PDF(Pubmed)
Abstract：
This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.
摘要：
这项研究探讨了慢性脊髓损伤（SCI）患者的15年泌尿系统并发症，并调查了视频尿动力学研究（VUDS）和膀胱管理的预测因素。分析864例SCI患者，平均随访15.6年，我们评估了并发症,并利用多变量逻辑回归进行风险评估.VUDS因素，如自主神经反射异常，逼尿肌括约肌协同失调，膀胱尿道反流(VUR),膀胱收缩,高排尿逼尿肌压力显着增加了复发性尿路感染（rUTI）的可能性。低膀胱顺应性，VUR,膀胱收缩显著增加了肾积水的风险，膀胱收缩和逼尿肌过度活动和逼尿肌活动不足会增加慢性肾脏疾病的风险。自愿排尿降低了rUTI和VUR风险，而Valsalva机动辅助排尿增加肾积水风险。总之,VUDS中发现的膀胱收缩与SCI的长期泌尿系统并发症相关,我们建议已经经历膀胱收缩的患者应优先考虑自愿排尿作为首选的膀胱管理策略,以最大限度地减少rUTI和VUR等其他并发症的风险.这些发现揭示了以前研究中未探索的方面，强调在这一患者人群中需要积极的管理策略。
