Bladder management and urological complications in patients with chronic spinal cord injuries in Taiwan

Abstract

ObjectivesNeurogenic voiding dysfunction (NVD) results in lower urinary tract symptoms and upper urinary tract complications. Management of urinary tract dysfunction in patients with spinal cord injury (SCI) must be based on patient needs and urological complications. This study surveyed the bladder management and urological complications in patients with SCI in Taiwan. Materials and methodsA total of 894 patients with SCI were surveyed throughout Taiwan over a period of 5 years (2007–2011). All patients received neurological and urological examinations, renal sonography, bladder sonography, and urinalysis. They were further requested to report urinary tract infections (UTI), voiding conditions, and bladder management in the past 3 years. The bladder management and urological complications were analyzed based on different SCI levels and duration of disease. ResultsAmong all patients, 39.7% voided spontaneously or by reflex, 23.8% used percussion to void, 20.9% voided by abdominal pressure, 18.1% used clean intermittent catheterization (CIC), and 22.9% had indwelling catheters or cystostomy. Detrusor sphincter dyssynergia (DSD) was noted in 39.7% of patients and autonomic dysreflexia (AD) in 19.9%. UTI was noted in 483 (54%) patients, hydronephrosis in 110 (12.3%) patients, and severe urinary incontinence in 257 (28.7%) patients. UTI occurred significantly more often in patients without, than with normal voiding. CIC was more frequently used in patients with duration of SCI < 1 year, but the rate of CIC significantly decreased as the duration of SCI increased. ConclusionThe rates of urological complications in patients with chronic SCI remained high in this survey in Taiwan. Patients with a duration of SCI > 5 years chose indwelling catheters or a cystostomy more often than CIC.