The Stockholm Spinal Cord Uro Study: 3. Urodynamic characteristics in a regional prevalence group of persons with spinal cord injury and indications for improved follow-up

Abstract

Aims

Examine the outcome of urodynamic studies in a regional prevalence group of patients with traumatic spinal cord injury (SCI), explore relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions, assess the role of urodynamics in SCI follow-up.

Methods

In a cross-sectional study, 211 patients were included, who attended a yearly check-up and had urodynamics performed as part of the follow-up in addition to S-creatinine, S-cystatin-C, renal ultrasound, and a questionnaire regarding complications. Relationships between urodynamic parameters and renal complications/other SCI-related dysfunctions were explored by descriptive and comparative statistics.

Results

Neurogenic detrusor overactivity (NDO) was found in 150, underactive/acontractile detrusor in 44, normal detrusor function in 17 patients. Maximum detrusor pressures during filling/voiding in NDO attained mean levels of >40 cm H₂O in 68% of patients and >25 cm H₂O in 83%. Reduced compliance of the bladder wall, cystometric bladder capacity <250 mL, and detrusor overactivity leakage during filling were associated with higher detrusor pressures. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications among patients with SCI duration 11–20 years. No significant relationships were found between other urodynamic parameters and renal/other SCI-related complications. Renal complications in underactive/acontractile and normal detrusor function co-varied with evidence of previous NDO and other co-morbidities which may negatively influence kidney function.

Conclusions

Maximum detrusor pressures during the filling/voiding phases attained high levels in a majority of patients. Detrusor overactivity during more than one-third of the filling phase was significantly related to signs of renal complications.

Keywords:

• Urodynamics
• neurogenic bladder
• detrusor overactivity
• spinal cord injury
• renal complications
• follow-up program

Acknowledgements

The authors wish to thank Professor Richard Levi for instrumental help in setting up the study, and the staff at the Spinalis clinic for performing interviews, database registration, and physical examinations. We wish to especially acknowledge the work of Associate Professor Hans Wijkström who was part of the research team and actively engaged in the analysis of study data but sadly passed away during the preparation of the manuscript.

Ethics approval

The study was approved by the Regional Human Ethics Committee at the Karolinska Institute, Stockholm (2007/35-31/3).

Disclosure statement

The authors report no conflicts of interest.

Geolocation statement

This study was carried out at the Spinalis clinic, Aleris Rehab Station, Stockholm, Sweden.

Additional information

Funding

This work was supported by grants from the Norrbacka-Eugenia Foundation and Wellspect HealthCare.