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Original article

This is an early access version

Lower urinary tract symptoms (LUTS) as a clinical feature of lumbar spinal stenosis (LSS): a prospective study with lumbar spine morphometry analysis

By
Harun Hodzic ,
Harun Hodzic

Department of Surgery, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Hakija Bečulić ,
Hakija Bečulić

Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Emir Begagic ,
Emir Begagic
Contact Emir Begagic

Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Nejla Huseinspahić ,
Nejla Huseinspahić

Department of General Medicine, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Igor Sladojević ,
Igor Sladojević

Department of Anatomy, School of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina

Department of Anatomy, School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Andrej Popov ,
Andrej Popov

Department of Anatomy, School of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina

Rasim Iriškić ,
Rasim Iriškić

Department of Gynaecology, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina

Tarik Zulović ,
Tarik Zulović

Department of Gynaecology, Canton Hospital Zenica, Zenica, Bosnia and Herzegovina

Emir Becirovic ,
Emir Becirovic

Department of Intensive Care, Internal Clinic, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Goran Lakičević ,
Goran Lakičević

Department of Neurosurgery, University Hospital Mostar, Mostar, Bosnia and Herzegovina

Adem Nuhović ,
Adem Nuhović

Department of General Medicine, School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Haso Sefo ,
Haso Sefo

Neurosurgery Clinic, University Clinical Centre Sarajevo, Sarajevo, Bosnia and Herzegovina

Aldin Jusić ,
Aldin Jusić

Department of Neurosurgery, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina

Jovana Radovanović
Jovana Radovanović

Department of Physiology, School of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

Department of Anaesthesiology, Clinical Hospital Zvezdara, Belgrade, Serbia

Editor: Besim Prnjavorac

Abstract

Aim To investigate clinical and morphometric characteristics of patients with lower urinary tract symptoms (LUTS) due to lumbar spinal stenosis (LSS).
Methods This study evaluated LSS patients using clinical assessments of motor, sensory, bladder, and bowel functions, and functional disability scores from the Oswestry Disability Index (ODI) and Swiss Spinal Stenosis Questionnaire (SSSQ). Morphometric analysis included MRI measurements of the anteroposterior diameter of the intervertebral disc and dural sac, and the modified Torg-Pavlov ratio (mTPR), with follow-up re-evaluations at 6 months.
Results Of 159 patients, 49 (30.8%) had LUTS and 110 (69.2%) were in the control group. LUTS patients had a significantly higher prevalence of neurogenic claudication (100% vs. 47.3%; p<0.001), lower back pain (93.9% vs. 77.3%; p=0.011), and lower extremity pain (57.1% vs. 34.5%; p=0.008). The LUTS group also had higher ODI (54.0 vs. 50.0; p=0.019) and SSSQ score (44.0 vs. 34.0; p<0.001). Morphometric analysis showed significantly lower mTPR in LUTS patients (median 0.31 vs. 0.45; p<0.001), with an AUC of 0.704 (95%CI 0.627-0.774). mTPR≤0.31 predicted surgical revision within 6 months (OR:3.4, CI: 1.2-9.8), motor deficiency (OR:2.1, 95%CI: 1.4-5.2), and persistent LUTS post-surgery (OR:4.5, 95%CI: 1.1-18.9). mTPR≤0.34 was associated with worse follow-up outcome, including increased ODI (β:3.2; 95%CI: 1.1-5.3; p=0.004) and SSSQ score (β:4.8; 95%CI:2.1-7.5).
Conclusion LUTS patients with LSS exhibit more severe symptoms and poorer outcome, with mTPR≤0.34 being a predictor of adverse clinical outcome and the need for surgical revision within 6 months.

Author Contributions

Conceptualization, H.H., H.B. and E.B.; Investigation, H.H., E.B., G.L. and A.N.; Writing – original draft, H.H., G.L., H.S. and A.J.; Writing – review & editing, H.H., H.B., E.B. and J.R.; Methodology, H.B., E.B. and N.H.; Resources, H.B., R.I. and T.Z.; Supervision, H.B., E.B. and H.S.; Data curation, E.B.; Software, E.B.; Visualization, E.B.; Validation, I.S., A.P. and R.I.; Formal Analysis, T.Z. and E.B.; Project administration, E.B. All authors have read and agreed to the published version of the manuscript.

Citation

Funding Statement

No specific funding was received for this study

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

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