Urodynamic or video-urodynamic assessment in patients with spinal cord injury: This is not a question!

Abstract

Study design: Case report. Objectives: The objective of this study was to demonstrate the additional value of combined video-urodynamic investigations compared with urodynamic investigation alone in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury (SCI). Setting: The study was conducted in a spinal cord injury rehabilitation center in Switzerland. Methods: A patient with complete SCI since 1984 evacuated the bladder by reflex voiding. Owing to the lack of clinical symptoms, he refused urologic controls for 15 years. In July 2014, he was referred to our hospital with acute septicemia. Results: The hydronephrosis responsible for the septicemia was successfully treated by intravenous antibiotics and ureteral stenting. Subsequently, a neuro-urologic assessment was performed. Urodynamic examination was normal. Video-urodynamics, however, revealed massive morphologic alterations of the lower and upper urinary tracts, which were responsible for the septicemia. Conclusion: Our case demonstrates the necessity of regular video-urodynamic controls even in asymptomatic SCI patients. Persons using triggered voiding may be at a higher risk for secondary changes, as a sustained detrusor pressure is necessary for this technique.