From the Guidelines
Yes, a mid-thoracic syrinx can cause urinary retention. A syrinx is a fluid-filled cavity that develops within the spinal cord, and when it occurs in the mid-thoracic region, it can disrupt the neural pathways that control bladder function. The thoracic spinal cord contains important autonomic pathways that regulate urinary function, including those that coordinate between the pontine micturition center in the brainstem and the sacral spinal cord. When a syrinx expands, it compresses these pathways, potentially leading to detrusor-sphincter dyssynergia, where the bladder muscle and urethral sphincter do not coordinate properly. This results in difficulty emptying the bladder completely or initiating urination.
Key Considerations
- The most recent and highest quality study on the topic of neurogenic lower urinary tract dysfunction is from 2021, which provides guidance on the treatment and follow-up of such conditions 1.
- Patients with urinary retention due to a thoracic syrinx may require intermittent catheterization, as suggested by the American Heart Association/American Stroke Association for stroke patients with urinary retention 1.
- Anticholinergic medications like oxybutynin for bladder spasticity, or alpha-blockers such as tamsulosin to relax the urethral sphincter, may also be considered, although the use of alpha-blockers should be approached with caution in certain patients, as noted in guidelines for managing benign prostatic hyperplasia 1.
- The definitive treatment, however, addresses the underlying syrinx, which may involve surgical procedures like syringosubarachnoid shunting or syringostomy to decompress the cavity and prevent further neurological deterioration.
Management Strategies
- Intermittent catheterization may be necessary for initial management, as indicated by guidelines for stroke rehabilitation 1.
- Medications such as oxybutynin or tamsulosin may be used to manage symptoms of urinary retention, but their use must be carefully considered based on individual patient factors.
- Surgical intervention to address the syrinx itself is crucial for preventing long-term neurological damage and improving quality of life.
Prioritizing Patient Outcomes
- In managing a mid-thoracic syrinx causing urinary retention, it is essential to prioritize interventions that minimize morbidity, mortality, and improve quality of life, considering the most recent and highest quality evidence available 1.
From the Research
Causes of Urinary Retention
- Urinary retention can be caused by various factors, including obstructive, infectious and inflammatory, pharmacologic, neurologic, or other causes 2
- Neurologic causes, such as spinal cord lesions, can lead to urinary retention 2
Syringomyelia and Urinary Retention
- A syrinx, a fluid-filled cavity within the spinal cord, can cause neurogenic bladder and urinary retention 3
- A case study reported a patient with an extensive syrinx along the entire spinal cord and a Chiari type I malformation, who presented with urinary retention as the main symptom 3
Mid Thoracic Syrinx and Urinary Retention
- While there is no direct evidence in the provided studies specifically addressing the relationship between a mid thoracic syrinx and urinary retention, it is possible that a syrinx at this level could affect the spinal cord and lead to neurogenic bladder and urinary retention 3
- The studies suggest that neurologic causes, including spinal cord lesions, can lead to urinary retention, which supports the possibility that a mid thoracic syrinx could cause urinary retention 2, 3
Management of Urinary Retention
- Initial management of urinary retention includes bladder catheterization with prompt and complete decompression 2
- Alpha blockers, such as tamsulosin and alfuzosin, have been shown to increase success rates of trial without catheter and reduce the incidence of recurrent acute urinary retention 4, 5, 6