The Stockholm Spinal Cord Uro Study: 1. Basic characteristics and problem inventory

Abstract

Objective: To assess urinary tract function and complications in a regional prevalence group of patients with traumatic spinal cord injury (SCI), and to estimate risk factors for recurring complications. Materials and methods: A total of 412 patients who attended a yearly check-up at the Spinalis SCI clinic were included. A regional follow-up programme for neurogenic bladder dysfunction was applied, including S-creatinine and S-cystatin-C, urine culture, residual urine, ultrasound of kidneys, urodynamic studies, and a questionnaire regarding complications during the preceding year. Descriptive statistics and logistic regression were used to estimate risk factors. Results: All patients completed blood tests and the questionnaire. A urine culture was completed by 96%, ultrasound by 88%, residual urine by 75%, urodynamics by 51%, and all parts of the study by 47%. One quarter of patients displayed pathological findings regarding kidney function. Urodynamics verified neurogenic overactive bladder in a majority, and a high proportion with intravesical filling pressures above 40 cm H 2 O, a commonly used cut-off level for kidney safety. Subjectively, 47% of patients reported complications during the past year with urinary tract infection (UTI) as the most common one. Other complications were rare. Conclusions: With the aid of a regular follow-up programme, SCI patients can achieve a relatively stable situation regarding urinary tract function. UTI is the most common complication. Indicators of renal complications are frequent but not clearly related to the number of UTIs, nor to intravesical filling pressures. Main risk factors for complications are cervical levels and more complete neurological lesions.

The Stockholm Spinal Cord Uro Study: 2. Urinary tract infections in a regional prevalence group: frequency, symptoms and treatment strategies

“…Two sub-groups of patients with further problems were identified: those who had many infections and those who had severe, febrile infections requiring treatment in hospital. In comparison, other urogenital complications were reported at low frequencies, 3-5% [1].…”

“…In the questionnaire, participants reported UTIs as infection related symptoms which had been treated with a course of antibiotics. Objective measurements and patient-reported data were collected for each individual, as previously reported [1], see Table 2.…”

“…This article is the second report from the Stockholm Spinal Cord Uro Study, a comprehensive survey of urinary tract function in a regional prevalence population of patients with chronic traumatic spinal cord injury (SCI). In our first article [1] we presented the basic characteristics of the patient group including complications in the urinary tract, as found in a cross-sectional study based on a yearly check-up visit at the Spinalis out-patient clinic in Stockholm.…”

“…Residual urine was measured in 75% of all study patients [1]. Those who practice normal micturition or reflex stimulation had the highest frequency of residual volume >100 mL (17% and 67%, respectively), while users of CIC or indwelling catheter had the lowest rates (6% and 0%, respectively).…”

“…Urinary tract infection (UTI) is the most prevalent complication in patients with chronic SCI and a cause of significant morbidity [1][2][3]. It may cause or aggravate autonomic symptoms such as spasticity, autonomic dysreflexia and neuropathic pain [4], lead to a need of increased personal assistance, time away from work and social activities, as well as loss of financial income.…”