Article
Is there a role of ambulatory urodynamics in neuro-urology?
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Published: | November 20, 2024 |
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Introduction: Video-urodynamic investigation (VUDI) is the gold standard to assess neurogenic lower urinary tract dysfunction (NLUTD), but in some patients the findings are equivocal. We therefore aimed to investigate if an ambulatory urodynamic investigation (aUDI) could provide additional information in such selected patients and thereby support clinical decision making for the neuro-urological management.
Methods: We investigated 59 neuro-urological patients who underwent an aUDI due to discrepancies between lower urinary tract symptoms (LUTS) and VUDI findings. All these patients had no changes in therapies influencing the lower urinary tract and a stable underlying neurological disorder between VUDI and aUDI. The patients were divided in two groups. Group 1 (n=37): patients reporting urgency symptoms without the presence of detrusor overactivity (DO) in VUDI. Group 2 (n=22): patients with DO and a maximum detrusor storage pressure (pDetmax) jeopardizing the upper urinary tract (defined as >40 cmH2O) but without any LUTS. Findings between VUDI and aUDI were compared.
Results: The median time interval between VUDI and aUDI was 215 (Q1-Q3: 40-356) days.
Using aUDI a DO could be unmasked in 70% (26/37) of patients in group 1 (median age 52, Q1-Q3 40-61 years; 59% female subjects), with a median pDetmax of 44 (Q1-Q3: 26-85) cmH2O.
In 95% (21/22) of patients in group 2 (median age 49 (Q1-Q3 41-57 years; 23% female subjects) a DO was confirmed performing aUDI. The median pDetmax was 52 (Q1-Q3: 38-56) cmH2O and 56 (Q1-Q3: 25-92) cmH2O (p=0.787), for VUDI and aUDI, respectively.
Overall maximum cytometric bladder capacity was similar between the groups at time of VUDI (575, Q1-Q3: 383-735 mL) vs. (543, Q1-Q3: 443-746) (p=0.796).
Conclusion: In neuro-urology, aUDI has a role if VUDI findings are equivocal and might be relevant for clinical decision-making warranting more well-designed prospective studies.