Urodynamic utilization in the adult spina bifida patient: An institutional review

PURPOSE: To characterize common clinical indications for urodynamic, a bladder function test, in adults with spina bifida. METHODS: A retrospective chart review was performed for 215 patients seen in an adult multidisciplinary spina bifida clinic who were registered with the National Spina Bifida Patient Registry from October 2011 to October 2018. Descriptive statistics were used for statistical comparisons. RESULTS: A total of 52 of 215 patients developed a clinical indication for urodynamics. Of these, 71 (33%) patients (8 of whom underwent testing twice) had urodynamics performed, resulting in a total of 79 urodynamic study encounters that were analyzed. Thirty-four (43%) urodynamic testing cases were performed due to a symptomatic change in lower urinary tract function; 14 (18%) were due to declining renal function or concern for upper tract deterioration based on imaging. The data obtained from urodynamic investigation led to new recommendations for urinary tract management in 59 (75%) of the urodynamic studies performed. A total of 32 of the 90 (35%) recommendations made were surgical interventions and 30 (33%) were for a change in medical management. Interestingly, 8 of the 18 (44%) routine or baseline urodynamic tests performed led to new recommendations in urinary tract management. CONCLUSION: A total of 24%of patients in the multidisciplinary spina bifida clinic developed an indication for urodynamic testing over a 7-year period which resulted in new recommendations for urinary tract management in most. As more patients with spina bifida enter adulthood, the indications for urodynamic evaluation may become more defined, since the results often lead to alterations in bladder management.

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

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.

Decrease of urinary bladder contractility in patients with benign prostate hyperplasia

Aim of the study.Estimation of the decrease of urinary bladder contractility in patients with benign prostate hyperplasia (BPH). Patients and methods.In 146 BPH patients (mean age 62,1 0,8) urodynamic investigation including uroflowmetry and pressure-flow study was performed. The results of miction cystometry were evaluated using Shafer nomogram, the emptying idex was calculated as relation of voiding volume to maximal cystometric capacity. Results.56,2% BPH patients showed the decreased detrusor contractility. The results of urinary bladder contractility estimation by Shafer nomogram are dependent on the degree of infravesical obstruction (IVO). The emptying index is not related to the presence and degree of IVO and characterizes the degree of urinary bladder emptying as well as contraction duration. Concomitant lumbar osteochondrosis and diabetes detoriates urinary bladder emptying. Reliable contractility estimation may only be performed based on urodynamic study since basic BPH patients examination is not sufficient. Conclusion.In has to be considered during treatment strategy planning that in many BPH patients low urinary truct disfunction is determined by the decrease of urinary bladder contractility and not by IVO.

Urethral pressure profile assessment after artificial urinary sphincter implantation (FlowSecure™ and AMS-800™): A case series

The AMS-800™ artificial urinary sphincter has become the ‘gold standard’ in the treatment of male stress urinary incontinence. In 2006, the novel artificial urinary sphincter FlowSecure™ containing a stress relief balloon providing low cuff pressures at rest with conditional pressure elevation during periods of stress has been launched. We assessed the intraurethral pressure in the cuff area of the AMS-800 and the FlowSecure by urethral pressure profile in four patients each. Urethral pressure profile was performed at rest and during coughing. In addition, continence situation and patient satisfaction after artificial urinary sphincter implantation was assessed. At rest, median pressure in the cuff region was 74 (38–117, FlowSecure) cm H2O and 102 (95–110, AMS-800) cm H2O. During coughing, pressure peaks rose to 135 (54–162, FlowSecure) cm H2O and 202 (128–216, AMS-800) cm H2O. Median pad usage before artificial urinary sphincter implantation in the FlowSecure and the AMS-800 group was 4 (3–4) and 4.5 (2–6) pads/24 h, respectively. At the time of urodynamic investigation, median pad usage declined to 1.5 (0–4) pads/24 h in the FlowSecure and to 1 (1–2) pads/24 h in the AMS-800 group. Seven of eight patients reported on a satisfactory quality of life, and one patient remained unhappy after FlowSecure implantation. It remains unclear if the trade-off in favour of lower cuff pressures, and consecutively lower intraurethral pressures, holds truly long-term benefits regarding device revision, explantation and patient satisfaction.