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

The Reliability of Urodynamic Parameters as Predictors of 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 I have the following financial interests or Disclosure code relationships to disclose: No financial relationships N 3

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? • • Protect the kidneys Protect the kidneys • Facilitate full and efficient urine emptying • Restore natural voiding pattern, as much as possible • Prevent urinary incontinence

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. Water Cystometry#1 400 300 Vinfus ml 200 100 0 90 Pdet 60 cmH2O 30 0 90 Pves 60 cmH2O 30 0 90 Pabd 60 cmH2O 30 0 30 EMGave 20 uV 10 0 ST PI1 PI3 PI5 PI7 PI9 PI11 PI13 PI15 PI16 PI18 PI20 PI2 PI4 PI6 PI8 PI10 PI12 PI14 PI17 PI19 75 s 00:00 02:30 05:00 07:30 10:00 12:30 15:00 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? YES/NO Is videourodynamic study in these patients vital in terms of portraying prognosis and in guidance of treatment? YES/NO