PD36-02 VOLITIONAL VOIDING OF THE BLADDER AFTER SPINAL CORD INJURY: VALIDATION OF BILATERAL LOWER EXTREMITY MOTOR FUNCTION AS A KEY PREDICTOR

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction II1 Apr 2018PD36-02 VOLITIONAL VOIDING OF THE BLADDER AFTER SPINAL CORD INJURY: VALIDATION OF BILATERAL LOWER EXTREMITY MOTOR FUNCTION AS A KEY PREDICTOR Christopher Elliott, Kai Dallas, Dimitar Zlatev, Craig Comiter, James Crew, and Kazuko Shem Christopher ElliottChristopher Elliott More articles by this author , Kai DallasKai Dallas More articles by this author , Dimitar ZlatevDimitar Zlatev More articles by this author , Craig ComiterCraig Comiter More articles by this author , James CrewJames Crew More articles by this author , and Kazuko ShemKazuko Shem More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1725AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES For many persons with spinal cord injury (SCI), a return of volitional bladder voiding is considered more important than regaining motor function. Recently a predictive model using only composite bilateral lower extremity motor (LEM) scores for levels L2-S1 (range 0-50) was put forth by the European Multicenter Spinal Cord Injury (EMSCI) study group that showed excellent predictive power with an area under the curve (AUC) of 0.912. However appropriate validation of this model is lacking. We sought to further validate the EMSCI model using a national SCI cohort. METHODS We created models of volitional voiding using the United States National SCI Database for the years 2007-2016. In addition to testing LEM scores, we evaluated other patient variables that we hypothesized might affect volitional voiding including age, gender, rectal motor/sensory preservation, AIS classification and sensory level. Logistic regression modeling and receiver operator characteristic (ROC) curves were created. RESULTS In the cohort of 4327 individuals, volitional voiding was present in 1333 (30.8%) at 1-year follow-up. While younger age, female gender, improved AIS classification and more caudal sensory level were all predictors of volitional voiding, LEM scores were the most predictive (AUC=0.919). Addition of the other patient characteristics did little to improve the predictive power of LEM scores (AUC=0.932 for the full model). Further analysis of the predictive power of LEM scores suggests that the negative predictive value is better than the positive predictive value as LEM AUC decreases in groups more likely to volitionally void (AIS C=0.724 and AIS D=0.644). CONCLUSIONS Our study verifies the validity of the EMSCI predictive model of volitional voiding after SCI. The differing ability of LEM scores to predict voiding based on neurologic class of injury should be noted. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e726-e727 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christopher Elliott More articles by this author Kai Dallas More articles by this author Dimitar Zlatev More articles by this author Craig Comiter More articles by this author James Crew More articles by this author Kazuko Shem More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...