Asian Spine J.  2019 Aug;13(4):615-620. 10.31616/asj.2018.0217.

The Spectrum of Clinical and Urodynamic Findings in Patients with Spinal Tuberculosis Exhibiting Lower Urinary Tract Symptoms, before and after Spinal Surgical Intervention with Antitubercular Treatment: A Prospective Study

• Shrivastava N
• Singh P
• Nayak B
• Garg B

• KMID: 2455652
• DOI: http://doi.org/10.31616/asj.2018.0217

Abstract

STUDY DESIGN: Observational study. PURPOSE: This study aims to assess the clinical and urodynamic parameters in patients with spinal tuberculosis (TB) exhibiting lower urinary tract symptoms (LUTS) at the time of presentation and after spinal surgical intervention. OVERVIEW OF LITERATURE: Variable urodynamic findings in patients with spinal TB.
METHODS
We prospectively evaluated 10 patients with spinal TB exhibiting LUTS. Urinary symptoms were assessed by the American Urological Association (AUA) symptom score. We performed a urodynamic study (UDS), including electromyography, in all patients before and 3 months after spinal surgery.
RESULTS
The mean age of patients was 29.7 years (range, 15-52 years), and the mean AUA symptom score was 12.5 and 11.8 before and after spinal surgery, respectively. Overall, five patients exhibited improvement in the AUA symptom score, and three showed no change, while two patients' condition worsened. We observed detrusor overactivity (DO) in two patients, and detrusor sphincter dyssynergia (DSD) in four patients. In addition, high-pressure voiding (HPV) was noted in two patients. On follow-up after spinal surgery, DO and DSD exhibited no improvement. Although HPV resolved, two patients developed new-onset poor compliance with worsening DO and DSD. Furthermore, two patients had bilateral hydronephrosis before surgery, which resolved on follow-up.
CONCLUSIONS
Patients with spinal TB exhibiting LUTS can display a spectrum of clinical presentations and variable UDS findings. As two patients exhibited new onset poor compliance with bilateral hydronephrosis in one of them, this study concludes that a close follow-up for upper tracts in these patients is required despite successful spinal surgery.

Keyword

Spinal tuberculosis; Urodynamics; Detrusor

MeSH Terms

Ataxia
Compliance
Electromyography
Follow-Up Studies
Humans
Hydronephrosis
Lower Urinary Tract Symptoms*
Observational Study
Prospective Studies*
Tuberculosis, Spinal*
Urodynamics*