PDF(Pubmed)
Abstract：
Background/Objectives: This study aimed to identify the unique characteristics of neurogenic bladders and associated symptoms in patients with cervical or thoracic myelopathy using clinical surveys and urodynamic studies (UDSs). Methods: Patients with degenerative cervical (DCM) or thoracic (DTM) myelopathy and lower urinary tract symptoms (LUTSs) scheduled for decompressive surgery were prospectively enrolled. A UDS was performed one day preceding surgery to evaluate the preoperative urological function. Subjective symptoms were evaluated using the International Prostate Symptom Score (IPSS) and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire before surgery and one year postoperatively. Results: Sixty-two patients (DCM: 50, DTM: 12) with a mean age of 63.2 years (men: 30, women: 32) were enrolled. The UDS revealed that 5 (8.1%) patients, all with DCM, exhibited completely normal UDS results, and the remaining 57 had at least one abnormal finding. Based on the International Continence Society classification, an underactive bladder was significantly more common in patients with DTM compared to patients with DCM (75.0% vs. 18.0%, p < 0.001). The results of the questionnaire showed that the voiding symptom IPSS were significantly worse, preoperatively, in patients with DTM (5.0 ± 4.4 [DCM] vs. 8.7 ± 4.5 [DTM]; p = 0.013). One year postoperatively, the IPSS grade of 24.0% of patients with DCM improved, whereas only one (8.3%) patient with DTM showed improvement. Conclusions: Patients with DTM reported worse voiding symptoms and exhibited more underactive bladders on UDS than patients with DCM before decompression. One year postoperatively, more patients with DCM showed subjective improvements in urinary function than those with DTM.
摘要：
背景/目的：本研究旨在通过临床调查和尿动力学研究（UDSs）来确定颈椎或胸椎脊髓病患者的神经源性膀胱和相关症状的独特特征。方法：前瞻性招募计划进行减压手术的退行性颈椎（DCM）或胸（DTM）脊髓病和下尿路症状（LUTSs）患者。手术前一天进行UDS以评估术前泌尿系统功能。使用国际前列腺症状评分（IPSS）和日本骨科协会颈脊髓病评估问卷在手术前和术后一年评估主观症状。结果：纳入62例患者（DCM：50，DTM：12），平均年龄63.2岁（男性：30，女性：32）。UDS显示有5名（8.1％）患者，所有与DCM，表现出完全正常的UDS结果，其余57人至少有一个异常发现。根据国际连续性社会的分类，与DCM患者相比，DTM患者的膀胱活动不足明显更常见(75.0%vs.18.0%,p<0.001)。问卷结果显示排尿症状IPSS明显恶化,术前,在DTM患者中（5.0±4.4[DCM]vs.8.7±4.5[DTM]；p=0.013）。术后一年,24.0％的DCM患者的IPSS等级得到改善，而只有1例(8.3%)DTM患者表现出改善。结论：与减压前DCM患者相比，DTM患者的排尿症状较差，并且在UDS上表现出更多的膀胱活动不足。术后一年,与DTM患者相比，DCM患者的排尿功能主观改善更多。
