Science Alert: Spinal Cord Injury – Beginning of A New Life

Posted by Maria Åberg Håkansson, April 10, 2018

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A spinal cord injury (SCI) is a severe health condition that changes lives in many ways. For this reason, there is a strong research focus on preventing injury and improving outcomes. Recent research has used examples of different aspects of SCI, either from birth (e.g. spina bifida) or as a result of injuries later in life, for example after an accident.

wellspect-science-alert-bladder-and-bowel

A recent study shows that SCI is much more than ‘only survivable’ and that SCI is not incompatible with getting pregnant. In fact, pregnancy in women with SCI has generally good outcomes and is associated with acceptable risks. However, close monitoring, medication adjustments, and changes in bladder management may still be required. Another study explores sexual dysfunction and quality of life among sexually active women with spina bifida. The results show that even though sexual dysfunction is common, occurring in about 55% of cases, improvement may be possible by solving problems with urinary incontinence. Depression is also a disease traditionally associated with SCI. New epidemiological data only partially confirms this ‘truth’ and suggests that only certain factors (presence of pain, pressure ulcers, and a lower education level) predict depression, while others, such as use of intermittent catheterization as opposed to normal urine voiding, do not seem to have any major impact.

SCI often requires some kind of active bladder management. Research based on 5250 people with spina bifida from the US National Spina Bifida Patient Registry shows that bladder management differs between adults and younger patients and that intermittent catheterization is common, performed by 77%. For this reason, urological follow-up is important but practice patterns seem to vary around the world. Clinical practice guidelines recommend that urological follow-up after SCI should include medical history, clinical examination, renal laboratory tests, imaging surveillance, urodynamics, and cystoscopy. At the same time, major differences between care patterns are reported from high versus low-resource countries, showing that access to more advanced levels of care leads to better outcomes and life expectancy for people with SCI.

In addition to bladder management, bowel care is often necessary after SCI. Unfortunately, this medical need may be of lower priority for healthcare professionals, as there is still a stigma surrounding discussion of this area, and there is a lack of general standards covering bowel care.

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Summary of Publications

Bladder management during pregnancy in women with spinal-cord injury: an observational, multicenter study.

https://www.ncbi.nlm.nih.gov/pubmed/29600402 

Author and Origin

Andretta E, Landi LM, Cianfrocca M, Manassero A, Risi O, Artuso G.
Italy

Summary

Observational survey of bladder management in 52 pregnant women with spinal cord injury.

Conclusions

Pregnancy in women with spinal cord injury generally has good outcomes and limited risks, but often requires changes in bladder management, such as increased use of intermittent catheterization.

Comments and Access

Epidemiology data on bladder management among pregnant women with spinal cord injury. 
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Sexual function and quality of life in women with spina bifida: Are the women with spina bifida satisfied with their sexual activity?

https://www.ncbi.nlm.nih.gov/pubmed/29521435 

Author and Origin

Choi EK, Kim SW, Ji Y, Lim SW, Han SW.
South Korea

Summary

Observational survey evaluating sexual function and its impact on quality of life in 44 women with spina bifida.

Conclusions

Sexual dysfunction was common and seen in 55% of sexually active women with spina bifida. Urinary continence was associated with better sexual function. There was a weak positive correlation between quality of life and sexual function.

Comments and Access

Study exploring sexual function among women with spina bifida. The results suggests that urinary continence is one contributor to better sexual function.


Depressive mood in individuals with spinal cord injury (SCI) living in Greece.

http://dx.doi.org/10.1038/s41393-018-0093-z 

Author and Origin

Tzanos IA, Mavrogenis A, Gioti K, Papaggeloppoulos P, Panagiotopoulos E.
Greece

Summary

Observational survey of depression in 164 people with spinal cord injury living in Greece.

Conclusions

The prevalence of major depressive disease was 18% and it was associated with presence of pain, pressure ulcers, and a lower education level. There was no difference found between users of intermittent catheterization and those with normal voiding.

Comments and Access

Epidemiological data from Greece presenting relatively low levels of depression among people living with spinal cord injury.


Bladder Management and Continence Outcomes in Adults with Spina Bifida: Results from the National Spina Bifida Patient Registry 2009-15.

https://www.ncbi.nlm.nih.gov/pubmed/29588216 

Author and Origin

Wiener JS, Suson KD, Castillo J, Routh JC, Tanaka S, Liu T, Ward E, Thibadeau J, Joseph D; National Spina Bifida Patient Registry.
US

Summary

Observational retrospective study on bladder management in 5250 people with spina bifida from the US National Spina Bifida Patient Registry.

Conclusions

Bladder management differed between adults and younger patients, but intermittent catheterization was common, performed by 77%. Continence was associated with age, type of injury, and employment status.

Comments and Access

Epidemiology data on bladder management, continence, and intermittent catheter use among people with spina bifida.


Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury.

https://www.ncbi.nlm.nih.gov/pubmed/29569211 

Author and Origin

Przydacz M, Chlosta P, Corcos J.
Canada

Summary

Review and clinical practice guideline regarding urological follow-up of patients after spinal cord injury.

Conclusions

Practice patterns for urological follow-up of people with spinal cord injury vary around the world. It is recommended to include medical history, clinical examination, renal laboratory tests, imaging surveillance, urodynamics, and cystoscopy.

Comments and Access

Clinical practice guideline for urological follow-up of people with spinal cord injury.


Current and future international patterns of care of neurogenic bladder after spinal cord injury.

https://www.ncbi.nlm.nih.gov/pubmed/29605828 

Author and Origin

Gomelsky A, Lemack GE, Castano Botero JC, Lee RK, Myers JB, Granitsiotis P, Dmochowski RR.
US

Summary

Review of international patterns of bladder management for people with spinal cord injury.

Conclusions

There are differences between care patterns. For example, established patterns and low mortality rates in high-resource countries versus inadequate intermittent catheterization supplies in many low-resource countries.

Comments and Access

Review summarizing different countries’ care pattern of neurogenic bladder secondary to spinal cord injury.


Bladder Management in Children: Intermittent Catheterization Education.

https://www.ncbi.nlm.nih.gov/pubmed/29499121 

Author and Origin

Fortuna SM, Korcal L, Thomas G.
US

Summary

Review of indications, problems, and best practice recommendations associated with intermittent catheterization bladder management in children.

Conclusions

Intermittent catheterization is a safe method that is associated with many benefits such as reduced infections, preserved renal function, improved continence, and improved self-esteem and body image.

Comments and Access

Practical guide and education for intermittent catheterization use in children, encouraging progressive independence.


Experience of Nurses Caring for Patients With Neurogenic Bowel Dysfunction: A Qualitative Study.

https://www.ncbi.nlm.nih.gov/pubmed/29521927  

Author and Origin

Todd C, Woodward S.
UK

Summary

A qualitative study of 11 registered nurses who provided bowel care to patients following spina cord injury.

Conclusions

Nurses were motivated by the medical need for bowel care but often saw it as low priority due to the unpleasant nature, and displayed avoidance tactics. Standardization of bowel care training may reduce the stigma.

Comments and Access

Qualitative study of nurses’ perception of bowel care in people with neurogenic bowel dysfunction as a result of spinal cord injury.

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This blog post is an extract of the Science Alert from April 2018 (76040-USX-20180409)

Topics: Science Alert, Spinal Cord Injury (SCI)