The Reliability of Urodynamic Parameters as Predictors

of a “Hostile Bladder" in the Neuropathic Population

Dr. Jacob Golomb, MD

Former Head of Female Urology & Neurourology

Service, Chaim Sheba Medical Center, Israel

Panelists:

• Dr. Polina Reyblat, MD, Chair, Department of Urology, Kaiser Permanente

Los Angeles Medical Center, USA.

• Dr. Dmitry Pushkar, MD, Professor & Head of Urology, Moscow State

University of Medicine and Dentistry, Russia.

• Dr. Kobi Stav, MD, Head of Neurourology unit, Assaf HaRofeh Medical

Center, Israel.

• Dr. Ilan Gruenwald, MD, Head of Neurourology unit, Rambam Medical

Center, Israel.

Financial and Other Disclosures

3

I have the following financial interests or

relationships to disclose: Disclosure code

No financial relationships N

Lower urinary tract dysfunction in neuropathic patients

What is the expected yield of a urodynamic evaluation

in the neuropathic patient?

Treatment options

Prognosis Prognosis

What are the targets of the neuro-urological treatment

in neuropathic patients?

• Facilitate full and efficient urine emptying

• Restore natural voiding pattern, as much as possible

• Prevent urinary incontinence

• Protect the kidneys • Protect the kidneys

What is a hostile bladder?

OR

What are the urodynamic risk factors for upper urinary

tract deterioration?

• High-pressure detrusor overactivity with a high

detrusor leak point pressure (> 40 cmH2O)

• Decreased compliance (< 20 cc/cmH2O) with

a high detrusor leak point pressure (> 40 cmH2O)

• Decreased cystometric capacity with a large PVR

• Videourodynamic findings? Does it really matter?

Case # 1: 55-years-old male. Paraplegia D12. SIC. Rare leakage.

Decreased compliance with a high detrusor leak point pressure. Non-relaxing

sphincter with massive reflux on videourodynamics.

Case # 2: 65-years-old male. Tetraparesis C6-7. Empties spontaneously with

continuous leakage.

Decreased compliance, combined with high-pressure detrusor overactivity, with a

high detrusor leak point pressure. Bilateral massive reflux on videourodynamics.

Case # 3: 52-years-old male. Paraplegia D10-11. SIC + anticholinergics.

Leaks urine.

Vinfus

ml

0

100

200

300

400

Pdet

cmH2O

0

30

60

90

Pves

cmH2O

0

30

60

90

Pabd

cmH2O

0

30

60

90

EMGave

uV

0

10

20

30

Water Cystometry#1

75 s 00:00 02:30 05:00 07:30 10:00 12:30 15:00

ST PI1

PI2

PI3

PI4

PI5

PI6

PI7

PI8

PI9

PI10

PI11

PI12

PI13

PI14

PI15 PI16

PI17

PI18

PI19

PI20

Decreased compliance with a high detrusor leak point pressure. Non-relaxing

sphincter with massive reflux on videourodynamics.

Case # 4: 38-years-old male. Paraplegia T10-11. SIC + anticholinergics.

Leaks urine.

Decreased compliance with a high detrusor leak point pressure. Large bladder

diverticulum on videourodynmics.

Case # 5: 4-years-old girl; s/p removal of lumbar neuroblastoma, with continuous

incontinence. Wears diapers.

Decreased compliance, combined with detrusor overactivity, with a high detrusor

leak point pressure. No leakage on videourodynamics.

Case # 6: 12-years-old female. MMC. SIC. Leaks urine.

Decreased compliance with a high detrusor leak point pressure. Massive

reflux on videourodynamics.

Is urodynamic evaluation critical in the treatment of lower urinary

tract dysfunction in neuropathic patients?

Is videourodynamic study in these patients vital in terms of

portraying prognosis and in guidance of treatment?

YES/NO

YES/NO