Simultaneous Measurement of Cystometry and Diuresis Renography during Full and Empty Bladder in Neurogenic Bladder Patients: A Preliminary Report

Abstract

In 9 patients (4 male and 5 female; mean 24.7 years old) with ñeurogenic bladder dysfunction, diuresis renography and water filling cystometry were simultaneously monitored with a full and empty bladder, and findings of diuresis renography with a full bladder were compared with those of diuresis renography with an empty bladder. According to O’Reilly’s classification, findings of diuresis renography with a full bladder were significantly worse than those of diuresis renography with an empty bladder, regardless of cystometry patterns and bladder compliances. Although every kidney without hydro-nephrosis on intravenous pyelogram showed normal diuresis renography with an empty bladder, some kidneys with hydronephrosis showed an obstructive pattern even with an empty bladder. These results suggest that in some patients with neurogenic bladder dysfunction, deterioration of the upper urinary tract occurs more easily with a full than with an empty bladder, regardless of bladder pressure and bladder compliance.

Effect of a Full Bladder on Urine Production in Humans

“…These observations are in accordance with the finding that high bladder filling produces not only delayed accumulation of tracer but also prolonged retention of activity in the pelvis in radioisotope renography (21). In patients with neurogenic bladder, diuresis renography was significantly worse with full contra empty bladder, regardless of cystometry patterns and bladder compliance (22). Another study examined four patients, who had had operations altering the normal urinary tract anatomy so that the normal neurologic and anatomic connections did not exist (23).…”

“…Conflicting results as to the change in GFR have also been reported. Some authors report a reduction in GFR or clearances (4,5,19), others no significant change (1,22,29) as in this study. Denervation of the renal artery or denervation obtained by renal transplantation appears to abolish the vesico-renal reflex (2, 4), but no reports from human studies exists, and the existence of a vesico-renal reflex in humans has been queried (23).…”

Ambulatory urodynamic monitoring: state of the art and future directions

“…However, straight catheterization provides a gold-standard measurement of bladder contents. Thus, in clinical UDS, fluid is infused at a known rate into an emptied bladder, providing a real-time value of bladder volume based on the duration of infusion; however, renal diuresis will confound this measurement 57 . Furthermore, voided volume is measured over time by uroflowmetry, providing information on urine flow in addition to quantity.…”

Effect of the abnormal bladder when full on upper tract drainage using a combined cystometrogram‐99mTc‐mercapto‐acetyltriglycine renogram: a prospective study

“…It seems unlikely that enterocystoplasty alone is the cause. Several studies [3,4] have reported that in some such patients a full bladder or reservoir can cause upper tract obstruction that is independent of bladder pressure. Glassberg et al .…”