A proposed guideline for the urological management of patients with spinal cord injury

Abrams, Paul; Agarwal, Meena; Drake, Marcus; El-Masri, W; Fulford, Simon; Reid, S.R.; Singh, G.; Tophill, Paul

doi:10.1111/j.1464-410x.2008.07457.x

Cited by 108 publications

(70 citation statements)

References 2 publications

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“…[14][15][16] These educational activities of the society also underlined that CIC was the gold standard for bladder management according to the published guidelines. 17,18 Of the respondents, 70% was aware of the potential kidney and bladder problems after SCI. This high rate of awareness correlates well with the high rates of the performance of urinary tract imaging (67.7%) and urodynamic studies (76%) after the injury.…”

Section: Discussionmentioning

confidence: 99%

Urologic health condition of spinal cord-injured patients living in Turkey

et al. 2014

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Objectives: To determine the urologic health condition of spinal cord-injured (SCI) patients living in Turkey, and to analyze the relationship between the prevalence of urologic health condition parameters and the patient's characteristics. Methods: Telephone call survey was conducted with a structured questionnaire among all members of Turkish Society of Spinal Cord Injured Patients. Results: Data were obtained from 300 patients. Mean age was 42 years with a male/female ratio of 2.3, while the most common cause of injury was transport (35.3%). Although 70% were aware of potential kidney and bladder problems after injury 460% of the patients were not under regular urologic follow-up. Secondary health problems experienced as being most important was urination problems (50%). Of the patients 72.7% (83% in females vs 68% in males) had urinary incontinence (UI) during last 3 months, and 64.3% used clean intermittent catheterization (CIC) (68% in males vs 56% in females), while 73%, 57% and 26% of incontinent patients used diaper/pad, medication and condom catheter, respectively, and the use of CIC decreased with time. Surgical procedures on urinary tract were performed in 22.6% of the patients; stone surgeries were the most frequent ones. Conclusion: This study demonstrated that the UI rate was high among SCI patients, and more common in females with fairly good proportion of patients using incontinence medication. Main bladder management method was CIC and more prevalent in males, although the use of CIC decreased with time. Urinary stone surgery was the leading surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Urologic health condition of spinal cord-injured patients living in Turkey

et al. 2014

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“…One case series of four patients with silent pyonephrosis cautions that stone presentation may be very nonspecific in patients with SCI and includes increased spasms, sweating and nonspecific abdominal discomfort. 15 Suggested guidelines in the United Kingdom for the urological management of patients with SCI recommend upper tract surveillance with an annual ultrasound (Level 5) 16 There is currently no published evidence regarding the incidence of asymptomatic stones detected on annual follow-up, or regarding the role of CT surveillance of the upper tracts in this group of patients.…”

Section: Presentation Of Stone Disease In Sci Patientsmentioning

confidence: 99%

Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient

Ramsey

McIlhenny

2011

Spinal Cord

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Objective: The objective is to review the published literature on the aetiology and evidence-based management of stone disease in the spinal cord-injured patient. Methods: A PubMed and Medline search was performed using the terms 'spinal cord injury', 'paraplegia', 'stone', 'nephrolithiasis', 'urolithiasis', 'calculus', 'spinal cord injury' or 'paraplegia' with 'SWL', 'ureteroscopy', 'chemolysis' and 'PCNL.' The Cochrane database, the National Institute for Clinical Excellence guidelines and the Scottish Intercollegiate guidelines were searched using the terms 'spinal cord injury' and 'urolithiasis' and 'nephrolithiasis'. Results: A total of 32 papers were identified, mainly case series or case-cohort studies with few contemporary papers. The risk of developing a renal stone after spinal cord injury (SCI) is between 7 and 20% over a period of 8-10 years. Stone formation may be related to early demineralisation of bone or chronic infection. Biochemical abnormalities are not significantly different between stone-forming and non-stone forming patients, though these patients differ from healthy controls. Presentation may be atypical, but is most commonly recurrent urinary tract infection. Treatment may be complicated by lower limb contractures limiting retrograde access. Several case series report success with shock wave lithotripsy varying from 50 to 70%, though comparisons are limited by heterogeneous indications and reporting. Percutaneous nephrolithotomy remains the gold standard for stones measuring 2 cm and above. Stone-free rates of 90% have been reported, though surgery was often complex with higher complication rates. Conclusion: Management of upper urinary tract stones in patients with SCI is complex regarding surgical technique, post-operative care and recurrence rates. Further contemporary case series must use standardised reporting tools to allow valid comparisons.Spinal Cord (2011) 49, 948-954;

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“…8 There seems to be a consensus among all the guidelines on the immediate and short-term management of SCI patients as is the agreement for the need for lifelong follow-up to preserve renal function, prevent complications, promote continence and improve quality of life. 4,5 However, the frequency of follow-up and investigations undertaken reveal considerable variation among these guidelines.…”

Section: Introductionmentioning

confidence: 99%

“…4 SCI patients are best managed in a SCI centre with integrated facilities for rehabilitation and a multidisciplinary approach: involving urologists, rehabilitation specialists, specialist nurses and physiotherapists etc. 5 Although it is agreed that patients with NLUTD should have regular follow-up, there is little concusses how this should be monitored over the long-term to detect urological complications. 6 We conducted a survey of SCI units in 2004 to evaluate the longterm urological management of SCI patients in the United Kingdom and Eire, which showed a considerable variation in urological practice among SCI centres in the United Kingdom and Eire.…”

Section: Introductionmentioning

confidence: 99%

“…7 Since then guidelines have been published on the management of NLUTD, and NLUTD in association with SCI. These include the European Association of Urology (EAU) guidelines for management of NLUTD, 4 proposed British guidelines for the urological management of patients with SCI 5 and the consortium for spinal cord medicine in the United States. 8 There seems to be a consensus among all the guidelines on the immediate and short-term management of SCI patients as is the agreement for the need for lifelong follow-up to preserve renal function, prevent complications, promote continence and improve quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Long-term urological management in spinal injury units in the UK and Eire: a follow-up study

et al. 2014

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Aims: The majority of patients with spinal cord injury (SCI) will develop neurogenic lower urinary tract dysfunction (NLUTD). These patients require a long-term urological follow-up. The follow-up protocol has varied across SCI units in the United Kingdom and Eire. We reviewed the long-term management in the SCI units to identify changes in practice over a decade and compared them to current guidelines. Methods: We present results of a review of all SCI centres in the United Kingdom and Eire on their long-term urological management before and after the current guidelines and compared the results with European Association of Urology (EAU) Guidelines on NLUTD and the proposed British guidelines for the urological management of patients with SCI. Data were collected through questionnaires posted to SCI units. Results: SCI patients are followed up in outpatients annually in the SCI centres and the frequency of follow-up remains largely unchanged. More SCI units perform renal tract imaging annually as a part of SCI follow-up. Most units follow the proposed British guideline indications for urodynamics and do not perform 'routine urodynamics'. Conclusions: We conclude that the long-term management of SCI patients in SCI units in the United Kingdom and Eire has changed overtime to follow the proposed British guidelines. EAU guidelines offer a more extensive follow-up regime. Last, there is a continued lack of high-quality evidence to support an optimal long-term follow-up protocol. Importantly, there is a lack of evidence on clinical outcomes when these guidelines have been followed. Spinal Cord (2014) 52, 640-645; doi:10.1038/sc.2014.90; published online 10 June 2014 INTRODUCTIONThe annual incidence of spinal cord injury (SCI) is up to 40 cases per million. 1 Most of these patients develop neurogenic lower urinary tract dysfunction (NLUTD). 2 Mortality due to urological complications has decreased over recent years; 3 due to meticulous attention to the kidneys and bladder. Long-term urological follow-up is needed to optimise the bladder by low-pressure filling and complete bladder emptying. Restoration of continence is a goal for improved quality of life. 4 SCI patients are best managed in a SCI centre with integrated facilities for rehabilitation and a multidisciplinary approach: involving urologists, rehabilitation specialists, specialist nurses and physiotherapists etc. 5 Although it is agreed that patients with NLUTD should have regular follow-up, there is little concusses how this should be monitored over the long-term to detect urological complications. 6 We conducted a survey of SCI units in 2004 to evaluate the longterm urological management of SCI patients in the United Kingdom and Eire, which showed a considerable variation in urological practice among SCI centres in the United Kingdom and Eire. 7 Since then guidelines have been published on the management of NLUTD, and NLUTD in association with SCI. These include the European Association of Urology (EAU) guidelines for management of NLUTD, 4 proposed Britis...

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A proposed guideline for the urological management of patients with spinal cord injury

Cited by 108 publications

References 2 publications

Urologic health condition of spinal cord-injured patients living in Turkey

Urologic health condition of spinal cord-injured patients living in Turkey

Evidence-based management of upper tract urolithiasis in the spinal cord-injured patient

Long-term urological management in spinal injury units in the UK and Eire: a follow-up study

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