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Can the Severity of Bladder Deformity Predict Storage Bladder
Pressure, and Does it Relate to Upper Urinary Tract Damage
in Neurogenic Bladder Patients?
Valeerat Swatesutipun, Teerayut Tangpaitoon*
Faculty of Medicine, Thammasat University Hospital, Thammasat University
*Corresponding Author E-mail: Teerayut@tu.ac.th
Objective: Abstract
One key goal in managing neurogenic lower urinary tract dysfunction (NLUTD) is
maintaining low bladder storage pressure to protect the upper urinary tract. While
urodynamic studies are valuable for assessing bladder pressure, their limited availability
in many developing regions poses challenges. This study aimed to evaluate the severity
of bladder deformity relating to the level of storage detrusor pressure and the risk of
developing UUTD in patients with NLUTD.
Methods: We retrospectively reviewed 111 NLUTD patients from traumatic spinal cord injury, spinal
dysraphism, or spinal cord disease who visited our Neurogenic Bladder clinic between
2016 and 2020. Patients included underwent both videourodynamic studies and renal
ultrasound. UUTD was defined as vesicoureteral reflux or hydronephrosis. Bladder deformities
were graded as normal, mild, moderate, or severe based on Ogawa’s classification using
cystographic images. Storage detrusor pressure was measured at cystometric capacity, and
its association with UUTD was analyzed.
Results: A total of 102 patients met inclusion criteria. Group 1 (n=77) had a significantly lower
median storage detrusor pressure (9 cmH₂O) compared to Group 2 (n = 25, 29 cm H2O;
p<0.001). Group2 showed higher rates of compliance bladder (70.8%, p<0.001), detrusor
sphincter dyssynergia (76%, p=0.022), and reliance on clean intermittent catheterization
(60% vs. 32%). Both univariable and multivariable analysis showed Group 2 had a
significantly higher risk of UUTD (RR 3.08, 3.45, p<0.05).
Conclusion: Moderate to severe bladder deformity is associated with high storage detrusor pressure (at
29 cmH
2O) and increased risk of UUTD. Bladder deformity observed via cystography may
serve as a practical surrogate marker for elevated bladder pressure and UUT risk, especially
in settings where urodynamic studies are unavailable.
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