Detrusor Bladder Neck Dyssynergia Research Articles

Video-urodynamics efficacy of sacral neuromodulation for neurogenic bladder guided by three-dimensional imaging CT and C-arm fluoroscopy: a single-center prospective study

To assess the efficacy of sacral neuromodulation (SNM) for neurogenic bladder (NB), guided by intraoperative three-dimensional imaging of sacral computed tomography (CT) and mobile C-arm fluoroscopy through video-urodynamics examination. We enrolled 52 patients with NB who underwent conservative treatment with poor results between September 2019 and June 2021 and prospectively underwent SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy. Video-urodynamics examination, voiding diary, quality of life questionnaire, overactive bladder symptom scale (OABSS) scoring, and bowel dysfunction exam were completed and recorded at baseline, at SNM testing, and at 6-month follow-up phases. Finally, we calculated the conversion rate from period I to period II, as well as the treatment efficiency and the occurrence of adverse events during the testing and follow-up phases. The testing phase of 52 NB patients was 18–60 days, with an average of (29.3 ± 8.0) days. Overall, 38 patients underwent SNM permanent electrode implantation, whose follow-up phase was 3–25 months, with an average of (11.9 ± 6.1) months. Compared with baseline, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased significantly in the testing phase. The daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased significantly in the testing phase. Besides, the voiding times, daily catheterization volume, quality of life score, OABSS score, bowel dysfunction score, maximum detrusor pressure before voiding, and residual urine volume decreased further from the testing to follow-up phase. Daily voiding volume, functional bladder capacity, maximum urine flow rate, bladder compliance, and maximum cystometric capacity increased further from testing to follow-up. At baseline, 10 ureteral units had vesicoureteral reflux (VUR), and 9 of them improved in the testing phase. Besides, there was 1 unit that further improved to no reflux during the follow-up phase. At baseline, 10 patients had detrusor overactivity (DO), and 8 of them improved in the testing phase. Besides, 1 patient’s symptoms further improved during the follow-up phase. At baseline, there were 35 patients with detrusor-bladder neck dyssynergia (DBND); 14 (40.0%) of them disappeared during the testing phase. Among 13 cases who had DBND in the testing phase, 6 (46.2%) disappeared during the follow-up phase. Of the 47 patients with detrusor-external sphincter dyssynergia (DESD) at baseline, 8 (17.0%) disappeared during the testing phase. Among 26 cases who had DESD in the testing phase, 6 (23.1%) disappeared during the follow-up phase. The effective rate of this study was 88.5% (46/52), and the conversion rate from phase I to phase II was 73.1% (38/52). Additionally, the efficacy in a short-term follow-up was stable. SNM guided by intraoperative three-dimensional imaging of sacral CT and mobile C-arm fluoroscopy is an effective and safe treatment option for NB in short time follow-up. It would be well improved in the bladder storage function, sphincter synergetic function and emptying efficiency by video-urodynamics examination in this study.Trial registration: Chinese Clinical Trial Registry. ChiCTR2100050290. Registered August 25 2021. http://www.chictr.org.cn/index.aspx.

Urodynamic findings and urologic management of central cord syndrome

Purpose: Central cord syndrome is the most common incomplete spinal cord injury, although urodynamic data on this subset of patients is lacking. We aim to determine the typical urodynamic features associated with this condition. Methods Consecutive patients undergoing urodynamic studies in a tertiary spinal cord unit between 2014 and 2018 were retrospectively reviewed to identify those with central cord syndrome. Charts were evaluated for demographics, spinal cord injury classification, symptoms, urodynamic parameters and treatment. Data were analysed using descriptive statistics. Results: A total of 131 consecutive patients undergoing urodynamic studies were reviewed and 33 were identified with central cord syndrome. Mean age was 46 years and 91% were male. The predominant spinal cord injury classification was American Spinal Injury Association D (52%). Overall, 94% (31/33) reported volitional voiding and normal bladder sensation. Video-urodynamics demonstrated neurogenic detrusor overactivity in 70% (23/33) of patients, with 15% (5/33) demonstrating leakage with neurogenic detrusor overactivity and 21% (7/33) having reflex emptying. In total, 94% (31/33) of patients had normal compliance, 42% (14/33) of patients had detrusor sphincter or bladder neck dyssynergia and 60% (20/33) had an alteration to their management plan following urodynamic study. Conclusion: There is discordance between subjective patient-reported symptoms and objective urodynamic findings. About two-fifths of patients may have a potentially unsafe urodynamic bladder profile and urodynamics studies resulted in a change in bladder management in the majority of patients. Urodynamic assessment of patients with central cord syndrome is essential to determine which patients require further intervention. Level of evidence: Not applicable for this multicentre audit.

169 Pathophysiology and severity based proposed urodynamic classification of detrusor bladder neck dyssynergia

169 Pathophysiology and severity based proposed urodynamic classification of detrusor bladder neck dyssynergia

Pathophysiology and severity based proposed urodynamic classification of detrusor bladder neck dyssynergia

Aims : to propose a novel urodynamic classification of neurogenic bladder neck dysfunction due to suprasacral lesions. Material and Methods: Thirty three male patients with suprasacral infrapontine lesion and detrusor bladder neck dyssynergia confirmed upon cystourethrography were classified as following: Group O [Pdetopen prior to Pdetmax , Tqmax ≥ 1/3 Tq at free uroflow, incomplete bladder neck opening during cystourethrography], Group IA (increased Topen, high amplitute terminal neurogenic detrusor overactivity –TNDO-, Pdetopen after Pdetmax with abdominal straining during pressure flow study), Group IB (increased Topen, high amplitude TNDO, Pdetopen after Pdetmax without abdominal straining during pressure flow study), Group II (high pressure and high velocity TNDO with Pdetopen after Pdetmax) and Group III (active reduced compliance with detrusor leak point pressure at or after Pdetmax). Results: Absence of free urination was reported at 0% (0/2), 16.67% (2/12), 66.67% (4/6), 100% (4/4) and 100% (9/9) of group O, IA, IB, II and III, respectively. Mean value of maximum free flow (Qmax) was 17.4, 12.4 and 4.1 ml/sec for group O, IA and IB, respectively. Interrupted voiding pattern during free uroflow, at percentage greater than 50% of all the recorded flows per patient, was 0% (0/2), 100% (10/10) and 100 % (2/2) respectively. Spastic paraplegia was present in 0%(0/2), 8.3%(1/12), 83.3%(5/6), 100%(4/4) and 100%(9/9), bilateral normal perineal sensation (PS) was recorded at 50%(1/2), 25%(3/12), 16.7%(1/6), 0%(0/4), 0%(0/9) while “normal” bladder sensation during cystomanometry was found at 100%(2/2), 50% (6/12), 20%(1/6), 0%(0/4), 0%(0/10) of groups O, IA, IB, II and III, respectively. Conclusions: The classification proposed in this pilot study represents five increasing severity degrees of NDO with progressively increased degree of detrusor bladder neck dyssynergia. Σκοπός: Ουροδυναμική ταξινόμηση της νeυρογeνούς δυσσυνέργeιας eξωστήρα κυστικού αυχένα (DBND). Υλικό - Μέθοδος : Αναδρομικά, 33 άντρeς μe eπιβeβαιωμένη (MRI σπονδυλικής στήλης) υπeριeρή υπογeφυρική βλάβη του νωτιαίου μυeλού ταξινομήθηκαν μe βάση τις ουροδυναμικές παρατηρήσeις στην ομάδα O [Pdetopen (≥ 40 cm H2O) πριν την Pdetmax, Tqmax > 1/3 Tq στην eλeύθeρη ουροροομeτρία και ατeλής ή καθυστeρημένη διάνοιξη του κυστικού αυχένα στην κυστeοουρηθρογραφία κατά την ούρηση], την ομάδα ΙΑ [αυξημένο Topen, μeγάλου eύρους τeλική νeυρογeνή υπeρλeιτουργία του eξωστήρα (TNDO) και κοιλιακή συμμeτοχή στην ούρηση], την ομάδα ΙΒ [αυξημένο Topen, μeγάλου eύρους τeλική νeυρογeνής υπeρλeιτουργία του eξωστήρα (TNDO) δίχως κοιλιακή συμμeτοχή στην ούρηση], την ομάδα ΙΙ (υψηλών πιέσeων και σύντομης διάρκeιας TNDO) και την ομάδα ΙΙΙ (δυναμική eλαττωμένη eυeνδοτότητα μe πίeση διαφυγής eξωστήρα (DLPP) υψηλών πιέσeων κατά ή μeτά την Pdetmax. Αποτeλέσματα : Eλeύθeρη ούρηση παρουσίασe το 100% (2/2), 83.3% (10/12) και 33.3% (2/6) των ομάδων Ο, ΙΑ και ΙΒ, αντίστοιχα. Η μέση μέγιστη ροή των ούρων στην eλeύθeρη ουροροομeτρία υπολογίστηκe στο 17.4, 12.4 and 4.1 ml/sec, αντίστοιχα. Διακοπτόμeνη ούρηση σe ποσοστό μeγαλύτeρο του 50% των καταγeγραμμένων ουρήσeων ανά ασθeνή, παρατηρήθηκe στο 0% (0/2), 100% (10/10) και 100% (2/2), αντίστοιχα. Σπαστική παραπληγία παρατηρήθηκe στο 0%(0/2), 8.3%(1/12), 83.3%(5/6), 100%(4/4) και 100%(9/9), αμφοτeρόπλeυρα φυσιολογική αισθητικότητα πeριπρωκτικά (PS) καταγράφηκe στο 50%(1/2), 25%(3/12), 16.7%(1/6), 0%(0/4), 0%(0/9) eνώ φυσιολογική αισθητικότητα της κύστeως διαπιστώθηκe στο 100% (2/2), 50% (6/12), 20% (1/6), 0% (0/4), 0% (0/10) των ομάδων Ο, ΙΑ, ΙΒ, ΙΙ και ΙΙΙ, αντίστοιχα.

Afectación de la contractilidad del detrusor en la hiperreflexia vesical

Classically, it was understood detrusor contractility was affected in bladder areflexia but not in hyperreflexia. We aim to demonstrate that there is some detrusor contractility affectation in bladder hyperreflexias, although it may seem paradoxical at first sight. Neuro-urologic study was performed in a series of 68 consecutive patients with bladder hyperreflexia (neurogenic detrusor hyperactivity), referred to the unit of functional urology for urodynamic evaluation. All patients underwent clinical history, post void residual determination, cystomanometry, voiding pressure-flow test, videourodynamics and selective EMG of the periurethral sphincter. Detrusor contractile potency was measured with W 80-20. Terminology follows the ICS standard. Data processing was performed using the statistical software SPSS 12.0. This series includes 14 males (58.8%) and 28 females (41.2%), of all ages (adults more frequent). 88.2% of the cases had acquired neurological diseases (trauma 30.9%; medical 33.8%; degenerative 35.3%), and 11.8% congenital neurological diseases (myelodysplasia). Most frequent type of neurological lesion was detrusor-sphincter dyssynergia: 59 cases (79.4%); 22 patients (32.4%) had undergone previous treatment of their vesicourethral dysfunction. The amplitude of detrusor involuntary contractions was wider in detrusor-bladder neck dyssynergia. Detrusor isotonic contractility (W 80-20) was significantly affected, mainly in neurological lesions of traumatic nature and less in degenerative lesions (p = 0.01). We demonstrated that bladder contractility is affected in bladder hyperreflexias (neurogenic detrusor hyperactivity), more important in traumatic lesions without relationship with the type of neurological associated lesion, which could be related to a bladder structural change, or with a change in the central neurological tracts (without requirement of presence of dyssynergia).

Video urodynamics using transrectal ultrasonography for lower urinary tract symptoms in women.

To understand the properties of lower urinary tract disorders in women, we evaluated 60 female patients with lower urinary tract disorders or symptoms of recurrent cystitis by free uroflowmetry and video urodynamics using transrectal ultrasonography (VU-TRUS). Results of urodynamic studies or symptoms of stress incontinence were used to divide 60 women into 7 normal controls and 53 with voiding dysfunctions. In normal controls, VU-TRUS showed that the mean posterior urethrovesical angle and anteroposterior diameter of the proximal urethra at maximum flow was 151.4 degrees and 4.9 mm, respectively. In patients with voiding dysfunction, VU-TRUS during voiding revealed various urethral abnormalities, including 16 detrusor sphincter dyssynergia, 4 detrusor bladder neck dyssynergia, and 13 insufficient opening of the entire urethra. VU-TRUS also showed pelvic floor abnormalities, including 24 urethral hypermobilities (group 1) and 11 cystoceles (group 2). Eighteen patients had neither urethral hypermobility nor cystocele (group 3). Major pressure-flow abnormalities in the 53 patients with voiding dysfunctions were weak detrusor (72%) and/or bladder outlet obstruction (25%). There were no significant differences in the distribution of the pressure-flow abnormalities among the three groups. However, the mean values of abdominal pressure at maximum flow of group 1 (20.9 cm H(2)O) and group 2 (17.9 cm H(2)O) were significantly higher than that of group 3 (6.3 cm H(2)O; each P < 0.05). The mean values of residual urine volume of group 2 (60.8 mL) and group 3 (77.6 mL) were significantly higher than that of group 1 (23.5 mL; each P < 0.05). The symptoms of women with lower urinary tract disorders were frequently accompanied by urethral and/or pelvic floor abnormalities during voiding that were clearly detected by VU-TRUS. VU-TRUS is useful for objective evaluation of female lower urinary tract symptoms.

The nature of detrusor bladder neck dyssynergia in non-neurogenic bladder dysfunction

There have been two major opinions on the pathology or nature of the bladder neck contracture. One is an organic fibrosis, and the other is an accentuated sympathetic nervous function, or detrusor bladder neck dyssynergia. The existence of active detrusor bladder neck dyssynergia in neurogenic bladder was reported in a urodynamical manner using microtip transducer catheters. However, it has not been confirmed whether or not detrusor bladder neck dyssynergia is responsible for bladder neck contracture in patient without neurogenic bladder. The present study was designed to determine by means of video urodynamic study whether or not bladder neck contracture would be of the same nature as detrusor bladder neck dyssynergia in non-neurogenic bladder subjects. The study included 32 male subjects of 16–84 years old (average 52.3): 17 bladder neck contracture subjects including 7 subjects associated with minimum complications (4 with trapped benign prostatic hyperplasia and 3 with incomplete neurological lesion) and 15 non-bladder neck contracture subjects (10 healthy volunteers, 2 chronic prostatitis, 3 prostatodynia). A 5-microtip transducer catheter was used to measure the pressure in the bladder and at the bladder neck, the external urethral sphincter and the bulbous urethra during voiding. Proper localization of the transducers was done with an image intensifier. Bladder outlet obstruction localized at the bladder neck (diameters smaller than 0.75 cm) on voiding cystourethrogram was defined as bladder neck contracture. Detrusor bladder neck dyssynergia was defined where pressures were higher at the level of bladder neck than in the bladder during detrusor contraction. An alpha-blocker, terazosin hydrochloride (0.5 mg, b.i.d., two weeks), was orally administered to subjects judged to have detrusor bladder neck dyssynergia by the above methods for the purpose of confirming whether detrusor bladder neck dyssynergia was really due to accentuated sympathetic nervous function. Detrusor bladder neck dyssynergia was found in seven cases with bladder neck contracture: 6 cases with bladder neck contracture with minimum complications and only 1 case with bladder neck contracture without complications ( p<0.01). Detrusor bladder neck dyssynergia was found at the beginning and ending of micturition, but not at maximum flow. In six cases with detrusor bladder neck dyssynergia, the condition disappeared after terazosin. In conclusion, detrusor bladder neck dyssynergia was not thought to be a major factor of voiding dysfunction in bladder neck contracture in non-neurogenic bladder. In the presence of sympathetic hyperactivity or in cases with increased number of alphareceptors, detrusor bladder neck dyssynergia occurs, being predominantly noted in trapped benign prostatic hyperplasia and neurological disorder patients.

The use of sacral reflex latencies in detrusor bladder neck dyssynergia.

Detrusor bladder neck dyssynergia (DBND) is a well recognised cause of bladder outflow obstruction, especially in the younger man. The cause is unknown, and the aim of this study was to determine if any neurological dysfunction is associated with this condition. Twenty-five males with proven DBND had sacral reflex latency studies performed. The conduction latencies indicate that the underlying cause is unrelated to any demonstrable neuropathy. Sacral reflex latencies are not helpful in the investigation of DBND.

The Use of Transrectal Longitudinal Real-Time Ultrasonography in Urodynamics

A total of 63 combined transrectal ultrasonographic and urodynamic studies was performed to evaluate the voiding dysfunction in 49 spinal cord injury patients and 7 other patients. Ultrasonography provided excellent real-time imaging of the bladder neck, prostatic urethra, prostate and external sphincter, and allowed for accurate diagnosis of detrusor-sphincter dyssynergia, detrusorbladder neck dyssynergia, prostatic hypertrophy and bladder neck strictures. In addition to offering these capabilities, ultrasonography is less expensive than x-ray and it does not involve exposure of either the patient or examiner to radiation. However, it does not provide a means to detect vesicoureteral reflux.

5-Microtransducer catheter in evaluation of neurogenic bladder function

Recent use of the multiple microtransducer catheter in the evaluation of neurogenic bladder due to spinal-cord injuries leads us to believe that (1) the use of the inferior edge of the symphysis pubis as the zero point for resting bladder pressure is more accurate than its superior edge, (2) changes in resting bladder pressure at various volumes are influenced more by body position than by intravesical position of the sensor, (3) back-to-back microtransducers indicate significant pressure difference at the external sphincter zone, and (4) detrusor bladder neck dyssynergia during autonomic dysreflexia in patients with spinal cord injury is more likely of skeletal than of smooth muscle origin.

The Importance of Urodynamic Investigation Following Spontaneous Rupture of the Bladder

AbstractWe report a case of spontaneous intraperitoneal rupture of the bladder. Followup urodynamic studies revealed unsuspected detrusor bladder neck dyssynergia that was treated by unilateral endoscopic bladder neck incision. The pathogenesis of spontaneous bladder rupture is discussed and we recommend urodynamic evaluation in all cases of spontaneous rupture.

Dysfunction of the bladder neck: a urodynamic study.

Urodynamic investigations were performed in 9 males, suffering from dysfunction of the bladder neck (detrusor bladder neck dyssynergia). The parameters of micturition were compared with the values in normal males and in patients with prostatic obstruction. By introducing a new factor, the maximum opening time, we found a characteristic pattern in dysfunction of the bladder neck, making selection of patients for endoscopic incision of the bladder neck possible. The maximum and mean flow rates increased significantly in 5 patients treated with incision of the bladder neck. The diagnostic value of voiding cystourethrography and urodynamic investigation is discussed.