Signes de lutte dans les vessies neurologiques des lésions de la queue de cheval et du cône terminal☆

Introduction. - The bladder deformations observed in the neurogenic bladders are frequent, particularly in the "upper motor neuron" bladder type (paraplegia, multiple sclerosis). We wanted to verify the predictive factors of such damage and particularly, if the urodynamic typology intervened in their genesis by using the model of cauda equina syndrome and conus medullaris lesions. Patients and methods. - We have studied retrospectively the presence of cystographic bladder deformations at patients with neurogenic bladder due to cauda equina syndrome or conus medullaris lesion according to their urodynamic status: either overactive or acontractile detrusor. Results. - Of 68 patients, (mean age 47.2 years), 34 had an overactive and 34 an acontractile detrusor. The presence of bladder deformations was associated with an overactive detrusor (p = 0.04). However, 50% of the patients with acontractile detrusor had bladder deformations, and those deformations were associated with male sex, and this excluding urologic obstruction. Conclusion. - This study demonstrates the existence of bladder deformations in the hypoactive lower motor neuron neurogenic bladder type. If the bladder deformations seem more frequent in the overactive neurogenic bladder type, their specific and repeated search is also necessary during the follow-up of the lower motor neuron neurogenic bladder type. (C) 2010 Elsevier Masson SAS. All rights reserved.