Detrusor Acontractility after Acute Spinal Cord Injury-Myth or Reality?

Abstract

Purpose: We assessed urodynamic parameters within the first 40 days after spinal cord injury to investigate whether the detrusor is acontractile during the acute phase of spinal cord injury.

Materials and methods: We performed a prospective cohort study in 54 patients with neurogenic lower urinary tract dysfunction due to acute spinal cord injury who underwent urodynamic investigation within the first 40 days after injury at a single university spinal cord injury center.

Results: Urodynamic investigation revealed an acontractile detrusor in only 20 of the 54 patients (37%) but unfavorable urodynamic parameters in 34 (63%). We found detrusor overactivity in 32 patients, detrusor-sphincter dyssynergia in 25, maximum storage detrusor pressure greater than 40 cm H₂O in 17, vesicoureteral reflux in 3 and low bladder compliance (less than 20 ml/cm H₂O) in 1. More than 1 unfavorable urodynamic parameter per patient was possible.

Conclusions: In contrast to the common notion of an acontractile detrusor during acute spinal cord injury, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after spinal cord injury. Considering that early treatment of neurogenic lower urinary tract dysfunction in patients with acute spinal cord injury might improve the long-term urological outcome, urodynamic investigation should be performed timely to optimize patient tailored therapy.

Keywords: muscle hypotonia; neurogenic; spinal cord injuries; urinary bladder; urodynamics.