Differences in Urodynamic Variables for Vesicoureteral Reflux Depending on the Neurogenic Bladder Type

Annals of Rehabilitation Medicine, 2014 · DOI: http://dx.doi.org/10.5535/arm.2014.38.3.347 · Published: May 1, 2014

Spinal Cord Injury Urology Rehabilitation

Simple Explanation

Neurogenic bladder following spinal cord injury can lead to complications like vesicoureteral reflux (VUR), where urine flows backward into the kidneys. This study compares urodynamic variables at the onset of VUR in patients with overactive versus underactive bladders due to spinal cord injury. The research aims to provide baseline data for optimal voiding times with intermittent catheterization to prevent VUR in neurogenic bladder patients.

Study Duration

February 2008 to June 2011

Participants

28 men with spinal cord injury and vesicoureteral reflux

Evidence Level

Not specified

Key Findings

1
Bladder volume and compliance at the onset of VUR showed significant differences between patients with detrusor overactivity and those with detrusor underactivity.
2
VUR occurred at a lower bladder capacity in patients with detrusor overactivity compared to those with detrusor underactivity.
3
VUR occurred at a lower intravesical pressure than the conventionally recognized critical detrusor pressure (≥40 cm H2O).

Research Summary

This study investigates the differences in urodynamic variables at the onset of vesicoureteral reflux (VUR) between patients with spinal cord injury who have overactive versus underactive bladders. The findings indicate that bladder volume and compliance at the onset of VUR differ significantly between the two groups, with VUR occurring at a lower capacity in patients with detrusor overactivity. The research concludes that VUR can occur at a lower intravesical pressure than the previously established critical detrusor pressure, emphasizing the need to maintain lower detrusor pressure for VUR prevention.

Practical Implications

Personalized Management

Tailor bladder management strategies based on the type of neurogenic bladder (overactive vs. underactive) to prevent VUR.

Lower Pressure Targets

Maintain detrusor pressure below 40 cm H2O to minimize the risk of VUR, especially in neurogenic bladder patients.

Optimal Voiding Schedules

Establish optimal voiding schedules via intermittent catheterization to prevent VUR, considering bladder capacity and compliance differences.

Study Limitations

1
The study was conducted only on male patients, limiting the generalizability of the findings to women.
2
The study lacks synchrony between voiding cystourethrography and urodynamic study.
3
Artificial bladder filling during urodynamic studies may differ from physiological conditions.

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