A Potential Urodynamic Classification of Voiding Patterns in Neurogenic Lower Urinary Tract Dysfunction Due to...

Area of Science:

• Urology
• Neuroscience
• Medical Devices

Background:

• Lower-level spinal cord injury (LSCI) often leads to complex bladder dysfunction.
• Characterizing urodynamic findings is crucial for managing neurogenic bladder.
• Existing classification systems may not fully capture the nuances of voiding patterns post-LSCI.

Purpose of the Study:

• To characterize urodynamic findings in men with LSCI.
• To evaluate the efficacy of a new pressure-based classification framework, the bladder-sphincter dyscoordination syndrome (BSDS).
• To introduce and define a neurogenic bladder outlet obstruction (NBOO) phenotype for straining-dependent voiding difficulty.

Main Methods:

• Retrospective analysis of urodynamic studies in 81 men with LSCI (T10 or below).
• Evaluation of key urodynamic measures including pressures, volumes, flow rates, and voiding efficiency.
• Comparison of patients with and without detrusor overactivity (DO) and classification of voiding discoordination using BSDS subtypes (DHP, DMP, DLP, APP) and NBOO criteria.

Main Results:

• Patients with DO exhibited higher filling pressures and lower first desire volumes.
• Among 63 patients with voiding discoordination, 50.8% met NBOO criteria, showing worse emptying than classical detrusor-sphincter dyssynergia (DSD).
• The BSDS framework successfully classified 93.8% of patients into four subtypes (DHP, DMP, DLP, APP).

Conclusions:

• The BSDS framework offers a novel, pressure-based method for describing voiding patterns after LSCI.
• The NBOO descriptor provides a valuable classification for straining-dependent voiding difficulty when conventional indices are insufficient.
• This framework links urodynamic findings to potential management strategies, guiding treatment by identifying primary bladder or outlet issues.