Diagnosis and Localization of a Complicated Urinary Tract Infection in Neurogenic Bladder Disease by Tubular Proteinuria and Serum Prostate Specific Antigen

Abstract

Introduction: Urinary tract infection is the most frequent complication occurring in patients with spinal cord injuries and can cause renal failure and male infertility. We used the urinary a-1-microglobulin (a1Mg) as a marker for pyelonephritis and the serum prostate specific antigen (PSA) as a marker for prostatitis with reference to the currently available methods. The aim of our study is (1) to diAerentiate between upper (pyelonephritis) and lower urinary tract infection (cystitis, prostatitis) in neurogenic bladder disease, (2) to determine if high (438.58C) fever in a neurogenic bladder disease patient was due to urological (prostatitis, pyelonephritis) causes or not. Patients and methods: We evaluated 147 patients of whom 27 had acute pyelonephritis, 16 had prostatitis with fever, 13 had chronic pyelonephritis, 68 had cystitis; 23 were control patients of whom nine had fever (438.58C) and 14 did not. The diagnoses and localizations were made on the basis of clinical evidence, with a CT scan, urography, bladder wash-out tests, and five glass-specimen tests. The urinary a1Mg was determined using latex enhanced immunonephelometry and the serum PSA was measured using RIA. Results: For the urinary a1Mg, the sensitivity is 96% and the specificity 93% for the diagnosis of acute pyelonephritis. The serum PSA has a sensitivity of 69% and specificity of 96% in the diagnosis of prostatitis. The urinary a1Mg has a sensitivity of 96% and a specificity of 56% and the serum PSA has a sensitivity of 68% and a specificity of 100% in the diAerential diagnosis of prostatitis and pyelonephritis. The best discriminative parameter between pyelonephritis and prostatitis was the urinary a1Mg/serum PSA ratio with a sensitivity of 92% and specificity of 88%. Conclusion: Upper-tract infection with fever can be diagnosed in neurogenic bladder disease by determining the urinary a1Mg. In male patients, the serum PSA should be determined to distinguish upper-tract infection from prostatitis. High fever does not significantly influence our parameters so that we can diAerentiate whether or not high fever is due to urological causes.