Level of Injury Does Not Correlate with the Urodynamic Finding

Case 1: A 33-year-old man with C6 SCI shows urodynamically safe condition

The patient presents as a new patient to the Urology Clinic. He is a 33-year-old gentleman who sustained a C6 SCI by a gunshot injury 20 months ago. He is now wheelchair dependent. The patient has never had a fluoroscopic urodynamic evaluation performed since his injury and presents today for evaluation.

He empties with CIC 4 times a day. He states that his volumes are between 200mL and 400mL. He states that he is dry between catheterizations. Of note, the patient states that he does have problems with UTIs approximately 1 in a month. He states that these episodes are characterized by cloudy urine and changes in blood pressure and occasionally a fever. He has been treated with various antibiotics in the past for these episodes of urinary tract infections.

A fluoroscopic urodynamic evaluation [VIDEO] revealed that the patient had a bladder neck that was closed at rest. His compliance was noted to be completely normal without any abnormal rises in pressure. He did not have a reflux contraction nor did he have reflux.

His bladder is a low-pressure bladder which can be safely managed by CIC and imipramine 10 mg p.o. t.i.d. and oxybutynin 5 mg t.i.d. Therefore, we will not increase or change these medications at this time. Given his history of recurrent UTIs, we will start Mandelamine 1 g p.o. b.i.d. We will then have the patient followup with us in 3 months' time. Regarding his erectile dysfunction, we will have the patient followup with andrology team.

Case 2: A 21-year-old men with C7 SCI showed DSD

A 21-year-old man with a C7 SCI sustained in a motor vehicle accident one and a half year ago and is now wheelchair bound. He catheterizes every 3 to 4 hours with volumes of 250mL to 400mL. He has leakage in between. He does not have any problems with UTIs.

Fluorourodynamics studies demonstrated abnormal compliance and detrusor sphincter dyssynergia as well as leakage at approximately 130 mL. The bladder is small and the bladder contracts at a small volume. He also demonstrated some right VUR.

We placed him on a medical regimen of terazosin 2 mg p.o. at bedtime, oxybutynin patch, and imipramine 10 mg p.o. b.i.d. If triple drug therapy does not work, that the next step in management to protect his upper tracts would be surgery (i.e., augmentation cystoplasty).

Comments and Lessons: The above 2 cases are of very similar features in terms of age, level of injury, completeness of injury, duration after injury. But it shows marked difference in the urodynamic finding. These cases indicate poor prediction of the lower urinary characteristics even in the same lesion of SCI.

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