Surveillance and management of urologic complications after spinal cord injury

Abstract

There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

“…PCPs and other health providers face uncertainty about neurogenic lower urinary tract dysfunction (NLUTD) in SCI and its complications such as UTI due to the complexity of the condition and lack of clear evidence-based guidelines. 1,2 The goal of this article is to provide insight into SCI-related NLUTD and its management.…”

Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

“…Therefore, regular urine cytological study and/or cystourethroscopy are not recommended to screen for bladder cancer in asymptomatic SCI patients (LoE 5, GoR C2). 66 On the contrary, the age at onset of bladder cancer is younger and the prevalence of bladder cancer is higher, respectively, in this population than in the general population. Furthermore, it should be noted that cancer-specific survival is lower because early detection is often difficult, and unfavorable pathological findings are frequently observed, which results in an advanced stage at diagnosis.…”

“…The sensitivity of urine cytological study and cystourethroscopy is not adequate to screen for bladder cancer, because the prevalence of bladder cancer in this population is not as high as expected. Therefore, regular urine cytological study and/or cystourethroscopy are not recommended to screen for bladder cancer in asymptomatic SCI patients ( LoE 5, GoR C2 ) …”

Management of urethrocutaneous fistulae complicating sacral and perineal pressure ulcer in neurourological patients: A national multicenter study from the French‐speaking Neuro‐urology Study Group and the Neuro‐urology committee of the French Association of Urology

“…This emphasizes the importance of patient education for the self‐management of ISC and the need for regular and adapted follow‐up to evaluate the ability to understand, accept, and perform the procedure. Moreover, the presence of urethral trauma induced by repeat ISC must be controlled by regular cystoscopy …”

“…Moreover, the presence of urethral trauma induced by repeat ISC must be controlled by regular cystoscopy. 27 Certain SPPU locations are more likely to develop UCF. Indeed, an ischial pressure ulcer, previous orthopedic surgery (ischiectomy or femoral head/neck resection), multiple pressure ulcer and osteomyelitis are recognized as major risk factors.…”