{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T12:26:26Z","timestamp":1788956786350,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical Research Project of Shanghai Municipal Health Commission","award":["202240379"],"award-info":[{"award-number":["202240379"]}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFB4703305"],"award-info":[{"award-number":["2022YFB4703305"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shanghai Advanced Rehabilitation Medical Technology and Management Innovation Project","award":["SHKFJS007A"],"award-info":[{"award-number":["SHKFJS007A"]}]},{"name":"Key Projects of Shanghai Science and Technology on Biomedicine","award":["22Y31900202"],"award-info":[{"award-number":["22Y31900202"]}]},{"name":"Key Projects of Shanghai Science and Technology on Biomedicine","award":["23Y11906300"],"award-info":[{"award-number":["23Y11906300"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: To characterize urodynamic findings after lower-level spinal cord injury (LSCI) and to evaluate a new pressure-based classification framework\u2014the bladder\u2013sphincter dyscoordination syndrome (BSDS)\u2014for describing voiding patterns. We also introduce a descriptive \u201cneurogenic bladder outlet obstruction\u201d (NBOO) phenotype for straining-dependent voiding difficulty. Methods: We retrospectively analyzed the first urodynamic studies (December 2020\u2013August 2024) in 81 men with LSCI (injury at T10 or below). Key urodynamic measures included detrusor and intravesical pressures during filling and voiding, bladder volumes (first desire to void and capacity), compliance, maximum flow rate (Q_max), post-void residual (PVR), voiding efficiency, and the ratio of detrusor to abdominal pressure rise (\u0394Pdet\/\u0394Pabd). We compared cases with detrusor overactivity (DO) versus those without DO. Among those with voiding discoordination, we distinguished classical detrusor\u2013sphincter dyssynergia (DSD) from a proposed NBOO phenotype (characterized by abdominal straining pressure \u2265 40 cmH2O, detrusor pressure &lt; 20 cmH2O, incomplete emptying, and no anatomic obstruction). We further classified discoordination cases using the BSDS framework into four subtypes\u2014dual high-pressure (DHP), detrusor-muscle predominant (DMP), dual low-pressure (DLP), and abdominal-pressure predominant (APP)\u2014based on reference pressure thresholds (detrusor 20 cmH2O; abdominal 40 cmH2O). Results: Patients with DO (43.2%) showed significantly higher detrusor pressures during filling (at first desire to void and at capacity) and a lower first desire volume than non-DO patients, while maximum capacity was similar (p = 0.105). During voiding, DO cases had lower PVR and higher emptying rates, although the detrusor-vs-abdominal pressure contribution (\u0394Pdet\/\u0394Pabd) was comparable between groups. Among 63 patients with voiding discoordination, 32 (50.8%) met NBOO criteria; these NBOO cases exhibited lower detrusor and intravesical voiding pressures but worse emptying (higher PVR) compared to classical DSD cases. Overall, 76 of 81 patients (93.8%) fit within the BSDS classification\u2014distributed as 22 DHP, 13 DMP, 15 DLP, and 26 APP patterns. Conclusions: The BSDS framework (and the NBOO descriptor when conventional indices cannot be applied) offers a novel way to describe voiding patterns after LSCI. It links urodynamic observations to potential management strategies (by identifying whether the bladder or outlet is the primary issue). Prospective studies are needed to validate this framework against outcomes such as upper tract integrity, continence, and dependence on catheterization.<\/jats:p>","DOI":"10.3390\/jcm15072627","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:40:52Z","timestamp":1774878052000},"page":"2627","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A Potential Urodynamic Classification of Voiding Patterns in Neurogenic Lower Urinary Tract Dysfunction Due to Lower-Level Spinal Cord Injury"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8645-9551","authenticated-orcid":false,"given":"Shucong","family":"Peng","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"},{"name":"School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shan","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiuming","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8792-9362","authenticated-orcid":false,"given":"Qun","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyan","family":"Shen","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianghong","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junfa","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yulian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gang","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/S1474-4422(15)00070-8","article-title":"Lower Urinary Tract Dysfunction in the Neurological Patient: Clinical Assessment and Management","volume":"14","author":"Panicker","year":"2015","journal-title":"Lancet Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1097\/JU.0000000000002239","article-title":"The AUA\/SUFU Guideline on Adult Neurogenic Lower Urinary Tract Dysfunction: Treatment and Follow-Up","volume":"206","author":"Ginsberg","year":"2021","journal-title":"J. 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