Extended voiding cystometry: technique and results of monitoring in patients with suprasacral spinal cord injury.

Extended voiding cystometry was performed for 3-10 h at the natural filling rate of 20 patients with complete suprasacral spinal cord injury and detrusor hyperreflexia and vesicosphicter dyssynergia who had normal upper tracts. This technique provided documentation of the frequency, duration, and amplitude of and the change in the intercontraction pressure during multiple physiologic voiding cycles. The percentage of time occupied by contractile activity and that during which intravesical pressures were >40 cmHO were also calculated. The detrusor activity in this patient group has not previously been reported. Although our patients demonstrated frequent (2.1 contractions/h) high-amplitude (56.8 cmHO), long (4 min/contraction) contractions and spent substantial time (13.8% of the time monitored) in contractile activity that maintained intravesical pressures of >40 cmHO (8.4%), they showed no evidence of upper tract disease. The five patients who underwent outlet procedures because of clinically problematic autonomic dysreflexia demonstrated a statistically significant postoperative decrease in contraction amplitude ( P<0.01) and in time during which intravesical pressures were >40 cmHO ( P<0.05). Extended voided cystometry enabled the measurement of detrusor contractility patterns and resting intravesical pressures that resulted from physiologic filling rates over an extended period, therefore providing considerably more information about detrusor activity than do conventional cystometric techniques. [ABSTRACT FROM AUTHOR]