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SUFU 2019: Urinary TIMP-2 is Significantly Associated with Poor Bladder Compliance and Upper Urinary Tract Damage in Adult Patients with Spina Bifida

Miami, FL (UroToday.com) This was a single center prospective study which aimed to assess the predictive values of 5 urinary markers (NGF, BDNF, TIMP-2, TGF-B1 et PGE2) for detrusor overactivity/poor bladder compliance and for upper urinary tract damage in adult patients with spina bifida.

The urine of the voiding/self-catheterization immediately preceding the urodynamic were collected and stored at -80°C. An upper urinary tract imaging was systematically performed. The urinary NGF, BDNF, TIMP-2, TGF-B1 were assessed using validated ELISA kits. The urinary markers level was adjusted on the urinary creatinine level. The primary endpoint was upper urinary tract damage defined as renal scarring or renal atrophy or hydronephrosis on imaging.

There were 41 patients included. Of all urinary markers, only TIMP-2 was significantly associated with poor bladder compliance (p=0.04). There was no other statistically significant association between urinary markers and urodynamic parameters (bladder compliance, Maximum detrusor pressure (Pdet max), maximum cytometric capacity or detrusor overactivity). TIMP-2 was also the only urinary marker significantly associated with upper urinary tract damage on imaging (p=0.02). Of all urodynamic parameters, poor bladder compliance was the only one associated with upper urinary tract damage (p=0.01), while Pdetmax did not reach statistical significance (p=0.07). The diagnostic performances of urinary TIMP-2 for upper urinary tract damage were slightly superior to PdetMax and slightly inferior to bladder compliance (ROC curves, figure 1) with an area under the curve (AUC) of 0.72. For the optimal threshold of 400 pg/ml, sensitivity was 71.4% and specificity was 74.1%.
UroToday SUFU2019 TIMP
The authors confirmed the potential interest of TIMP-2 to predict high-risk urodynamic features and upper urinary tract damage in adult spina bifida patients. This finding confirms the strong pathophysiological role of extracellular matrix alteration in adult spina bifida patients and DO/poor bladder compliance. TIMP-2 could be a therapeutic target in this population.

Presented by: Benoit Peyronnet, MD, Department of Urology, Rennes University Hospital, Rennes, France
Co-Authors: Claire Richard, MD1, Claude Bendavid, MD1, Florian Naudet, MD1, Juliette Hascoet, MD1, Charlène Brochard, MD1, Nelly Senal, MD1, Quentin Alimi, MD1, Zine-Eddine Khene, MD1, Anne Corlu, MD1, Bruno Clément, MD PhD1, Laurent Siproudhis, MD PhD1, Guillaume Bouguen, MD PhD1, Jacques Kerdraon,MD1, Andrea Manunta,MD1, Xavier Gamé, MD PhD2
Author Affiliation:
1. The University of Rennes, France
2. The University of Toulouse, France

Written by: Bilal Farhan, MD, Clinical Instructor, Female Urology and Voiding Dysfunction, Department of Urology, University of California, Irvine @Bilalfarhan79 at the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction Winter Meeting, SUFU 2019, February 26 - March 2, 2019, Miami, Florida