Temporal development of unfavourable urodynamic parameters during the first year after spinal cord injury

Objectives: To describe the temporal development of and risk factors for the occurrence of unfavourable urodynamic parameters during the first year after spinal cord injury (SCI). Patients and methods: This population-based longitudinal study used data from 97 adult patients with a single-event traumatic or ischaemic SCI who underwent video-urodynamic investigation (UDI) at a university SCI centre. The first occurrences of unfavourable urodynamic parameters (detrusor overactivity combined with detrusor sphincter dyssynergia [DO-DSD], maximum storage detrusor pressure ≥40 cmH2 O, bladder compliance <20 mL/cmH2 O, vesico-ureteric reflux [VUR] and any unfavourable parameter [composite outcome]) were evaluated using time-to-event analysis. Results: The majority of the population (87/97 [90%]) had at least one unfavourable urodynamic parameter. Most unfavourable urodynamic parameters were initially identified during the 1- or 3-month UDI, including 92% of the DO-DSD (78/85), 82% of the maximum storage pressure ≥40 cmH2 O (31/38), and 100% of the VUR (seven of seven) observations. No low bladder compliance was observed. The risk of DO-DSD was elevated in patients with thoracic SCI compared to those with lumbar SCI (adjusted hazard ratio [aHR] 2.38, 95% confidence interval [CI] 1.16-4.89). Risk of maximum storage detrusor pressure ≥40 cmH2 O was higher in males than females (aHR 8.33, 95% CI 2.51-27.66), in patients with a cervical SCI compared to those with lumbar SCI (aHR 14.89, 95% CI 3.28-67.55), and in patients with AIS Grade B or C compared to AIS Grade D SCI (aHR 6.17, 95% CI 1.78-21.39). No risk factors were identified for the composite outcome of any unfavourable urodynamic parameter. Conclusions: The first UDI should take place within 3 months after SCI as to facilitate early diagnosis of unfavourable urodynamic parameters and timely treatment. Neuro-urological guidelines and individualised management strategies for patients with SCI may be strengthened by considering sex and SCI characteristics in the scheduling of UDIs. Keywords: #Urology; longitudinal studies; spinal cord injuries; survival analysis; urinary bladder, neurogenic; urinary bladder, overactive; urodynamic

Urodynamics Are Essential to Predict the Risk for Upper Urinary Tract Damage after Acute Spinal Cord Injury

We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH$_{2}$O, bladder compliance < 20 mL/cmH$_{2}$O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH$_{2}$O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69-0.89), C-statistic 0.78 (95% CI: 0.69-0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68-0.89), C-statistic 0.76 (95% CI: 0.68-0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage

bTUNED: transcutaneous tibial nerve stimulation for neurogenic lower urinary tract dysfunction

OBJECTIVE To present the protocol for a randomized controlled trial (RCT) evaluating the efficacy and safety of transcutaneous tibial nerve stimulation (TTNS) for refractory neurogenic lower urinary tract dysfunction (NLUTD). STUDY DESIGN AND RESULTS bTUNED (bladder and TranscUtaneous tibial Nerve stimulation for nEurogenic lower urinary tract Dysfunction) is an international multicentre, sham-controlled, double-blind RCT investigating the efficacy and safety of TTNS. The primary outcome is success of TTNS, defined as improvements in key bladder diary variables at study end compared to baseline values. The focus of the treatment is defined by the Self-Assessment Goal Achievement (SAGA) questionnaire. Secondary outcomes are the effect of TTNS on urodynamic, neurophysiological, and bowel function outcome measures, as well as the safety of TTNS. CONCLUSIONS A total of 240 patients with refractory NLUTD will be included and randomized 1:1 into the verum or sham TTNS group from March 2020 until August 2026. TTNS will be performed twice a week for 30 min during 6 weeks. The patients will attend baseline assessments, 12 treatment visits and follow-up assessments at the study end

Wenn die Blase drängt: Neue therapeutische Möglichkeiten

Zusammenfassung. Die überaktive Harnblase ist definiert durch einen imperativen Harndrang mit oder ohne Drang-Inkontinenz und ist meist assoziiert mit einer Pollakisurie am Tag und in der Nacht, ohne dass ein Harnwegsinfekt oder eine andere offensichtliche Pathologie zugrunde liegt. Die Prävalenz der überaktiven Harnblase beträgt ab dem 40sten Lebensjahr ca. 17% und nimmt mit steigendem Alter zu. Die damit verbundenen Gesundheitskosten sind enorm. Meist ist die Lebensqualität erheblich eingeschränkt und oft führt die Standard-Therapie mit Antimuskarinika/Beta3-Adrenozeptor-Agonisten zu keiner relevanten Beschwerdebesserung. Doch es gibt neue therapeutische Möglichkeiten: Mit neuromodulativen Verfahren (wie der transkutanen elektrischen Nervenstimulation, der transkutanen oder perkutanen tibialen Nervenstimulation oder der sakralen Neuromodulation) oder Onabotulinumtoxin A-Injektionen in den Detrusor kann auch in aussichtslos scheinenden Situationen oft eine erstaunliche Wirkung erzielt werden. </jats:p

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

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

Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury: A Descriptive Study of Urodynamic Findings

Purpose: We aimed to provide a real-world description of neurogenic lower urinary tract dysfunction within the first year after spinal cord injury with a focus on unfavorable urodynamic parameters that are associated with urological morbidity. Materials and methods: Urodynamic investigations from 97 patients with traumatic or ischemic acute spinal cord injury and managed according to the European Association of Urology Guidelines on Neuro-urology were analyzed at a single university spinal cord injury center at 1 month, 3 months, 6 months, and 12 months after injury. Unfavorable urodynamic parameters were defined as detrusor overactivity in combination with detrusor sphincter dyssynergia, maximum storage detrusor pressure of 40 cmH2O or higher, bladder compliance less than 20 mL/cmH2O, and vesicoureteral reflux of any grade. Results: One or more unfavorable urodynamic parameter was observed in 87 out of 97 patients (90%) within the first year after spinal cord injury. Eighty-eight percent of the patients showed detrusor overactivity with detrusor sphincter dyssynergia, 39% a maximum storage detrusor pressure of 40 cmH2O or higher, and 7% vesicoureteral reflux. No patient developed a low-compliance bladder. Conclusions: Using a standardized urodynamic follow-up schedule, we found unfavorable urodynamic parameters in a majority of the population within the first year after spinal cord injury. As early treatment based on urodynamic findings might reduce the risk of deterioration of upper and lower urinary tract function, thereby improving long-term outcomes, there is need for further research regarding recommendations for a urodynamic follow-up schedule during the first year after spinal cord injury. Keywords: neurogenic; overactive; spinal cord injuries; urinary bladder; urodynamic