow rate (t=2.489, p<0.05) between cord injured group and non-neurogenic group. There were no significant difference in other urodynamic parameters such as bladder capacity (t=1.844, p=0.099), compliance (t=0.727, p=0.477), DLPP (t=0.322, p=0.752), PVR (t=1.036, p=0.314) when compared dyssnergic sphincter acitivty patients in each two groups.
Conclusion : Detrusor-sphincter dysfunction was not infrequent in patients with non-neurogenic bladder. And those who have dyssynergic sphincter activity had higher bladder capacity and compliance tendency. Also, cord injury group had higher peak detrusor pressure at maximal urinary flow rate during voiding than that of non-neurogenic bladder group. Further study with more patients is necessary. |
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