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JU INSIGHT: Neurogenic Lower Urinary Tract Dysfunction in the First Year After Spinal Cord Injury

By: Marko Kozomara, MD*; Veronika Birkhäuser, MD*; Collene E. Anderson, MHS; Mirjam Bywater, MD; Oliver Gross, MD; Stephan Kiss, MD; Stephanie C. Knüpfer, MD, PhD; Miriam Koschorke, MD; Lorenz Leitner, MD; Ulrich Mehnert, MD, PhD; Helen Sadri, MD; Ulla Sammer, MD; Lara Stächele, MD; Jure Tornic, MD; Martin W. G. Brinkhof, PhD; Martina D. Liechti, PhD; Thomas M. Kessler, MD | Posted on: 17 Jan 2023

Kozomara M, Birkhäuser V, Anderson CE, et al. Neurogenic lower urinary tract dysfunction in the first year after spinal cord injury: a descriptive study of urodynamic findings. J Urol. 2023;209(1):225-232.

Study Need and Importance

Most patients with spinal cord injury (SCI) progressively develop neurogenic lower urinary dysfunction, which not only impairs health-related quality of life, for example, due to urinary incontinence, but also represents a significant risk for deterioration of renal function. Urodynamic investigation is considered the gold standard to objectively assess lower urinary tract function. The first year after SCI is of special interest due to the potential for neurological changes, implying that lower urinary tract function is also not stable during this time period. It also represents a window of opportunity as early diagnosis and treatment based on urodynamic findings could play a pivotal role in long-term urological outcomes. Nevertheless, guidelines and recommendations on evaluation and diagnosis of neurogenic lower urinary dysfunction do not provide a predefined follow-up schedule for the first year after SCI.

What We Found

In our cohort of 97 patients we observed 1 or more unfavorable urodynamic parameters in 87 patients (90%) within the first year after SCI (see Table).

Limitations

Our department is part of a specialized university SCI center, and thus selection toward more severe cases cannot be ruled out, and transportation of the findings to other settings should be undertaken with caution. Furthermore, our study population received neuro-urological treatment guided by urodynamic findings, so it reflects the outcomes that are observed in routine clinical practice.

Interpretation for Patient Care

We found that almost all of the patients showed at least 1 unfavorable urodynamic parameter within the first year after acute SCI. As early treatment based on urodynamic findings might decrease the risk of deterioration of the upper urinary tract, an early urodynamic investigation and standardized follow-up schedule seem to be of utmost importance.

*Co-first authors.

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