Usporedba cistometrijskih kapaciteta i intravezikalnih tlakova kod prokapavanja u tetraplegičnih i paraplegičnih bolesnika s ozljedom kralježničke moždine i neurogenom hiperaktivnošću detruzora

The aims were to compare cystometric capacities and leak-point intravesical pressures between tetraplegic and paraplegic spinal cord injury patients with neurogenic detrusor overactivity, and to assess eligibility of using suprapubic tapping voiding with external collection device in tetraplegic patients. Filling cystometry at non-physiological filling rate was performed in 122 spinal cord injury patients at rehabilitation or annual check-up using Dantec Etude urodynamic machine. Sixty-seven tetraplegic and 55 paraplegic patients were diagnosed with neurogenic detrusor overactivity, all with suprasacral level of injury. The mean cystometric capacity (CC) was 260±117 mL (range 53-500) in tetraplegic group and 289±135 mL (range 42-530) in paraplegic group. There was no significant between-group difference in CC (P=0.220). The mean leak-point intravesical pressure (Pves LPP) at CC was 72±25 cm H2O (range 25-124) in tetraplegic group and 70±27 cm H2O (range 25-140) in paraplegic group. The difference was not significant (P=0.711). The findings were equally unfavorable in both groups, suggesting the method of suprapubic tapping voiding with external collection device to be no more advisable in tetraplegic than in paraplegic patients. Neurogenic bladder should be managed with the same caution in cervical (tetraplegic) and thoracolumbar (paraplegic) patients, including intermittent catheterization as the first treatment choice, as opposed to the use of the less carer-time-consuming suprapubic tapping voiding with external collection device.Ciljevi rada bili su usporediti cistometrijske kapacitete i intravezikalne tlakove kod prokapavanja u tetraplegičnih i paraplegičnih osoba s ozljedom kralježničke moždine i neurogenom hiperaktivnošću detruzora, i ocijeniti podobnost suprapubičnog lupkanja s kondom urinal drenažom u tetraplegičnih bolesnika. Cistometrija nefiziološkom brzinom punjenja učinjena je kod 122 bolesnika s ozljedom kralježničke moždine tijekom rehabilitacije ili godišnje evaluacije stanja uporabom urodinamskog aparata Dantec Etude. Neurogenu hiperaktivnost detruzora imalo je 67 bolesnika s tetraplegijom i 55 bolesnika s paraplegijom, svi sa suprasakralnom razinom ozljede. Srednja vrijednost cistometrijskog kapaciteta (CK) za tetraplegičnu skupinu bila je 260±117 ml (raspon 53-500), a za paraplegičnu skupinu 289±135 ml (raspon 42-530). Nije nađena značajna razlika CK među skupinama (P=0,220). Srednja vrijednost intravezikalnog tlaka kod promokravanja pri CK za tetraplegičnu skupinu bila je 72±25 cm H2O (raspon 25-124), a za paraplegičnu skupinu 70±27 cm H2O (raspon 25-140). Razlika među skupinama nije bila značajna (P=0,711). Nalazi su bili podjednako loši u obje skupine, stoga se metoda suprapubičnog lupkanja s kondom urinal drenažom ne može preporučiti u tetraplegičnih bolesnika više no u paraplegičnih. Neurogeni mjehur treba pažljivo liječiti u cervikalnih (tetraplegičnih) i torakolumbalnih (paraplegičnih) bolesnika, što uključuje intermitentnu kateterizaciju kao metodu izbora naspram za asistenta manje vremenski zahtjevnim suprapubičnim lupkanjem s uporabom kondom urinal drenaže