Exclusive Image Gallery on Human Spinal Cord Regeneration-Clinical Image-25

Abstract

Clinical urinary bladder function test (Urodynamics). Improvement of the urinary bladder functions, quantified by urodynamics in a 30-year-old female patient. A. 3 months after the accident resulting paraplegia sub Th12 following spinal cord lesion. B. 12 months after the accident (lesion level lowered to sub L3). In A, the detrusor pressure (Pdet) is generated by the contracture of the bladder wall, as the pressure difference between abdominal pressure (Pabd, measured in the rectum) and the bladder pressure (Pves, measured in the bladder). Electromyographic recording obtained with surface electrodes from the sphincters and the pelvic floor (EMG) is shown; the external sphincters and the functionally correlated pelvic floor muscles show similar sEMG activity (the rhythmic pressure peaks in A do not originate in the bladder). In A, the detrusor shows nearly no activity with retrograde bladder filling at 25 ml/min; in B, the detrusor shows first activity at 360 ml bladder filling. A detrusor-sphincteric-dyssynergia occurs, because the detrusor pressure peaks occur at the same time as the sphincter EMG activity peaks (B) (bladder and sphincter contract at the same time, so that fluid can only emerge from the bladder at high bladder pressure; there is a danger of reflux through the ureter into the kidneys). The EMG peaks are a bit irregular, probably because the fluid, leaving the bladder, shunts transiently the EMG electrodes. Exact functional description of B: 2x coughing (B below) increases the EMG activity and passively the pressure in the abdomen and in the bladder (marked by the small arrows, physiologic). The bulbocavernosus reflex (induced by pressure applied to the clitoris) increased the EMG activity of the sphincters (physiologic). Conclusion: The reflex arch is in order; sacral nerve roots and nerves have not been damaged in the accident. I (bottom right): The patient feels an increase of unvolitional detrusor pressure (first feeling of bladder pressure at 360 ml). She tries to contract the sphincters to stop the bladder emptying. Shortly after the desire to empty the bladder, as the detrusor pressure decreases, fluid is leaving the bladder. II: Due to tapping onto the bladder, the bladder reflex is activated (detrusor activated, nearly no abdominal pressure); fluid is leaving the bladder. III: Due to the abdominal muscular pressure the pressure in the abdomen increases as does passively the pressure in the bladder (the detrusor is not activated); fluid left the bladder. With a delay, the detrusor was activated by the bladder reflex. - The urinary bladder of the patient is partly functioning. It has to be further improved by therapy induced reorganization of the CNS: (1) An earlier feeling of bladder filling, (2) an increase of the time difference between the feeling of the first bladder filling and the un-volitionally emptying of the bladder (for the time being, approx. 10 min, in dependence on whether the patient is physically active (such as walking) or not, (3) further learning how to activate the detrusor on volition, and (4) the physiologic coordination between the bladder and the external sphincter functioning (to stop the detrusor-sphincter-dyssynergia).