Evaluation of the Concordance Between Clinical Indications and Urodynamic Findings: A Single-Center Retrospective Study.

The aim of this systematic review is to assess urinary biomarkers studied in children with neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD). The systematic review was conducted in accordance with the PRISMA guidelines. The screening was performed on PUBMED without any publication date limitation. Only original articles were included. Parameters related to the following topics were obtained: study design, characteristics of participants, number of participants, age, control group, types of biomarkers, measurement technique in urine, subgroup analysis, urodynamic findings, and outcome. Dutch Cochrane Checklist (DCC) and level of evidence by EBRO platform were used for quality assessment. Meta-analysis was performed with the Comprehensive Meta-Analysis Version 4 program. A total of 494 studies were screened and 16 studies were included. 11 (68.75%) were conducted in children with non-neurogenic LUTD and 5 (31.25%) neurogenic LUTD. Nerve growth factor (NGF) was evaluated in 12 studies, brain-derived neurotrophic factor (BDNF) in 5, Tissue Inhibitor of Metalloproteinase-2 (TIMP-2) in 2, transforming growth factor beta-1 (TGF Beta-1) in 2, neutrophil gelatinase-associated lipocalin (NGAL) in 1, and Aquaporin-2 in 1. According to DCC, 10 (62.5%) articles were evaluated on 4 (37.5%) items and 4 articles on 5 items. The average score was 3.91+/-0.56. The level of evidence was found as B for 13 (81.25%) articles and C for 3 (18.75%). In meta-analysis, urinary NGF levels in children with non-neurogenic LUTS were significantly higher than in the healthy control group (Hedges's g = 1.867, standard error = 0.344, variance = 0.119, p = 0.0001). Urinary biomarkers are promising for the future with their noninvasive features. However, prospective studies with larger sample sizes are needed to better understand the potential of urinary biomarkers to reflect urodynamic and clinical findings in children with LUTD.

Urinary tract infection in patients with lower urinary tract dysfunction

Cross-Sectional Study of Determinants of Upper and Lower Urinary Tract Outcomes in Adults with Spinal Dysraphism—New Recommendations for Urodynamic Followup Guidelines?

Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction

Neurogenic lower urinary tract dysfunction (NLUTD) in asymptomatic patients with MS has been described in preliminary studies, but specific investigations of this topic are rare. Many authors advise early diagnosis and treatment of NLUTD in patients with MS. In contrast, clinical practice and different guidelines recommend neuro-urological diagnostics only in the presence of symptoms. Our aim was to investigate the characteristics of NLUTD and the correlations of clinical parameters with NLUTD in asymptomatic patients with MS. We evaluated bladder diaries, urodynamic findings, and therapy proposals. Correlations of the voided volume, voiding frequency, urinary tract infections, and uroflowmetry including post-void residual with the urodynamic findings were determined. In our study, 26% of the patients were asymptomatic. Of these, 73.7% had urodynamic findings indicative of NLUTD, 21.1% had detrusor overactivity, 13.2% had detrusor underactivity, 13.2% detrusor overactivity and detrusor sphincter dyssynergia, and 57.9% had radiologically abnormal findings of the bladder. No patients presented low bladder compliance or renal reflux. Clinical parameters from the bladder diary and urinary tract infections were found to be correlated with NLUTD, and the absence of symptoms did not exclude NLUTD in patients with MS. We observed that urinary tract damage is already present in a relevant proportion. Based on our results, we recommend that patients with MS be screened for NLUTD regardless of the subjective presence of urinary symptoms or the disease stage.

The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-up.

Background: Multiple sclerosis patients often develop neurogenic lower urinary tract dysfunction with a potential risk of upper urinary tract damage. Diagnostic tools are urodynamics, bladder diary, uroflowmetry, and post-void residual, but recommendations for their use are controversial. Objective: We aimed to identify clinical parameters indicative of neurogenic lower urinary tract dysfunction in multiple sclerosis patients. Methods: 207 patients were prospectively assessed independent of the presence of lower urinary tract symptoms. We analyzed Expanded Disability Status Scale scores, uroflowmetry, post-void residual, rate of urinary tract infections, standardized voiding frequency, and voided volume in correlation with urodynamic findings. Results: We found a significant correlation between post-void residual (odds ratio (OR) 4.17, confidence interval (CI) 1.20–22.46), urinary tract infection rate (OR 3.91, CI 1.13–21.0), voided volume (OR 4.53, CI 1.85–11.99), increased standardized voiding frequency (OR 7.40, CI 2.15–39.66), and urodynamic findings indicative of neurogenic lower urinary tract dysfunction. Expanded Disability Status Scale shows no correlation. Those parameters (except post-void residual) are also associated with reduced bladder compliance, as potential risk for kidney damage. Conclusion: Therefore, bladder diary and urinary tract infection rate should be routinely assessed to identify patients who require urodynamics.

"Can spot urine CA19-9 be a potential biomarker in lower urinary tract dysfunction in children?"

Urodynamics is the more accurate diagnostic tool to assess functional alterations of lower urinary tract. International guidelines provide specific indications to adopt this test for the evaluation algorithm of patients with lower urinary tract symptoms. Although recent innovations in diagnostic methodologies, especially regarding ultrasounds, have reduced the use of urodynamics compared to the past, this procedure retains its importance in specific conditions, such as in patients with neurogenic lower urinary tract dysfunction, when symptoms do not improve after first line therapeutic approaches, especially in cases of complicated urinary incontinence and bladder outlet obstruction. Among patients’ cathegories who are often requested to provide urodynamic data are those undergoing hemodialysis. In these subjects urinary symptoms often develop reducing quality of life and increasing the risk of severe sistemic complications. Furthermore, bladder outlet obstruction and other alterations that increase the risk of vesico-ureteral refluxes and chronic urinary retention have to be excluded before a kidney transplant. Urodynamics can properly assess lower urinary tract dysfunction of patients undergoing hemodialysis, who are often oliguric and anuric, and therefore suffering for bladder atrophy with impaired function. This alteration is frequently responsible for recurrent inflammatory disorders of the lower urinary tract. Considering these aspects and lack of data provided by Literature on this topic, aim of this study was to assess the prevalence of lower urinary tract symptoms in a cohort of patients undergoing hemodialysis and to investigate their urodynamic findings. The results show that lower urinary tract symptoms are prevalent in patients attending our hemodialysis center, being inflammatory disorders the most represented as a consequence of bacterial urinary tract infections. Lower urinary tract symptoms, especially urinary burning, frequency, urgency and nocturia, resulted to be the third reason for seeking medical assistance by patients, following cardiovascular and respiratory symptoms. Urodynamics showed in all patients a reduced cystometric capacity, often associated with reduced compliance and detrusor overactivity; pressure / flow studies provided evidence either of bladder outlet obstruction and underactive detrusor.

Neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction are often associated with spinal cord injury (SCI). In Brazil, studies and statistical data on these dysfunctions are scarce. To estimate the prevalence of neurogenic bowel dysfunction and neurogenic lower urinary tract dysfunction in Brazilians diagnosed with traumatic and nontraumatic SCI. In this retrospective cross-sectional study, a form was used to collect sociodemographic and clinical data from medical records. The Mann-Whitney statistical tests were used for 2 independent samples, Pearson's chi-square test for categorical variables, and the Kruskal-Wallis test for more than 2 independent samples for quantitative variables. A logistic regression model was used to understand the factors associated with neurogenic bowel dysfunction. The sample comprised 1056 participants from all regions of Brazil. Of this sample, 60.90% had traumatic SCI, and 69.03% were male. The prevalence of neurogenic bowel dysfunction in the sample was 88%, and the prevalence of neurogenic lower urinary tract dysfunction was 90.6%. Participants with traumatic SCI are more affected by neurogenic bowel and lower urinary tract dysfunction than those with nontraumatic SCI. Most people with SCI have neurogenic lower urinary tract and bowel alterations, especially those with traumatic SCI. Further studies are needed, and bowel and bladder reeducation programs should be provided in rehabilitation centers.

The AUA/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Diagnosis and Evaluation.

Clinical guidelines for the diagnosis and management of neurogenic lower urinary tract dysfunction

Objective: The aim of this retrospective review is to determine whether risk stratification for renal deterioration in neuro-urology patients is supported by urodynamic findings in terms of bladder safety and whether urodynamic findings affect bladder management in this patient group. The primary endpoints are to determine any statistically significant differences between the high and low risk for renal deterioration groups in terms of urodynamic findings regarding bladder safety, and the frequency of changes in bladder management following video-urodynamics (VUDs). Methods: VUDs, which were performed between March 2015 and March 2021 in view of neurogenic lower urinary tract dysfunction, were included in the study. These were divided into those performed in patients with high risk and those in patients with low risk for renal deterioration categories according to criteria specified in the National Institute of Clinical Excellence (NICE) Urinary Incontinence in Neurological Disease guidelines. The two groups were then statistically compared in terms of urodynamic parameters for bladder safety and changes in management thereafter. Results: In total, 69 VUDs were included, 49.3% were classified as having been performed in high risk for renal deterioration patients, and 50.7% as low risk. 50% of those in the former group were found to have an unsafe bladder versus 31.4% in the latter group ( p = 0.12). Meanwhile, 65.2% of VUDs resulted in a change in bladder management, with no difference in change in management frequency between the two risk stratification groups ( p = 0.36). Conclusion: The lack of statistically significant difference in urodynamic bladder safety findings and change in frequency of bladder management for the low and high risk for renal deterioration categories in this cohort bring into question the need for risk stratification in the clinical decision to perform VUDs in the neurogenic bladder patient. Level of evidence: 2c

This study aimed to evaluate caregivers of children with urinary incontinence in terms of the caregiving burden and its associated manifestations. Caregivers of children who are being treated for urinary incontinence secondary to neurogenic and non-neurogenic lower urinary tract dysfunction (LUTD) were evaluated for caregiver burden (Zarit score), depression (Beck Depression Inventory [BDI]), and anxiety (Beck Anxiety Inventory [BAI]). Additionally, children were evaluated for dysfunctional voiding score. All scores were statistically analyzed for correlation with and relation to the caregiver's emotional status. Zarit score was equal in caregivers of children with neurogenic and non-neurogenic LUTD. BDI score was higher in caregivers of patients with neurogenic LUTD, whereas BAI score was higher in caregivers of patients with non-neurogenic LUTD. In the evaluation performed, considering the etiological difference, Zarit score in the group with non-neurogenic LUTD correlated positively with BAI and BDI scores. In the neurogenic bladder group, Zarit score correlated with BDI score. It is important not only in psychiatric patients, but also in those with other chronic disease processes, to evaluate the mental status of caregivers and to support them in dealing with the problem.

This review was performed according to the methodology recommended