Leboutte Francois, Engesser Christian, Zahiti Leutrim, Rentsch Cyrill A, Seifert Helge, Anding Ralf, Hund-Georgiadis Margret, Möhr Sandra, Walter Matthias
Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland.
Clinic of Neurorehabilitation and Paraplegiology, REHAB Basel, 4055 Basel, Switzerland.
Biomedicines. 2023 Aug 31;11(9):2432. doi: 10.3390/biomedicines11092432.
The aim of this retrospective exploratory study was to investigate the prevalence of unfavorable findings during video-urodynamic studies (VUDS) in patients with minimally conscious state (MCS)/unresponsive wakefulness syndrome (UWS) and whether management of the lower urinary tract (LUT) was adjusted accordingly. A retrospective chart review was conducted to screen for patients diagnosed with MCS/UWS at our rehabilitation center between 2011 and 2020. Patients 18 years or older were included and underwent baseline VUDS after being diagnosed with MCS/UWS. We analyzed urodynamic parameters and subsequent changes in LUT management in this cohort. In total, 32 patients (7 females, 25 males, median age 37 years) with MCS/UWS were included for analysis. While at least one unfavorable VUDS finding (i.e., neurogenic detrusor overactivity [NDO], detrusor sphincter dyssynergia {DSD, high maximum detrusor pressure during storage phase [>40 cmHO], low-compliance bladder [<20 mL/cmHO], and vesico-uretero-renal reflux [VUR]) was found in each patient, NDO (78.1%, 25/32) and DSD (68.8%, 22/32) were the two most frequent unfavorable VUDS findings. Following baseline VUDS, new LUT treatment options were established in 56.3% (18/32) of all patients. In addition, bladder-emptying methods were changed in 46.9% (15/32) of all patients, resulting in fewer patients relying on indwelling catheters. Our retrospective exploratory study revealed a high prevalence of NDO and DSD in patients with MCS/UWS, illustrating the importance of VUDS to adapt LUT management in this cohort accordingly.
这项回顾性探索性研究的目的是调查最低意识状态（MCS）/无反应觉醒综合征（UWS）患者在视频尿动力学检查（VUDS）期间不良发现的发生率，以及下尿路（LUT）的管理是否相应调整。进行了一项回顾性病历审查，以筛选2011年至2020年期间在我们康复中心被诊断为MCS/UWS的患者。纳入18岁及以上的患者，在被诊断为MCS/UWS后接受基线VUDS检查。我们分析了该队列中的尿动力学参数以及LUT管理的后续变化。总共纳入了32例MCS/UWS患者（7例女性，25例男性，中位年龄37岁）进行分析。虽然在每位患者中都发现了至少一项不良VUDS发现（即神经源性逼尿肌过度活动[NDO]、逼尿肌括约肌协同失调[DSD]、储尿期最大逼尿肌压力过高[>40 cmH₂O]、低顺应性膀胱[<20 mL/cmH₂O]和膀胱输尿管肾反流[VUR]），但NDO（78.1%，25/32）和DSD（68.8%，22/32）是最常见的两项不良VUDS发现。在基线VUDS检查后，所有患者中有56.3%（18/32）建立了新的LUT治疗方案。此外，所有患者中有46.9%（15/32）改变了膀胱排空方法，减少了依赖留置导尿管的患者数量。我们的回顾性探索性研究表明，MCS/UWS患者中NDO和DSD的发生率很高，说明了VUDS对相应调整该队列中LUT管理的重要性。
