Urodynamic study is the powerful tool to diagnose a tethered cord syndrome early in the patients with spina bifida
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Tethered Cord
Urodynamic studies
Spinal dysraphism
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Urodynamic studies
Urodynamic testing
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Urodynamic studies
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Aim The main goals of neurogenic lower urinary tract dysfunction (NLUTD) management are preventing upper urinary tract damage (UUTD), improving continence, and quality of life. Here, we aimed to systematically assess all available evidence on urodynamics predicting UUTD in patients with NLUTD. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) Statement was performed in March 2017. Only neuro‐urological patients assessed by urodynamics were included. Any outcome of upper urinary tract function were evaluated. Results Forty‐nine studies (1 randomized controlled trial, 9 prospective, and 39 retrospective case series) reported urodynamic data on 4930 neuro‐urological patients. Of those, 2828 (98%) were spina bifida (SB) children. The total number of adults was 2044, mainly having spinal cord injury (SCI) (60%). A low bladder compliance was found in 568 (46.3%) and 341 (29.3%) of the paediatric and adult population, respectively. Hydronephrosis (HDN) was detected in 557 children (27.8%) in 19/28 studies and 178 adults (14.6%), mainly SCI, in 14/21 studies. Nine out of 30 multiple sclerosis (MS) patients affected by HDN (16.8%) showed low compliance in 4/14 studies. Conclusions Patients with SB and SCI have a higher risk of developing UUTD (mainly reported as HDN) compared to those with MS. Reduced compliance and high DLPP were major risk factors for UUTD. Although our findings clarify the mandatory role of urodynamics in the management of NLUTD, standardization and better implementation of assessments in daily practice may further improve outcomes of neuro‐urological patients based on objective measurements, that is, urodynamics.
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Urodynamic studies
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The article describes the history and background of the ambulatory urodynamic monitoring (AUM). In details are described the indications, method of implementation and especially interpretation of study results. The results of the OUM in clinical practice and the benefits of the use are presented.
Clinical Practice
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A single-center institutional review board-approved prospective cross-sectional observational study.Urodynamic studies are essential to accurately direct bladder management following spinal cord injury (SCI). There is no consensus on how often testing should be performed.To determine the impact of annual urodynamic studies on guiding bladder management following SCI.Individuals with traumatic SCI undergoing annual urological evaluations were enrolled in this study. They had to be injured for at least 2 years so that urodynamic changes could be compared with their previous annual urodynamic evaluation. Changes in the urodynamic parameters and autonomic dysreflexia were determined by comparing this study with the previous year's study. All studies were done with the same physician and nursing staff. Demographic data, bladder management, urodynamic parameters, and the need and type of interventions based on the urodynamic study were obtained. The main outcome measure was whether or not there was a need for an intervention based on the urodynamics. Interventions were classified as urological intervention, non-urological intervention, or a combination of urological and non-urological intervention. The impact of the type of bladder management, length of injury, and level of injury was also evaluated.Ninety-six consecutive individuals with SCI undergoing annual urodynamic evaluations were enrolled over a 5-month period. Overall, 47.9% of individuals required at least one type of intervention based on urodynamic studies: 82.6% were urological interventions (medication changes were most common, comprising 54.3% of urological interventions); 13.0% were non-urological interventions; and 4.3% were a combination of non-urological and urological interventions. The need for interventions did not appear to be influenced by the type of bladder management, the length of time post-injury or level of injury.Annual urodynamic evaluation plays an important role in guiding bladder management following SCI.
Urodynamic testing
Autonomic dysreflexia
Urodynamic studies
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