Influence of bladder management on epididymo-orchitis in patients with spinal cord injury: clean intermittent catheterization is a risk factor for epididymo-orchitis

Abstract

Study design: Retrospective study, based on cases of spinal cord injury (SCI). Objectives: To establish hazard ratios for risk of epididymo-orchitis in SCI. Setting: South Korea. Methods: A total of 140 male patients injured before 1987 were eligible for this investigation and have been followed up on a yearly basis from January 1987 to December 2003. Results: The average age at which the lesion occurred was 24.8 years old (range, 18-53). The average time since SCI was 16.9 years (range, 1-37). A total of 34 lesions (24.3%) were complete and 106 (75.7%) were incomplete. Over the 17 years, 39 patients (27.9%) were diagnosed with epididymo-orchitis. Epididymo-orchitis was more common for patients with a history of urethral stricture (66.7 versus 25.2%, P ¼ 0.014). We also found that epididymo-orchitis was more common for patients on clean intermittent catheterization (CIC) than with indwelling urethral catheterization (42.2% versus 8.3%, P ¼ 0.030). In multivariate analysis, patients on CIC had a 7.0-fold higher risk (odds ratio, 6.96; 95% confidence interval, 1.26-38.53; P ¼ 0.026); however, a history of urethral stricture lost statistical significance (P ¼ 0.074). For other variables, no positive association with epididymo-orchitis was observed. Conclusions: In this study, CIC was an independent risk factor for the development of epididymo-orchitis in patients with SCI. In addition, our findings suggest that urethral stricture may be a contributing factor for the development of epididymo-orchitis in these patients. Correct instructions about CIC are of utmost importance.

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

“…However, it would be expected that as an SPT avoids contact with the structures adjacent to the urethra, there would be fewer complications in that area and this has been shown in earlier studies. 11 With a larger number of patients, it is reasonable to expect that this would become significant.…”

Influence of Different Urination Methods on the Urinary Systems of Patients with Spinal Cord Injury

“…In a healthrelated quality of life survey using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) in 132 patients with spinal cord injury who were on CIC, Oh et al 18 found that, compared with the general population, patients' quality of life was significantly lower in all the SF-36 health domains. In a retrospective study of 140 male patients with spinal cord injury who used CIC or indwelling catheterization, Ku et al 19 found that the incidence of epididymo-orchitis was significantly higher in patients who used CIC compared with those who used indwelling urethral catheterization (42.2% versus 8.3%). Additionally, Liu et al 20 found that CIC performed by an attendant was related to the worst mental status in patients with spinal cord injury compared with other bladder management methods including normal voiding, reflex voiding and bladder expression.…”

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

“…1 The most common causes of AD are bladder distension, bowel distension and defecation. 3 In patients with SCI, modern urologic teaching has supported the avoidance of indwelling urinary catheters 5 and recommended clean intermittent catheterization (IC) as the safest bladder management method in terms of urological complications, 6 although reflex voiding is used in some cases. Improvement in the management of neurogenic bladder has dramatically reduced the number of deaths from urinary complications.…”

“…Improvement in the management of neurogenic bladder has dramatically reduced the number of deaths from urinary complications. 5 Conversely, little progress has been made in bowel management in patients with SCI because bowel-related problems are not usually life-threatening. Manual removal of stool could be associated with complications such as damage to the anorectal mucosa and anal sphincter in the anesthetized area.…”