Reliability of ambulatory urodynamics in patients with spinal cord injuries

Chamorro, M. Vírseda; Salinas, J.; Esteban, M.; Méndez, S.

doi:10.1002/nau.22303

Cited by 13 publications

(5 citation statements)

References 28 publications

(28 reference statements)

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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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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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“…subacute changes in bowel or bladder patterns). 46 As there is limited literature on autonomic recovery after SCI, further investigation is needed.…”

Section: Discussionmentioning

confidence: 99%

Characterizing preserved autonomic regulation following spinal cord injury: Methods of a novel concerted testing battery and illustrative examples of a new translationally focused data representation

Solinsky,

Burns,

Hamner

et al. 2024

Preprint

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Autonomic dysfunction is common after spinal cord injury, though differing from motor and sensory function, there are currently no established batteries of tests to comprehensively characterize these deficits. Further, while individual established autonomic tests have a long history and sound scientific background, translating these autonomic testing results to inform clinical understanding is a major barrier. Herein, we outline a battery of six laboratory autonomic tests which were carefully curated to collectively describe the ability of individuals with spinal cord injury to inhibit and recruit sympathetic activity through the injured spinal cord. Presenting normative control data in 23 uninjured individuals completing this testing battery, we further demonstrate the utility of extracting three key testing metrics for each test, comparing these control results to 11 individuals with spinal cord injury. Results demonstrate strong normality of data with testing psychometrics suggesting reliable reproducibility on repeat testing. Further, even in this preliminary sample of individuals with spinal cord injuries, clear differences begin to emerge. This illustrates the ability of this collective testing battery to characterize autonomic regulation after spinal cord injury. To aid in clinical translation, we further present a graphical representation, anautonomic phenotype, which serves as a snapshot of how normal or abnormal sympathetic inhibition and recruitment of activation may be after spinal cord injury. Utilizing theseautonomic phenotypes, three example cases of individuals with spinal cord injury highlight evidence of varied degrees of autonomically complete spinal cord injury. Together, this represents a key advancement in our understanding of autonomic function after spinal cord injury.

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“…Although relatively elaborate to carry out and to analyze, ambulatory‐UDS is thought to be a more accurate tool for diagnosing LUT dysfunctions in both children and adults . In case of DO, ambulatory‐UDS is reported to have a higher sensitivity compared with conventional‐UDS .…”

Section: Discussionmentioning

confidence: 99%

Differentiation of lower urinary tract dysfunctions: The role of ambulatory urodynamic monitoring

et al. 2015

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Abbreviations & Acronyms CISC = clean intermitting self-catheterization DO = detrusor overactivity IDC = involuntary detrusor contraction LUTS = lower urinary tract symptoms OAB = overactive bladder SD = standard deviation UDS = urodynamic study/ studies UI = urinary incontinence UTI = urinary tract infection Objectives: To determine the value of ambulatory urodynamic monitoring in the assessment of patients with lower urinary tract symptoms. Methods: This was a cross-sectional study including patients who underwent both conventional urodynamic and ambulatory urodynamic assessment at our Center between December 2002 and February 2013. The ambulatory urodynamic studies were interpreted in a standardized way by a resident experienced with urodynamic measurements, and one staff member who specialized in incontinence and urodynamics. Results: A total of 239 patients (71 male and 168 female) were included in the present study. The largest subgroup of patients, 79 (33%), underwent ambulatory urodynamic monitoring based on suspicion of an acontractile bladder. However, 66 of these patients (83.5%) still showed contractions on ambulatory urodynamics. Other groups that were analyzed were patients with suspected storage dysfunction (47 patients), inconclusive conventional urodynamic studies (68 patients) and incontinence of unclear origin (45 patients). Particularly in this last group, ambulatory urodynamics appeared to be useful for discrimination between different causes of incontinence. Conclusions: Ambulatory urodynamic monitoring is a valuable discriminating diagnostic tool in patients with lower urinary tract symptoms who have already undergone conventional urodynamics, particularly in the case of patients with suspected bladder acontractility and incontinence of unclear origin during ambulatory urodynamics. Further study is required to determine the clinical implications of the findings and their relationship with treatment outcome.

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Reliability of ambulatory urodynamics in patients with spinal cord injuries

Cited by 13 publications

References 28 publications

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

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

Characterizing preserved autonomic regulation following spinal cord injury: Methods of a novel concerted testing battery and illustrative examples of a new translationally focused data representation

Differentiation of lower urinary tract dysfunctions: The role of ambulatory urodynamic monitoring

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