Residual urine volumes after intermittent catheterization in men with spinal cord injury

Abstract

Study design: Prospective cross-sectional study. Objectives: To investigate residual urine volumes after intermittent catheterization (IC) in men with spinal cord injury (SCI) and the effect of residual urine on the rate of symptomatic urinary tract infections (UTIs). Setting: Single SCI rehabilitation center in Switzerland. Methods: Sixty men experienced in IC (X6 months) emptied their bladder twice by IC. Immediately after catheterization, residual urine was determined by ultrasonography. Personal characteristics and bladder diary details (annual UTI rate, catheter type) were also collected. Results: The median residual urine volume was 7.0 ml (lower quartile (LQ): 0.0, upper quartile (UQ): 20.3 ml). No residual urine was observed after 42% (n ¼ 50) of all catheterizations (n ¼ 120). Unsatisfactory residual volumes (that is, 450 ml) were observed after 9% (n ¼ 11) of all catheterizations. There was no significant (P ¼ 0.95) difference between the median residual urine volume of men with recurrent (42 UTIs per year) UTIs (2.5 ml, LQ: 0.0, UQ: 29.3 ml) and the volume of those with sporadic (p2 UTIs per year) UTIs (6.0 ml, LQ: 0.0, UQ: 20.0 ml). INTRODUCTIONPioneered by Guttmann and Frankel 1 and Lapides et al., 2 intermittent catheterization (IC) is now the standard method for bladder evacuation in spinal cord injury (SCI) patients suffering from urinary retention as a result of neurogenic lower urinary tract dysfunction (NLUTD). 3 However, there are only sparse data on the efficiency of IC in evacuating urine from the bladder, indicating that there is some residual urine after IC in certain patients. [4][5][6] Residual urine is considered to be an important risk factor for urinary tract infections (UTIs), 7,8 and even small volumes may predispose for infections. 4 Although less frequent than with indwelling catheterization, 9,10 recurrent UTIs are a major problem affecting SCI patients with NLUTD using IC, even when applying adequate catheterization techniques. 11 Merritt et al. 8 have reported greater residual urine volumes after IC in SCI patients with bacteriuria compared with those with negative urine cultures. However, there are no current data on residual urine volumes after IC in SCI patients and their effect on the occurrence of symptomatic UTIs.We have therefore prospectively investigated the residual urine volumes after IC in men with NLUTD resulting from SCI. In addition, the hypothesis that individuals with recurrent (42 UTIs per year) symptomatic UTIs show greater residual urine volumes after IC compared with those with sporadic (p2 UTIs per year) symptomatic UTIs was tested.

Long‐term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor

“…The observed median residual urine volume was 20 mL, and a residual urine volume ≤50 mL is considered satisfactory. 16,17 Our data do not allay the concern of deteriorating detrusor pressure with SARS; however, the changes do not seem to be clinically relevant during the first decade after surgery. A decrease in stimulation detrusor FIGURE 1 The changes in maximum detrusor pressure during anterior root stimulation (Pdet_stim_max) during the follow-up for women and men.…”

“…Furthermore, the decrease in stimulation pressure neither resulted in an increase in the number of daily stimulations for bladder evacuation nor an increase in residual urine after voiding. The observed median residual urine volume was 20 mL, and a residual urine volume ≤50 mL is considered satisfactory . Our data do not allay the concern of deteriorating detrusor pressure with SARS; however, the changes do not seem to be clinically relevant during the first decade after surgery.…”

Activation of common signaling pathways during remodeling of the heart and the bladder

“…The increase in wall thickness corresponds to the severity of obstruction [18], with a significant correlation between the two observed in men with BPH [19]. In contrast, volume overload injury in the bladder of human patients is a rare occurrence, and is usually prevented by catheterization [20]. Bladder hypertrophy is characterized by changes in the expression profile of SM contractile and signaling proteins, modification of extracellular matrix (ECM) proteins, and an increase in bladder innervation [21,22].…”

Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction

“…Many different risk factors for UTIs such as patient or injury characteristics, psychosocial or behavioral aspects, bladder evacuation method or residual urine have been considered. [9][10][11][12] However, there is insufficient evidence to assess the relevance of most of these factors. 9 Only injury severity and indwelling catheterization have been demonstrated to be associated with UTIs.…”