Authors reply Re: Vasudeva P, Kumar V, Yadav S, Prasad V, Kumar N, Kumar S, et al. Urodynamic assessment of detrusor function in the very acute phase of traumatic spinal cord injury: A prospective cohort study. Indian J Urol 2024;40:31-6

We thank the readers for their interest in this study. First, addressing the discrepancy about autonomic dysreflexia, what we wanted to say here was that it was in our protocol to abort the urodynamics if the patient developed autonomic dysreflexia, however, no patient developed autonomic dysreflexia during the study. Regarding the maximum cystometric capacity, since the filling was stopped at 500 cc in patients with "absent bladder sensations", there was no way that this parameter could have been documented in a true sense. In so far as the voiding phase parameters like PdetQmax are concerned, none of the patients generated any pressure during the voiding phase as mentioned in the manuscript. The institute's ethical committee approval number was IEC/VMMC/SJH/Thesis/2020-03/CC-07. We agree a follow-up urodynamics would have added more value to our study, however, as stated in the limitations, we could not get these six patients with unfavorable urodynamic findings back to our hospital for a repeat urodynamic assessment. A few expired due to complications of the spinal cord injury (SCI) and others were not willing/financially unable to travel and were being managed by an indwelling catheter. A subgroup analysis to identify factors that could predict unfavorable urodynamic parameters was performed as mentioned in the original manuscript, however no risk factors could be found. This is in line with other authors who have performed similar studies and reported a lack of correlation between the urodynamic findings and the status of neurological examination, American Spinal Injury Association impairment scale, and the level of SCI.[1] We humbly disagree with the statement that this study has no value for the Indian patients. It is well-established that intermittent catheterization is the safest method of bladder drainage in SCI patients.[2] It has been shown that patients who are discharged on an indwelling catheter, majority would continue to be on this method of bladder emptying at long term follow-up and so all efforts should be made to institute intermittent catheterization early on in the recovery period.[3] It is also established that an indwelling catheter does not guarantee the safety of the upper tracts.[2] Once again, we sincerely thank the readers for taking an interest in our research and highlighting the salient features of our study. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.