Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee

Schurch, Brigitte; Iacovelli, Valerio; Averbeck, Márcio Augusto; Carda, Stefano; Altaweel, Waleed; Agrò, Enrico Finazzi

doi:10.1002/nau.23369

Cited by 22 publications

(17 citation statements)

References 68 publications

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“…Some studies suggested that urodynamic examination should be performed after the recovery of bladder function following acute SCI, three months after injury (13). The members of the International Continence Society (ICS) Urodynamics Committee on the SCI core panel recommend performing the first exam as soon as possible after the end of the spinal shock phase and then conducting repeated testing at 6 and 12 months after the injury (21).…”

Section: Implications For Practicementioning

confidence: 99%

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury

Lu¹,

Cheng²,

Lin³

et al. 2021

Ann Palliat Med

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Background: Urodynamics is the gold standard for evaluating the function of neurogenic bladder after spinal cord injury (SCI), but there are few studies on urodynamics in patients with complete and incomplete suprasacral SCI in different periods.There is a lack of sufficient evidence for the timing of the first urodynamic examination. Methods:The urodynamic results of 101 patients with complete and incomplete suprasacral SCI at 0-30, 31-60, 61-90, and 91-365 days after injury were included. Urodynamic parameters were compared between 0-90 and 91-365 days, including detrusor overactivity (DO), bladder compliance (BC), bladderfilling sensation, maximum cystometric capacity (MCC), detrusor external sphincter dyssynergia (DESD), maximum urinary flow rate (Q max ), detrusor pressure at a maximum urinary flow rate (P detQmax ).Results: There were 45 patients with complete SCI and 56 with incomplete SCI. With the course's prolongation, the proportion of DO increased gradually in patients with complete and incomplete injury within 90 days, while the MCC gradually decreased. The bladder-filling sensation of patients with complete SCI is mostly absent. Significant differences were found between 0-90 and 91-365 days in terms of DO, DESD, MCC, Q max , and P detQmax incomplete SCI, and DESD in incomplete SCI, and between complete and incomplete SCI in terms of DO, bladder filling sensation, MCC, Q max , P detQmax at 0-90 days after injury, and bladder filling sensation at 91-365 days after injury.Conclusions: Urodynamic examination should be conducted as soon as possible after injury in patients with incomplete suprasacral SCI, while for those with complete injury, the urodynamic examination can be initiated following clinical symptoms within 90 days after injury.

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Section: Implications For Practicementioning

confidence: 99%

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury

Lu¹,

Cheng²,

Lin³

et al. 2021

Ann Palliat Med

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“…Timely establishment of urodynamic observations during the initial period post-injury and continued life-long monitoring of detrusor overactivity is paramount after SCI [23], given the negative effects of NDO on the upper urinary tracts and the association with increased frequency and severity of UTIs. We propose yearly investigations until a stable urodynamic situation and stable bladder management have been reached.…”

Section: Discussionmentioning

confidence: 99%

The Stockholm Spinal Cord Uro Study: 3. Urodynamic characteristics in a regional prevalence group of persons with spinal cord injury and indications for improved follow-up

Farrelly

Lindbo²,

Seiger

2021

Scandinavian Journal of Urology

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Aims: Examine the outcome of urodynamic studies in a regional prevalence group of patients with traumatic spinal cord injury (SCI), explore relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions, assess the role of urodynamics in SCI follow-up. Methods: In a cross-sectional study, 211 patients were included, who attended a yearly check-up and had urodynamics performed as part of the follow-up in addition to S-creatinine, S-cystatin-C, renal ultrasound, and a questionnaire regarding complications. Relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions were explored by descriptive and comparative statistics. Results: Neurogenic detrusor overactivity (NDO) was found in 150, underactive/acontractile detrusor in 44, normal detrusor function in 17 patients. Maximum detrusor pressures during filling/voiding in NDO attained mean levels of >40 cm H 2 O in 68% of patients and >25 cm H 2 O in 83%. Reduced compliance of the bladder wall, cystometric bladder capacity <250 mL, and detrusor overactivity leakage during filling were associated with higher detrusor pressures. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications among patients with SCI duration 11-20 years. No significant relationships were found between other urodynamic parameters and renal/other SCI-related complications. Renal complications in underactive/acontractile and normal detrusor function co-varied with evidence of previous NDO and other co-morbidities which may negatively influence kidney function. Conclusions: Maximum detrusor pressures during the filling/voiding phases attained high levels in a majority of patients. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications.

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“…The ICS recommended annual urological monitoring, to detect complications and to adjust bladder management [ 22 ]. More specifically, Schurch et al and the GENULF recommended in patients with dysraphism or spinal cord injury a yearly examination because of their “high-risk” bladder, which could be delayed by one to two years after attaining controlled NLUTD [ 2 , 3 ]. De Sèze et al recommended a cystometry every one to three years in MS patients [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Prioritization of risk situations in neuro-urology: guidelines from Association Française d’Urologie (AFU), Association Francophone Internationale des Groupes d’Animation de la Paraplégie (A.F.I.G.A.P.), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d’UroDynamique et de Pelvi-Périnéologie (SIFUD-PP)

et al. 2021

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Purpose The current health crisis has drastically impacted patient management in many fields, including neuro-urology, leading to a mandatory reorganization. The aim of this work was to establish guidelines regarding the prioritization and optimal timing of each step of neurogenic lower urinary tract dysfunction management. Methods A steering committee included urologists and physical medicine and rehabilitation practitioners. Based on a literature review and their own expertise, they established a comprehensive risk-situation list and built a risk scale, allowing multiple other experts to score each clinical situation. New recommendations were generated using a Delphi process approach. Results Forty-nine experts participated in the rating group. Among the 206 initial items, 163 were selected and divided into four domains, diagnosis and assessment, treatment, follow-up, and complications, and two sub-domains, general (applicable for all neurological conditions) and condition-specific [varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, dysraphism, lower motor neuron lesions)]. The resulted guidelines are expert opinions established by a panel of French-speaking specialists, which could limit the scalability of this work. Conclusions The present multidisciplinary collaborative work generates recommendations which complement existing guidelines and help clinicians to reorganize their patients’ list in the long term with a personalized medicine approach, in the context of health crisis or not. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-021-03804-4.

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Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee

Abstract: Urodynamic is highly recommended for patients with SCI after a proper initial assessment. Regular urodynamic follow-up is recommended to avoid upper urinary tract damage. However, until now, there is limited evidence on how frequently urodynamic control should be performed.

Cited by 22 publications

References 68 publications

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury

Urodynamic findings in patients with complete and incomplete suprasacral spinal cord injury at different stages after injury

The Stockholm Spinal Cord Uro Study: 3. Urodynamic characteristics in a regional prevalence group of persons with spinal cord injury and indications for improved follow-up

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