DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201317

Comparison of urodynamic parameters with respect to neurological levels in post-traumatic spinal cord injury patients

Rohit Ramesh Gaikar, Anil Kumar Gaur, Sumedh Narayan More, Vaibhav Shivram Lokhande, Amol Babanrao Khade

Abstract


Background: Urodynamic evaluation is mandatory in order to correctly assess and classify bladder dysfunction in spinal cord injury (SCI) patients. Study investigated patterns of neurogenic bladder dysfunction in patients with post traumatic spinal cord injury and assessed the relationship of detrusor leak point pressure with compliance, post void residual urine volume and maximum cystometric capacity.

Methods: Eighty six patients with neurogenic bladder secondary to traumatic spinal cord injury (SCI) underwent cystometry with electromyography (EMG). T-test was used to compare detrusor leak point pressure (LPP) between complete and incomplete injury groups. Pearson correlation test was used to seek correlation between detrusor LPP and compliance, post void residual volume (PRV) and maximum cystometric capacity (MCC).

Results: Mean detrusor LPP in suprasacral complete injury group, suprasacral incomplete injury group and sacral complete injury was 52±21 cm of H2O, 53±18 cm of H2O and 16±9 cm of H2O respectively. No significant difference in detrusor LPP was found between suprasacral complete and incomplete group on t-Test (p= 0.571068). Significant difference in detrusor LPP was found between suprasacral and sacral group (p= 5.71891E-12). Mean compliance in sacral injury group was 24±16 and in suprasacral complete injury group was 5±6. Mean compliance in suprasacral incomplete injury group was 4±2. Pearson correlation showed negative correlation (r = -0.6918934) between detrusor leak point pressure and compliance (p= 1.2744E-13). Negative correlation (r = -0.311409922) was observed between detrusor leak point pressure and post leak/ void residual urine volume (p= 0.003335033) and between detrusor LPP and maximum cystometric capacity (r = -0.31354), (p= 0.003115).

Conclusions: Significant difference in urodynamic parameters exists between sacral and suprasacral injury patients. However there is no significant difference in urodynamic parameters between complete and incomplete injury at suprasacral level.


Keywords


Detrusor hyperreflexia, Detrusor sphincter dyssynergia, Urodynamics

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References


Rudy DC, Awad SA, Downie JW. External sphincter dyssynergia: an abnormal continence reflex. J Urol. 1988;140(1):105-10.

Tribe CR, Silver JR. In: Renal failure in paraplegia. Pitman, London, UK. 1969:54-90.

Devivo MJ, Black KJ, Stover SL. Causes of death during the first 12 years after spinal cord injury. Arch Phys Med Rehabil. 1993;74:248-54.

Soden R, Walsh J, Middleton J, Craven M, Rutkowski, Susie Y. Causes of death after spinal cord injury. Spinal Cord. 2000;38:604-10.

Ku J. The management of neurogenic bladder and quality of life in spinal cord injury. BJU Int. 2006;98:739-45.

Schöps TF, Schneider MP, Steffen F, Ineichen BV, Mehnert U, Kessler TM. Neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury: long-term urodynamic findings. BJU Int. 2015;115:33-8.

Stöhrer M, Bertil CD, David CK, Emmanuel DP, G K, Guus P. EAU guidelines on neurogenic lower urinary tract dysfunction. European Urol. 2009;56:81-8.

Groen J, Pannek J, Castro DD, Del PG, Gross T, Hamid R, et al. Summary of European association of urology (EAU) guidelines on neuro-urology. European Urol. 2016;69(2):324-33.

Elise D, Patel C, Tharian B, Westney O, Graves D, Hairston J. Diagnostic discordance of electromyography versus voiding cystourethrogram for detrusor-external sphincter dyssynergy. Neurourol Urodyn. 2005;242:616-21.

Sara S, Carmin K, Elise D. Combined diagnostic modalities improve detection of detrusor external sphincter dyssynergia. ISRN Obst Gynecol. 2011;32:3421.

Dmochowski K. Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urol. 2000;55:490-4.

Patki P, Woodhouse J, Hamid R. Lower urinary tract dysfunction in ambulatory patients with incomplete spinal cord injury. J Urol. 2006;175:1784-7.

American spinal injury association. International standards for neurological classification of SCI (ISNCSCI) worksheet. Available at https:// asia-spinalinjury.org/international-standards-eurological - classification - sci - isncsci-worksheet/. Accessed on 15 December 2019.

Schafer W, Abrams P, Liao L, Mattiasson A, Pesce F, Spangberg A, et al. Good urodynamic practices: uroflowmetry, filling cystometry and pressure-flow studies. Neurourol Urodyn. 2002;21:261-74.

Gammie A, Clarkson B, Constantinou C, Damaser M, Drinnan M, Geleijnse G, et al. International continence society guidelines on urodynamic equipment performance. Neurourol Urodyn. 2014;33:370-9.

Steven K, Michael C, Jerry B. Bladder and sphincter behavior in patients with spinal cord injury. J Urol. 1991;146:113-7.

Erol B, Koçak T, Kadıoğlu A, Müslümanoğlu L, Karamehmetoğlu S, Akıncı M, et al. The relationship between level of injury and bladder behaviour in patients with post-traumatic spinal cord injury. Ulus Travma Acil Cerrahi Derg. 2009;15(4):377-82.

Kooshesh M, Safdarian M, Nikfallah A, Vaccaro AR, Movaghar RV. Association between detrusor muscle function and level of the spinal cord injury. Cent European J Urol. 2018;71(1):92-7.

Sasa M, Dzidic I, Kejla Z. Neurogenic detrusor overactivity: comparison between complete and incomplete spinal cord injury patients. Neurourol Urodynamics. 2008;27:504-6.

Arnold EP, Fukui J, Anthony A, Utley WL. Bladder function following spinal cord injury: a urodynamic analysis of the outcome. Br J Urol. 1984;56(2):172-7.

Light JK, Faganel J, Beric A. Detrusor areflexia in suprasacral spinal cord injuries. J Urol. 1985;134(2):295-7.