Article

OBJECTIVES: To investigate voiding dysfunction and upper urinary tract status in
survivors of coma resulting from traumatic brain injury (TBI), and to compare
clinical and urodynamic results with neurologic and psychological features as
well as functional outcomes. DESIGN: Observational study focused on urologic
dysfunction and neurologic outcome in coma survivors after traumatic brain injury
in the postacute and chronic phase. SETTING: A postcoma unit in a rehabilitation
hospital. PARTICIPANTS: Consecutive patients (N=57) who recovered from coma of
traumatic etiology and who were admitted during a 1-year period to a postcoma
unit of a rehabilitation hospital. INTERVENTIONS: Patients underwent clinical
urologic assessment, urodynamics with the assessment of the Schafer nomogram and
the projected isovolumetric detrusor pressure to evaluate detrusor contractility,
ultrasound assessment of the lower and upper urinary tract and voiding
cystourethrography, routinely performed, according to the International
Continence Society Standards. Neurologic variables assessed were brain injury and
disability severity, and neuropsychological status. Neuroimaging identified the
site of cerebral lesions. MAIN OUTCOME MEASURES: Urinary symptoms, disability by
means of the Glasgow Outcome Scale (GOS), and neuropsychological status by means
of the Neurobehavioral Rating Scale (NBRS), and the relationships among them.
RESULTS: Of the 57 patients studied, 30 had overactive bladder (urge
incontinence) symptoms, 28 had detrusor overactivity, and 18 had detrusor
underactivity with associated pseudodyssynergia in 15 of these patients. Eleven
patients had hypertrophic bladder; 3, bilateral pyelectasia; and 2,
vesicoureteral reflux. Disability measured by GOS was severe in 8 patients and
moderate in 27, while recovery was good in 22 patients. The mean NBRS total score
indicated a mild cognitive impairment. Neuroimaging showed diffuse brain injury
in all patients. Statistically significant relationships were found between urge
incontinence, detrusor overactivity, and poor neurologic functional outcome,
between detrusor overactivity and right hemisphere damage (P=.0001), and between
impaired detrusor contractility and left hemisphere injuries (P=.0001).
CONCLUSIONS: Most patients who recovered from coma resulting from TBI have
symptoms of overactive bladder syndrome and voiding difficulties. These urinary
problems correlate with cerebral involvement and neurologic functional outcome.
CI - Copyright (c) 2011 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS