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The Role of Ambulatory Urodynamics in Spinal Cord Injury

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    The Role of Ambulatory Urodynamics in Spinal Cord Injury

    From Nature Reviews Urology
    The Role of Ambulatory Urodynamics in Spinal Cord Injury
    Anne P. Cameron

    Authors and Disclosures

    Posted: 06/15/2011; Nat Rev Urol. 2011;8(6) © 2011 Nature Publishing Group

    Abstract and Introduction
    Bladder management is an important aspect of the management of patients with spinal cord injury (SCI). A device capable of performing ambulatory urodynamics on individuals with SCI has recently been developed; however, the benefit of ambulatory urodynamics in patients with SCI is disputed.

    A new device has been developed to perform ambulatory urodynamics on individuals with SCI.[1] The hand-held device was tested on 28 patients, and the results were recently published.[1] However, many clinicians question the usefulness of ambulatory urodynamics compared to standard urodynamics, and a group in The Netherlands has recently gone so far as to state that there is no primary role for this investigation in patients with SCI.[2]

    In individuals with SCI, bladder management is of the utmost importance, given their risk of incontinence, bladder stones, urinary tract infections and upper tract deterioration.[3] Urodynamics are a key part of the routine follow-up[4] of these individuals and can be used to diagnose poor compliance, high-pressure storage or neurogenic detrusor overactivity (NDO), all of which can lead to these complications.[3] Some would argue that conventional urodynamic evaluation is an artificial situation, in which the bladder is filled too rapidly and the patient is immobile, neither of which is physiologically normal.[5] Furthermore, a typical urodynamics investigation lasts less than 20 minutes, and provides only a brief snapshot of lower urinary tract function.

    Ambulatory urodynamics are similar to conventional urodynamics except that they are carried out over a prolonged period of time (usually several hours), during which the patient performs their usual daily activities. Bladder filling is accomplished with the patient's own urine production instead of fluid filling with a catheter. A pressure-sensing catheter is placed in the bladder and, typically, also in the rectum, to measure abdominal pressure. Electromyography (EMG) patches can also be used.[1,5]