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Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

Research output: Contribution to journalReview article

  • Hilary Z Hu
  • Nicolas Granger
  • ND Jeffery
Original languageEnglish
Pages (from-to)1575–1588
Number of pages14
JournalJournal of Veterinary Internal Medicine
Volume30
Issue number5
Early online date16 Aug 2016
DOIs
DateAccepted/In press - 27 May 2016
DateE-pub ahead of print - 16 Aug 2016
DatePublished (current) - Sep 2016

Abstract

Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C-fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex-mediated simultaneous detrusor and sphincter contractions or detrusor-sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease-associated changes can impact on the quality of life and life expectancy of spinal-injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.

    Research areas

  • canine, Incontinence, spinal cord injury, bladder, neurogenic, Urodynamic, cystometry, urodynamics, urinary, spinal

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    Rights statement: This is the final published version of the article (version of record). It first appeared online via Wiley at http://onlinelibrary.wiley.com/wol1/doi/10.1111/jvim.14557/full. Please refer to any applicable terms of use of the publisher.

    Final published version, 608 KB, PDF document

    Licence: CC BY

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