Science Alert: Neurogenic lower urinary tract dysfunction from 3 perspectives - spinal cord injury, spina bifida, and multiple sclerosis.

Posted by Maria Åberg Håkansson, January 30, 2019

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One common reason behind lower urinary tract dysfunction is neurological damage secondary to spinal cord injury (SCI), spina bifida, or multiple sclerosis. Even though the everyday situation is different for people living with these conditions, they share many problems linked to their bladder.

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Spinal cord injury

People experiencing a traumatic spinal cord injury face many life-changing consequences of their injury. These changes affect their quality of life and require adaptations, but people tackle this in different ways. New research explores these differences to gain a deeper understanding in what factors have an impact on individuals' quality of life definitions, appraisals, and adaptations after spinal cord injury.

Bladder and urological complications are common and experienced by many people after spinal cord injury. These complications are also often behind the need to seek healthcare after injury, which occurs about three times per person during the first year after injury. From a long-term perspective, bladder problems seem to be consistent over time, and both overactive and underactive bladder are common.

In the future, it is likely that UTIs can be prevented to a larger extent also for those who are using a catheter because of a spinal cord injury. New results show promising findings on the use of an immune-stimulating vaccine (Uro-Vaxom®) for prophylactic therapy of UTIs in 136 persons with spinal cord injury. The use of the vaccine seemed to be able to reduce the proportion of patients suffering recurrent UTIs from 93% to 60%. The effect was significant among both patients who use catheters and those who do not.

Spina bifida

The problems facing children and adults living with spina bifida are similar to those experienced after a traumatic spinal cord injury. The need to actively manage their bladder is a common scenario and catheter use is a central therapy. For this group of people, there is also evidence in favor of using intermittent instead of indwelling catheters to lower the risk of UTI. A new study shows that the incidence of UTI can be reduced from 2.8 episodes per year to 1.1 episodes per year after introducing intermittent catheterization. Another study also shows that intermittent catheterization is preferable to pressure voiding with the Valsalva maneuver, as this can be harmful and cause prolapse.

Multiple sclerosis

Many people with multiple sclerosis develop neurogenic lower urinary tract dysfunction. The onset may vary in time and symptoms, but regardless of this, the kidneys are at risk. A new study shows that kidney changes occur among people with multiple sclerosis, and decreased kidney function is seen in about 3% of patients. This suggests that proactive monitoring and control of bladder function among people with multiple sclerosis is warranted.

 

 

Summary of Publications


Title

Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model. 
https://www.ncbi.nlm.nih.gov/pubmed/30188802    

Author and Origin

Rohn EJ, Tate DG, Forchheimer M, DiPonio L.
USA

Summary

Observational survey of 40 persons with spinal cord injury aimed at understanding individuals' quality of life (QOL) definitions, appraisals, and adaptations.

Conclusions

The Schwartz and Sprangers response shift model was used to clarify changes in QOL after spinal cord injury. Active engagement to maintain QOL, redefinition of QOL, and a relative lack of response shift were all identified. 

Comments and Access

Study exploring QOL adaptations and changes after spinal cord injury by applying a contextual setting. 


Title

Self-reported health problems and prioritized goals in community-dwelling individuals with spinal cord injury in Sweden.
https://www.ncbi.nlm.nih.gov/pubmed/30225513    

Author and Origin

Divanoglou A, Augutis M, Sveinsson T, Hultling C, Levi R.
Sweden

Summary

Observational survey of health problems and functional goals among 203 community-dwelling individuals with spinal cord injury.

Conclusions

33% reported living with less than 2 unbearable physical or psychological problems. Problems related to bladder and balance seem to be consistent while others (e.g. type of pain, excessive weight) seem to vary.

Comments and Access

Epidemiological data on self-reported problems and goals associated from people with spinal cord injury. Bladder problems seem to be consistent over time.


Title

Healthcare utilization following spinal cord injury: Objective findings from a regional hospital registry.
https://www.ncbi.nlm.nih.gov/pubmed/30277845 
 

Author and Origin

Sikka S, Callender L, Driver S, Bennett M, Reynolds M, Hamilton R, Warren AM, Petrey L.
USA

Summary

Observational retrospective study of healthcare use during the first year after injury among 591 persons with spinal cord injury.

Conclusions

58% had additional healthcare use with a median of 3 visits per person. Some of the most common reasons to seek care were pressure ulcer, neurogenic bowel/bladder, and urinary tract infection.

Comments and Access

Epidemiological data on healthcare use among people with spinal cord injury. Urological complications are among the most common reasons for seeking healthcare.


Title

Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catherization.
https://www.ncbi.nlm.nih.gov/pubmed/30277852 

Author and Origin

Neyaz O, Srikumar V, Equebal A, Biswas A.
India

Summary

Observational prospective study of urodynamic changes and urinary tract infection (UTI) in 31 persons with spinal cord injury, practicing intermittent catheterization.

Conclusions

Both overactive (n = 15) and underactive (n = 16) bladder were verified in the sample. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive bladder group. 

Comments and Access

Epidemiological data of intermittent catheterization use and occurrence of UTI in people with spinal cord injury.


Title

Urinary tract infections and bladder management over the first year after discharge from inpatient rehabilitation.
https://www.ncbi.nlm.nih.gov/pubmed/30374411 

Author and Origin

Stillman MD, Hoffman JM, Barber JK, Williams SR, Burns SP.
USA

Summary

Observational, retrospective analysis of bladder complications during the first year after discharge in 169 patients with spinal cord injury. 

Conclusions

The cumulative incidence of urinary tract infection (UTI) was 71%, and 27-46% of subjects reported UTIs during each 3-month period. Subjects who were spontaneous voiders had fewer UTIs than those using a catheter.

Comments and Access

Study exemplifying the high incidence of UTI during the first year after spinal cord injury.


Title

Effects of oral immunomodulation therapy on urinary tract infections in individuals with chronic spinal cord injury-A retrospective cohort study.
https://www.ncbi.nlm.nih.gov/pubmed/30350886 

Author and Origin

Krebs J, Fleischli S, Stoyanov J, Pannek J.
Switzerland

Summary

Observational, retrospective study of the use of immune-stimulating vaccine (Uro-Vaxom®) as prophylactic therapy for urinary tract infections (UTI) in 136 persons with spinal cord injury.

Conclusions

Using the vaccine seemed to reduce the proportion of patients with recurrent UTIs from 93% to 60%. The effects were significant among both catheter users and non-catheter users.

Comments and Access

One of the first studies evaluating the use of UTI vaccine in people with neurogenic lower urinary tract dysfunction, secondary to spinal cord injury. 

Read the Publication Highlight


Title

The effects of augmentation cystoplasty and botulinum toxin injection on patient-reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization.
https://www.ncbi.nlm.nih.gov/pubmed/30375055 

Author and Origin

Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, Rosenbluth J, Jha A, Patel D, Welk B; Neurogenic Bladder Research Group (NBRG. org).
USA

Summary

Observational, prospective study in 879 patients practicing intermittent catheterization after spinal cord injury.

Conclusions

67% used catheterization alone, 19% together with Botox, and 15% with a reconstructed bladder. Intermittent catheterization with a reconstructed bladder was associated with the greatest improvement in quality of life.

Comments and Access

Study exemplifying how intermittent catheterization adherence and outcomes after spinal cord injury may be improved by bladder augmentation. 


Title

Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective.
https://www.ncbi.nlm.nih.gov/pubmed/30346256

Author and Origin

AlSaleh AJ, Qureshi AZ, Syamsuddin Abdin Z, Mushabbab AlHabter A.
Saudi Arabia

Summary

Observational survey of bladder management methods in 50 persons with spinal cord injury. 

Conclusions

41 patients were discharged on intermittent catheterization but 11 stopped within 3 months, mainly due to lack of accessibility and financial support. There was a reported lack of education regarding bladder management. 

Comments and Access

Survey showing accessibility and financial barriers to intermittent catheterization that affect long-term adherence.  


Title

Intermittent Catheterization and Urinary Tract Infection: A Comparative Study Between Germany and Brazil.
https://www.ncbi.nlm.nih.gov/pubmed/30260906 

Author and Origin

Faleiros F, Käppler CO, Rosa T, Gimenes FRE.
Brazil

Summary

Observational survey of 200 intermittent catheter users in Brazil and Germany, investigating factors that affect urinary tract infection (UTI) rates in people with spina bifida.

Conclusions

Although differences were seen in age and technique, starting intermittent catheterization significantly reduced the incidence of UTI (2.8 episodes per year before vs 1.1 episodes per year after introduction, P < .001). 

Comments and Access

Study providing real world evidence supporting reduction in UTI rate with intermittent catheterization in people with spina bifida. 


Title

Risk of prolapse and urinary complications in adult spina bifida patients with neurogenic acontractile detrusor using clean intermittent catheterization versus Valsalva voiding.
https://www.ncbi.nlm.nih.gov/pubmed/30311685 

Author and Origin

El Akri M, Brochard C, Hascoet J, Jezequel M, Alimi Q, Khene ZE, Richard C, Bonan I, Kerdraon J, Gamé X, Manunta A, Siproudhis L, Peyronnet B.
France

Summary

Observational, retrospective study comparing voiding with Valsalva or intermittent catheterization among 55 adult spina bifida patients.

Conclusions

After a follow-up of 5-6 years, rectal prolapse/intussusception was higher among Valsalva users (32%) than in catheter users (4%). Vaginal prolapse was also more common among Valsalva users (33% vs 11%).

Comments and Access

Study suggesting that Valsalva voiding can be harmful in adult spina bifida patients and that intermittent catheterization is preferable.  


Title

Assessment of renal deterioration and associated risk factors in patients with multiple sclerosis.
https://www.ncbi.nlm.nih.gov/pubmed/30267726 

Author and Origin

Shakir NA, Satyanarayan A, Eastman J, Greenberg BM, Lemack GE.
USA

Summary

Observational retrospective study of renal deterioration in 355 patients with multiple sclerosis (MS), followed for 6 years. 

Conclusions

3% had renal deterioration, and overactive bladder was associated with decrease in renal function. This suggests that active monitoring and control in MS patients is warranted.

Comments and Access

Epidemiological data on kidney changes in people with MS, most likely linked to development of neurogenic lower urinary tract dysfunction. 


 Read the Publication Highlight


This blog post is an extract of the Science Alert from November 2018 (76040-USX-20181113) 

Topics: Neurogenic bladder, Spinal Cord Injury (SCI), Multiple Sclerosis (MS)