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Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions

Objective. To investigate the relationship between lesion severity and other clinical factors and bladder function recovery. Patients and methods. The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to...

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Published in:Disability and rehabilitation 2008, Vol.30 (5), p.330-337
Main Authors: Scivoletto, G., Cosentino, E., Morganti, B., Farchi, S., Molinari, M.
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creator Scivoletto, G.
Cosentino, E.
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description Objective. To investigate the relationship between lesion severity and other clinical factors and bladder function recovery. Patients and methods. The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Statistics. Logistic approach with univariate and multivariate analysis. Results. Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p < 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p < 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. Discussion and conclusion. Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. Patients with bladder function recovery show a higher frequency of central cord and Brown-Sequard syndromes (with better prognosis) and a lower frequency of detrusor-sphincter dyssynergia.
doi_str_mv 10.1080/09638280701265596
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Patients and methods. The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Statistics. Logistic approach with univariate and multivariate analysis. Results. Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p &lt; 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p &lt; 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. Discussion and conclusion. Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. 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Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. Discussion and conclusion. Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. 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Patients and methods. The charts of 269 patients with traumatic and non traumatic spinal cord lesion (SCL) were reviewed and the following information was recorded: lesion to admission time, injury variables, length of stay and neurological status. At five months, urological outcome was assessed by voiding modalities, and urodynamics according to International Continence Society. Statistics. Logistic approach with univariate and multivariate analysis. Results. Both ASIA impairment at admission and age were significantly correlated with bladder function outcome. None of the patients with ASIA A impairment at admission reached volitional voiding at five months. ASIA B patients had a 90% lower probability of achieving good bladder control and ASIA C ones a 65% lower than ASIA D patients (p &lt; 0.05). Older patients had a significant lower probability (60%) of achieving volitional voiding than younger ones (p &lt; 0.05). Of the 121 patients with ASIA D impairment at discharge only 78 voided spontaneously and showed a higher frequency of cervical lesions and a lower frequency of detrusor-external sphincter dyssynergia. Discussion and conclusion. Bladder recovery in patients with complete SCL is limited. ASIA B patients showed a better neurological recovery and, concurrently, better bladder function recovery than ASIA A patients, thus demonstrating the importance of sensation preservation for recovery. Younger patients show better bladder recovery than older ones, probably because of different efficiency of spinal cord plasticity. Finally, patients with good neurological recovery may not achieve volitional voiding. 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subjects Admissions
Adolescent
Adult
Age
Aged
Aged, 80 and over
ASIA impairment
bladder recovery
Cauda Equina - injuries
Chi-Square Distribution
Child
Disability
Female
Humans
Male
Middle Aged
Prognosis
Recovery
Recovery of Function
Severity of Illness Index
Spinal cord injuries
Spinal Cord Injuries - physiopathology
Spinal Cord Injuries - rehabilitation
Spinal cord lesion
Statistics, Nonparametric
Urinary Bladder, Neurogenic - physiopathology
Urinary Bladder, Neurogenic - rehabilitation
title Clinical prognostic factors for bladder function recovery of patients with spinal cord and cauda equina lesions
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