Objectives: To investigate current clinical practice in the treatment of urinary tract infections (UTIs) in persons with spinal cord injury (SCI) in SCI centers where German is spoken and to compare it with current guidelines and evidence-based standards evaluated by a literature review. Methods: A standardized questionnaire was mailed to 16 SCI rehabilitation centers. The results were compared with a literature review Results: Of the 16 centers, 13 responded. Indications for UTI treatment, medications, and treatment duration differed substantially among the individual centers and from the existing guidelines. Antibiotic treatment is regarded as the method of choice. Compared with the existing literature, patients in two center were undertreated, whereas they were overtreated in seven centers. Conclusion: Even in specialized centers, treatment of UTI in patients with SCI is based more on personal experience of the treating physicians than on published evidence. This may at least partly be due to the paucity of evidence-based data. The observed tendency toward overtreatment with antibiotics carries substantial future risks, as this strategy may well lead to the induction of multiresistant bacterial strains. Therefore, developing guidelines would be an important step toward a unification of the different treatment strategies, thus reducing unnecessary antibiotic treatment. Furthermore, evidence-based studies evaluating the success of antibiotic treatment as well as the usefulness of alternative strategies are urgently needed.

Definition, Risk Factors and ComorbiditiesDiabetic neuropathy is a clinically manifest or subclinical disease of the peripheral nerves, which occurs as a consequence of diabetes mellitus or other underlying causes. It can affect the somatic and/or autonomic nervous system. The risk of distal symmetric polyneuropathy and autonomic neuropathy increases with the following risk factors, indicators and co-morbidities: ▶ Duration of diabetes ▶ Glycaemic control (hyperglycaemia) ▶ Arterial hypertension ▶ Peripheral artery disease (PAD) ▶ Mönckeberg's medial sclerosis ▶ Diabetic retinopathy and nephropathy ▶ Depression ▶ Visceral obesity ▶ Hyperlipidaemia ▶ Alcohol and/or nicotine abuse ▶ Insufficient physical activity ▶ Demographic factors (age, height, weight) Distal symmetric sensorimotor polyneuropathy contributes to the aetiology of diabetic foot syndrome in 85-90 % of cases and is thus of paramount significance in the risk constellation for foot ulcers and amputation. In addition, it is deemed an important predictor of cardiovascular morbidity and mortality. The prevalence of polyneuropathy in patients with manifest type 1 and type 2 diabetes is approximately 30 %. Some 13-26 % of diabetic patients have painful neuropathy.

Objective: To investigate changes of the bacterial spectrum and susceptibility in bacteria isolated from urine samples of spinal cord injury patients followed in a strict outpatient setting. Subjects and Methods: Due to neurogenic dysfunction, urinary tract infections are common in spinal cord injury patients. Nosocomial urinary tract infections and resistance against antibiotics are increasing problems in hospitalized spinal cord injury patients. Urine samples were obtained by aseptic catheterization during 1,293 outpatient appointments at our institution over a period of 6 years. The urine samples were analyzed for bacterial colonization and microbiologically evaluated. Results: We demonstrate significant changes in both bacterial spectrum and bacterial resistance in an outpatient population as well. Even multiresistant staphylococcus species were detected, in spite of excluding nosocomial infections. Conclusions: Antibiotic treatment should be limited to symptomatic urinary tract infections and be initiated after sensitivity testing only. Empiric use of antibiotics must be limited to highly symptomatic infections until the results of sensitivity testing are available.

Study design: A retrospective interview study of mothers with spinal cord injuries (SCIs) who gave birth over the last 15 years. Objectives: To identify the medical complications of women with SCIs during pregnancy and childbirth in Switzerland and to describe how they dealt with these complications. Settings: Swiss Paraplegic Research in Nottwil, the University of Lausanne and participants' homes. Methods: Data were collected by self-reported questionnaires and descriptive analysis was conducted. Results: Seventeen women with SCIs who gave birth to 23 children were included. Thirteen of the women were paraplegics and four were tetraplegics. All of them practiced an independent bladder management. Three women changed their bladder management techniques during pregnancy. Five women reported an increased bladder evacuation frequency during pregnancy, and six women reported a new onset or increase in incontinence. We observed no significant increase in bowel dysfunction or skin breakdown due to their pregnancies. Ten women were hospitalised during the course of their pregnancies. Aside from urinary tract infections/ pyelonephritis, women were hospitalised for falls, hypertension, pneumonia, preeclampsia, pre-term labour or tachycardia. Conclusion:The results of our study clearly demonstrated that, although medical complications are not infrequent during pregnancy in women with SCIs, pregnancy and delivery in this group of women are possible without posing intolerable risks to the mothers or the children. Urological problems seemed to be the most frequent complication during pregnancy.

Autoimmune diseases can affect the blood vessels, causing systemic vasculitis. Although testicular manifestation of some autoimmune diseases is not uncommon, only a few cases of acute orchitis are described in the literature. The underlying pathological condition in testicular manifestations of autoimmune diseases is severe vasculitis causing inflammation and infarction. In patients with recurrent episodes of scrotal swelling and pain, testicular vasculitis as the first sign of a systemic disease should be taken into consideration.

IntroductionUrinary tract infections (UTIs) are one of the most common morbidities in persons with neurogenic lower urinary tract dysfunction (NLUTD). They are associated with a significant morbidity and mortality, and they affect the quality of life of the affected patients. Diagnosis and treatment of UTI in this group of patients are challenging. In this review, the current strategies regarding diagnosis, treatment, and prevention are summarized.Diagnosticsit is important to correctly diagnose a UTI, as treatment of bacteriuria should strictly be avoided. A UTI is defined as a combination of laboratory findings (leukocyturia and bacteriuria) and symptoms. Laboratory findings without symptoms are classified as asymptomatic bacteriuria. Routine urine screening is not advised.TreatmentOnly UTI should be treated; treatment of asymptomatic bacteriuria is not indicated. Prior to treatment, urine for a urine culture should be obtained. Antibiotic treatment for ~7 days is advised.PreventionIn recurrent UTI, bladder management should be optimized and morphologic causes for UTI should be excluded. If UTIs persist, medical prophylaxis should be considered. Currently, no prophylactic measure with evidence-based efficacy exists. Long-term antibiotic prophylaxis should be used merely as an ultimate measure. Among the various mentioned innovative approaches for UTI prevention, bacteriophages, intravesical instillations, complementary and alternative medicine techniques, and probiotics seem to be most promising.ConclusionRecently, several promising innovative options for UTI prophylaxis have been developed which may help overcome the current therapeutic dilemma. However, further well designed studies are necessary to evaluate the safety and efficacy of these approaches.

Objective: Sphincterotomy is a well-established therapeutic option in male patients with neurogenic bladder dysfunction and detrusor-sphincter-dyssynergia due to spinal cord lesions. Indication and prediction of treatment outcome, however, are mainly based on clinical parameters. We analyzed the clinical usefulness of preoperative urodynamic evaluation for the prediction of success in patients undergoing external sphincterotomy. Materials and Methods: In a retrospective study, residual urine, retrograde perfusion pressure (RESP) and detrusor leak point pressure (DLPP) in 62 male patients with spinal cord injury were assessed before sphincterotomy. Data were compared to surgical success evaluated by postoperative DLPP and residual urine. Results: Sphincterotomy was successful in 85.4% of our patients. In multivariate analysis, both preoperative DLPP and RESP were superior to measurement of residual urine concerning prediction of surgical success. However, these differences were not statistically significant. Conclusion: To our knowledge, this is the first study to evaluate preoperative predictors for surgical success in patients undergoing sphincterotomy. Although urodynamic evaluation is strongly advised prior to surgery in patients with spinal cord lesions, it improves prediction of success only marginally.

An 8-year-old boy presenting with intermittent haematuria and dysuria was investigated with voiding cystourethrography (VCUG), urethroscopy and perineal MRI. VCUG and urethroscopy did not provide a definitive diagnosis, while MRI clearly demonstrated a homogeneous, oval cystic lesion extending from the bulbourethral glands and slightly impressing the bulbous urethra. The patient was found to have an imperforate Cowper's syringocele. Treatment consisted of marsupialisation and the patient became symptom free. To the authors' knowledge, this is the first description of the MRI characteristics of an imperforate Cowper's syringocele in a paediatric patient.