Neurogenic Lower Urinary Tract Dysfunction—Do We Need Same Session Repeat Urodynamic Investigations?

Bellucci, Carlos Henrique Suzuki; Wöllner, Jens; Gregorini, Flavia; Birnböck, Dorothee; Kozomara, Marko; Mehnert, Ulrich; Kessler, Thomas M.

doi:10.1016/j.juro.2011.11.107

Cited by 27 publications

(13 citation statements)

References 20 publications

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“…12 Consequently, for the treatment of NLUTD, the primary goal is to protect UUT function, improve urinary incontinence, restore or partially restore lower urinary tract function, and improve the quality of life of patients. 13 Keeping the pressure in the urinary bladder within a safe and reasonable range during the filling and voiding period can significantly reduce damage to the UUT, thus reducing the risk of death caused by urinary system diseases in these patients. Therefore, this approach is the golden rule for the treatment of patients with NB.…”

Section: Discussionmentioning

confidence: 99%

“…13 For patients with high pressure during the urine storage period (DO, low bladder compliance), the main purpose of treatment is to transform the overactive, high-pressure bladder into a stable, low-pressure bladder, although this outcome may in turn produce or increase residual urine volume. 13 The decreased detrusor pressure can also reduce urinary incontinence, thereby facilitating social rehabilitation and improving the life of patients. Lowering the detrusor pressure is also very helpful for preventing urinary tract infections.…”

Section: Discussionmentioning

confidence: 99%

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Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation

Liu

Wang

Ying

2020

Neurourology and Urodynamics

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Aims To assess the urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux (VUR) who underwent sacral neuromodulation (SNM). Methods We retrospectively reviewed the records of 19 patients with neurogenic lower urinary tract dysfunction (NLUTD) who underwent SNM at our center from July 2018 to July 2019. Clinical data and video‐urodynamic parameters were collected. VUR grading systems were used to evaluate upper urinary tract function. Results The mean test duration was 24 ± 8.2 days. The urodynamic evaluation showed a significant increase in the mean maximum cystometric capacity (136.3 ± 118.2 vs 216.5 ± 137.8 mL; P = .0071) and compliance (8.7 ± 8.52 vs18.3 + 16.47 mL/H2O; P = .016), as well as a decrease in maximum intravesical pressure (57 ± 39.23 vs 36.58 ± 31.16 H2O; P = .0064). In the voiding phase, none of the patients had automatic urination at the baseline and testing phases. In 8 of 19 patients who had detrusor overactivity (DO), the DO disappeared (four patients) or was delayed (four patients). The VUR in 3 of 12 ureter units disappeared. The grade of VUR or the volume before VUR improved in 8 ureter units, and the remaining 1 did not change significantly. An implant was performed in 16 cases. After permanent implantation, all patients needed intermittent catheterization to empty the bladder. Conclusions This retrospective study indicates that SNM can improve the urinary storage function of the bladder in appropriate patients with NLUTD. For patients with VUR, SNM can cure or reduce VUR by improving DO and bladder compliance.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation

Liu

Wang

Ying

2020

Neurourology and Urodynamics

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“…Combined pelvic floor EMG and videocystourethrography during UDI are the most accepted and widely agreed methods for diagnosing detrusor sphincter dyssynergia [ 24 ]. In the present study, however, we refrained from using videocystourethrography to avoid radiation exposure to our healthy volunteers.…”

Section: Discussionmentioning

confidence: 99%

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

et al. 2016

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ObjectivesTo evaluate whether urodynamic investigation (UDI), the gold standard to assess refractory lower urinary tract symptoms (LUTS), is appropriate to select healthy volunteers with apparent normal lower urinary tract function as control subjects for comparative studies.Subjects and Methods42 healthy subjects (22 women, mean age 32±10 years; 20 men, mean age 37±12 years) without LUTS were included into this prospective single-centre cohort study. All subjects recorded a 3-day bladder diary, completed validated questionnaires regarding LUTS, and underwent neuro-urological assessment as well as free uroflowmetry. Same session repeat UDI was performed according to “Good Urodynamic Practice” recommended by the International Continence Society, but using an air-charged instead of a water-filled catheter, and evaluated by a blinded investigator.ResultsAll 3-day bladder diaries, LUTS questionnaires, neuro-urological assessments and free uroflowmetries were within normal limits. Overall (either during the first or second UDI), same session repeat UDI revealed pathological findings in 71% (30/42): Detrusor overactivity was detected in 14% (3/22) and 30% (6/20), post void residual >100mL in 14% (3/22) and 25% (5/20), bladder outlet obstruction in 9% (2/22) and 20% (4/20) and detrusor sphincter dyssynergia in 77% (17/22) and 65% (13/20) of our women and men, respectively.Repeatability of detrusor overactivity (κ = 0.78, 95% CI: 0.54–1.02) and detrusor sphincter dyssynergia (κ = 0.77, 95% CI: 0.55–0.98) showed substantial agreement between both UDIs. All other assessed urodynamic parameters had wide 95% limits of agreement for differences in the parameters indicating poor repeatability.ConclusionsMore than 70% of our healthy subjects showed pathological urodynamic findings. Although UDI is the gold standard to assess refractory LUTS, it seems not to be applicable in healthy subjects to define normal lower urinary tract function. Therefore, we do not recommend using UDI to select healthy control subjects.

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“…Nevertheless, FC largely depends on the subjective perceptions and collaboration of the patient and is hence not an objective measurement of bladder sensations. In addition, the reliability of the FC is questionable and its variability and outcome resolution is too large to detect differences smaller than 100 mL [11, 12]. Moreover, FC only covers sensory information from the bladder but not from the urethra.…”

Section: Introductionmentioning

confidence: 99%

Protocol for a prospective, randomized study on neurophysiological assessment of lower urinary tract function in a healthy cohort

et al. 2016

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BackgroundLower urinary tract symptoms are highly prevalent and a large proportion of these symptoms are known to be associated with a dysfunction of the afferent pathways. Diagnostic tools for an objective and reproducible assessment of afferent nerve function of the lower urinary tract are missing. Previous studies showed first feasibility results of sensory evoked potential recordings following electrical stimulation of the lower urinary tract in healthy subjects and patients. Nevertheless, a refinement of the methodology is necessary.MethodsThis study is a prospective, randomized trial conducted at Balgrist University Hospital, Zürich, Switzerland. Ninety healthy subjects (forty females and fifty males) without lower urinary tract symptoms are planned to be included in the study. All subjects will undergo a screening visit (including standardized questionnaires, 3-day bladder diary, urinalysis, medical history taking, vital signs, physical examination, neuro-urological examination) followed by two measurement visits separated by an interval of 3 to 4 weeks. Electrical stimulations (0.5Hz-5Hz, bipolar, square wave, pulse width 1 ms) will be applied using a custom-made transurethral catheter at different locations of the lower urinary tract including bladder dome, trigone, proximal urethra, membranous urethra and distal urethra. Every subject will be randomly stimulated at one specific site of the lower urinary tract. Sensory evoked potentials (SEP) will be recorded using a 64-channel EEG cap. For an SEP segmental work-up we will place additional electrodes on the scalp (Cpz) and above the spine (C2 and L1). Visit two and three will be conducted identically for reliability assessment.DiscussionThe measurement of lower urinary tract SEPs elicited by electrical stimulation at different locations of the lower urinary tract has the potential to serve as a neurophysiological biomarker for lower urinary tract afferent nerve function in patients with lower urinary tract symptoms or disorders. For implementation of such a diagnostic tool into clinical practice, an optimized setup with efficient and reliable measurements and data acquisition is crucial. In addition, normative data from a larger cohort of healthy subjects would provide information on variability, potential confounding factors and cut-off values for investigations in patients with lower urinary tract dysfunction/symptoms.Trial registrationClinicaltrials.gov; Identifier: NCT02272309.

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Neurogenic Lower Urinary Tract Dysfunction—Do We Need Same Session Repeat Urodynamic Investigations?

Cited by 27 publications

References 20 publications

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation

Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation

Urodynamic Investigation: A Valid Tool to Define Normal Lower Urinary Tract Function?

Protocol for a prospective, randomized study on neurophysiological assessment of lower urinary tract function in a healthy cohort

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