Neurogenic Bladder and Urodynamic Outcomes in Patients with Spinal Cord Myelopathy

Neurogenic lower urinary tract dysfunction is a common complication following spinal cord damage. It is associated with an increased risk of long-term complications, such as urinary incontinence, urinary tract infection, urinary reflux, hydronephrosis, and renal impairment. Patients with nontraumatic spinal cord myelopathy (SCM) – caused by conditions such as malignancy, infections, degenerative conditions resulting in cord compression, and spinal cord infarction – are typically managed in a wide range of settings and are much less likely to be admitted to a specialist spinal rehabilitation unit. The primary objective of this project was to study the neurogenic bladder functioning and UD findings in patients admitted to a spinal rehabilitation service with a diagnosis of SCM. The secondary objectives were to assess whether the recommendations made following UDs resulted in a clinically important change to the patient’s bladder management and to determine whether the recommendations made as a result of the UDs were followed.

• 1
  The most common UD finding was overactive detrusor with no dysynergia (n = 31; 48%), followed by overactive detrusor with sphincter dysynergia (n = 16; 25%) and detrusor areflexia/underactive (n = 12; 18%).
• 2
  Key UD findings were median cystometric capacity 414 mL (interquartile range [IQR], 300-590), median maximum detrusor contraction 49.5 cmH2O (IQR, 25-85), and median residual volume post voiding 100 mL (IQR, 5-200).
• 3
  The recommendations for changes to bladder management following UDs resulted in clinically important changes to existing strategies in 57 studies (88%).