Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Maximal detrusor pressure can be predicted using technetium-99m-mertcaptoacetyltriglycine renal scintigraphy in the early stages of spinal cord injury

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Retrospective cohort study.

Objective

To investigate the potential of technetium-99m-mercaptoacetyltriglycine (99mTc-MAG-3) renal scintigraphy for predicting maximal detrusor pressure in the early stages of spinal cord injury (SCI).

Setting

Tertiary rehabilitation facility.

Methods

Medical records of individuals with SCI admitted between January 2020 and April 2023 who underwent both 99mTc-MAG-3 renal scintigraphy and urodynamic study within 90 days of SCI onset were retrospectively reviewed. Pearson’s coefficient analysis was performed to determine the relationship between 99mTc-MAG-3 renal scintigraphy findings and urodynamic study findings. A multivariate linear regression analysis was performed to determine the best predictors of maximal detrusor pressure. A multivariate logistic regression analysis was performed to determine risk factors for high detrusor pressure.

Results

Ninety-four participants were enrolled in this study. Pearson’s correlation analysis showed that effective renal plasma flow (ERPF) and ERPF (% predicted) were significantly correlated with maximal detrusor pressure. The multivariate linear regression analysis demonstrated that ERPF (% predicted) was a significant predictor of maximal detrusor pressure. The multivariate logistic regression analysis showed that ERPF (% predicted) was significantly associated with high detrusor pressure. The receiver operating characteristic curve demonstrated that the predictive model had an area under the curve of 0.725, with an ERPF (% predicted) cut-off of 64.05%, sensitivity 1.000, and specificity 0.429.

Conclusions

These results suggest that 99mTc-MAG-3 renal scintigraphy may be useful for predicting high detrusor pressure in early SCI and may guide the timing of urodynamic studies in individuals with early SCI for appropriate management of neurogenic lower urinary tract dysfunction.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Pearson’s correlation analysis of ERPF and ERPF (% predicted) to urodynamic study findings.
Fig. 2: Receiver operating characteristic curve analysis of ERPF (% predicted) to presence of high detrusor pressure.

Similar content being viewed by others

Data availability

The authors will freely share the unfiltered raw data underlying the results of this study.

References

  1. Manack A, Motsko SP, Haag-Molkenteller C, Dmochowski RR, Goehring EL Jr, Nguyen-Khoa BA, et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn. 2011;30:395–401.

    Article  PubMed  Google Scholar 

  2. Anderson CE, Birkhäuser V, Jordan X, Liechti MD, Luca E, Möhr S, et al. Urological management at discharge from acute spinal cord injury rehabilitation: a descriptive analysis from a population-based prospective cohort. Eur Urol Open Sci. 2022;38:1–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol. 2021;206:1106–13.

    Article  PubMed  Google Scholar 

  4. Lawrenson R, Wyndaele JJ, Vlachonikolis I, Farmer C, Glickman S. Renal failure in patients with neurogenic lower urinary tract dysfunction. Neuroepidemiology. 2001;20:138–43.

    Article  CAS  PubMed  Google Scholar 

  5. Danforth TL, Ginsberg DA. Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics? Urol Clin North Am. 2014;41:445–52.

    Article  PubMed  Google Scholar 

  6. Watanabe T, Rivas DA, Chancellor MB. Urodynamics of spinal cord injury. Urol Clin North Am. 1996;23:459–73.

    Article  CAS  PubMed  Google Scholar 

  7. Nosseir M, Hinkel A, Pannek J. Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn. 2007;26:228–33.

    Article  PubMed  Google Scholar 

  8. Harris CJ, Lemack GE. Neurourologic dysfunction: evaluation, surveillance and therapy. Curr Opin Urol. 2016;26:290–4.

    Article  PubMed  Google Scholar 

  9. Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, et al. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J. 2019;13:E157–E76.

    PubMed  PubMed Central  Google Scholar 

  10. Welk B, Schneider MP, Thavaseelan J, Traini LR, Curt A, Kessler TM. Early urological care of patients with spinal cord injury. World J Urol. 2018;36:1537–44.

    Article  PubMed  Google Scholar 

  11. Alsulihem A, Corcos J. Evaluation, treatment, and surveillance of neurogenic detrusor overactivity in spinal cord injury patients. Neurosciences. 2019;6:13.

    CAS  Google Scholar 

  12. Bywater M, Tornic J, Mehnert U, Kessler TM. Detrusor acontractility after acute spinal cord injury-myth or reality? J Urol. 2018;199:1565–70.

    Article  PubMed  Google Scholar 

  13. Kozomara M, Birkhäuser V, Anderson CE, Bywater M, Gross O, Kiss S, et al. Neurogenic lower urinary tract dysfunction in the first year after spinal cord injury: A descriptive study of urodynamic findings. J Urol. 2023;209:225–32.

    Article  PubMed  Google Scholar 

  14. Tuna H, Cermik TF, Tuna F. Monitoring of renal function using 99mTc-DMSA and 99mTc-DTPA scintigraphy in patients with spinal cord injury. Rev Esp Med Nucl Imagen Mol. 2012;31:322–7.

    CAS  PubMed  Google Scholar 

  15. Klingensmith WC 3rd, Lammertse DP, Briggs DE, Smith WI, Roberts JF, Froelich JW, et al. Technetium-99m-MAG3 renal studies in spinal cord injury patients: normal range, reproducibility, and change as a function of duration and level of injury. Spinal Cord. 1996;34:338–45.

    Article  PubMed  Google Scholar 

  16. Phillips JR, Jadvar H, Sullivan G, Lin VW, Segall GM. Effect of radionuclide renograms on treatment of patients with spinal cord injuries. AJR Am J Roentgenol. 1997;169:1045–7.

    Article  CAS  PubMed  Google Scholar 

  17. Eshima D, Taylor A Jr. Technetium-99m (99mTc) mercaptoacetyltriglycine: update on the new 99mTc renal tubular function agent. Semin Nucl Med. 1992;22:61–73.

    Article  CAS  PubMed  Google Scholar 

  18. Bih LI, Changlai SP, Ho CC, Lee SP. Application of radioisotope renography with technetium-99m mercaptoacetyltriglycine on patients with spinal cord injuries. Arch Phys Med Rehabil. 1994;75:982–6.

    Article  CAS  PubMed  Google Scholar 

  19. Linsenmeyer TA. Update on bladder evaluation recommendations and bladder management guideline in patients with spinal cord injury. Current Bladder Dysfunction Reports. 2007;2:134–40.

    Article  Google Scholar 

  20. Çetinel B, Önal B, Can G, Talat Z, Erhan B, Gündüz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study. Neurourol Urodyn. 2017;36:653–8.

    Article  PubMed  Google Scholar 

  21. Ozkan B, Demirkesen O, Durak H, Uygun N, Ismailoglu V, Çetinel B. Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction? Urology. 2005;66:99–104.

    Article  PubMed  Google Scholar 

  22. Önal B, Kırlı EA, Selçuk B, Buğdaycı D, Can G, Çetinel B. Risk factors predicting upper urinary tract deterioration in children with spinal cord injury. Neurourol Urodyn. 2021;40:435–42.

    Article  PubMed  Google Scholar 

  23. Swatesutipun V, Tangpaitoon T. The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis. Neurourol Urodyn. 2022;41:991–1001.

    Article  PubMed  Google Scholar 

  24. Caramel R, Corcos J Normal urodynamic parameters in adults. In: Corcos J, Ginsberg D, Karsenty G Textbook of the Neurogenic Bladder. 3rd ed. CRC Press, New York, 2016. pp 411-23.

  25. Linsenmeyer TA Urologic management and renal disease in spinal cord injury. In: Kirshblum S, Lin VW Spinal Cord Medicine. 3rd ed. Demos Medical Publishing, New York, 2019. 332-86.

  26. Staskin DR. Hydroureteronephrosis after spinal cord injury. Effects of lower urinary tract dysfunction on upper tract anatomy. Urol Clin North Am. 1991;18:309–16.

    Article  CAS  PubMed  Google Scholar 

  27. Kao CH, Changlai SP. 99Tcm-MAG3 renal studies: effective renal plasma flow in patients with spinal cord injuries. Nucl Med Commun. 1996;17:1068–71.

    Article  CAS  PubMed  Google Scholar 

  28. Solinsky R, Garstang SV, Linsenmeyer TA. Comparing the role of renal ultrasound vs MAG3 renal scans for evaluation of neurogenic bladder after spinal cord injury. J Spinal Cord Med. https://doi.org/10.1080/10790268.2022.2088504:1-5 2022.

  29. Block B, Castro-DĂ­az DM, Del Popolo G, Groen J, Hamid R, Karsenty G et al. EAU guidelines on neuro-urology. European Association of Urology. 2023. https://uroweb.org/guidelines/neuro-urology/.

  30. Bywater M, Tornic J, Mehnert U, Kessler TM. Detrusor acontractility after acute spinal cord injury: Myth or reality? J Urol. 2018;199:1565–70.

    Article  PubMed  Google Scholar 

Download references

Funding

This study is supported by a research grant of Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine.

Author information

Authors and Affiliations

  1. Department and Research Institute of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Su Ji Lee & Ji Cheol Shin

Authors
  1. Su Ji Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ji Cheol Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

This paper was co-authored by SJL and JCS. JCS contributed as a corresponding author. SJL and JCS contributed equally to data analysis and interpretation. All authors participated in the writing and editing of the manuscript.

Corresponding author

Correspondence to Ji Cheol Shin.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The study was approved by the institutional review board of Severance Hospital, Yonsei University Health System, Seoul, Korea (4-2022-1490).

Patient consent

Due to the retrospective nature of the study, the review board waived the need for informed consent.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lee, S.J., Shin, J.C. Maximal detrusor pressure can be predicted using technetium-99m-mertcaptoacetyltriglycine renal scintigraphy in the early stages of spinal cord injury. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00967-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41393-024-00967-w

Search

Advanced search

Quick links