Factors associated with Hydronephrosis and Vesicoureteral Reflux in Spinal Cord Injured Patients
Factors associated with Hydronephrosis and Vesicoureteral Reflux in Spinal Cord Injured Patients
Keywords:
spinal cord injury, vesico-ureteral reflux, hydronephrosis, urodynamics, neurogenic lower urinary tract dysfunctionAbstract
Abstract
Objectives: To investigate factors associated with hydronephrosis and vesicoureteral reflux (VUR) indicating upper urinary tract deterioration in spinal cord injured (SCI) patients.
Setting: Maharat Nakhon Ratchasima Hospital.
Study design: Retrospective study.
Subjects: SCI patients admitted at Rehabilitation ward between August 2008 and July 2018.
Methods: Medical records of the subjects were reviewed retrospectively. General demographic, urological and imaging data including hydronephrosis, VUR and bladder deformity were reviewed. Associations between all variables and hydronephrosis/VUR were identified.
Results: Of 278 patients, 30.2% had hydronephrosis and 24% had VUR. The most common bladder management was indwelling catheterization (66.5%) followed by triggered reflex voiding and incontinence (16.5%), voluntary voiding and continence (10%), combined voiding with clean intermittent catheterization (CIC) (4%), and CIC alone (2.9%). Bivariate analysis showed that age at onset, completeness of lesion, time interval from onset of injury, bladder management, antimuscarinic medication used, detrusor hyperreflexia, poor bladder compliance, small bladder volume, detrusor pressure (Pdet) > 40 mmHg and high grade bladder deformity were significantly associated with hydronephrosis and VUR. Five variables correlated with hydronephrosis/VUR were triggered reflex voiding with incontinence, indwelling catheterization, anticholinergic medication, high grade bladder deformity and time interval from onset of injury with adjusted odds ratios (95%CI) of 8.90 (2.50, 31.62), 7.23 (2.22, 23.59), 2.00 (1.11, 3.70), 1.82 (1.01, 3.30) and 1.01 (1.00, 1.02) respectively in multivariate analysis.
Conclusion: Triggered reflex voiding with incontinence and indwelling catheter were a strong predictor of hydronephrosis and/or vesicouretheral reflux whereas other factors such as taking antimuscarinic medication, high grade bladder deformity and time interval from onset of injury could be a less predictive factor in patients with spinal cord injury. Therefore, trigger reflex voiding and long-term indwelling catheter should not be recommended, and thus, those using such bladder emptying techniques should be closely monitored with regular urological check-up to early detection of upper urinary tract deterioration.
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