Managing the urinary tract in spinal cord injury

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Abstract

This review sets out to provide an overview of the author’s approach to the management of the urinary tract in the patient who has suffered from an injury to their spinal cord. Emphasis is given to the need to understand the fundamental pathophysiological patterns that are seen with injuries that involve the sacral segments of the cord (the conus) and those that spare the conus but interrupt communication between the sacral parasympathetic and somatic centers and the brain (supraconal lesions). The importance of patient participation in management decisions is highlighted by considering the different ways in which the urinary tract can be managed and how the clinician needs to try to meet patient expectations and requirements while establishing safe urological management. Finally, consideration is given to the importance of establishing an appropriate follow up regime and managing urinary tract complications effectively.

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Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury.

A Esclarín De Ruz, E García Leoni, R. Herruzo Cabrera (2000)

To our knowledge risk factors for urinary tract infection associated with various drainage methods in patients with spinal cord injury have never been evaluated overall in the acute period. We identified the incidence and risk factors associated with urinary tract infection in spinal cord injured patients. We prospectively followed 128 patients at our spinal cord injury reference hospital for 38 months and obtained certain data, including demographic characteristics, associated factors, methods of urinary drainage, bladder type, urological complications and predisposing factors of each infection episode. Logistic regression modeling was done to analyze variables and identify risk factors that predicted urinary tract infection. Of 128 patients 100 (78%) were male with a mean age plus or minus standard deviation of 32 +/- 14.52 years. All patients had a nonfatal condition by McCabe and Jackson guidelines, and 47% presented with associated factors. The incidence of urinary tract infection was expressed as number episodes per 100 patients daily or person-days. The overall incidence of urinary tract infection was 0.68, while for male indwelling, clean intermittent, condom and female suprapubic catheterization, and normal voiding the rate was 2.72, 0.41, 0.36, 0. 34 and 0.06, respectively. The risk factors associated with urinary tract infection were invasive procedures without antibiotic prophylaxis, cervical injury and chronic catheterization (odds ratio 2.62, 3 and 4, respectively). Risk factors associated with repeat infection were a functional independence measure score of less than 74 and vesicoureteral reflux (odds ratio 10 and 23, respectively). Spinal cord injured patients with complete dependence and vesicoureteral reflux are at highest risk for urinary tract infection.

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Management of urinary tract infection in patients with spinal cord injuries.

M.E. García Leoni, A Esclarín De Ruz (2003)

Urinary tract infection (UTI) is responsible for major morbidity and mortality in spinal cord injury (SCI) patients. Several factors appear to be responsible for an increased risk of infection in the neurogenic bladder. Incomplete voiding, elevated intravesical pressure and catheter use contribute to an increased risk of symptomatic urinary tract infection. Frequent exposure to antibiotics increases the risk of infection by resistant organisms. UTIs interfere with rehabilitation, and may lead to secondary urologic complications. The classic symptoms of UTI are unreliable indicators in SCI patients with neurogenic bladder. Lack of pyuria reasonably predicts the absence of UTI in SCI patients. Asymptomatic bacteriuria need not be treated with antibiotics. Symptomatic UTI warrants therapy in all patients.

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[Trans-appendicular continent cystostomy in the management of the neurogenic bladder].

P Mitrofanoff (1979)

The comfort obtained in some cases of neurogenic bladder of the girl, thanks to unsterile self catheterization, and usual absence of septic complications, incite to search for a process which could be used for the boys as well as girls in those cases where urethral catheterization cannot be done. What's more, if the catheterization is easy to achieve even by young children and if the process brings complete dryness, almost perfect conditions of comfort would be achieved. A cystostomy with a continent opening easy to catheterize and associated with a closure of the vesical neck, was the objective. We had the idea to use the appendix in order to create a passage between the skin and the bladder, the tip of the appendix opening into the bladder at the end of an anti-reflux submucosal tunnel and the other end hemmed to the skin. The bladder neck is usually closed in the course of the same operation. From October 1976 to January 1979, 16 children have gone through such a vesicostomy. In two more cases a trans-ureteral cystostomy was created. Five cases were a failure owing to a too small bladder and required a cutaneous diversion. The continence of the vesicostomy is total and the comfort obtained is excellent for the other 13 cases. Some complications result directly from this technique. It concerns more particularly cutaneous fistula (1 case) or with urethral repermeation (2 cases). Other problems, common to all conservative treatments of a neurogenic bladder, are discussed:vesico-renal reflux, dilatation of the upper urinary tract, urinary infections and of course, risk for the renal function. They appear to be related with a small and hypertonic bladder. Obviously these problems must be kept in mind and require a strict selection for the vesicostomy and a strict followup.

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Journal

Journal ID (nlm-ta): Indian J Urol

Journal ID (publisher-id): IJU

Title: Indian Journal of Urology : IJU : Journal of the Urological Society of India

Publisher: Medknow Publications (India )

ISSN (Print): 0970-1591

ISSN (Electronic): 1998-3824

Publication date (Print): Apr-Jun 2010

Volume: 26

Issue: 2

Pages: 245-252

Affiliations

Department of Urology, Pinderfields Hospital, Wakefield, West Yorkshire, UK

Author notes

For correspondence: Dr. Simon C. W. Harrison, Department of Urology, Pinderfields Hospital, Aberford Road, Wakefield, West Yorkshire, WF1 4DG, UK. E-mail: Simon.Harrison@ 123456midyorks.nhs.uk

Article

Publisher ID: IJU-26-245

DOI: 10.4103/0970-1591.65399

PMC ID: 2938550

PubMed ID: 20877604

SO-VID: 9337f973-65f4-4f88-848a-acaf9a314900

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This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Managing the urinary tract in spinal cord injury

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Most cited references 74

Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury.

Management of urinary tract infection in patients with spinal cord injuries.

[Trans-appendicular continent cystostomy in the management of the neurogenic bladder].

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