Dyssynergic Vesicourethral Responses During Bladder Rehabilitation in Spinal Cord Injury Patients: Effects of Suprapubic Percussion, Credé Method and Bethanechol Chloride

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Abstract
Five normal men and 70 spinal cord injury male patients underwent 100 studies with the multiple pressure recording technique, incorporating the continuous infusion principle for sphincter pressure monitoring. Gross cystosphincteric dyssynergia was noted in the majority of patients with complete upper motor neuron bladders less than 2 yr in duration. Some form of synergic voiding patterns was noted, mostly in patients with incomplete upper motor neuron bladders. The external sphincter tended to be synergic in late cases of upper motor neuron bladders. Internal sphincter dyssynergia was uncommon in cases of injuries less than 2 yr in duration, with the exception of patients who have autonomic dysreflexia. Bladder neck obstruction seemed to be more common in late lesions secondary to global hypertrophy of the bladder. Rehabilitation maneuvers and bethanechol chloride administration may exaggerate detrusor sphincter dyssynergia and injudicious use of such procedures could be detrimental to the urinary tract.