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Acute spinal cord injury: Do ambulatory patients need urodynamic investigations?


Bellucci, Carlos H Suzuki; Wöllner, Jens; Gregorini, Flavia; Birnböck, Dorothee; Kozomara, Marko; Mehnert, Ulrich; Schubert, Martin; Kessler, Thomas M (2013). Acute spinal cord injury: Do ambulatory patients need urodynamic investigations? Journal of Urology, 189(4):1369-1373.

Abstract

PURPOSE: We sought to compare urodynamic parameters of ambulatory versus non-ambulatory acute spinal cord injured (SCI) patients. PATIENTS & METHODS: A total of 60 patients (mean age 58 years, 27 women and 33 men) suffering from neurogenic lower urinary tract dysfunction (NLUTD) due to acute SCI (duration of injury <40 days) were prospectively evaluated. The patients were dichotomized according to the Mobility for Moderate Distances subscale of the Spinal Cord Independence Measure (SCIM) version III into ambulatory (≥3) and non-ambulatory (<3). Video-urodynamic parameters including maximum detrusor pressure during storage phase, bladder compliance, detrusor overactivity (DO), detrusor external sphincter dyssynergia (DESD), and vesico-uretero-renal reflux were compared between the two groups. RESULTS: Of the 60 acute SCI patients, 17 were ambulatory and 43 non-ambulatory patients, respectively. Mean duration of injury at urodynamic investigation was 30 ± 8 days. The lesion level was cervical in 14, thoracic in 28, lumbar/sacral in 18 patients. Comparing unfavorable urodynamic parameters, no significant differences were found between ambulatory versus non-ambulatory patients: high-pressure system during storage phase (29% versus 33%, p=0.81), low-compliance bladder (12% versus 7%, p=0.54), DO (24% versus 47%, p=0.1), DESD (18% versus 21%, p=0.77), and vesico-uretero-renal reflux (0% versus 5%, p=0.36). CONCLUSIONS: In acute SCI, ambulatory and non-ambulatory patients have a similar risk for unfavorable urodynamic measures. Thus, we strongly recommend the same neuro-urological assessment including urodynamic investigations in all acute SCI patients independent of the walking ability.

Abstract

PURPOSE: We sought to compare urodynamic parameters of ambulatory versus non-ambulatory acute spinal cord injured (SCI) patients. PATIENTS & METHODS: A total of 60 patients (mean age 58 years, 27 women and 33 men) suffering from neurogenic lower urinary tract dysfunction (NLUTD) due to acute SCI (duration of injury <40 days) were prospectively evaluated. The patients were dichotomized according to the Mobility for Moderate Distances subscale of the Spinal Cord Independence Measure (SCIM) version III into ambulatory (≥3) and non-ambulatory (<3). Video-urodynamic parameters including maximum detrusor pressure during storage phase, bladder compliance, detrusor overactivity (DO), detrusor external sphincter dyssynergia (DESD), and vesico-uretero-renal reflux were compared between the two groups. RESULTS: Of the 60 acute SCI patients, 17 were ambulatory and 43 non-ambulatory patients, respectively. Mean duration of injury at urodynamic investigation was 30 ± 8 days. The lesion level was cervical in 14, thoracic in 28, lumbar/sacral in 18 patients. Comparing unfavorable urodynamic parameters, no significant differences were found between ambulatory versus non-ambulatory patients: high-pressure system during storage phase (29% versus 33%, p=0.81), low-compliance bladder (12% versus 7%, p=0.54), DO (24% versus 47%, p=0.1), DESD (18% versus 21%, p=0.77), and vesico-uretero-renal reflux (0% versus 5%, p=0.36). CONCLUSIONS: In acute SCI, ambulatory and non-ambulatory patients have a similar risk for unfavorable urodynamic measures. Thus, we strongly recommend the same neuro-urological assessment including urodynamic investigations in all acute SCI patients independent of the walking ability.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:19 Dec 2012 15:19
Last Modified:07 Dec 2017 17:24
Publisher:Elsevier
ISSN:0022-5347
Publisher DOI:https://doi.org/10.1016/j.juro.2012.10.013
PubMed ID:23069382

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