Urodynamic evaluation of detrusor pressure and blood pressure reaction in patients with a reflux urinary bladder after spinal cord injury

Sammanfattning: This thesis is focused on urodynamic evaluation of variables that are associated with the risk of upper urinary tract dysfunction and autonomic dysreflexia in patients with a reflex urinary bladder after spinal cord injury. The detrusor pressure was measured with suprapubic catheters during 24 or 12 hours of physiological filling (diuresis) and during consecutive cystometries. Within the ftlled volumes the bladder compliance was high. During contractions the maximum detrusor pressure and its duration varied both interand intraindividually. Thus, mean values from a series of contractions seem to be necessary in order to characterize a patient. There was no difference between mean values during physiological filling compared with 10 rnl/min or 50 ml/min fill cystometry and there was no systematic change during a series of four consecutive cystornetries with a 10 min interval. When a closed 12F urethral catheter was added in order to mimick a transurethral urodynamic techrtique, there was an increase of the amplitude and duration of the detrusor pressure and a decrease of the average flow rate, indicating an obstructive effect. In patients with a high level spinal cord injury, the blood pressure was also measured every 30 s, during a series of four consecutive cystometries. In each cystometry there was an elevation of the systolic and diastolic blood pressure. The maximum blood pressure was always observed during the detrusor contraction. The amplitude of the blood pressure response varied intraindividually but did not change in any particular direction during the series of cystometries. When 10 mg rtifedipine was given sublingually, and a series of four cystometries was repeated, there was a sigrtificant decrease of the maximum blood pressure.