| Autor: |
Birkhäuser V; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Anderson CE; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Swiss Paraplegic Research, 6207 Nottwil, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland., Kozomara M; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Urology, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland., Bywater M; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland., Gross O; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Kiss S; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland., Knüpfer SC; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Neuro-Urology, Clinic for Urology, University Hospital Bonn, 53127 Bonn, Germany., Koschorke M; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Urology, Cantonal Hospital Aarau, 5001 Aarau, Switzerland., Leitner L; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Mehnert U; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Sadri H; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Sammer U; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Stächele L; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Tornic J; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland.; Department of Urology, Winterthur Cantonal Hospital, 8400 Winterthur, Switzerland., Liechti MD; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland., Brinkhof MWG; Swiss Paraplegic Research, 6207 Nottwil, Switzerland.; Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland., Kessler TM; Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland. |
| Abstrakt: |
We used clinical parameters to develop a prediction model for the occurrence of urodynamic risk factors for upper urinary tract (UUT) damage during the first year after acute spinal cord injury (SCI). A total of 97 patients underwent urodynamic investigation at 1, 3, 6, and 12 months after acute SCI, within the framework of a population-based longitudinal study at a single university SCI center. Candidate predictors included demographic characteristics and neurological and functional statuses 1 month after SCI. Outcomes included urodynamic risk factors for UUT damage: detrusor overactivity combined with detrusor sphincter dyssynergia, maximum storage detrusor pressure (pDetmax) ≥ 40 cmH 2 O, bladder compliance < 20 mL/cmH 2 O, and vesicoureteral reflux. Multivariable logistic regression was used for the prediction model development and internal validation, using the area under the receiver operating curve (aROC) to assess model discrimination. Two models showed fair discrimination for pDetmax ≥ 40 cmH 2 O: (i) upper extremity motor score and sex, aROC 0.79 (95% CI: 0.69-0.89), C-statistic 0.78 (95% CI: 0.69-0.87), and (ii) neurological level, American Spinal Injury Association Impairment Scale grade, and sex, aROC 0.78 (95% CI: 0.68-0.89), C-statistic 0.76 (95% CI: 0.68-0.85). We identified two models that provided fair predictive values for urodynamic risk factors of UUT damage during the first year after SCI. Pending external validation, these models may be useful for clinical trial planning, although less so for individual-level patient management. Therefore, urodynamics remains essential for reliably identifying patients at risk of UUT damage. |
