The Reliability of Urodynamic Parameters as Predictors of a Hostile - - PowerPoint PPT Presentation

The Reliability of Urodynamic Parameters as Predictors

• f 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 100 200 300 400 Pdet cmH2O 30 60 90 Pves cmH2O 30 60 90 Pabd cmH2O 30 60 90 EMGave uV 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