Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study

Abstract

The aim of this study was to establish hazard ratios for the risk of complications of the upper urinary tract in relation to bladder management methods in patients with spinal cord injury. A total of 179 male patients were eligible for this investigation which was followed-up on a yearly basis until 2003. The average age at which the lesion occurred was 25.2 years (range 18-57). The average duration of follow-up since SCI was 29.3 years (range 10-53). During follow-up, the incidence of vesicoureteral reflux (VUR) was 15.1%. A total of 61 (34.1%) and 44 (24.6%) patients were diagnosed with pyelonephritis and renal stones, respectively. There were no significant differences in these complications among groups. Upper tract deterioration (UTD) was observed in 58 patients (32.4%). The incidence of UTD in the urethral catheter group (51.7%) was higher than that in other groups (P=0.008). Using multivariate analysis, patients with VUR were shown to have a higher risk of pyelonephritis (odds ratio 2.78; 95% confidence interval 1.16-6.68), and UTD (odds ratio 22.10; 95% confidence interval 6.92-70.56). We also found that UTD was more common for patients with an indwelling urethral catheter than for patients using other methods. For other variables, no positive association was observed. In cases which cannot undergo intermittent catheterization, or when the bladder cannot empty spontaneously, a suprapubic catheter is better than a urethral catheter for reducing UTD in this population. These findings suggest that even at a late stage post injury, bladder management methods are still important.

Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases

“…The bladder management method has been reported to have no effect on renal calculi formation. 8,15 Bartel et al 5 noted bladder calculi by IUC in 6.6% and by CIC in 2%. Chen et al 14 found that IUC was associated with a substantially greater risk of bladder calculi; however, Ku et al 12 did not show this relationship with bladder calculi.…”

“…[1][2][3][4][5] The principle aim of managing LUT dysfunction is the prevention of complications and preservation of upper urinary tract function. 1,[6][7][8] Therefore, these patients need life-long urological assessment at regular intervals to minimize urinary tract-associated morbidity. [6][7][8] Although there is no agreed protocol for the follow-up procedure, ultrasound (US) has an important role in the urinary tract surveillance of SCI patients.…”

“…1,[6][7][8] Therefore, these patients need life-long urological assessment at regular intervals to minimize urinary tract-associated morbidity. [6][7][8] Although there is no agreed protocol for the follow-up procedure, ultrasound (US) has an important role in the urinary tract surveillance of SCI patients. 3,7 It is one of the most commonly used diagnostic tools in rehabilitation practice because it is widely available, noninvasive, safe, affordable and does not expose patients to any radiation.…”

Reply to Katsumi et al.

“…Doing so, it is evident that intermittent catheterization is superior to indwelling catheters of any kind. [2][3][4] In this case, no misunderstanding about the status of indwelling catheters in the treatment of patients with neurogenic bladder dysfunction due to spinal cord injury would have been possible.…”

A scoping review of important urinary catheter induced complications

“…Among the most common urinary catheter complications are: anaphylaxis (allergic reaction to latex), cytotoxicity and hypersensitivity [37 40], symptomatic bacterial infection [19,41 51], catheter blockage (due to calculi and encrustations) [52 60], catheter fracture and malignancy [61], hematuria (blood in urine) [ 52,59, 62 64], intravesical knotting [4, 65 67], inflammation (due to pyelonephritis and epididymitis) [44,56,[58][59]62,68], erosion and periurethral abscess [56,59,62], mechanical trauma (partial damage, perforation and urinary leakage) [11 12, 52, 55, 69 73], urethral fistulae [59,62], urethral stenosis and stricture [56,62,72], and urosepsis [62 63, 74 76]. While several studies have investigated the morbidity and mortality associated with urinary catheters [52,62], to date no comprehensive review has been performed which has focused specifically on identifying and analyzing important complications caused or exacerbated by the mechanical interaction (i.e., physical contact) between the catheter and urinary tract.…”