Videourodynamic predictive factors of urological complications in patients with chronic spinal cord injury and detrusor sphincter dyssynergia

Abstract

Background: Patients with suprasacral spinal cord injury (SCI) often develop neurogenic lower urinary tract dysfunction, with detrusor sphincter dyssynergia (DSD) being a prevalent and clinically significant condition. The severity of DSD is classified into three grades, with higher grades associated with an increased risk of urological complications. However, few studies have systematically compared these complications across different DSD grades.

Methods: We conducted a retrospective cohort study of 543 SCI patients diagnosed with neurogenic detrusor overactivity with or without DSD using video urodynamic studies (VUDS) and electromyography. Patients were categorized into non‑DSD, DSD grade 1, DSD grade 2, and DSD grade 3 subgroups. The primary outcome was the incidence of urological complications, including recurrent urinary tract infection (rUTI), renal stone, bladder stone, vesicoureteral reflux, hydronephrosis, and autonomic dysreflexia (AD), across subgroups. The secondary outcome used logistic regression models to assess the association between DSD grade, bladder management strategies, VUDS parameters, and the occurrence of urological complications.

Results: Higher DSD grades were significantly associated with an increased risk of rUTI and AD. Spontaneous voiding was linked to a lower risk of both complications, whereas clean intermittent catheterization was associated with a higher incidence of rUTI, and indwelling catheterization was linked to an increased risk of AD. However, VUDS parameters did not significantly correlate with complications. Subgroup analyses further revealed that clean intermittent catheterization was associated with a higher risk of hydronephrosis in patients with DSD grade 1, while indwelling catheterization was linked to an increased risk of AD in patients with DSD grade 3.

Conclusion: This study reveals that higher DSD grades are linked to increased risks of rUTI and AD, though VUDS parameters alone are not statistically significant predictors. Instead, bladder management strategies play a crucial role. Catheterization should be tailored to patients' SCI severity, catheterization ability, and urinary tract condition. Regular follow‑up is vital to adjust management based on complications, VUDS changes, and quality of life, ensuring optimal care.

Keywords: Complications; Detrusor sphincter dyssynergia; Spinal cord injuries; Urinary catheterization; Urodynamics.