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Thread: mid thoracic SCI and urinary retention

  1. #1

    mid thoracic SCI and urinary retention

    i recently saw a patient with a T4-8 epidural abscess who presented with urinary retention (as well as bilateral lower extremity weakness and numbness) . how is this explained since at this level, if anything one would expect a contacted bladder. was it an acute effect of "spinal shock"? could there have been anatomic variation in this person such that the sacral levels were at T8 vertebral level?

  2. #2
    When I was initially diagnosed with transverse myelitis (later changed to MS), the lesion was midthoracic and my symptoms were exactly the ones you describe. As my doctor explained, anything "below the dam" can be affected.

  3. #3
    Don't read the basic books!!! Does every pt wth high blood pressure have the same blood pressure etc... then no sci person is the same either. And the anatomy and nervous system is very complicated. I know the books say..... but that might be the majority-they make it sound so certain and every person and every level is different. At first there is spinal shock then the true bladder pattern sets in after that. A certain level mght have the 80% this type of bladder but what about that other 20%- you are treating the patient and not the text book. And Urodynamics( and a good pt history helps) determine everything. Especially thoracic they will either be normal, or have an overactive bladder or an underactive bladder. Especially since there is the artery of Adamkiwiez- spelled wrong I am sure- that if involved- and is in that area changes things.
    They need complex urodyanmics with vcug -to tell you how much they hold, if they have a contraction, how much they empty ( some, none, leaks, squirts, what pressure was at resting and when voiding ( and this tells you if safe for kidneys) and if they leak of not in between.and take fluor to look for sphincter spasm- called dsd- detrussor sphincter dysynergy usually with NDO-neurogenic detrussor overactivity AKA OAB or overactive bladder- and they leak or squirt but don't empty and capacity is low and they need an antichoilinergic and to cath- or this is recommendation if they can. And pressures when voiding can be too high for kidney safety.
    Even with a Neurogenic detrussor underactivity- NDU or underactive bladder ( aka areflexic or flaccid bladder) the capacity can still be low or the sphincter denervated (leak) or there pressures could be high and they might need an anticholirgic. Keeping the kidneys safe is most important.
    They need to see a urologist and let him do the treatment. Get the results of his Urodynamics and I will explain it to you.
    CWO

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