Urodynamic findings by routine preoperative assessment in 46 scoliotic patients

Aims: In our center it has become routine to include urodynamic investigation in our preoperative assessment of scoliosis surgery. Urodynamic findings of bladder dysfunction are e.g. instable detrusor contractions, abnormal bladder compliance and capacity and detrusor-sphincter-dyscoordination. The term of neurogenic bladder dysfunction is applied if an underlying cause of the nervous system was identified. The aim of this retrospective study was to identify the incidence of urodynamic anomalies in scoliotic patients undergoing surgery.

Methods: We retrospectively analysed data of 46 patients, investigated between 2006 and 2010; 22 were females, 24 were males. The results of urodynamic testing (cystomanometry with uroflowmetry) were analysed for signs of bladder dysfunction and association with the underlying disease, number of urinary tract infections and grade of immobility.

Results: Abnormal urodynamic findings were seen in 23 out of 46 patients (50%). In comparison with their medical history they were classified as neurogenic bladder dysfunction or instable bladder dysfunction.

Neurogenic bladder dysfunction was diagnosed in 18 patients (39%). In 3 patients neurogenic bladder was already known and treated, all of whome had meningomyelocele. 14 patients had cerebral palsy, one had neurofibromatosis (NF) type 1. 15 out of these 18 patients were non ambulant and urinary tract infections in longterm history were found in 11.

Instable bladder dysfunction was diagnosed in 5 cases (11%), 3 of whom had muscle diseases, one suffered from malformed vertebrae without spinal impairment; one had an idiopathic form of scoliosis. In this cohort 2 out of 5 were non-ambulant and none had former urinary tract infections.

Normal urodynamic findings were seen in 23 patients (50%).17 of them had idiopathic scoliosis or skeletal abnormalities, 2 had congenital abnormalities of the central nervous system, 2 had muscle disease, one patient was suffering from NF. Only 4 out of these 23 patients were non-ambulant, and only 2 had had urinary tract infections.

Conclusion: This study illustrates that urological dysfunction is very frequent in skoliotic patients with neurologic disorder and is often associated with immobility, and a history of urinary tract infections. In only 3 patients there was preexisting awareness and therapy in place. We recommend urodynamic examinations for better perioperative management but also for better urologic care and follow-up.