Biomedical subjects
Publications and source records attributed to K B Labib.
The use of urodynamic evaluation as a diagnostic tool for evaluating subtle neurologic lesions involving the second, third, and fourth segments of the sacral spinal cord is redefined. Six illustrative cases are presented.
Urodynamic evaluation was done 45 times on 41 consecutive patients with multiple sclerosis. Bladder symptoms correlated poorly with any single urodynamic finding and, accordingly, a comprehensive evaluation was necessary to define the underlying pathophysiology. Only 63 per cent of the patients with symptoms of urgency, frequency and urge incontinence actually were found to have uninhibited bladder contractions, while 73 per cent of the patients with obstructive symptoms had detrusor areflexia. Six patients (15 per cent) had a marked change in urodynamic findings upon repeat examination either because of a change in symptomatology or poor response to treatment. An additional 6 patients had vesicoureteral reflux. Bladder symptoms in multiple sclerosis patients should serve more to alert the clinician to the need for urodynamic testing than to mandate specific treatment.
Twenty-two boys with myelodysplasia and incontinence were evaluated urodynamically. Three types of bladder function were noted, but each could not be correlated with any particular neuroligic level. The integrity of the external sphincter innervation was determined by electomyographic monitoring of periurethral striated muscle. Bladder sphincter dyssynergia was found in one of the boys with voluntary control, five with involuntary bladder contractions, and five with adynamic bladders who voided by Credé's method. A radiologically narrow external sphincter on voiding cystography could only be correlated with the bioelectric activity in children with dyssynergia. A narrow sphincter was also noted in three children with synergy and four with complete lower motor neuron lesions. Marked fibrosis was found to be the cause of narrowing of external sphincter area in these boys. Thus, urodynamic evaluation helped define the etiology of outlet obstruction when it was present in the boy with myelodysplasia. A classification of bladder sphincter function is proposed.
Sixteen women underwent complete urodynamic investigation of acute urinary retention. Simultaneous recordings of intravesical and rectal pressures allowed an easy distinction to be made between bladder contractions and abdominal straining. Needle electromyograms, viewed on an oscilloscope by an experienced electromyographer, permitted an exacting neurologic diagnosis. Although the cause was psychogenic in 7 patients, 9 others had subtle evidence of organic pathology, one of whom had a spinal cord tumor. A logical format for evaluating acute urinary retention is presented.
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