Association between detrusor muscle function and level of the spinal cord injury

Urodynamic findings and therapeutic approaches for neurogenic lower urinary tract dysfunction in patients with thoracic spinal cord injury

OBJECTIVES

To evaluate urodynamic examination results and treatment methods of neurogenic lower urinary tract dysfunction (NLUTD) in patients with traumatic thoracic spinal cord injury (SCI).

METHODS

Ninety-one patients with traumatic thoracic SCI were included in the study. The urodynamic analyses of the patients were conducted retrospectively using their laboratory outcomes. The patients were divided into subgroups according to the sensory innervation of the bladder (T1-10/T11-12), the preservation of sensory functions in the sacral segment (complete lesion/incomplete lesion), and the duration of injury (< 6 months/ ≥ 6 months) and evaluations in subgroups were carried out.

RESULTS

A total of 91 patients (69 males, 22 females) were included in the study. When comparing between the subgroups, the sense of bladder fullness was preserved more in the T11-T12 group with a statistically significant difference (p < 0.001). While storage disorder, the rate of indwelling catheter use during hospitalization, bacterial growth of 105 CFU/ml in the urine culture, and anticholinergic drug recommendation after urodynamic examination were higher in the complete lesion group, the rate of spontaneous/catheter-free voiding, the number of patients in which sense of bladder fullness was preserved-partially preserved, and alpha-blocker drug recommendation after urodynamic examination was higher in the incomplete lesion group, with a statistically significant difference in all parameters (all p values < 0.05).

CONCLUSION

Our results demonstrate that there are differences in neurogenic lower urinary tract dysfunction features in subgroups of traumatic thoracic SCI patients. Regular urinary system evaluation and necessary changes in treatment should be carried out in this patient group.

Potential predictors of detrusor underactivity in a urology outpatient clinic: a 5-year single center experience study

BACKGROUND Detrusor underactivity (DU) is diagnosed using urodynamics, which caused by a combination of strength and duration of the bladder muscle and resulted in prolonged bladder emptying. Invasive urodynamics, which are limited in many clinical settings, should be performed efficiently in high-risk patients to reduce the risk of emerging complications during and after the procedure. Therefore, this study was aimed to identify the potential predictors of DU for limited clinical settings. METHODS This retrospective study was retrieved from the medical records of patients who underwent urodynamics in the Department of Urology, Cipto Mangunkusumo Hospital from 2015 to 2020. Age, sex, bladder capacity, bladder compliance, bladder outlet obstruction, history of stroke, diabetes mellitus (DM) status, and neurological abnormalities were analyzed using chi-square and Mann–Whitney to examine the potential predictors of DU. The odds ratio (OR) of each factor was also calculated. Logistic regression was furtherly used for the analysis. RESULTS A total of 649 patients were included in this study. Male (OR = 1.74, 95% CI = 1.28–2.38) and DM patients (OR = 2.06, 95% CI = 1.36–3.11) had a higher risk of DU, while bladder outlet obstruction (OR = 0.54, 95% CI = 0.39–0.76) was the protective factor of DU. Furthermore, multivariate analysis showed that the potential predictors of DU were male (OR = 1.903, 95% CI = 1.37–2.64), DM (OR= 1.899, 95% CI = 1.22–2.95), and bladder outlet obstruction (OR = 0.32, 95% CI = 0.32–0.65). CONCLUSIONS Age, sex, bladder outlet obstruction, and history of DM could become the predictors of DU.