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Detrusor Overactivity in Patients With Cauda Equina Syndrome

Kim, Seo-Young MD*; Kwon, Hee Chung MD*; Hyun, Jung Keun MD, PhD*,†,‡

doi: 10.1097/BRS.0000000000000410
Diagnostics
SLIDE

Study Design. Retrospective cross-sectional study.

Objective. To delineate the neurogenic bladder type in patients with cauda equina syndrome (CES) and to suggest, in light of the clinical, radiological, and electrophysiological findings, a possible cause of bladder dysfunction.

Summary of Background Data. Many patients with CES experience bladder dysfunction, although the type of neurogenic bladder is quite variable in the clinical setting. Bladder dysfunction in patients with CES is usually areflexic or acontractile detrusor. However, detrusor overactivity (DOA) also reported the cases that cannot be explained by pure root injuries in the cauda equina region.

Methods. Patients with CES with neurogenic bladder were studied, all of whom (n = 61; mean age ± SD, 48.0 ± 15.9 yr) underwent urodynamic analysis, magnetic resonance imaging (MRI), and electrophysiology. According to the urodynamic findings, the neurogenic bladder was classified into 2 types: DOA and detrusor underactivity or acontractility. The highest level of injury (HLI) or level of injury was determined and analyzed on the basis of the clinical-urodynamic and electrophysiological findings, respectively.

Results. Twenty patients with CES (32.8%) showed DOA; in most of them (85.0%, 17/20 patients), the HLI on electrophysiological assessment was L2 or above. Forty-one patients with CES showed detrusor underactivity or acontractility; and most of the patients with CES whose HLI was L3 or below showed detrusor underactivity or acontractility (91.2%, 31/34 patients). None of the HLI or level of injury from the clinical or magnetic resonance imaging findings correlated with neurogenic bladder type. We also found that urodynamic findings including maximal detrusor pressure and bladder capacity was partially correlated with the HLI on electrophysiological assessment (r2 = 0.244, P < 0.001 and r2 = 0.330; P < 0.001, respectively).

Conclusion. DOA was seen most often in patients with CES whose HLI was L2 or above, and might be associated with combined conus medullaris lesion. Electrophysiology might be the most useful assessment tool for prediction of neurogenic bladder type in patients with CES.

Level of Evidence: 4

We conducted a retrospective cross-sectional study involving patients with cauda equina syndrome. Twenty patients (32.8%) showed detrusor overactivity; in most of them (85.0%, 17/20 patients), the highest level of injury on electrophysiological assessment was L2 or above, and might be associated with combined conus medullaris lesion.

*Department of Rehabilitation Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea; and

Department of Nanobiomedical Science and BK21PLUS NBM Global Research Center for Regenerative Medicine, and

Institute of Tissue Regeneration Engineering (ITREN), Dankook University, Cheonan, Republic of Korea.

Address correspondence and reprint requests to Jung Keun Hyun, MD, PhD, Department of Nanobiomedical Science and BK21 PLUS NBM Global Research Center for Regenerative Medicine, Dankook University, San 16-5 Anseo-dong, Dongnam-gu, Cheonan 330-714, Republic of Korea; E-mail: rhhyun@dankook.ac.kr

Acknowledgment date: January 20, 2014. Revision date: April 15, 2014. Acceptance date: April 20, 2014.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Dankook University grant funds in 2013 were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins