Bladder management methods and urological complications in spinal cord injury patients

Abstract

Background:The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups.Materials and Methods:545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 – 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages.Results:The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization.Conclusions:Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.

Bladder management in individuals with chronic neurogenic lower urinary tract dysfunction

“…Mainly, moderate rates (4-9%) have been observed in European studies, 2,19,20 whereas in other parts of the world reported TUC rates range from 17 to 41%. 14,15,18 The use of SPC seems to be similar (11-14%) 14,18 or less common (4-9%) 15,19 compared with present data (13%).…”

“…6,7 The majority of individuals with NLUTD who abandon IC seem to change to indwelling catheterization. 6,7 However, bladder evacuation by indwelling catheterization is associated with an increased risk of serious complications, [8][9][10][12][13][14][15] and thus individuals at risk of changing to indwelling catheterization should be identified and alternative solutions should be offered. In the present study, gender, age, injury severity and injury duration were significant predictors of bladder evacuation by SPC or TUC.…”

“…6,7 Yet, indwelling catheters are associated with an increased risk of complications such as bladder cancer, 8,9 bladder stones [10][11][12][13] and urinary tract infections. 14,15 We have therefore investigated the association of patient and injury characteristics with the bladder evacuation method in individuals with chronic NLUTD. The following hypotheses were tested: gender, age, injury severity and injury duration have a significant effect on bladder evacuation with an indwelling catheter.…”

Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation

“…Guenther et al 10 observed no significant difference in the stricture rates between men using IC (that is, 22%) and men using spontaneous or triggered reflex voiding (that is, 24%). Singh et al 11 reported higher stricture rates with IC (that is, 18%) compared with other evacuation methods, such as normal, spontaneous or reflex voiding and suprapubic catheterization (that is, 2%). However, no statistical comparison was performed between these groups.…”

“…7,8 The main body of literature has been published more than a decade ago, and the reported stricture occurrence rate is generally lower (o10%) in earlier investigations [7][8][9] compared with more recent ones (~20%). 10,11 Over the years, different catheter materials and methods have been introduced. The catheter surface has been claimed to be an important factor in the development of urethral strictures.…”