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Abstract：
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 cmH2O], low-compliance bladder [<20 mL/cmH2O], 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.
摘要：
这项回顾性探索性研究的目的是调查最低意识状态（MCS）/反应迟钝的觉醒综合征（UWS）患者在视频尿动力学研究（VUDS）中不利发现的发生率，以及下尿路（LUT）的管理是否相应调整。在2011年至2020年期间，我们在我们的康复中心进行了回顾性图表审查，以筛选诊断为MCS/UWS的患者。包括18岁或以上的患者，并在诊断为MCS/UWS后接受基线VUDS。我们分析了该队列中的尿动力学参数和随后的LUT管理变化。总的来说,32名患者（7名女性，25名男性，中位年龄37岁)的MCS/UWS纳入分析。而至少有一个不利的VUDS发现(即，神经性逼尿肌过度活跃[NDO]，逼尿肌括约肌协同失调{DSD,储存阶段最大逼尿肌压力高[>40cmH2O]，低顺应性膀胱[<20mL/cmH2O]，并且在每位患者中发现了膀胱输尿管肾反流[VUR]），NDO（78.1%，25/32）和DSD（68.8%，22/32）是两个最常见的不利VUDS发现。在基线VUDS之后，56.3%(18/32)的患者建立了新的LUT治疗方案.此外,46.9%(15/32)的患者改变了膀胱排空方法，导致更少的患者依赖留置导管。我们的回顾性探索性研究揭示了NDO和DSD在MCS/UWS患者中的高患病率。说明了VUDS在此队列中相应调整LUT管理的重要性。
