The Experimental And Clinical Study On The Treatment Of Spastic Bladder After Spinal Cord Injury

For paraplegic patients after spinal cord injury, it's important to solve the problem of bladder malfunction, which can improve the patients' living quality and decrease the mortality rate and complications. This paper is included the following 5 parts: the clinical study on urodynamic examination and classification of bladder function after spinal cord injury; the comparative study on the treatment effects of baclofen and verapamil in treating spastic bladder after spinal cord injury; the expernnental study of dog sacral nerve distributions and its influence on lower urinary tract function; the experimental and clinical studies on differential sacral nerve rhizotomy for treatment of spastic bladder after spinal cord injury. With which we performed both basic and clinical studies on the treatment of spastic bladder after spinal cord injury.1.The clinical study on urodymic examination and classification of bladder function after spinal cord injury: In order to understand the characters of bladder malfunction after spinal cord injury and set up the theoretical basis for the following treatment We investigated the urodynamic changes on 86 paraplegic patients with the following results; 1. Different segment and severity of spinal cord injury would results in different urodynamic manifestations and bladder function and also different complications. According to the difference, the bladder was classified as the following 3 classes: (1 )bladder with hyper-reactive musculus detrusor urinae and coordinated musculus sphincter uretbrae.(2)bladder with hyper-reactive musculus detrusor urinae and discoordinated musculus sphincter urethrae.(3)bladder with no reactivity of musculus detrusor urinae. The above results suggested the following: 1. To classify the bladder after spinal cord injury according to the urodynamic manifestations gave the importantguidance on clinical work. 2. It抯 the first and key point to effectively treat the spastic bladder after spinal cord injury for treatment of bladder malfunction.2.The comparative study on the treatment effects of baclofen and verapamil in treating spastic bladder after spinal cord injury: To investigate the possibility and the effect of medicine treatment of spastic bladder, we were the domestic No.1 to treat spastic bladder with baclofen the international newest products of antispastic drugs for striated muscles. The results revealed that baclofen treatment improved the storage and evacuation function of bladder and the extremities spasticity was also released obviously, thus the treatment effect of baclofen was superior to that of verapumil. We then concluded that Baclofen could be the first choice of medicine to treat spastic bladder in paraplegic patients for its treatment effect was certain and reliable.3.The experimental study of dog sacral nerve distribution and its influence on lower urinary tract function:For further understanding of the distribution of dog sacral nerve in bladder, urinea and penis, and in order to set up theoretical basis for selective sacral nerve rhizotomy in treating spastic bladder after spinal cord injury, 12 dogs were respectively given electrical stimulation to S 1 3 nerve roots and the contraction of musculus sphincter urethrae and detrusor urinae, the change of bladder pressure and penis erection were examined and recorded. We found that electrical stimulation to Si nerve root induced peak value of evoked motor action potential of musculus detrusor urinae and change of bladder pressure, which amounted to 60% of that in normal condition. Electrical stimulation to S2 nerve root induced peak value of evoked motor action potential of musculus sphincter urethrae, which amounted to 57% of that in normal condition. Electrical stimulation to S3 nerve root could improve dog penis erection. We then concluded that Si mainly distributes in musculus detrusor urinae, S2 mainlydistributes in musculus sphinctor urethrae, 53 mainly distributes in penis. There were combined distributions and significant individual difference.4.The e...