#0896

How Brain Tumor impacts Neurogenic Lower Urinary Tract Dysfunction

C. Liu¹, H. Lee¹, A. Liu²

¹Kaohsiung Medical University Hospital, Urology, Kaohsiung, Taiwan
²Kaohsiung Medical University Hospital, Neurosurgery, Kaohsiung, Taiwan

Introduction:

Neurogenic Lower Urinary Tract Dysfunction (NLUTD) involves urinary disorders caused by neurological conditions that disrupt bladder control. It usually presents clinically as incontinence or an inability to empty the bladder. Common in patients with brain tumors and spinal cord injuries, NLUTD manifests as detrusor overactivity (DO), pseudo detrusor-sphincter dyssynergia (DSD), and detrusor underactivity (DU). These issues can lead to recurrent infections and hydroureteronephrosis, causing deteriorating renal function and significantly affecting quality of life. The diagnosis of DO and DSD is considered paramount for improving a patient’s quality of life. The primary goals of management include preventing upper tract decompensation and relieving symptoms. A specific understanding of the pathophysiology in each individual is essential for selecting the appropriate therapy. Urodynamic study (UDS) likely plays a crucial role in the evaluation and management of patients with neurogenic voiding dysfunction.

Material and methods:

A total of 100 patients diagnosed with brain tumors were enrolled in this study. UDS, uroflowmetry, and post-void residual (PVR) urine measurements were conducted both preoperatively and three months postoperatively. Additionally, validated questionnaires, including the International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS), Patient Perception of Bladder Condition (PPBC), and Neurogenic Bladder Symptom Score (NBSS), were administered before and after surgery to assess urinary function and patient-reported outcomes.

Results:

Our study cohort had 19 male and 81 female patients, with a median age of 63 years and a mean age of 58 years. Brain tumor locations included the frontal lobe (n=28), temporal lobe (n=17), pituitary region (n=14), cerebellum (n=9), and cerebellopontine angle (n=10). UDS findings revealed that 70% of patients experienced urinary incontinence preoperatively, with symptomatic improvement observed in 50% of cases one month postoperatively. Among the cohort, 8 patients (11%) exhibited DO (4 males, 4 females), 2 patients had pseudo-DSD, and 4 patients demonstrated DU. Bladder outlet obstruction was diagnosed in 13 male patients (68%), with an average uroflowmetry Qmax of 9.4 mL/s. Low detrusor contractility was identified in 4 male patients (21%). Symptom evaluation based on the IPSS for male patients revealed nocturia in 94%, urinary frequency in 47%, intermittency in 27%, urgency in 27%, and weak stream in 27%, while incomplete emptying and straining were each reported by 20%. For both genders, the mean OABSS score was 2.9, the PPBC score was 1, and the NBSS score was 10.54. Patients with frontal lobe lesions exhibited the most pronounced urinary dysfunction. Additionally, lower preoperative muscle strength was associated with a higher incidence of DO.