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SUMMARY

The current study was undertaken to study improvement in bladder compliance in spinal cord injury patients
with detrusor overactivity treated with anticholinergic drug and clean intermittent catheterization. These patients
were followed up over a period of six months for changes in four prime parameters namely post void residual
urine volume, detrusor leak point pressure, maximum cystometric capacity and bladder compliance.

Through clinical examination of spinal cord injury subjects was done.

The patients were asked to maintain a bladder diary and maintain a record of urinary tract infection episodes.

Urodynamic study was performed after proper calibration of the machine and all studies and data collection
were done by myself.

The average age at the time of study was 36.42 years. The mean age of males (n=32) was 33.11 years and of
females (n=3) was 38.66 years.

Mean duration of spinal cord injury was 26.8 months (SD 14.05). In males the mean duration was 23.71
months (SD 15.33) and in females 36 months (SD 12).

Among 35 subjects 32 patients had complete spinal cord injury and 3 patients had incomplete spinal cord injury.

Among 35 subjects, 3 patients had impaired bladder sensation and 32 patients had no bladder sensation.

Among 35 subjects 32 patients had DSD and 3 patients did not have DSD. This remained the same throughout
the study and there was no neurological recovery of bladder sensation or detrusor sphincter dysynergia.

The mean post void residual urine volume increased from 119.14 ml (SD28.21) at baseline to 190.85 ml
(SD34.33) at first follow up, 214.85 ml (SD33.28) at second follow up and 232 ml (SD49.21) at last follow
up. The P value is < 0.0001, considered extremely significant.

Mean detrusor leak point pressure decreased from 79.88(SD15.85) at baseline to 27.45(SD9.44) at first
follow up, 20.5(SD10.02) at second follow up and 24.97(SD7.22) at last follow up. The P value is < 0.0001,
considered extremely significant.

A significant increase in maximum cystometric capacity was noted from 190.82(SD45.35) at baseline to
376.22(SD85.62) at one month, 399.91(SD54.62) at 3months and 426.22(SD46.34) at 6 months. The P
value is < 0.0001, considered extremely significant.

Bladder Compliance increased from 2.46(SD0.76) at baseline to 15.63(SD7.17) at one month,


24.86(SD11.95) at 3 months and 18.15(SD4.39) at 6 months. The P value is < 0.0001, considered extremely
significant.

Incidence of Urinary tract infection increased from 5.74 % at baseline to 11.42 % at one month and 20% at 3
and 6 month follow up.

To conclude, clean intermittent catheterisation and anticholinergic drug treatment significantly improves bladder
compliance in spinal cord injury patients with overactive detrusor. As the response to anticholinergic drug is not
consistent and uniform in all patients, an urodynamic study is essential to titrate the dosage and advise the
patient regarding frequency of clean intermittent catheterisation. Clean intermittent catheterisation also offers
the patient independence in bladder emptying and improves his/ her quality of life.