Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary?

Abstract

Study Design: Prospective, non-randomized study. Objectives: To assess the incidence of urinary tract infection after urodynamics in patients with spinal cord injury. Setting: Outpatient clinic of a university hospital in Germany. Methods: Urinary tract infection and clinical symptoms in 109 consecutive outpatients with spinal cord injury following urodynamic evaluation were studied. Results: Data from 72 patients were evaluable. Of these, seven patients (9.7%) developed a significant urinary tract infection. Five of these were symptomatic. Pre-existing asymptomatic bacteriuria was not associated with a higher risk for post-interventional infection. The technique of the bladder management did not correlate with urinary tract infection rates. Conclusion: In this study, symptomatic urinary tract infections after cystometry were not infrequent. Therefore, it seems that antibiotic prophylaxis cannot be omitted in patients with spinal cord injury undergoing urodynamic investigation.

Factors Related to the Occurrence of Urinary Tract Infection Following a Urodynamic Study in Patients With Spinal Cord Injury

“…Latthe et al [17] reported that significant bacteriuria decreased by 40% after prophylactic antibiotic therapy, and Foon et al [13] reported that prophylactic antibiotic therapy reduced the risk of significant bacteriuria compared with that in the placebo group and it also decreased the risk of hematuria. Pannek and Nehiba [18] reported the occurrence of significant UTI in 9.7% of outpatients with demonstrable symptoms and concluded that prophylactic antibiotic therapy should be prescribed to patients with SCI who are about to undergo UDS, since the therapy is relatively safe. There are no standardized criteria for prescribing prophylactic antibiotic therapy for patients who are going to receive a UDS.…”

Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury

“…Cystometry is a urodynamic procedure that measures the filling and voiding functions of the lower urinary tract. It is indicated for diagnostic and monitoring purposes in human patients who show clinical signs of urinary incontinence, including those caused by neurogenic lower urinary tract dysfunction . Data on intravesical pressure, bladder storage capacity, detrusor overactivity, and bladder compliance can be obtained using this diagnostic tool.…”

Antibiotic Use for Urodynamics: A Comprehensive Review that Informs Local Practice

“…5,7 Spinal cord injured patients who perform clean intermittent catheterization have a higher incidence of significant UTI after UDS (8.3%) compared to those patients who empty their bladders by reflex voiding (1.4%). 28 The overall incidence of significant UTI was 7 of 72 (9.7%). Clear distinctions between asymptomatic bacteriuria and significant UTI were made.…”

“…3,19,23,30 However, despite these measures postinterventional complications continue to occur. 11,28 The majority of low risk patients could be treated expectantly, warranting thorough patient education and clear guidelines. The benefits of antibiotic use should be balanced with the risk of UTI, adverse reactions, susceptibility profiles and cost benefit analysis of widespread antibiotic prophylaxis.…”