Risk Factors for Upper Urinary Tract Impariment among Patients with Lumbosacral Vertebrae Lesions

Objective To investigate the risk factors for upper urinary tract impairment among patients with lumbosacral vertebrae lesions.Methods A total of 40 patients diagnosed by spine MRI were enrolled.Urine analysis and mid-stream urine culture,and serum creatinine detection were performed in 40 patients,ultrasound of the urinary system was performed in 29 patients,intravenous urography(IVU) was performed in 30 patients,cystography was performed in 22 patients and urodynamic study was carried out in 33 patients.Multivariate regression analysis was employed with upper urinary impariment as dependent variable and possible risk factors for upper urinary impariment as.independent variables.Results Upper urinany tract impariment occurred in 20 patients,with hydronephrosis and upper urinary tract dilation in 12 cases and vesico-urethral reflux(VUR) in 17 cases(27 sides);levels of serum creatinine(98.2±86.3)μmol/L abnormally increased in 6 cases.Urinary tract infections were found in 17 patients.Average post-void residual(PVR) was(262±232)ml among the 31 positive cases(31/35).During filling phase,the mean value of maximal detrusor pressure(Pdetmax) was(41±21)cm H2O and the detrusor compliance was(22±19)ml/cm H2O;detrusor-sphincter dyssynergia(DSD) was seen in 16 cases(48.5%),detrusor areflexia in 16 cases(48.5%),and detrusor underactivity in 13 cases(39.4%).Maximal urethral closure pressure(MUCP) was(76±33)cm H2O among the 16 cases that underwent resting urethral pressure profile(RUPP).Multivariate regression analysis showed that possible risk factors for upper urinary tract impairment included low detrusor compliance,high maximal detrusor pressure,high PVR,high MUCP,impariment of the detrusor,DSD,and urinary tract infections(P0.05);while factors including age,sex,type of lumbosacral vertebrae lesions,modus operation,the rate of urine flow,and bladder capacity were possibly among the unrelated factors for the upper urinary tract function(P0.05).Conclusion Low detrusor compliance,high maximal detrusor pressure,high PVR,high MUCP,impariment of the detrusor,DSD,and urinary tract infections are among the risk factors for upper urinary tract impairment in patients with lumbosacral vertebrae lesions.