We reviewed our database with 2496 urodynamic studies between January 2008 and March 2018 and found 172 (6,89%) male patients with urodynamically proven DUA. Mean age was 59,6 years (SD ± 15,1). The majority of patients had voiding symptoms (57 patients (33,1%) or acute urinary retention (29 patients (16,9%)). In 28 patients we found mixed incontinence (16%) or urgency incontinence (26 patients (15,1%)). The ethiology of DUA was neurogenic in 106 patients (61,6%), mainly spinal cord injury (27 patients (25,5%)), multiple sclerosis ( 14 patients (13,2%)) or diabetes mellitus (13 patients (12,3%)). In the other 66 patients (38,4%) the ethiology was non-neurogenic.
All patients underwent urodynamic study. Near 60% of the patients had another urodynamic diagnosis in the filling phase such as detrusor overactivity (42 patients (24,4%)) or low compliance (17 patients (9,9%)). Of the 172 patients with DUA, 36 patients (20,9%) were excluded from analysis because CIC was started at the time of the diagnosis. Other 74 (43%) patients were excluded because they continued their follow up in other Hospitals due to geographic reasons. Then, 62 (36,1%) patients were fit for analysis. Table 1 summarizes baseline urodynamic parameters of these patients. No differences were found between neurogenic and non-neurogenic DUA in baseline parameters in the free Uroflowmetry neither in the P/Q study.
Mean follow up was 4,88 years (SD + 2,56). Table 2 summarizes the need of CIC and complications during follow-up.
In the non-neurogenic group, there was no significant change in Uroflowmetry variables or in clinical voiding symptoms.
In the neurogenic group, 6 patients who initially were conservatively managed required CIC during follow up due to a worsening in PVR. When reviewing the records of these 6 patients we found in the baseline Urodynamic study, significantly higher PVR (316,66 vs. 114,63 ml p=0,0001) and significantly lower bladder voiding efficiency (9,61 vs. 30,69 % p= 0,017) compared to the other neurogenic patients.
We perform a multivariate analysis to study risk factors for CIC requirement. We included as explicative variables: ethiology (Categorized as neurogenic or non-neurogenic), and baseline urodynamic variables (Qmax, bladder voiding efficiency, Pdet.uo, BCI and PdetQmax). Unfortunately, when performing the logistic binary regression analysis, none of these variables was found as risk factor to require CIC during the follow up.
Regarding complications, there were no differences in UTI or bladder stones between patients according to the DUA ethiology.