Risk factors of video urodynamics and bladder management for long‑term complications in patients with chronic spinal cord injury

Scientific Reports, 2024 · DOI: https://doi.org/10.1038/s41598-024-63441-w · Published: June 14, 2024

Simple Explanation

This study investigated the long-term urological issues that arise in patients with chronic spinal cord injuries (SCI). It looked at how video-urodynamic study (VUDS) results and different bladder management methods could predict the development of complications over a 15-year period. The research found that specific issues identified during VUDS, such as a contracted bladder, and certain bladder management techniques, like using the Valsalva maneuver, significantly increased the risk of complications like recurrent urinary tract infections and kidney problems. The study suggests that SCI patients with a contracted bladder should prioritize volitional voiding (voluntary urination) to minimize the risk of further urological complications. These results highlight the importance of proactive and tailored management strategies for SCI patients.

Study Duration

Mean 15.6-year follow-up

Participants

864 SCI patients

Evidence Level

Not specified

Key Findings

1
A contracted bladder identified in VUDS is associated with long-term urological complications in SCI.
2
Volitional voiding reduces the risk of recurrent urinary tract infections (rUTI) and vesicourethral reflux (VUR).
3
Valsalva maneuver-assisted voiding increased hydronephrosis risk.

Research Summary

This study analyzes long-term urological complications in 864 SCI patients with a mean 15.6-year follow-up, assessing complications and utilizing multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). The study proposes that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR.

Practical Implications

Personalized Bladder Management

Tailor bladder management strategies based on VUDS findings to minimize long-term urological complications.

Prioritize Volitional Voiding

Encourage volitional voiding, when feasible, to reduce the risk of rUTI and VUR in SCI patients.

Avoid Valsalva Maneuver

Discourage the use of Valsalva maneuver-assisted voiding to prevent hydronephrosis.

Study Limitations

1
Retrospective nature of the study
2
Absence of data of hospitalization due to febrile UTI
3
The limitation of the study is not all urodynamic characteristic parameters were collected

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