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Detrusor acontractility after acute spinal cord injury: Myth or reality?


Bywater, Mirjam; Tornic, Jure; Mehnert, Ulrich; Kessler, Thomas M (2018). Detrusor acontractility after acute spinal cord injury: Myth or reality? Journal of Urology, 199(6):1565-1570.

Abstract

PURPOSE We assessed urodynamic parameters within the first 40 days after spinal cord injury (SCI) investigating whether the detrusor is acontractile during the acute phase of SCI. PATIENTS AND METHODS We performed a prospective cohort study including 54 patients with neurogenic lower urinary tract dysfunction (NLUTD) due to acute SCI undergoing urodynamic investigation (UDI) within the first 40 days after injury at a single university SCI center. RESULTS and Limitations: Of the 54 patients, UDI revealed an acontractile detrusor in only 20 (37%) but unfavorable urodynamic parameters in a total of 34 (63%) patients. Detrusor overactivity was found in 32 patients, detrusor sphincter dyssynergia in 25, maximum storage detrusor pressure >40cmH2O in 17, vesico-uretero-renal reflux in 3 and low bladder compliance (<20mL/cmH2O) in 1 patient (more than one unfavorable urodynamic parameter possible). CONCLUSIONS In contrast to the common notion of an acontractile detrusor during acute SCI, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after SCI. Considering that early treatment of NLUTD in patients with acute SCI might improve long-term urological outcome, UDI should be performed timely to optimize patient-tailored therapy.

Abstract

PURPOSE We assessed urodynamic parameters within the first 40 days after spinal cord injury (SCI) investigating whether the detrusor is acontractile during the acute phase of SCI. PATIENTS AND METHODS We performed a prospective cohort study including 54 patients with neurogenic lower urinary tract dysfunction (NLUTD) due to acute SCI undergoing urodynamic investigation (UDI) within the first 40 days after injury at a single university SCI center. RESULTS and Limitations: Of the 54 patients, UDI revealed an acontractile detrusor in only 20 (37%) but unfavorable urodynamic parameters in a total of 34 (63%) patients. Detrusor overactivity was found in 32 patients, detrusor sphincter dyssynergia in 25, maximum storage detrusor pressure >40cmH2O in 17, vesico-uretero-renal reflux in 3 and low bladder compliance (<20mL/cmH2O) in 1 patient (more than one unfavorable urodynamic parameter possible). CONCLUSIONS In contrast to the common notion of an acontractile detrusor during acute SCI, almost two-thirds of our patients showed unfavorable urodynamic parameters within the first 40 days after SCI. Considering that early treatment of NLUTD in patients with acute SCI might improve long-term urological outcome, UDI should be performed timely to optimize patient-tailored therapy.

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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
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:15 January 2018
Deposited On:02 Feb 2018 11:16
Last Modified:11 May 2018 01:02
Publisher:Elsevier
ISSN:0022-5347
OA Status:Closed
Publisher DOI:https://doi.org/10.1016/j.juro.2018.01.046
PubMed ID:29352989

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Embargo till: 2019-01-17