長久以來，我們普遍認爲急性脊髓損傷的病人無法順利自行解尿是因為逼尿肌不收縮的原因。然而，事情真的如我們想的這樣單純嗎？除了逼尿肌不收縮外，難道沒有其他原因造成病人無法自行解尿嗎？一篇來自瑞士蘇黎世大學附設醫院脊髓損傷研究中心的研究，發表在2018年7月JU(The Journal of Urology)的論文指出，該團隊在2012年至2015年間共收錄了54位因急性脊髓損傷而出現神經性下尿路功能障礙病人，在受傷的40天內接受尿路動力學檢查，發現只有37%的病人出現逼尿肌不收縮(acontractile detrusor)，其餘63%病人則是出現合併一種及一種以上異常的尿路動力學檢查狀況，包括32位病人出現逼尿肌過動(Detrusor overactivity, DO)、25位病人出現逼尿肌括約肌共濟不全(detrusor-sphincter-dyssynergia, DSD)、17位病人在儲尿期最大逼尿肌壓力(maximum storage detrusor pressure)大於40公分水柱、3位病人出現膀胱輸尿管逆流(vesicoureteral reflux)、1位病人則是膀胱順應性不佳(低於20cc/cmH2O)。此項研究，除了證實急性脊髓損傷的病人受傷後40天可能會出現逼尿肌不收縮外，更提供額外的證據說明甚至有2/3的病人，會出現除了逼尿肌不收縮外的異常的尿路動力學檢查。因此，對於急性脊髓損傷的病患，及早實行尿路動力學檢查，並根據檢查結果早期介入治療，將有助於下尿路功能的改善並減少整體治療的花費。

Purpose:
We assessed urodynamic parameters within the first 40 days after spinal cord injury to investigate whether the detrusor is acontractile during the acute phase of spinal cord injury.

Materials and Methods:
We performed a prospective cohort study in 54 patients with neurogenic lower urinary tract dysfunction due to acute spinal cord injury who underwent urodynamic investigation within the first 40 days after injury at a single university spinal cord injury center.

Results:
Urodynamic investigation revealed an acontractile detrusor in only 20 of the 54 patients (37%) but unfavorable urodynamic parameters in 34 (63%). We found detrusor overactivity in 32 patients, detrusor-sphincter dyssynergia in 25, maximum storage detrusor pressure greater than 40 cm H2O in 17, vesicoureteral reflux in 3 and low bladder compliance (less than 20 ml/cm H2O) in 1. More than 1 unfavorable urodynamic parameter per patient was possible. Conclusions: In contrast to the common notion of an acontractile detrusor during acute spinal cord injury, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after spinal cord injury. Considering that early treatment of neurogenic lower urinary tract dysfunction in patients with acute spinal cord injury might improve the long-term urological outcome, urodynamic investigation should be performed timely to optimize patient tailored therapy.