Impact of annual urodynamic evaluations on guiding bladder management in individuals with spinal cord injuries

• Published in: The journal of spinal cord medicine 2013-09, Vol.36 (5), p.420-426
• Main Authors: Linsenmeyer, Todd A., Linsenmeyer, Mark A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Autonomic dysreflexia; Autonomic Dysreflexia - diagnosis; Autonomic Dysreflexia - physiopathology; Autonomic Dysreflexia - therapy; Bladder management; Continuity of Patient Care; Cross-Sectional Studies; Detrusor sphincter dyssynergia; Female; Follow-Up Studies; Humans; Male; Middle Aged; Morbidity; Neurogenic bladder; Paraplegia; Physical Examination; Predictive Value of Tests; Prospective Studies; Spinal cord injuries; Spinal Cord Injuries - complications; Tetraplegia; Urinary Bladder - physiology; Urinary Bladder, Neurogenic - diagnosis; Urinary Bladder, Neurogenic - physiopathology; Urinary Bladder, Neurogenic - therapy; Urinary Bladder, Overactive - diagnosis; Urinary Bladder, Overactive - physiopathology; Urinary Bladder, Overactive - therapy; Urinary Catheterization; Urodynamics; Urodynamics - physiology; Urology; Young Adult
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1179/2045772313Y.0000000106

Study design A single-center institutional review board-approved prospective cross-sectional observational study. Context Urodynamic studies are essential to accurately direct bladder management following spinal cord injury (SCI). There is no consensus on how often testing should be performed. Objective To determine the impact of annual urodynamic studies on guiding bladder management following SCI. Methods Individuals with traumatic SCI undergoing annual urological evaluations were enrolled in this study. They had to be injured for at least 2 years so that urodynamic changes could be compared with their previous annual urodynamic evaluation. Changes in the urodynamic parameters and autonomic dysreflexia were determined by comparing this study with the previous year's study. All studies were done with the same physician and nursing staff. Demographic data, bladder management, urodynamic parameters, and the need and type of interventions based on the urodynamic study were obtained. The main outcome measure was whether or not there was a need for an intervention based on the urodynamics. Interventions were classified as urological intervention, non-urological intervention, or a combination of urological and non-urological intervention. The impact of the type of bladder management, length of injury, and level of injury was also evaluated. Results Ninety-six consecutive individuals with SCI undergoing annual urodynamic evaluations were enrolled over a 5-month period. Overall, 47.9% of individuals required at least one type of intervention based on urodynamic studies: 82.6% were urological interventions (medication changes were most common, comprising 54.3% of urological interventions); 13.0% were non-urological interventions; and 4.3% were a combination of non-urological and urological interventions. The need for interventions did not appear to be influenced by the type of bladder management, the length of time post-injury or level of injury. Conclusion Annual urodynamic evaluation plays an important role in guiding bladder management following SCI.