Abstract
Purpose of Review
To identify urodynamic risk factors that are most impactful in patients with neurogenic bladder (NGB) and review the recent literature on this, and summarize the historic evidence for those risk factors.
Recent Findings
A systematic English language literature review was done between August 2018 and August 2023 to identify urodynamic risk factors for urologic complications in patients with NGB. A scoring method was developed and assessed to evaluate the quality of scientific literature concerning urodynamic risk factors. Ten studies met the inclusion criteria, of which 80% were retrospective. Eight of 10 studies found that high detrusor leak point pressure (DLPP) and/or low bladder compliance (LBC) were risk factors for upper tract deterioration. One study found no correlation between urodynamic risk factor and urologic complication. Urologic complications studied were upper urinary tract deterioration (UUTD), recurrent or febrile UTI, and need for surgery. The quality metrics complication score ranged from 7 to 20 (out of 39) across the ten articles included in this study.
Summary
The maintenance of low bladder pressure continues to be the mainstay of preventing UUTD in NGB. The widely accepted urodynamic risk factors that predict urologic complications in NGB patients have poor contemporary documentation in the recent literature. Notwithstanding, we believe DLPP, low bladder compliance, and detrusor external sphincter dyssynergia continue to be major risk factors for the development of urologic complication.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Hartmann KE, United States. Agency for Healthcare Research and Quality., Vanderbilt Evidence-based Practice Center. Treatment of overactive bladder in women. Rockville, MD: Agency for Healthcare Research and Quality, Dept. of Health and Human Services; 2009. ix, 121 p. p.
McGuire EJ, Woodside JR, Borden TA, Weiss RM. Prognostic value of urodynamic testing in myelodysplastic patients. J Urol. 1981;126(2):205–9.
Cetinel B, Onal B, Can G, Talat Z, Erhan B, Gunduz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a retrospective study. Neurourol Urodyn. 2017;36(3):653–8.
Shin JC, Lee Y, Yang H, Kim DH. Clinical significance of urodynamic study parameters in maintenance of renal function in spinal cord injury patients. Ann Rehabil Med. 2014;38(3):353–9.
•• Zhou G, Jiang M, Liu X, Li S, Chen J. Risk factors associated with recurrent febrile urinary tract infection in children with neurogenic bladder who perform clean intermittent catheterization. Neurourol Urodyn. 2023;42(7):1485–90. This study found low bladder compliance, DO, and low bladder capacity were risk factors for recurrent UTI.
Glassberg KI. The valve bladder syndrome: 20 years later. J Urol. 2001;166(4):1406–14.
Musco S, Padilla-Fernandez B, Del Popolo G, Bonifazi M, Blok BFM, Groen J, et al. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: a systematic review. Neurourol Urodyn. 2018;37(5):1522–40.
Prakash R, Puri A, Anand R, Jain AK, Lal B, Garg V. Predictors of upper tract damage in pediatric neurogenic bladder. J Pediatr Urol. 2017;13(5):503 e1-e7.
Tarcan T, Sekerci CA, Akbal C, Tinay I, Tanidir Y, Sahan A, et al. Is 40 cm H(2) O detrusor leak point pressure cut-off reliable for upper urinary tract protection in children with myelodysplasia? Neurourol Urodyn. 2017;36(3):759–63.
Rosier PF. The evidence for urodynamic investigation of patients with symptoms of urinary incontinence. F1000Prime Rep. 2013;5:8.
Langley LL, Whiteside JA. Mechanism of accommodation and tone of urinary bladder. J Neurophysiol. 1951;14(2):147–52.
Klevmark B. Motility of the urinary bladder in cats during filling at physiological rates. I. Intravesical pressure patterns studied by a new method of cystometry. Acta Physiol Scand. 1974;90(3):565–77.
Ghoniem GM, Bloom DA, McGuire EJ, Stewart KL. Bladder compliance in meningomyelocele children. J Urol. 1989;141(6):1404–6.
Weld KJ, Graney MJ, Dmochowski RR. Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol. 2000;163(4):1228–33.
Comiter CV, Sullivan MP, Schacterle RS, Cohen LH, Valla SV. Urodynamic risk factors for renal dysfunction in men with obstructive and nonobstructive voiding dysfunction. J Urol. 1997;158(1):181–5.
Stohrer M, Goepel M, Kondo A, Kramer G, Madersbacher H, Millard R, et al. The standardization of terminology in neurogenic lower urinary tract dysfunction: with suggestions for diagnostic procedures. International Continence Society Standardization Committee. Neurourol Urodyn. 1999;18(2):139–58.
•• Yu WR, Kuo HC. Usefulness of videourodynamic study in the decision-making of surgical intervention and bladder management for neurogenic lower urinary tract dysfunction among patients with myelomeningocele. Int Urol Nephrol. 2022;54(8):1815–24. This study found low bladder compliance was a risk factor for needing surgery.
Kurzrock EA, Polse S. Renal deterioration in myelodysplastic children: urodynamic evaluation and clinical correlates. J Urol. 1998;159(5):1657–61.
• Lyu L, Yao YX, Liu EP, Zhang YP, Hu HJ, Ji FP, et al. A study of urodynamic parameters at different bladder filling stages for predicting upper urinary tract dilatation. Int Neurourol J. 2022;26(1):52–9. This study found high DLPP and low bladder compliance were risk factors for UUTD.
Wein AJ, Kavoussi LR, Partin AW, Peters C. Campbell-Walsh urology. Eleventh edition. ed. Philadelphia: Elsevier; 2015. xxxii, pages 2823–3598.
Leng WW, McGuire EJ. Obstructive uropathy induced bladder dysfunction can be reversible: bladder compliance measures before and after treatment. J Urol. 2003;169(2):563–6.
Seki N, Masuda K, Kinukawa N, Senoh K, Naito S. Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization. Int J Urol. 2004;11(11):973–7.
McKibben MJ, Seed P, Ross SS, Borawski KM. Urinary tract infection and neurogenic bladder. Urol Clin North Am. 2015;42(4):527–36.
Shaikh N, Mattoo TK, Keren R, Ivanova A, Cui G, Moxey-Mims M, et al. Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr. 2016;170(9):848–54.
•• Jiang M, Deng J, Zhou G, Li S, Liu G. Risk factors for recurrent urinary tract infection in children with neurogenic bladder following clean intermittent catheterization. Urology. 2022;164:224–9. This study found low bladder compliance was associated with recurrent UTIs.
Blaivas JG, Sinha HP, Zayed AA, Labib KB. Detrusor-external sphincter dyssynergia: a detailed electromyographic study. J Urol. 1981;125(4):545–8.
Blaivas JG, Labib KL, Bauer SB, Retik AB. A new approach to electromyography of the external urethral sphincter. J Urol. 1977;117(6):773–7.
Blaivas JG, Barbalias GA. Detrusor-external sphincter dyssynergia in men with multiple sclerosis: an ominous urologic condition. J Urol. 1984;131(1):91–4.
Blaivas JG. The neurophysiology of micturition: a clinical study of 550 patients. J Urol. 1982;127(5):958–63.
Mukai S, Shigemura K, Nomi M, Sengoku A, Yamamichi F, Fujisawa M, Arakawa S. Retrospective study for risk factors for febrile UTI in spinal cord injury patients with routine concomitant intermittent catheterization in outpatient settings. Spinal Cord. 2016;54(1):69–72.
Elmelund M, Klarskov N, Bagi P, Oturai PS, Biering-Sorensen F. Renal deterioration after spinal cord injury is associated with length of detrusor contractions during cystometry-a study with a median of 41 years follow-up. Neurourol Urodyn. 2017;36(6):1607–15.
Linsenmeyer TA, Bagaria SP, Gendron B. The impact of urodynamic parameters on the upper tracts of spinal cord injured men who void reflexly. J Spinal Cord Med. 1998;21(1):15–20.
Abrams P. Bladder outlet obstruction index, bladder contractility index and bladder voiding efficiency: three simple indices to define bladder voiding function. BJU Int. 1999;84(1):14–5.
Chen SF, Lee CL, Kuo HC. Change of detrusor contractility in patients with and without bladder outlet obstruction at ten or more years of follow-up. Sci Rep. 2019;9(1):18887.
Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, et al. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol. 2014;65(2):389–98.
Osman NI, Chapple CR. Contemporary concepts in the aetiopathogenesis of detrusor underactivity. Nat Rev Urol. 2014;11(11):639–48.
Corona LE, Lee T, Marchetti K, Ivancic CSS, Kraft VKH, et al. Urodynamic and imaging findings in infants with myelomeningocele may predict need for future augmentation cystoplasty. J Pediatr Urol. 2019;15(6):6441–5.
Koff SA, Mutabagani KH, Jayanthi VR. The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. J Urol. 2002;167(1):291–7.
Ghafar MA, Shabsigh A, Chichester P, Anastasiadis AG, Borow A, Levin RM, Buttyan R. Effects of chronic partial outlet obstruction on blood flow and oxygenation of the rat bladder. J Urol. 2002;167(3):1508–12.
Chevalier RL. Biomarkers of congenital obstructive nephropathy: past, present and future. J Urol. 2004;172(3):852–7.
Peruzzi L, Lombardo F, Amore A, Merlini E, Restagno G, Silvestro L, et al. Low renin-angiotensin system activity gene polymorphism and dysplasia associated with posterior urethral valves. J Urol. 2005;174(2):713–7.
Furness PD 3rd, Maizels M, Han SW, Cohn RA, Cheng EY. Elevated bladder urine concentration of transforming growth factor-beta1 correlates with upper urinary tract obstruction in children. J Urol. 1999;162(3 Pt 2):1033–6.
Rule AD, Jacobson DJ, Roberts RO, Girman CJ, McGree ME, Lieber MM, Jacobsen SJ. The association between benign prostatic hyperplasia and chronic kidney disease in community-dwelling men. Kidney Int. 2005;67(6):2376–82.
Pavlakis AJ, Siroky MB, Goldstein I, Krane RJ. Neurourologic findings in Parkinson’s disease. J Urol. 1983;129(1):80–3.
Flisser AJ, Walmsley K, Blaivas JG. Urodynamic classification of patients with symptoms of overactive bladder. J Urol. 2003;169(2):529–33 (discussion 33–4).
• Ekberl IG, Taner S. Risk determination for upper urinary tract damage in children with neuropathic bladder. J Paediatr Child Health. 2023;59(7):863–70. This study found high DLPP and low bladder capacity were risk factors for renal scar.
Peyronnet B, Richard C, Bendavid C, Naudet F, Hascoet J, Brochard C, et al. Urinary TIMP-2 and MMP-2 are significantly associated with poor bladder compliance in adult patients with spina bifida. Neurourol Urodyn. 2019;38(8):2151–8.
• Swatesutipun V, Tangpaitoon T. The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis. Neurourol Urodyn. 2022;41(4):991–1001. This study found high storage pressure and low bladder compliance were risk factors for UUTD.
Shakir NA, Satyanarayan A, Eastman J, Greenberg BM, Lemack GE. Assessment of renal deterioration and associated risk factors in patients with multiple sclerosis. Urol. 2019;123:76–80.
Shigemura K, Kitagawa K, Nomi M, Yanagiuchi A, Sengoku A, Fujisawa M. Risk factors for febrile genito-urinary infection in the catheterized patients by with spinal cord injury-associated chronic neurogenic lower urinary tract dysfunction evaluated by urodynamic study and cystography: a retrospective study. World J Urol. 2020;38(3):733–40.
Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, et al. Patient reported bladder related symptoms and quality of life after spinal cord injury with different bladder management strategies. J Urol. 2019;202(3):574–84.
Chavez-Iniguez JS, Navarro-Gallardo GJ, Medina-Gonzalez R, Alcantar-Vallin L, Garcia-Garcia G. Acute kidney injury caused by obstructive nephropathy. Int J Nephrol. 2020;2020:8846622.
Mizdrak M, Kumric M, Kurir TT, Bozic J. Emerging biomarkers for early detection of chronic kidney disease. J Pers Med. 2022;12(4). https://doi.org/10.3390/jpm12040548.
Funding
No funding was received for this article.
Author information
Authors and Affiliations
Contributions
S.M. wrote the main manuscript text, along with J.B. Both D.W. and Y.F. prepared tables. J.B. prepared figures. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Marshall, S.J., Wang, D., Fung, Y.C. et al. Urodynamic Findings that Are Most Impactful for Patients with Neurogenic Bladder and the Literature that Supports This. Curr Bladder Dysfunct Rep (2024). https://doi.org/10.1007/s11884-024-00745-7
Accepted:
Published:
DOI: https://doi.org/10.1007/s11884-024-00745-7