Perrin Andry, Corcos Jacques
Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada.
Biomedicines. 2023 Apr 9;11(4):1134. doi: 10.3390/biomedicines11041134.
The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review.
For this narrative review, a PubMed search was performed by cross-referencing the keywords "urodynamics", "neurogenic bladder", "utility", "clinical utility" and "clinical performance" with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used.
Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients' management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities.
Despite the paucity of existing literature assessing the utility of urodynamic study-specifically video-urodynamic study-in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.
临床工具的效用在于其临床性能评估，并描述该工具在医疗环境中的相关性和实用性。尿动力学和影像尿动力学研究在神经泌尿外科患者的诊断、治疗及预后评估中针对特定尿动力学特征的管理效用是本综述的重点。
对于本叙述性综述，通过将关键词“尿动力学”“神经源性膀胱”“效用”“临床效用”和“临床表现”与神经源性下尿路功能障碍管理的相关术语进行交叉引用，在PubMed上进行了检索。还使用了该领域最知名专家的临床实践指南和标志性综述。
在神经泌尿外科患者管理的诊断、治疗和预后阶段对尿动力学研究的效用进行了评估。我们关注其在识别和评估几种不良事件时的临床表现，如神经源性逼尿肌过度活动、逼尿肌-括约肌协同失调、逼尿肌漏尿点压力升高以及膀胱输尿管反流的存在，这些可能是泌尿系统合并症发生风险较高的指标。
尽管现有评估尿动力学研究（特别是影像尿动力学研究）在神经泌尿外科患者中效用的文献较少，但它仍然是精确评估该类患者下尿路功能的金标准。就其效用而言，它在管理的每个阶段都具有较高的临床表现。对可能不良事件的反馈有助于预后评估，并可能促使我们对当前的建议提出质疑。
