We aim to investigate the role of video urodynamic studies in the management of spinal cord injury patients. Our primary aim was to determine if urodynamic studies are in fact needed as part of baseline investigations for all spinal cord injury patients as we hypothesize that initial management can be safely based on symptom review combined with upper tract surveillance.

A multicentre retrospective study was performed collating data pertaining to spinal cord injury patients who underwent their initial post injury video urodynamic studies between 2017 and 2019. Follow up upper tract imaging (USS or CT) over a five-year period was assessed for evidence of hydronephrosis. Data collected included patient symptoms, pre-test bladder management strategies, video urodynamic findings and follow up upper tract imaging.

141 patients were included in this study. 63.8% of patients in the cohort had their bladder management changed following their urodynamic study. 73.3% of these patients presented with symptoms suggestive of NDO of whom 87.7% underwent minor interventions (medication alteration, intravesical botox injection, alteration to their catheter regime).
44.7% of patients demonstrated high risk features on their video urodynamics defined as evidence of reflux, poor compliance, detrusor sphincter dyssynergia or maximum detrusor pressures >75cm H20.1 Of these patients, 68% underwent a bladder management change. 86% of these management alterations could have been instigated based on symptoms alone.
Only 5 (3.5%) patients were identified as having hydronephrosis on follow up surveillance imaging. 4 of these patients demonstrated high risk features on urodynamic studies. All were symptomatic of neurogenic overactivity and had their bladder management changed with either the addition of intravesical botox or alterations to their catheter regimens.

Although approximately half of our patients demonstrated urodynamic features associated with a higher risk of upper tract dysfunction, the proportion of these patients that subsequently developed hydronephrosis was only 6%.  
Post-test alterations in bladder management were minor and largely based on pre-test symptoms. As such they could easily have been undertaken based on symptoms alone without the need for urodynamic studies.

Initial baseline video urodynamics studies may not be necessary in all spinal cord injury patients. Their management and upper tract safety can be determined with careful symptom review and scheduled upper tract imaging.

Çetinel B, Önal B, Can G, Talat Z, Erhan B, Gündüz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study. Neurourol Urodyn. 2017 Mar;36(3):653-658. doi: 10.1002/nau.22984. Epub 2016 Mar 2. PMID: 26934371.