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Duration of detrusor overactivity as an independent predictive factor of upper urinary tract deterioration in patients with traumatic spinal cord injury: results of a retrospective cohort study

Spinal Cord (2024)Cite this article

Subjects

Abstract

Objective

To determine whether duration of detrusor overactivity (DO) during a cystometric study is an independent predictive factor of upper urinary tract deterioration (UUTD) in patients with traumatic spinal cord injury (TSCI).

Study design

Retrospective cohort study.

Setting

A rehabilitation facility in Chiang Mai, Thailand.

Methods

Data were obtained from medical records of patients who underwent cystometric evaluation at 6–12 months after TSCI. The independent predictor of interest is the duration of DO, which was evaluated by the DO/cystometry ratio (DOratio). Other conventional urodynamic parameters (maximum detrusor pressure, cystometric capacity, bladder compliance, and detrusor-sphincter dyssynergia) and clinical parameters (age, sex, level and severity of injury, comorbidities, bladder emptying method, and history of urinary tract infection) were determined. The outcome was UUTD, which is indicated by chronic kidney disease (GFR < 60 ml/min/1.73 m2), hydronephrosis, and/or vesicoureteral reflux. Multivariable Cox regression analysis was used to determine the independent associations between DOratio and UUTD by adjusting with all other parameters.

Results

Medical records of 194 patients with TSCI were included in the study. During a combined total of 1260 follow-up years of those patients, 34 UUTD events were identified, indicating an incidence rate of 27.0 cases per 1000 person-years. After adjusting for all other parameters, a high DOratio (≥0.33) was significantly associated with UUTD (hazard ratio = 3.00 [95% CI: 1.12–7.99], p = 0.025).

Conclusion

DOratio may be an independent cystometric predictor of UUTD in patients with TSCI. However, further prospective study is needed prior to applying DOratio as a predictor of UUTD in clinical settings.

Clinical trial registration

There was no clinical trial registration since this study is not a clinical trial.

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Fig. 1: Detrusor overactivity/cystometry ratio and bladder compliance measurements.
Fig. 2: Kaplan–Meier cumulative failure plot for upper urinary tract deterioration.
Fig. 3: Kaplan–Meier cumulative failure plot for upper urinary tract deterioration categorized by detrusor overactivity-cystometry ratio.

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Data availability

The datasets generated and/or analyzed during this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We would like to thank Professor Dr. Lamar Robert for English language editing assistance. We would like to extend our thanks to Ms. Chanapat Pateekhum from Faculty of Medicine, Chiang Mai University, for providing statistical advice. SP would also like to acknowledge the Swiss Government Excellence Scholarship 2022 postdoctoral fellowship.

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Authors and Affiliations

  1. Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pratchayapon Kammuang-lue, Sintip Pattanakuhar & Maysa Sermsuk

  2. Health Services and Clinical Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland

    Sintip Pattanakuhar

  3. Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Chaisiri Angkurawaranon

  4. Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang Mai, Thailand

    Chaisiri Angkurawaranon

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  1. Pratchayapon Kammuang-lue
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Contributions

PK and MS designed the research question, collected and analyzed the data, and wrote the preliminary version of the manuscript. SP designed the research question, analyzed the data, wrote the preliminary version, and revised the final version of the manuscript. CA designed the research question, analyzed the data, and revised the final version of the manuscript.

Corresponding author

Correspondence to Sintip Pattanakuhar.

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Competing interests

The authors declare no competing interests.

Ethical approval

The authors certify that the protocol of this analysis was approved by the Research Ethics Committee of the Faculty of Medicine, Chiang Mai University, Thailand (Study No. REH-2562_06228). This study used deidentified retrospectively recorded data, therefore, informed consent is not applicable.

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Kammuang-lue, P., Pattanakuhar, S., Sermsuk, M. et al. Duration of detrusor overactivity as an independent predictive factor of upper urinary tract deterioration in patients with traumatic spinal cord injury: results of a retrospective cohort study. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00988-5

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