Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury.
OBJECTIVE
The vast majority of spinal cord lesions cause neurogenic bladder disorders. Detrusor hyperreflexia presents a major risk factor for renal damage in these patients. We evaluated the long-term results of patients with spinal cord injury treated at our institution.


METHODS
Eighty spinal cord injury patients (60 male, 20 female; mean age 29.6 years) with at least one follow-up visit a year for a minimum of five consecutive years, were included in this retrospective analysis. Follow-up included urodynamic evaluation, sonography of the upper and lower urinary tract, urine examination, and evaluation of renal function. Treatment modifications were based on the urodynamic findings.


RESULTS
Mean follow-up was 67.3 months (range 60-103 months). At initial presentation, 51 patients performed intermittent catheterization, 7 had indwelling catheters, 10 utilized reflex voiding, 2 patients presented with a Brindley stimulator, 10 patients used abdominal straining. At the end of our study, no patient had signs of renal damage. To achieve that goal, 8 patients underwent sphincterotomy, 3 received a Brindley stimulator, 3 underwent bladder augmentation, one Kock pouch was performed, and 12 patients were treated with botulinum-A-toxin injections in the detrusor. Twenty-two patients received intravesical anticholinergic therapy. In merely three patients, treatment was not modified during the entire follow-up.


CONCLUSIONS
In the long term, treatment strategy of neurogenic bladder dysfunction in patients with spinal cord injury had to be modified in almost all patients. 18.8% underwent surgery. For protection of the upper urinary tract and maintenance of continence, regular urodynamic follow-up is warranted.
Nosseir
Michael
M
Department of Urology and Neuro-Urology, Ruhr-Universität Bochum, Marienhospital Herne, Widumer Strasse 8, D-44627 Herne, Germany.
Hinkel
Andreas
A
Pannek
Jürgen
J
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D002408:Catheters, Indwelling; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging; D007677:Kidney Function Tests; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D014463:Ultrasonography; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014546:Urinary Catheterization; D014549:Urinary Incontinence / Q000503:physiopathology; D014552:Urinary Tract Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D014563:Urodynamics / Q000502:physiology*
D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A