Introduction: The aim of this study was to assess the predictive values of six urinary markers (NGF, BDNF, MMP-2, TIMP-2, TGF-B1 et PGE2) for adverse urodynamic features and for upper urinary tract damage in adult patients with spina bifida.
Methods: A single-center prospective trial was conducted from March 2015 to March 2017 including all consecutive adult spina bifida patients seen for urodynamic testing. The urine was collected and stored at -80°C. A urodynamic and an upper urinary tract were systematically performed. At the end of the inclusion period, urines were defrosted and urinary NGF, BDNF, TIMP-2, TGF-B1 were assessed using validated ELISA kits. The urinary markers levels were adjusted on the urinary creatinine level. Urinary MMP-2 levels were assessed by zymography.
Results: Fourty patients were included. Only TIMP-2 and MMP-2 were significantly associated with poor bladder compliance (p=0.043 and p=0.039 respectively). TIMP-2 was also the only urinary marker significantly associated with upper urinary tract damage on imaging (OR=19.81; p=0.02). Of all urodynamic parameters, bladder compliance and maximum detrusor pressure were the only ones associated with upper urinary tract damage on imaging (p=0.01 and p=0.02), The diagnostic performances of urinary TIMP-2 for upper urinary tract damage were slightly superior to PdetMax and bladder compliance with an area under the curve (AUC) of 0.72.
Conclusions: Urinary TIMP-2 and MMP-2 were significantly associated withpoor bladder compliance and urinary TIMP-2 was significantly associated with upper urinary tract damage.These findings support a pathophysiological role of extracellular matrix remodeling in poor bladder compliance of adult spina bifida patients. Source of
