Ivan Savić

BLADDER FUNCTION IN PATIENTS WITH LUMBAR INTERVERTEBRAL DISK PROTRUSION

PURPOSE We prospectively studied the effect of lumbar intervertebral disk protrusion on bladder function. Cystometry findings were particularly examined according to spinal level of disk protrusion and urological symptoms. MATERIALS AND METHODS We evaluated 77 men and 37 women 25 to 63 years old with lumbar intervertebral disk protrusion. Urodynamic investigation included uroflowmetry and simultaneous recording of intravesical, abdominal and detrusor pressure during bladder filling and voiding. RESULTS Detrusor areflexia was noted in 31 of the 114 patients (27.2%), while detrusor activity was normal in the remaining 83. According to the spinal level of disk protrusion, detrusor areflexia was evident in 3 of the 8 cases of L3, 10 of the 54 L4 and 18 of the 52 L5 disk protrusion. All 31 patients with detrusor areflexia reported difficult voiding with straining. CONCLUSIONS Detrusor areflexia develops in approximately a quarter of the patients with lumbar intervertebral disk protrusion. We did not find that the spinal level of lumbar disk protrusion had an effect on detrusor activity. All patients with detrusor areflexia had voiding disorders that manifested as voiding with straining.

Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion

Abstract. The relationship between voiding disturbances and urodynamic diagnosis in patients with lumbar intervertebral disk protrusion is controversial. The objective of this study was to determine the association between clinical data and urodynamic diagnosis, in order to reveal whether bladder dysfunction can be assessed on the basis of urological symptoms and signs. We prospectively studied 122 patients with lumbar intervertebral disk protrusion. Detrusor areflexia was found in 32 of these patients, while in the remaining 90 detrusor activity was normal. All patients with detrusor areflexia reported difficulty voiding by abdominal straining. The patients with normal urodynamic findings were either free of voiding disturbances (77 patients) or complained of frequent voiding (13 patients). In conclusion, there are cases of lumbar intervertebral disk protrusion in which the presence of bladder dysfunction can be predicted on the basis of clinical urodynamic testing, i.e. clinical neurological alterations, decreased bladder sensation, voiding by straining, increased bladder capacity, residual volume, and intermittent or continuous low flow curve on free uroflowmetry.