In this paper, we had a close look at a large sample (n=231 ) of patients with spinal cord injury at the findings of cystography during video urodynamics done at a mean of 8.5 years after SCI. In 19 patients (!), specific findings were seen: diverticula, cystocele, and vesicoureteral reflux. X-ray bladder appearance was categorized as normal/standard, tonic, or flaccid. These differed by maximum cystometric capacity, presence of neurogenic detrusor overactivity, and maximum detrusor pressure during detrusor overactivity, but not by bladder compliance. There was no difference in the categories found in different levels and completeness of SCI. In the 23 patients able to void no pathology was seen on urethral images. Renal ultrasound was normal in >99%. Repeated testing after 72 ± 143 weeks showed changed findings in 30%. Cystoscopy showed significantly more local pathologies such as bladder calculi, diverticula, and trabeculation grade.
Our data permit us to conclude that complications in the lower urinary tract can be seen on X-Ray imaging but only in a very limited number of cases. As our findings represent a real-life example of the actual yield of video urodynamics in patients with neurogenic bladder due to SCI treated following the international guidelines, we believe that time has come to make further multicentre evaluations to determine when imaging during urodynamics should be used or not. This would be a very interesting way forward in the light of preventing irradiation effects and help to lower the cost of the investigations. Also repeating similar surveys in other categories of neurogenic and non neurogenic dysfunction have to be done!
Written by: JJ Wyndaele, University Antwerp, Antwerp, Belgium.
Read the Abstract