A Comparative Study of Ultrasound Examination of Urinary Tract Performed on Spinal Cord Injury Patients with No Urinary Symptoms and Spinal Cord Injury Patients with Symptoms Related to Urinary Tract: Do Findings of Ultrasound Examination Lead to Changes in Clinical Management?

Bakul M Soni,Peter L Hughes,Subramanian Vaidyanathan

doi:10.1100/tsw.2006.382

Abstract

Findings of ultrasound examination of the urinary tract and changes in clinical management, which were instituted on the basis of ultrasound examination, were compared between two groups of spinal cord injury patients. Group 1 had no urinary symptoms when they underwent the scan, whereas group 2 was comprised of patients with symptoms pertaining to the urinary tract. Between 2000 and 2006, ultrasound examination of the urinary tract was performed in 87 spinal cord injury patients who had no urinary symptoms when they underwent the ultrasound scan. No abnormality was found in 63 patients. The ultrasound scan showed some abnormality of the urinary tract in 24 patients (simple cyst in the kidney: 4; reduced size of a kidney: 3; increased echogenicity of left kidney: 1; prominent extrarenal pelvis and mild calyceal dilatation: 1; slightly dilated renal pelvis and calyceal system: 1; pelvic kidney showing mild hydronephrosis: 1; foetal lobulation of kidney: 2; multicystic kidney with no interval change in the appearance since last examination: 1; 2-cm-diameter parapelvic cyst: 1; small renal calyceal calculus: 5; a little cortical scarring bilaterally: 1; focal renal scar: 2; generalised thinning of renal cortex: 3; increase in renal sinus fat: 3; trabeculated bladder: 2; small vesical diverticulum: 1; mild generalised bladder wall thickening: 1; small residual urine in postvoid scan; 2). No specific interventions were performed in these patients on the basis of ultrasound findings. In Group 2, ultrasound examination revealed serious abnormalities such as hydronephrosis, pyonephrosis, vesical calculi, vesical polyp in 20 of 21 patients, and all 20 patients required therapeutic intervention on the basis of ultrasound scan findings.In conclusion, routine ultrasound examination of the urinary tract in spinal cord injury patients who have no urinary symptoms may not be justifiable in terms of cost effectiveness; limited hospital resources should be directed to spinal cord injury patients with urinary symptoms so that ultrasound examination and therapeutic interventions based on ultrasound findings are carried out expeditiously.

Highlights

Ozer and Shannon from McGuire VA Medical Center, Richmond, Virginia[1] performed ultrasound scan of kidneys in 52 unselected spinal cord injury patients who returned to the spinal centre for their annual checkups; 36 patients did not have histories of urinary symptoms and renal ultrasound alone discovered no treatable pathology
Routine ultrasound examination of the urinary tract in spinal cord injury patients who have no urinary symptoms may not be justifiable in terms of cost effectiveness; limited hospital resources should be directed to spinal cord injury patients
These authors concluded that effectiveness of the ultrasound scan of kidneys in follow-up of spinal cord injury patients would be maintained in the demonstration of treatable disease by the selective use of renal sonography only in those patients with histories of urinary symptoms. The aim of this pilot study is to find out whether ultrasound examination of the urinary tract in spinal cord injury patients who do not have urinary symptoms when the ultrasound scan is performed is justifiable in our clinical setup. If this pilot study shows that the findings of ultrasound scan do not lead to changes in clinical management, we may omit routine ultrasound examination of the urinary tract in spinal cord injury patients who do not have symptoms related to the urinary tract

Summary

Introduction

Ozer and Shannon from McGuire VA Medical Center, Richmond, Virginia[1] performed ultrasound scan of kidneys in 52 unselected spinal cord injury patients who returned to the spinal centre for their annual checkups; 36 patients did not have histories of urinary symptoms and renal ultrasound alone discovered no treatable pathology. Renal ultrasound did show treatable disease in 2 of 16 patients with urinary symptoms These authors concluded that effectiveness of the ultrasound scan of kidneys in follow-up of spinal cord injury patients would be maintained in the demonstration of treatable disease by the selective use of renal sonography only in those patients with histories of urinary symptoms. The aim of this pilot study is to find out whether ultrasound examination of the urinary tract in spinal cord injury patients who do not have urinary symptoms when the ultrasound scan is performed is justifiable in our clinical setup. We can direct health care resources, which are not available ad infinitum, to those spinal cord injury patients with urinary symptoms so that ultrasound examination and therapeutic interventions are carried out promptly in these patients

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Conclusion