The Utility of Urodynamic Studies in Neuro-Urological Patients
Abstract
:1. Introduction
2. Methods
3. Analysis
3.1. UDS Diagnostic Performance
3.1.1. UDS and NDO
3.1.2. UDS and DSD
- Type 1 DSD presents a progressive increase in the external urinary sphincter (EUS) activity, with a peak at maximal detrusor contraction followed by a quick relaxation of the EUS as the detrusor pressure declines, allowing urination.
- Type 2 DSD shows clonic contractions of the EUS intermittently during the detrusor contraction, provoking intermittency of the urinary stream.
- Type 3 DSD is characterized by a continuous EUS contraction during the entire detrusor contraction, resulting in urinary obstruction or inability to urinate.
3.1.3. UDS and DLPP
3.1.4. VUDS Contribution
3.2. UDS Treatment Assessment Performance
3.2.1. UDS and NDO
3.2.2. UDS and DSD
3.2.3. UDS and DLPP
3.3. UDS Prognostic Evaluation Performance
3.3.1. UDS and NDO and DSD
3.3.2. UDS and DLPP
3.3.3. VUDS
4. Discussion
4.1. Paucity of Data
4.2. Medico-Economic Impact
4.3. Risk of UDS
4.4. Surrogate to UDS
4.5. Consistency with International Guidelines
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Abbreviations
BTX | Botox® |
CIC | clean intermittent catheterization |
DLPP | detrusor leak point pressure |
DSD | detrusor-sphincter dyssynergia |
EUS | external urinary sphincter |
LUT | lower urinary tract |
LUTS | lower urinary tract symptoms |
MS | multiple sclerosis |
NDO | neurogenic detrusor overactivity |
NLUTD | neurogenic lower urinary tract dysfunction |
PVR | post-voiding residual urine volume |
SCI | spinal cord injury |
UDS | urodynamic study |
UUT | upper urinary tract |
VUDS | video-urodynamic study |
VUR | vesico-ureteral reflux |
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Documents or Guidelines | Organization, Version | Recommendations | Level of Evidence/Grade of Recommendations | References |
---|---|---|---|---|
The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation | American Urological Association, 2021 | UDS, with or without fluoroscopy (VUDS), is recommended at initial evaluation of patients with unknown risk NLUTD and in the follow-up of those thought to be at moderate and high risk if change in signs and symptoms, new complications (autonomic dysreflexia, UTI, stones), UUT or renal function deterioration. | Moderate Recommendation; Evidence Level: Grade C | [2] |
EAU Guidelines on Neuro-Urology | European Association of Urology, 2022 | UDS investigation is the only method that can objectively assess the (dys-) function of the LUT. | 2a | EAU Guidelines, 2022. |
VUDS is the optimum procedure for urodynamic investigation in neuro-urological disorders. | 4 | |||
Perform urodynamic investigation as a mandatory baseline diagnostic intervention in high-risk patients at regular intervals. | Strong recommendation | |||
Urinary incontinence in neurological disease: assessment and management | National Institute for Health and Care Excellence, 2012 | Do not offer UDS routinely to people at low risk of renal complications (most MS patients). | [54] | |
Offer VUDS to people at high risk of renal complications (spina bifida, SCI or anorectal abnormalities). | ||||
Offer UDS before performing surgical treatments for NLUTD. | ||||
Neurogenic Lower Urinary Tract Dysfunction: Clinical Management Recommendations | Fifth International Consultation on Incontinence 2013 (Published 2016) | UDS should selectively be employed to supplement clinical assessment in determining management in NLUTD | [55] | |
UDS should be used to gauge potential impact on a renal function as a consequence of NLUTD. | ||||
Patients on CIC and bladder storage treatment often require long-term UDS and upper tract monitoring | A | |||
Patients with stress incontinence in association with NLUTD require VUDS to evaluate both bladder and sphincter function | C |
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Perrin, A.; Corcos, J. The Utility of Urodynamic Studies in Neuro-Urological Patients. Biomedicines 2023, 11, 1134. https://doi.org/10.3390/biomedicines11041134
Perrin A, Corcos J. The Utility of Urodynamic Studies in Neuro-Urological Patients. Biomedicines. 2023; 11(4):1134. https://doi.org/10.3390/biomedicines11041134
Chicago/Turabian StylePerrin, Andry, and Jacques Corcos. 2023. "The Utility of Urodynamic Studies in Neuro-Urological Patients" Biomedicines 11, no. 4: 1134. https://doi.org/10.3390/biomedicines11041134