Post-comatose cystomanometric peculiarities

Abstract

This study was the result of team work by urologists and neurologists in managing patients who have been in coma. The aim of this study is to evaluate the urodynamic differences between the various clinical conditions which characterise the coming out from a coma state. The second aim is to assess any correlation between clinical parameters (age, noxa of coma, Glasgow Coma Scale (GCS), days since brain lesion, days of catheterisation) and urodynamic findings. A urodynamic study was carried out on 24 patients (20 males and 4 females) who had come out of a coma state and were in the Subintesive Care Unit for coma in the Neurological Rehabilitation Department of our hospital. The patients were divided according to neurological criteria into 3 groups: persistent vegetative state (PVS), evoluted vegetative state (EVS) and minimally responsive state (MRS). No correlation was found between clinical parameters and urodynamic findings except between age and voiding percentage volume (%VV). Patients in PVS show detrusorial hyperreflexia with substantial contractions, while bladder residual volume (RV) is lower and voiding percentage volume (% VV) is higher than in the other two groups (P<0.05). EVS patients show detrusorial hyperreflexia (less than in PVS patients, but the difference is not statistically significant). MRS patients have higher bladder capacity than PVS and EVS patients, but again the difference is not statistically significant. Patients in PVS and EVS have a better micturition reflex (with regard to RV and %VV) than the MRS patients.