針對慢性脊髓損傷患者，錄影尿動力學檢查與排尿處置的長期併發症風險因素

陳妤甄1,2、張天霖3、楊家誠3、劉民慶3、郭漢崇3

高雄醫學大學 醫學院 臨床醫學研究所1 ; 高雄醫學大學附設醫院 泌尿部2;

 花蓮慈濟醫院泌尿部 3

Risk Factors of Video Urodynamics and Bladder Management for Long-Term Complications in Patients with Chronic Spinal Cord Injury

Yu-Chen Chen^1,2, Tien-Lin Chang³, Chia-Cheng Yang³, Ming-Ching Liu³, Hann-Chorng Kuo³

¹Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. ; ²Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan. ; ³Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan

Purpose: This study aims to report on the 15-year long-term urological complications experienced by patients with chronic spinal cord injury (SCI) and to investigate risk factors of video-urodynamic (VUDS) and bladder management in predicting urological complications in SCI patients.

Materials and Methods: A total of 864 patients with SCI underwent their initial VUDS during the first medical consultation post-injury. Long-term complications, such as recurrent urinary tract infections (rUTI), hydronephrosis, chronic kidney disease (CKD), urinary tract stone, and the bladder management were recorded. Univariate and multivariate logistic regression analyses were conducted to assess the risk factors identified in VUDS and bladder management, and their association with the occurrence of long-term complications.

Results: In this cohort, 654 (75.7%) were male, and 37.8% patients had cervical SCI. The mean follow-up duration was 15.6± 9.9 years. The multivariate logistic regression analysis revealed that autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high detrusor pressure (Pdet) at the initial VUDS significantly increased the risk of rUTI (adjusted odds ratio: 1.780, 1.535, 2.028, 3.156, 1.482, respectively). Low bladder compliance, VUR, and contracted bladder significantly increased the risk of hydronephrosis (adjusted odds ratio: 2.065, 10.342, 4.00, respectively). Contracted bladder and detrusor hyperactivity with impaired contractility significantly increased the risk of CKD (adjusted odds ratio: 4.975, 9.148, respectively). Regarding bladder management, spontaneous voiding significantly reduced the risk of rUTI and VUR, whereas voiding with Valsalva maneuvers significantly increased the risk of hydronephrosis.

Conclusions: Our study conducted an extensive analysis of VUDS parameters and various bladder management strategies, elucidating their associations with a spectrum of urological complications over an extended follow-up duration. A contracted bladder was identified as a significant VUDS-related risk factor for long-term urological complications. Spontaneous voiding, if feasible, serves as a protective factor against the occurrence of long-term rUTI and VUR. These findings shed light on four distinct aspects not extensively explored in prior studies.