Detrusor sphincter dyssynergia: can a more specific definition distinguish between patients with and without an underlying neurological disorder?

Abstract Study design Cross-sectional study. Objectives To evaluate if specific definitions of detrusor sphincter dyssynergia (DSD) might distinguish between individuals with spinal cord injury (SCI) and those with no underlying neurological disorder (NO ND). Setting Single tertiary university SCI center. Methods A series of 153 individuals, 81 with traumatic SCI and 72 with NO ND, were prospectively evaluated and included in this study. All individuals underwent a clinical neuro-urological examination, a neurophysiological work-up and a video-urodynamic investigation and were diagnosed with DSD as defined by the International Continence Society (ICS). We determined the DSD grades/types according to the classifications by Yalla (grade 1–3), Blaivas (type 1–3) and Weld (type 1–2). Distribution of the DSD grades/types were compared between SCI and NO ND individuals. Associations between the various DSD grades/types and clinical parameters, such as risk factors for upper urinary tract damage (all individuals) or lower extremity motor scores, SCI injury levels and severity scores (only SCI group), were assessed. Results The distribution of all DSD types were similar between groups (p > 0.05). None of the DSD classifications allowed risk assessment for upper urinary tract damage. A significant association between DSD type and other clinical parameters could not be found (p > 0.05). Conclusions None of the investigated DSD definitions can distinguish between patients with SCI and with NO ND. The more complex DSD classifications by Yalla, Blaivas or Weld cannot compete with the ICS binary yes-no definition which is pragmatic and straightforward for managing patients in daily clinical practice. Sponsorship None.

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High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458517703801 ◽

2017 ◽

Vol 24 (4) ◽

pp. 529-534 ◽

Cited By ~ 9

Author(s):

Benjamin V Ineichen ◽

Marc P Schneider ◽

Martin Hlavica ◽

Niels Hagenbuch ◽

Michael Linnebank ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Urinary Tract ◽

Roc Curves ◽

Clinical Parameter ◽

Upper Urinary Tract ◽

Lower Urinary Tract Dysfunction ◽

Consecutive Series ◽

Clinical Parameters ◽

Tract Damage

Background: Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. Objective: We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. Methods: A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). Results: Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06–1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%–87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. Conclusion: High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.

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Neurogenic Bladder: Epidemiology, Diagnosis, and Management

Seminars in Neurology ◽

10.1055/s-0040-1713876 ◽

2020 ◽

Vol 40 (05) ◽

pp. 569-579

Author(s):

Jalesh N. Panicker

Keyword(s):

Urinary Tract ◽

Lower Urinary Tract ◽

Upper Urinary Tract ◽

Lower Urinary Tract Dysfunction ◽

Renal Ultrasound ◽

Preliminary Evaluation ◽

Cord Injury ◽

Tailored Approach ◽

Tract Damage ◽

Lower Urinary

AbstractLower urinary tract dysfunction is a common sequel of neurological disease resulting in symptoms that significantly impacts quality of life. The site of the neurological lesion and its nature influence the pattern of dysfunction. The risk for developing upper urinary tract damage and renal failure is considerably lower in patients with slowly progressive nontraumatic neurological disorders, compared with those with spinal cord injury or spina bifida. This acknowledged difference in morbidity is considered when developing appropriate management algorithms. The preliminary evaluation consists of history taking, and a bladder diary and may be supplemented by tests such as uroflowmetry, post-void residual measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the clinical indications. Incomplete bladder emptying is most often managed by intermittent catheterization, and storage dysfunction is managed by antimuscarinic medications. Intra-detrusor injections of onabotulinumtoxinA have revolutionized the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. In select patients, reconstructive urological surgery may become necessary. An individualized, patient-tailored approach is required for the management of lower urinary tract dysfunction in this special population.

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A nonsurgical and nonpharmacological care bundle for preventing upper urinary tract damage in patients with spinal cord injury and neurogenic bladder

International Journal of Nursing Practice ◽

10.1111/ijn.12761 ◽

2020 ◽

Vol 26 (2) ◽

Author(s):

Hengying Fang ◽

Jinxiang Lin ◽

Limin Liang ◽

Xiaofang Long ◽

Xiaojia Zhu ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Urinary Tract ◽

Neurogenic Bladder ◽

Upper Urinary Tract ◽

Care Bundle ◽

Cord Injury ◽

Tract Damage

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Is baseline routine renal ultrasound indicated for all MS patients?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136838 ◽

2019 ◽

Vol 96 (1134) ◽

pp. 194-196

Author(s):

Igor B Títoff ◽

Victoria Titoff ◽

Thomas F Scott

Keyword(s):

Urinary Tract ◽

Upper Urinary Tract ◽

Renal Ultrasound ◽

Red Flags ◽

Inclusion Criteria ◽

Detrusor Sphincter Dyssynergia ◽

History Of ◽

Bladder Symptoms ◽

Tract Infections

BackgroundMost patients with multiple sclerosis (MS) develop multiple urological complaints due to hyperactive or hypoactive bladder, and may have detrusor-sphincter dyssynergia. Routine renal ultrasound (RUS) screening has been recommended for both symptomatic and asymptomatic MS patients; however, there is little data to support this practice.MethodsProspectively screened consecutive MS clinic patients in 2016–2017 with functional systems scores (FSS) indicating moderate to severe neurogenic bladder symptoms (FSS bladder ≥2) were sent for RUS. We also screened for history of urinary tract infections.Results872 patients were screened between 3 September 2016 and 13 April 2017. 58 patients met inclusion criteria for RUS. 6 were excluded due to non-compliance with testing or unavailability of results; 52 patients were imaged. Only 3/52 patients were found to have renal pathology requiring follow-up. Of those three, one had known symptomatic nephrolithiasis, and one had subsequently normal findings, leaving one patient newly found to have valid abnormal upper urinary tract (UUT) findings. Multiple incidental findings were also discovered.ConclusionThe minimal yield for significant UUT pathology found in this enriched group of symptomatic MS patients indicates that RUS screening for asymptomatic MS patients without clear risk factors is not indicated. Red flags for high risk of UUT complications should be used as triggers for baseline RUS screening in MS patients.

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