Determinants of functional recovery and length of stay in spinal cord injury inpatients: a retrospective analysis.

Systematic Review of Urological Followup After Spinal Cord Injury

Review Objective The purpose of this systematic review is to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic / neuropathic bladders. More specifically, the review questions are: What are the extrinsic and/or intrinsic factors that influence the suitability of individuals to perform self intermittent [urethral] catheterisation (SIMC)? What strategies promote long term compliance with SIMC? What are the advantages and disadvantages of using SIMC? Does SIMC improve the quality of life for people using this bladder management strategy? Criteria for considering studies for this review Types of Studies This review will incorporate the best available evidence for each of the sub-topics identified by the objectives and specific questions asked in this systematic review. Quantitative This component of the review will consider any randomised controlled trials (RCT) that examine the effectiveness of strategies to promote long term compliance with self-intermittent catheterisation. In the absence of RCT other quantitative research designs such as non-randomised experimental and quasi experimental, before and after studies, cohort studies and case series/case reports will be considered for inclusion in a narrative summary. For the remaining three sub-topics, i.e. quality of life, advantages and disadvantages of SIMC, and factors influencing suitability of individuals to perform SIMC, all quantitative research designs will be considered for inclusion. Qualitative This component of the review will consider any interpretive studies that draw on the experiences of intermittent self-catheterisation by adults for each of the sub-topics. This will include, but not be limited to, designs such as phenomenology, grounded theory and ethnography. Studies excluded from this review include: Those involving children and adolescents, i.e. > 18 years of age, Catheterisation performed by a carer or health professional, Catheterisation of a surgically created stoma, Indwelling catheters, Comparison of catheter types, Strategies to specifically reduce infection. Types of participants The review will include adults who are 18 years or older, who undertake urethral self-catheterisation for management of their neurogenic bladder dysfunction. Types of interventions/phenomena of interest The interventions, programs and strategies of primary interest are those TRUNCATED AT 350 WORDS

Retrospective analysis of medical records on spinal cord injury (SCI) patients with neuropathic bladder. To determine SCI patients' compliance with the method of bladder management they used on discharge from inpatient rehabilitation. Ankara University Medical School, Department of Physical Medicine and Rehabilitation, Spinal Cord Injury Unit, which treats patients referred from throughout Turkey. The bladder management method of 50 new SCI patients was noted at admission, discharge and follow-up. Reasons for changing the initial method were documented. For analysis, patients were grouped by gender, level and completeness of injury. Compliance with bladder management method was compared between these groups by chi-square test. The method of bladder management at admission was indwelling catheter (IC) for 86% of the patients. Most were switched to clean intermittent catheterisation (CIC) by rehabilitation discharge. Of 38 patients (76%) on CIC at discharge, 20 (52%) discontinued this method and reverted to IC during follow-up. Compliance with CIC was lower for women, for tetraplegics, and for those with complete injury. Dependence on care givers, severe spasticity interfering with catheterisation, incontinence despite anticholinergic agents, and lack of availability of external collective devices for female patients were the main reasons for low compliance with CIC. The bladder management method of SCI patients should be selected so as to be suitable to the patients' life style. Besides reducing morbidity, it also has to enhance the quality of life.

Lipid profile analysis in spinal trauma patients shows severe distortion of AA/DHA after injury

Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country.Design: Questionnaire based cross sectional surveySetting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, PakistanParticipants: All patients with SCI (irrespective of duration, level and etiology)Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis.Outcome Measures: Not applicableResults: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same ‘disposable’ catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection.Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.

People with spinal cord injury (SCI) are at increased risk of developing coronary heart disease (CHD). This study aimed at predicting CHD risk in a cohort of Saudi patients with SCI in comparison with patients without SCI and to correlate different demographic and clinical factors with Framingham Risk Score (FRS) in SCI patients. The study was conducted at the rehabilitation and the main hospitals of King Fahad Medical City, Riyadh, Saudi Arabia; on sixty patients with SCI and sixty controls of age ≥20years. FRS was calculated on a web-based calculator. For the SCI group, sub-groups were made for statistical analysis based on gender, cigarette smoking, neurological level and completeness of injury. The mean FRS for the SCI group (2±7.9) was significantly higher (P<0.001) than the control group (-2.24±3.4). The 10-year risk of developing CHD was low in 90% of the SCI group and 100% of the controls. The age, systolic blood pressure (SBP) and serum total cholesterol had a positive correlation to FRS in SCI patients and females had a significantly higher mean FRS than males (P=0.03). There was no significant relation of resultant FRS with time since SCI, smoking history and neurological level or completeness of injury. Our sample of Saudi patients with SCI had a higher FRS as compared to controls, however, majority had a low risk of developing CHD in next 10years. The age, SBP and total cholesterol surfaced as positive predictors of CHD in SCI patients. Time since SCI, smoking, and neurological level or completeness of injury did not influence the resultant FRS and thus the development of CHD.

Retrospective review of medical notes. To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). Inpatient rehabilitation unit of tertiary research hospital. Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

BackgroundIn spinal cord injury (SCI) patients, no correlation was found between the number of bladder infections per year, the period since injury, the neurologic level of the spinal cord lesion and the histopathology of the urinary bladder mucosa. The use of chronic indwelling urethral and/or suprapubic catheters in SCI patients is often associated with inflammatory and proliferative pathological conditions in neuropathic bladder.Presentation of the hypothesisWe propose a hypothesis that the type of bladder drainage in SCI patients influences the histological changes in the mucosa of neuropathic bladder. This hypothesis implies that SCI patients with long-term indwelling urinary catheters develop certain histological changes in bladder mucosa, which are seen less frequently in SCI patients, who do not use long-term indwelling catheters. The latter group includes patients, who perform regular intermittent catheterisation and those, who wear a penile sheath and empty their bladders satisfactorily by reflex voiding.We hypothesise that the following histological lesions are seen more frequently in the neuropathic bladder of SCI patients with long-term indwelling catheters.(1) Papillary or polypoid cystitis; (2) widespread cystitis glandularis; (3) moderate to severe, acute and chronic inflammatory changes in bladder mucosa; (4) follicular cystitis; (5) squamous metaplasia; and (6) urothelial dysplasiaAs per this hypothesis, it is postulated that the above pathological conditions are seen less often in SCI patients, who achieve complete, low-pressure emptying of the neuropathic bladder by regular intermittent catheterisation, and SCI patients with penile sheath drainage, who empty their bladders satisfactorily by reflex voiding.Testing the hypothesisA large prospective study of bladder biopsies in SCI patients practising different methods of bladder drainage is required to validate this hypothesis that the histological changes in bladder mucosa are related to the method of bladder drainage in SCI patients.Implications of the hypothesisWe propose a hypothesis that the method of bladder drainage in SCI patients influences histological changes in the bladder mucosa. If this hypothesis is validated, methods of bladder drainage such as intermittent catheterisation, which do not require the use of chronic indwelling catheters, should be recommended, in order to minimise adverse histological changes in the mucosa of neuropathic bladder of spinal cord injury patients.

This study aimed to investigate common complications during the chronic phase of spinal cord injury (SCI) and to assess bladder management methods and their associated complications in patients with neurogenic lower urinary tract dysfunction (NLUTD). A retrospective analysis was performed using clinical data from chronic-phase SCI patients across multiple centers in China. The study population included individuals diagnosed with SCI and admitted between January 1, 2017, and December 31, 2022. Chi-square tests were used to evaluate differences in the distribution of complications, disease duration, bladder management methods, and urinary complications. Univariate and multivariate analyses were conducted to identify risk factors for urinary complications. A total of 849 SCI patients from 28 provinces in China were included, showing significant demographic and clinical differences between traumatic SCI (TSCI) and non-traumatic SCI (NTSCI). Urinary tract infection (59.95%) and bowel-related complications, such as constipation (62.17%), were the most frequently reported complications. Additionally, the incidences of osteoporosis (38.50%), neuropathic pain (29.99%), bowel incontinence (12.06%), and hydronephrosis (11.91%) were also high. NLUTD was present in 90.58% of SCI patients. Among these, intermittent catheterization was associated with significantly lower rates of urological complications compared to indwelling catheterization (p = 0.025). Multivariate analysis identified bladder management method as a significant risk factor for urinary complications, with indwelling catheterization associated with a higher risk of urinary stones (p < 0.001) compared to intermittent catheterization. The high prevalence of bowel- and urological-related complications among Chinese SCI patients highlights the need for increased societal attention. In terms of bladder management, intermittent catheterization may provide greater benefits compared to indwelling catheterization. Further research and education are necessary to promote intermittent catheterization as a standardized bladder management approach for SCI patients.

Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. Patients with erectile dysfunction secondary to SCI were included in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 45 degrees . Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (P<0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P>0.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

Previous studies showed reorganised and/or altered activity in the primary sensorimotor cortex after a spinal cord injury (SCI), suggested to reflect abnormal processing. However, little is known about whether somatotopically specific representations can be activated despite reduced or absent afferent hand inputs. In this observational study, we used functional MRI and a (attempted) finger movement task in tetraplegic patients to characterise the somatotopic hand layout in primary somatosensory cortex. We further used structural MRI to assess spared spinal tissue bridges. We found that somatotopic hand representations can be activated through attempted finger movements in the absence of sensory and motor hand functioning, and no spared spinal tissue bridges. Such preserved hand somatotopy could be exploited by rehabilitation approaches that aim to establish new hand-brain functional connections after SCI (e.g. neuroprosthetics). However, over years since SCI the hand representation somatotopy deteriorated, suggesting that somatotopic hand representations are more easily targeted within the first years after SCI.

Spinal cord injury (SCI) patients are at increased risk of developing urolithiasis. Ureteroscopic management for stone disease in SCI patients is underreported. Endourologists face many challenges in the management of stone disease in SCI patients including decreased stone free rates (SFR), increased infection risk, increased complication rate, anatomical variation, increased comorbidity level and challenges to nursing care. We present our experience at a regional SCI centre. Retrospective data was collected from 2005-2017 from a single SCI unit for patients who underwent ureteroscopy for stone disease. A total of 21 patients underwent 41 procedures, 7 cases being a planned multi-stage approach. Bladder management included sheath catheter, urethral catheter, suprapubic catheter, intermittent self-catheterisation, mitrofanoff, and ileal conduit. Spinal cord level was cervical (71%) or thoracic (29%), with American Spinal Injury Association (ASIA) grade classification A (86%), C (9%) and D (5%). Median follow-up time for patients was 46 months. Average stone size was 27 mm (range, 5-59 mm) access was achieved 98% of patients, with an access sheath used in 63%. The SFR was 47% with a recurrence rate (RR) of 42%. The complication rate was 24% all being Clavien Dindo grade 2. Ureteroscopy in SCI can be challenging and careful multidisciplinary team planning for intervention is needed. Ureteroscopy offers a useful treatment option for SCI, however, is associated with a lower SFR and greater complication rate compared to that of the general population.

Background and Aim: Spinal cord injury (SCI) patients have an increased risk of developing urinary tract infections. The method of bladder drainage influences the risk of urinary tract infection (UTI), and most persons with SCI on per urethral continuous catheterization (CC) or clean intermittent catheterization (CIC) develop urinary tract infection. Identification and treatment of severe UTI with appropriate antibiotics as early as possible is associated with better outcomes in SCI patients. The aim of this study was to determine the prevalence and causative organisms of symptomatic urinary tract infection in spinal cord injury patients with different bladder management methods. Materials and Methods: A total of 50 patients with SCI were followed up at a rehabilitation centre from Jan 2020 to Dec 2021 in a prospective descriptive study. The demographic status, clinical and laboratory findings of the patients with SCI were studied and the prevalence and causative organisms of symptomatic UTI in these patients with different bladder management methods were analysed. Results: The commonest organisms isolated were E. coli (31%), Pseudomonas (29%) and Klebsiella (21%). The organisms isolated in the UTI were most sensitive to colistin (82%), followed by 59% being sensitive to both imipenem and tigecycline. Least sensitivity was seen to Piperacillin, Ceftriaxone and Levofloxacin. Maximum UTI episodes were seen in cases with CC followed by CIC. Least UTI episodes were seen in cases where supra-pubic cystostomy was done followed by patients who were self-urinating. Conclusion: Symptomatic UTI in SCI patients is more prevalent in patients with CC and CIC. Such patients should be started as early as possible on antibiotics depending on the antibiotic sensitivity pattern of the organisms isolated.

To disseminate the concept of community care waiting lists for spinal cord injury (SCI) patients with particular reference to carer support for management of neuropathic bladder by a regime of intermittent catheterisation. The surgical waiting list focuses only on operative procedures, and ignores the wider requirements for ensuring satisfactory rehabilitation of people with spinal cord injury in the community. A community-care waiting list for individuals with spinal cord injury should include the following aspects of community care: (1) Home adaptation; (2) Provision of appropriate mobility needs (including wheelchair and cushion); (3) Equipment for comfortable living (including provision of hoist, pressure relieving mattress); (4) Psychological support for spinal cord injury patients and their partners; (5) Nursing home or residential care placement where appropriate; (6) Carer support for global management of complex needs associated with spinal cord injury (eg neuropathic bladder and bowel). Whereas full physical adaptation of the home can wait for some time after discharge, carer support for intermittent catheterisation is required from the first day after discharge from a spinal unit. Lack of such support means that some SCI patients are discharged with long-term indwelling urinary catheters, even though clean intermittent catheterisation is known to be the safest regime for managing the neuropathic bladder. Therefore, the absence of a community care waiting list means that best practice cannot be achieved for some tetraplegic subjects. We believe that a community care waiting list for bladder management will help to provide optimum care for neuropathic bladder and, hopefully, reduce the complications related to long-term indwelling catheters in spinal cord injury patients.

Retrospective review of prospective database. To define the variability of neurologic examination and recovery after nonpenetrating complete thoracic spinal cord injuries (American Spinal Injury Association [ASIA] A). Neurologic examinations after spinal cord injury (SCI) can be difficult and inconsistent. Unlike cervical SCI patients, alterations in thoracic (below T1) complete SCI (ASIA A-based on the ASIA Impairment Scale [AIS]) patients' examinations are based only on sensory testing, thus changes in the neurologic level (NL) are determined only by sensory changes. A retrospective review of the placebo control patients in a multicenter prospective database used for the pharmacologic trial of Sygen. Patients were included if they had a complete thoracic SCI on initial evaluation, with completed ASIA examinations at follow-up weeks 4, 8, 16, 26, and 52. Specifically, pin prick (PP) and light touch (LT) were assessed and the absolute change was calculated as the number of spinal levels at a given observation time. Three thousand one hundred sixty-five patients were initially screened for the Sygen clinical trial, of which 51 were the control placebo patients used in this analysis. Alterations from the baseline examination (PP and LT) were fairly consistent and the median change/recovery in neurologic examination was 1 spinal level. Across all observations postbaseline, the average change for PP was 1.48 +/- 0.13 (mean +/- SE), and for LT, 1.40 +/- 0.13. There were equal proportions of directional changes (none, improved, lost). Changes in a thoracic complete (ASIA A) SCI patients ASIA examination as measured through sensory methods (PP/LT) are fairly uncommon. The overall examination had only 1- to 2-level variability across patients, indicating minimal change in the sensory examination over the follow-up period. Stability in the ASIA examination as measured through sensory methods has thus been demonstrated over time, making it an excellent tool to monitor changes in neurologic function.