Predicting Upper Urinary Tract Risk in the Neurogenic Bladder Patient

Abstract

In this review, we explore if risk factors for developing renal deterioration can be identified in a timely fashion, thereby preventing or delaying the progression of renal injury in the neurogenic bladder patient. Historically detrusor leak point pressure (DLPP) > 40 cm H2O has been used to identify risk of upper urinary tract dysfunction (UUTD). Recent studies suggest that DLPP should not be the only decision-making parameter to predict the risk of UUTD and that patients with DLPP > 20 cm H2O should be followed closely for upper tract assessment. Furthermore, a variety of urinary biomarkers can be used markers of UUTD to guide management of neurogenic patients. Urodynamic studies represent a valuable tool in the evaluation and monitoring of urinary tract function. Multiple sources have emphasized the early identification and regular follow-up of these patients to not only have a baseline urinary tract function but also to monitor renal function and evaluate for upper tract damage.