Detrusor Areflexia

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Methods

Outcome

Shin et al. 2002
Korea
Observational
N=50

Population: Patients with traumatic cauda equina injury: Normal compliance group (n=36):Mean age: 32.9 yr; Gender: males (n=20), females (n=16); Mean time from injury: 4.9 mo; Mean time interval between injury and rehabilitation: 3.4 mo; Voiding method: clean intermittent catheterization (n=20), reflex voiding (n=11), foley catheterization (n=3), normal voiding (n=2).Low compliance group (n=14):Mean age: 26.2 yr; Gender: males (n=6), females (n=8); Mean time from injury: 7.8 mo; Mean time interval between injury and rehabilitation: 5.9 mo; Voiding method: clean intermittent catheterization (n=2), reflex voiding (n=7), foley catheterization (n=5), normal voiding (n=0).\
Treatment: Urodynamic evaluation; normalization of compliance in patients in the low compliance group via oxybutynin and propiverine.
Outcome Measures: Presence of autonomous detrusor contraction (ADC), time since injury, voiding method prior to admission, maximal bladder capacity, maximal detrusor pressure, compliance, 

  1. No significant difference between the normal compliance and low compliance for age and sex.
  2. There was a significantly longer time interval between rehabilitation and time from injury in the low compliance group (p<0.05).
  3. In the normal compliance group, clean intermittent catheterizations were used significantly more compared to the low compliance group (p<0.05).
  4. The low compliance group had significantly lower mean compliance and mean maximal bladder capacity than the normal compliance group (p<0.01).
  5. Mean maximal detrusor pressure was significantly higher in the low compliance group (p<0.01).
  6. ADC observed in 6/14 patients in the low compliance group, these patients had significantly lower mean compliance, maximal bladder capacity and higher maximal detrusor pressure (p<0.05).
  7. Normalization of low compliance group led to significantly higher compliances and maximal bladder pressures (p<0.05), as well as significantly lower maximal detrusor pressures (p<0.05).
  8. Follow-up of normalization showed ADC to disappear and compliance and maximal bladder capacity to return to normal in 4/6 ADC patients. 
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