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
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.