Endoscopic treatment of vesicoureteral reflux with non-simultaneous involuntary detrusor contraction in chronic spinal cord injury patients with neurogenic detrusor overactivity.

OBJECTIVE: To analyze whether it is correct to use endoscopic treatment via bulking agents of vesicoureteral reflux (VUR) seen on video urodynamics with non-simultaneous involuntary detrusor contraction in chronic spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO). METHODS: A retrospective study was performed with a cohort of 76 patients (age 48.9 ± 14.4 years) (mean ± standard deviation) of both sexes with chronic SCI who underwent endoscopic treatment of VUR during the years 2008 to 2011. Patients were subjected to clinical examinations and video urodynamic studies preoperatively and 22 ± 11.4 months after the intervention. RESULTS: Resolution of VUR was achieved in 46 cases (61%). Cured patients had a statistically significant younger age and showed stress urinary incontinence more frequently. On the contrary, a greater grade of VUR, presence of bilateral reflux and presence of NDO were positively associated with treatment failure. The variables that independently influenced the cure of the reflux were NDO and reflux grade. CONCLUSIONS: The failure rate was high in patients with NDO, even though the reflux was not synchronous with involuntary detrusor contraction, and therefore these patients should have NDO eradicated before doing any anti-reflux procedures.

Reproducibility of non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction in males.

OBJECTIVE: To determine the repeatability of the parameters obtained from non-invasive urodynamics, using the cuff-uroflow, for the diagnosis of bladder outlet obstruction. MATERIAL AND METHODS: The study was carried out in a consecutive series of 34 males with functional urinary tract symptoms. The test-retest reproducibility of isometric pressure, flow in response to isovolumetric pressure and the energy transfer ratio obtained at two different times using the cuff-uroflow method was determined. RESULTS: Very good agreement for the flow in response to isovolumetric pressure measurement (intraclass correlation coefficient 0.96) and good agreement for the isovolumetric pressure measurement (intraclass correlation coefficient 0.87) and the energy transfer ratio (intraclass correlation coefficient 0.84) were demonstrated. The patients were classified into three groups according to the value of the energy transfer ratio, and it was found that there was very good agreement between the groups into which patients were classified as a result of the first and second measurements (kappa index 0.81). CONCLUSIONS: The parameters obtained with the cuff-uroflow are reliable and the energy transfer ratio allows one to classify patients into reproducible groups.