title: Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury.
abstract: 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.
authors.affiliation: Department of Urology and Neuro-Urology, Ruhr-Universität Bochum, Marienhospital Herne, Widumer Strasse 8, D-44627 Herne, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Nosseir
authors.forename: Andreas
authors.initials: A
authors.lastname: Hinkel
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
mesh_terms: 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*
chemical_list: D018680:Cholinergic Antagonists; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A