Differences in Urodynamic Variables for Vesicoureteral Reflux Depending on the Neurogenic Bladder Type
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Objective To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR.Methods A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded.Results At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups.Conclusion There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (≥40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.
Abstract
Objective To compare the urodynamic study variables at the onset of vesicoureteral reflux (VUR) between the overactive and underactive bladders in patients with spinal cord injury who presented with VUR.Methods A total of 28 (13 cases of detrusor overactivity and 15 detrusor underactivity) men were enrolled. We compared the urodynamic variables between the two groups; detrusor pressure and bladder compliance, the infused volume at the onset of VUR measured on a voiding cystourethrography and cystometric capacity, maximum detrusor pressure, and bladder compliance during filling cystometry were recorded.Results At the onset of VUR, the bladder volume and compliance, except for the detrusor pressure, showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance relative to the cystometric capacity showed a significant difference between the two groups. The detrusor pressure, bladder volume, and bladder compliance at the onset of VUR relative to the cystometric bladder capacity did not show any significant difference between the two groups.Conclusion There were differences in some variables at the onset of VUR depending on the type of neurogenic bladder. The VUR occurred at a lower capacity in neurogenic bladder with detrusor overactivity than in neurogenic bladder with detrusor underactivity at the same pressure. VUR occurred at a lower intravesical pressure compared to that known as the critical detrusor pressure (≥40 cm H2O) required for the development of VUR. The results of our study demonstrate that the detrusor pressure should be maintained lower than the well known effective critical detrusor pressure for the prevention and treatment of VUR.
참고문헌 (20)
- Talbot HS, "Late renal changes in paraplegia;hydronephrosis due to vesico-ureteral reflux", J Urol, 61, pp.870~882 (1949)
- Arant BS Jr, "Vesicoureteric reflux and renal injury", Am J Kidney Dis, 17, pp.491~511 (1991)
- Madersbacher H, "The various types of neurogenic bladder dysfunction: an update of current therapeutic concepts", Paraplegia, 28, pp.217~229 (1990)
- Madersbacher H, "Incontinence: 2nd international consultation on incontinence", pp.697~754 (2002), Health Publication Ltd
- Lebowitz RL, "International system of radiographic grading of vesicoureteric reflux: International Reflux Study in Children", Pediatr Radiol, 15, pp.105~109 (1985)
- Abrams P, "The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society", Am J Obstet Gynecol, 187, pp.116~126 (2002)
- Ku JH, "Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study", Urol Res, 33, pp.435~439 (2005)
- Kaufman AM, "Decreased bladder compliance in patients with myelomeningocele treated with radiological observation", J Urol, 156, pp.2031~2033 (1996)
- Gerridzen RG, "Risk factors for upper tract deterioration in chronic spinal cord injury patients", J Urol, 147, pp.416~418 (1992)
- McGuire EJ, "Prognostic value of urodynamic testing in myelodysplastic patients", J Urol, 126, pp.205~209 (1981)
- Hackler RH, "Bladder hypocompliance in the spinal cord injury population", J Urol, 141, pp.1390~1393 (1989)
- Wyndaele JJ, "Urology in spinal cord injured patients", Paraplegia, 25, pp.267~269 (1987)
- Dmochowski R, "Cystometry", Urol Clin North Am, 23, pp.243~252 (1996)
- Styles RA, "Longterm monitoring of bladder pressure in chronic retention of urine: the relationship between detrusor activity and upper tract dilatation", J Urol, 140, pp.330~334 (1988)
- Downey JA, "The physiological basis of rehabilitation medicine" (1994), Butterworth-Heinemann
- Caione P, "Predictive risk factors for chronic renal failure in primary high-grade vesico-ureteric reflux", BJU Int, 93, pp.1309~1312 (2004)
- Soylu A, "Predictors of renal scar in children with urinary infection and vesicoureteral reflux", Pediatr Nephrol, 23, pp.2227~2232 (2008)
- Lipsky H, "Primary vesico-ureteric reflux in adults", Br J Urol, 43, pp.277~283 (1971)
- Bors E, "Vesico-ureteral reflux in paraplegic patients", J Urol, 68, pp.691~698 (1952)
- Suzuki T, "Vesicoureteral reflux in the early stage of spinal cord injury: a retrospective study", Spinal Cord, 39, pp.23~25 (2001)