Neurogenic voiding dysfunction approved by urodynamic study: does it mandate the presence clinical neurogenic deficit?
Introduction and purpose: The clinical manifestations of neurogenic bladder can be as varied as the pathologic reasons, but urodynamic study (UDS) can assist in clinical decision-making and simplifying a complicated disease state. The aim of our study is to evaluate the findings of urodynamic study in patients with neurogenic bladder.
Materials and methods: The study included 249 (male 137 (55%), female 112, (45%) with median age of 41 years (range: 5-94). who underwent UDS and where found to have neurogenic bladder were retrospectively evaluated. Out of 249 patients 74 patients (29.7%) were pediatric. All parameters of UDS in terms of bladder pressure, bladder volume, compliance, leak point pressure, patient age, sex, chief complaint, associated neurogenic disease, clean intermittent catheterization, upper urinary tract situation, kidney function test and post voiding residue were reviewed. All urodynamic studies were done by one urologist.
Results: Urinary incontinence was the chief complaint in 121 patients (48.6%), significant post voiding residue in 44 patients (18%), 25 patients (10%) had inability to urinate and 59 patients (24%) had different types of chief complaints. Out of the study group only 16 patients (6.4%) had spinal cord injuries, 12 patients (4.8%) had spina bifida, 3 patients (1.2%) had Parkinson disease ,2 patients (0.8%) had cerebrovascular attack. The remaining patients 221 patients (88%) had no clinical spinal cord disorders. The median value of bladder capacity was 260 ml (rang:60 - 1100). The median value of bladder pressure was 35 cm H2O, (range: (5 – 150). The median value of post void residual urine was 48ml (range: (0- 700 ml).
Conclusion: Although the patients had neurogenic bladder according to urodynamic study most of the patients may not have clinical neurogenic deficits. Urinary incontinence was the chief compliant in the study group. Urodynamic study remains the main tool to diagnose the presence of neurogenic bladder regardless to the presenting symptoms.