Clinical significance of gender‑specific urodynamic investigation in evaluating bladder functional recovery in patients with lumbar intervertebral disc prolapse
DOI:
https://doi.org/10.18203/2349-2902.isj20261990Keywords:
Lumbar intervertebral disc prolapse, Urodynamic study, Gender difference, Bladder functional recovery, Neurogenic bladder, Decompression surgeryAbstract
Background: Lumbar intervertebral disc prolapse (LDP) frequently causes neurogenic bladder dysfunction due to sacral root compression. Urodynamic investigation is the gold standard for assessment, but the influence of gender on bladder functional recovery after decompression surgery remains unclear. Objectives were to evaluate the clinical significance of gender-specific urodynamic investigation in assessing bladder functional recovery after lumbar decompression surgery in patients with LDP.
Methods: This prospective longitudinal study included 30 patients (20 males, 10 females) with LDP who underwent microdiscectomy. Urodynamic parameters-maximum cystometric capacity (MCC), post-void residual urine (PVR), maximum detrusor pressure (Pdetmax), bladder compliance (BC), and maximum flow rate (Qmax)-were measured preoperatively and three months postoperatively. Gender-specific changes were analysed using paired t test, Wilcoxon signed-rank test, and McNemar-Bowker test.
Results: Preoperative urodynamic abnormalities were present in 73.3% of patients, with no significant gender differences at baseline. In males, significant improvements were observed in MCC (+14.95 ml, p=0.009), PVR (-16.06 ml, p<0.001), and Qmax (+4.90 ml/s, p<0.001). In females, only PVR showed a significant reduction (-54.86 ml, p=0.001). Overall, urodynamic normalisation occurred in 18.8% of males but in none of the females. Detrusor overactivity resolved in 25% of males versus 0% of females.
Conclusions: Gender significantly influences urodynamic recovery following lumbar decompression for LDP. Males attain more extensive and pronounced improvements, whereas females demonstrate limited recovery. Gender-specific urodynamic assessment is of considerable clinical importance for prognostication and personalized rehabilitation.
References
Vialle LR, Vialle EN, Suárez Henao JE, Giraldo G. Lumbar disc herniation. Rev Bras Ortop. 2010;45(1):17-22.
Adams MA, Roughley PJ. What is intervertebral disc degeneration, and what causes it? Spine. 2006;31(18):2151-61.
Gandhi J, Shah J, Joshi G, Vatsia S, DiMatteo A, Joshi G, et al. Neuro-urological sequelae of lumbar spinal stenosis. Int J Neurosci. 2018;128(6):554-62.
Bartolin Z, Savic I, Perse Z. Relationship between clinical data and urodynamic findings in patients with lumbar intervertebral disk protrusion. Urol Res. 2002;30(4):219-22.
Shenot PJ, Moy ML. Intervertebral disk prolapse. In: Corcos J, Ginsberg D, Karsenty G, editors. Textbook of the neurogenic bladder. 3rd ed. CRC Press. 2015;375-82.
Hellström P, Kortelainen P, Kontturi M. Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. J Urol. 1986;135(2):308-12.
Lieberman EG, Boone RM, Radoslovich S, Haj V, Hiratzka J, Marshall LM, et al. Prevalence of preoperative lower urinary tract symptoms in patients undergoing elective lumbar spine surgery. Spine. 2018;43(19):E1152-6.
Korse NS, Veldman AB, Peul WC, Vleggeert-Lankamp CL. The long term outcome of micturition, defecation and sexual function after spinal surgery for cauda equina syndrome. PLoS One. 2017;12(4):e0175987.
Musco S, Padilla-Fernández B, Del Popolo G, Bonifazi M, Blok BFM, Groen J, et al. Value of urodynamic findings in predicting upper urinary tract damage in neuro-urological patients: a systematic review. Neurourol Urodyn. 2018;37(5):1522-40.
Yao M, Simoes A. Urodynamic testing and interpretation. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2020.
Chou EC, Chen YJ, Tsai CH, Chen HY, Cheng CL, Chang CH. The correlation between urodynamic findings and clinical symptoms in patients with lumbar disc herniation. J Urol. 2006;175(4):1455-9.
Mallepally AR, Mohapatra B, Das K. Role of invasive urodynamic studies in establishing cauda equina syndrome and postoperative recovery. Global Spine J. 2022;12(7):1352-62.
Radulovic D, Tasic G, Jokovic M, Nikolic I. The role of surgical decompression of cauda equina in lumbar disc herniation in recovery of bladder function. Med Pregl. 2004;57(7-8):327-30.
Cong L, Li W, Wang W, Sun J, He X, Zhang J, et al. Urodynamic evaluation of bladder function in patients with lumbar intervertebral disc prolapse before and after surgery. Chin Med J. 2010;123(12):1535-8.
Khursheed N, Pahalwan B, Nisar H, Ramzan A, Wani S, Wani A, et al. The description of urodynamic study for bladder dysfunction in compressive myelo- or radiculopathy: a prospective study in an institutional setup. Asian J Neurosurg. 2019;14(3):828-33.
Chen Y, DeVivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-effects. Arch Phys Med Rehabil. 2005;86(6):1208-13.
Balasubramanian K, Kalsi P, Greenough CG, Sefton AJ. Reliability of clinical assessment in diagnosing cauda equina syndrome. Br J Neurosurg. 2010;24(4):384-8.
Yamanishi T, Yasuda K, Yuki T, Sakakibara R, Uchiyama T, Kamai T, et al. Urodynamic evaluation of surgical outcome in patients with urinary retention due to central lumbar disc prolapse. Neurourol Urodyn. 2003;22(7):670-5.
Gnanapragasam S, Gnanapragasam V, Sathasivam S. Gender differences in the management of neurogenic bladder. J Clin Urol. 2015;8(3):179-84.
Yoshimura N, Chancellor MB. Physiology and pharmacology of the bladder and urethra. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, editors. Campbell-Walsh urology. 11th ed. Elsevier; 2016;1660-85.
Robinson D, Cardozo L. Estrogen and the lower urinary tract. Neurourol Urodyn. 2011;30(5):754-7.
Stöhrer M, Blok B, Castro-Diaz D, Chartier-Kastler E, Del Popolo G, Kramer G, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56(1):81-8.
Downloads
Published
How to Cite
Issue
Section
