Neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury: long-term urodynamic findings

Abstract

Objectives: To investigate long-term urodynamic findings in patients with spinal cord injury (SCI) with neurogenic lower urinary tract dysfunction (NLUTD).

Patients and methods: A consecutive series of 246 patients with SCI (≥5 years since injury) and NLUTD were prospectively evaluated at a single university SCI centre. Data of the latest and earliest available urodynamic investigation were compared.

Results: Most of the patients had a thoracic SCI and American Spinal Injury Association (ASIA) impairment scale of A. The mean (sd) duration of SCI to the latest available urodynamic investigation was 17 (10) years and the mean patient age was 51 (14) years. At the earliest and latest available urodynamic investigation, more than half of the patients relied on intermittent self-catheterisation. During the course of disease, there was a relevant increase of patients undergoing onabotulinumtoxinA injections into the detrusor from 12% to 33%. Urodynamic findings at the earliest and latest available urodynamic investigation were within the safe limits and there were significant differences between both groups for maximum cystometric capacity (P < 0.001), compliance (P < 0.001) and maximum detrusor pressure during storage phase (P = 0.008). Vesico-uretero-renal reflux was detected in ≈5% and it was generally low grade.

Conclusions: Most of our regularly followed patients with NLUTD due to SCI for a mean of 17 years had urodynamic findings within the safe limits. Vesico-uretero-renal reflux was quite rare and generally low grade. Thus, regular follow-up with urodynamic investigation allowing for a patient-tailored management seems beneficial warranting randomised controlled longitudinal studies.

Keywords: long-term findings; neurogenic lower urinary tracts dysfunction; spinal cord injury; urodynamics.