Bladder management in persons with spinal cord lesion

Dahlberg, Angela; Perttilä, Ilkka; Wuokko, E; Ala‐Opas, Martti

doi:10.1038/sj.sc.3101650

Cited by 40 publications

(24 citation statements)

References 19 publications

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“…Dahlberg et al 27 also found that RV was associated with fewer UTIs than CISC. RV in the community is also safe provided patients are regularly and frequently followed up and monitored urologically by specialists familiar with the problems of patients with SCI.…”

Section: Discussionmentioning

confidence: 93%

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of The Midlands Centre for Spinal Injuries in Oswestry

et al. 2011

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Study design: Retrospective longitudinal study of short-and long-term urinary complications in chronic spinal cord injury (SCI) patients managed at the Midlands Centre for Spinal Injuries (MCSI). Setting: MCSI, Oswestry, UK. Method: A total of 185 SCI patients were admitted to the MCSI between 1984 and 1989. Only 119 patients who met the following criteria were included: traumatic SCI, Frankel grade A-D, admission within 6 weeks post injury, regular annual follow-up or alternate year at MCSI, follow-up longer than 8 years. Follow-up ranged between 8 and 21 years with a mean of 17.7 (s.d. ¼ 1.98). The method of bladder drainage varied from the time of injury. Drainage was by indwelling urethral catheterisation (IndUC) before admission to the MCSI. Within 24 h of admission, assisted clean intermittent catheterisation (ACIC) by the nursing staff was commenced. This was followed by clean intermittent self catheterisation (CISC) once the patient was mobilised in the wheel chair and trained in the procedure. When detrusor reflex activity develops, patients with good hand function were given a choice between CISC and reflex voiding (RV). Patients with poor hand function are given the choice between RV, suprapubic catheters or ACIC during hospitalisation and after discharge. Only a minority of these patients choose ACIC following discharge. RV was supplemented occasionally by sphincterotomy. There were 99 males and 20 females (5:1). The age at the time of injury was 16-63 years with a mean of 29 (s.d. ¼ 12). Instead of a single method, a pattern of bladder management was analysed in the context of three continuous phases: Phase1 preadmission to MCSI. Phase2 during first hospitalisation at MCSI. Phase3 post discharge. In each phase, the patients were divided into those with and without complications. The complications were analysed in relation to the management and other relevant factors. Results: The total complication rate at all stages was 62%. Complications of the upper urinary tract accounted for 22.6%. These results compared favourably with published material. Conclusion: The sequential system of supervised bladder management commencing with brief IndUC followed by IntC and/or RV remains effective in keeping the complication rate relatively low in SCI patients, who undergo regular surveillance and timely intervention. Sponsorship: The project was supported by SPIRIT, a charitable not for profit trust that supports teaching, training, clinical research and dissemination of knowledge about all aspects of spinal paralysis in the UK.

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Section: Discussionmentioning

confidence: 93%

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of The Midlands Centre for Spinal Injuries in Oswestry

et al. 2011

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“…7 Wyndaele et al 8 reported that conservative treatment is still the mainstay of the urological management in patients with SCI. Dahlberg et al 9 reported that patients using clean intermittent catheterization (CIC) combined with other methods (the mixed group) for bladder management had the higher frequency of urinary tract infection than other groups. Weld and Dmochowski 10 reported the complication rates of each bladder management method and inferred that inappropriate selection of a bladder management method may affect patient's quality of life.…”

Section: Introductionmentioning

confidence: 99%

The relationship between bladder management and health-related quality of life in patients with spinal cord injury in the UK

Liu

Gall

et al. 2009

Spinal Cord

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Study design: Cross-sectional study. Objectives: (1) To assess the relationship between bladder management methods and the healthrelated quality of life (HRQL) in patients with spinal cord injury (SCI). (2) To identify any correlation between the two questionnaires used to assess the quality of life (one validated for SCI and one validated for bladder symptoms). Setting: Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Middlesex, UK. Methods: This study is based on two questionnaires with results collected from 142 people with SCI. The two questionnaires were based on information from the Short-Form 36-Item Health Survey (SF-36) and the King's Health Questionnaire and included demographic characteristics, bladder management methods and the frequency of incontinence. Results: There is a moderate correlation between the results of the SF-36 and the King's Health Questionnaire. Only 21% SCI patients report normal voiding without any other form of bladder management. The type of bladder management may influence the HRQL in patients with SCI. Clean intermittent catheterization by attendant, indwelling transurethral catheterization and indwelling suprapubic catheterization are the three groups with the worst mental status. In addition, the frequency of incontinence is a strong influence on HRQL. Conclusions:The results of this study may provide a general baseline HRQL for patients with SCI. Our findings show the relationships between bladder management methods and quality of life in patients with SCI. In addition, the impact of incontinence on quality of life was also confirmed.

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“…Many patients with neurogenic bladder perform scheduled clean intermittent catheterizations (CIC) to assist with bladder emptying. However, these individuals still have a 4-fold-increased risk of UTI compared to those who do not perform CIC (2,3). Given the frequency of UTI, many neurogenic bladder patients are exposed to repeated courses of therapeutic antibiotics, thereby increasing the incidence of multidrug-resistant bacterial infections in this population.…”

mentioning

confidence: 99%

Enhanced Susceptibility to Urinary Tract Infection in the Spinal Cord-Injured Host with Neurogenic Bladder

et al. 2013

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g Neurogenic bladder predisposes to recurrent urinary tract infections (UTI) and renal failure, and susceptibility is commonly ascribed to urinary stasis from elevated residual urine volumes. Escherichia coli UTI was modeled in the spinal cord-injured (SCI) rat with the hypothesis that SCI animals would require fewer bacteria to establish infection, have an exaggerated inflammatory response, and have delayed clearance of infection compared to normal-voiding controls. T10 SCI rats and controls had median infectious doses (ID 50 ) of 10 2 and 10 5 CFU, respectively. Mean residual volumes in the SCI animals did not correlate with susceptibility to initiation of UTI or outcome. In the acute infection, control and SCI rats developed acute cystitis and pyelitis without acute differences in histopathological scores of inflammation. However, in vivo imaging of infected animals revealed persistently higher levels of bacteria in the SCI urine and bladders than were seen for controls over 2 weeks. Likewise, at 2 weeks, acute and chronic inflammatory infiltrates persisted in the bladders and kidneys of SCI rats, whereas inflammation largely resolved within the controls. Together these data demonstrate that SCI rats exhibit delayed clearance of infection and exaggerated inflammatory responses in bladders and kidneys; however, the severity of residual volumes does not predict increased susceptibility to UTI. These studies suggest that host-dependent mechanisms that are discrete from alterations in bladder physiology influence UTI susceptibility with the SCI-neurogenic bladder. This model will allow elucidation of SCI-neurogenic bladder-mediated changes in host response that yield UTI susceptibility and may lead to new preventative and therapeutic options. N eurogenic bladder refers to bladder dysfunction that is secondary to disruption of the central or peripheral nervous system pathways that regulate bladder storage and emptying. In children, the most common causes of neurogenic bladder are neural tube defects, such as spina bifida (myelomeningocele), while in adults, the most common cause is trauma-related spinal cord injury (SCI). Regardless of etiology, all patients with neurogenic bladder are at significantly increased risk for recurrent urinary tract infections (UTI) compared to the normally voiding population, with an annual incidence as high as 20 to 25% (1).A number of risk factors have been postulated for the increased susceptibility to UTI in patients with neurogenic bladder. They include urinary stasis due to elevated postvoid residual volumes, bladder overdistention, high-pressure voiding, vesicoureteral reflux, nephrolithiasis, and the use of chronic indwelling catheters. Many patients with neurogenic bladder perform scheduled clean intermittent catheterizations (CIC) to assist with bladder emptying. However, these individuals still have a 4-fold-increased risk of UTI compared to those who do not perform CIC (2, 3). Given the frequency of UTI, many neurogenic bladder patients are exposed to repeated courses of t...

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Bladder management in persons with spinal cord lesion

Cited by 40 publications

References 19 publications

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of The Midlands Centre for Spinal Injuries in Oswestry

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of The Midlands Centre for Spinal Injuries in Oswestry

The relationship between bladder management and health-related quality of life in patients with spinal cord injury in the UK

Enhanced Susceptibility to Urinary Tract Infection in the Spinal Cord-Injured Host with Neurogenic Bladder

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