URODYNAMICS IN SPINAL SHOCK PATIENTS

We investigated 17 spinal shock patients with traumatic complete cord lesions with cystometry, urethral pressure profile, anal and rectal pressure recordings, and electromyography of the pelvic floor sphincters. Bladder filling was accompanied by an elevation of resistance in the bladder neck area, with a concomitant increase of pressure in the external sphincter zone but without a simultaneous increase of the electromyographic activity. These results indicate an increased sympathetic activity in the smooth muscle component of the entire urethra. In the majority of patients the continuous withdrawal pressure profile had higher values in the membranous urethra than the interrupted withdrawal pressure profile, revealing the importance of sensory afferents from the urethral mucosal receptors in producing artifactual reflex activity in the pelvic floor muscles. In the majority of interrupted withdrawal urethral pressure profiles higher pressures were recorded in the juxtabulbous region than in the mid part of the membranous urethra. A somewhat decreased electromyographic activity was found in the anal and urethral spincters at rest. It did not often relate to the amount of resistance recorded in either sphincter. High urethral sphincter pressures and somatic activity of the conus medullaris reflexes show that external urethral and anal sphincters escape spinal shock, the primary characteristic of which is areflexia.