Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings

Abstract

Purpose: We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity. Materials and Methods: Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-Urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cm H 2 O or higher, bladder compliance less than 20 mL/cm H 2 O, and vesicoureteral reflux of any grade. Results: One or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cm H 2 O or higher, and 7% vesicoureteral reflux. No patient developed a low-compliance bladder. Conclusions: Using a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury.

The Utility of Urodynamic Studies in Neuro-Urological Patients

“…NDO associated with DSD was the most related unfavorable VUDS findings reported by Kozomara et al in up to 88% of 97 patients with traumatic or ischemic acute spinal cord injury in the first year after the incident. Early detection of the association between NDO and DSD allows for timely management of their potential complications [ 45 ]. Shin et al have demonstrated that follow-up UDS can not only confirm improvement in bladder storage volume and pressure but also that it has been correlated to a better-estimated plasma flow on nuclear renogram [ 14 ].…”

“…UDS is costly when taking into account the purchase of equipment and disposables, as well as the requirement for specialized staff. Early intervention based on urodynamic findings rather than initiating treatment only once complications of NLUTD are present could, however, spare resources and reduce overall costs [ 45 , 51 ].…”

Prevalence of Unfavorable Video-Urodynamic Findings and Clinical Implications in Patients with Minimally Conscious State/Unresponsive Wakefulness Syndrome: A Retrospective Descriptive Analysis

“…While none of the other studies reported on the presence of VUR, in our cohort, fortunately, only one patient had a VUR (i.e., grade 1). While VUR can be a complication after a prolonged period of high intravesical pressure in individuals with NLUTD [ 33 ], recent studies reported a similar low prevalence of VUR in individuals with acute SCI (i.e., within the first year after injury) [ 27 , 34 ]. Given the paucity of longitudinal urodynamic data in patients with MCS/UWS, at the present time, one can only refer to other entities of NLUTD, such as SCI and MS, regarding the risk of developing VUR long-term.…”

The impact of anticholinergics on cognitive function in patients with neurogenic lower urinary tract dysfunction: A narrative review

“…For example, after spinal cord injury (SCI, which occurs in 3–10/100,000 people), NLUTD is almost universal, with 90% of traumatic SCI patients having an unfavorable urodynamic finding in the 1 st year after their injury. [ 2 ] This is similar in spina bifida (SB, which occurs in approximately 30–40/100,000 people) where almost all people have some sort of bladder impairment, and over half have urinary incontinence. [ 3 ] Other diseases such as multiple sclerosis (MS, 80–250/100,000 depending on the country) tend to have increased NLUTD symptoms as the disease progresses.…”