Spinal cord injury (SCI) can be caused by either traumatic or non-traumatic events. The most common causes include road accidents, violence, and falls.
Men are more likely to suffer, with a male-to-female ratio of 4:1, but there is high variability in causes and profiles of those injured around the world. New figures suggest an overall incidence between 12 and 65 cases per million individuals per year and that the USA has the highest numbers of SCI caused by trauma.
The typical person with SCI is 40 years old at the time of injury, but epidemiological details reveal a bimodal age distribution. The first peak is between 18 and 29 years and involves mainly men who are injured, while the second peak is at 65 years and above, when more women are affected.
Urological complications have historically been one of the most common causes of death after SCI. However, modern interventions and better management have reduced the rate to about 13%. Neurogenic lower urinary tract dysfunction after SCI is nevertheless still common, occurring in about 74-80% of patients.
Intermittent catheterization is now best practice for bladder management after SCI. Research highlights the fact that both bladder and bowel dysfunction need to be addressed after SCI, and there are interesting new study results suggesting benefits from different kinds of therapy options. For example, nerve stimulation may be a useful treatment option for bladder dysfunction, and there are good indications for bladder and bowel benefits associated with acupuncture. Bladder and bowel symptoms secondary to SCI have a great impact on quality of life for the people affected, and finding solutions is of the highest priority, regardless of the treatment method involved.
Summary of Publications
Title
Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/29752515
Author and Origin
Hamid R, Averbeck M, Chiang H, Garcia A, Al Mousa RT, Oh SJ, Patel A, Plata M, Del Popolo G.
Worldwide
Summary
Review of worldwide epidemiological data of spinal cord injury (SCI) and associated neurogenic lower urinary tract dysfunction (NLUTD).
Conclusions
Spinal cord injury incidence varies from 12 to >65 cases per million people per year. Mean age at injury is 40 years, with incomplete tetraplegia as the most common outcome. SCI leads to NLUTD in 70-84% of cases.
Comments and Access
New and comprehensive review of SCI and NLUTD epidemiology.
Title
Surveillance and management of urologic complications after spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/29845320
Author and Origin
Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, Gousse A, Kielb S, Kraus S, Mangera A, Reid S, Szell N, Cruz F, Chartier-Kastler E, Ginsberg DA.
US
Summary
Review on complications, surveillance techniques, and strategies for management related to neurogenic lower urinary tract dysfunction after spinal cord injury.
Conclusions
It is recommended that patients should undergo an annual check including physical examination, renal functional testing, and upper tract imaging. Routine cystoscopy or urodynamic is not recommended. Urologic complications are common and often complex.
Comments and Access
Guideline recommending regular checks of the genitourinary system for surveillance and management of neurogenic lower urinary tract dysfunction after spinal cord injury.
Title
Optimal bladder management following spinal cord injury: Evidence, practice and a cooperative approach driving future directions in Australia.
https://www.ncbi.nlm.nih.gov/pubmed/29859181
Author and Origin
May Goodwin D, Brock J, Dunlop S, Goodes L, Middleton J, A AN, Wright B, Bragge P.
Australia
Summary
Australian review and clinical practice guideline regarding bladder changes following spinal cord injury.
Conclusions
Intermittent catheterization is identified as best practice but there is a delay in introducing it after the acute phase of spinal cord injury. Differences are seen between hospital and community practice.
Comments and Access
Australian best practice guideline on intermittent catheterization after spinal cord injury.
Title
Effect of spinal anterior root stimulation and sacral deafferentation on bladder and sexual dysfunction in spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/29744665
Author and Origin
Zaer H, Rasmussen MM, Zepke F, Bodin C, Domurath B, Kutzenberger J.
Denmark
Summary
Observational survey evaluating the effect of sacral anterior root stimulation with sacral deafferentation (SARS-SDAF) on bladder and sexual dysfunction in 287 people with spinal cord injury.
Conclusions
SARS-SDAF showed good satisfaction with regard to bladder emptying but lower scores for sexual performance. SARS-SDAF seems to be able to reduce the need for catheterization, both intermittent and indwelling, in cases of involuntary urine leakage.
Comments and Access
Study indicating promising results of nerve stimulation on bladder function among people with spinal cord injury.
Title
Symptoms of bowel dysfunction and their management after spinal cord injury in a New Zealand centre.
https://www.ncbi.nlm.nih.gov/pubmed/29771898
Author and Origin
Arnold EP, Losco G, English S, Frizelle F, Anthony A.
New Zeeland
Summary
Survey study of 54 patients with spinal cord injury cross-relating level of injury, AIS scale, latest urodynamic analysis with bowel symptoms and managements.
Conclusions
The study found no specific relationship between bowel sensation, bowel continence, bowel management, or bladder function.
Comments and Access
Survey study with SCI patients rating injury alongside bowel and bladder dysfunction.
Title
Spinal Cord Injury: How could acupuncture help?
https://www.ncbi.nlm.nih.gov/pubmed/29753705
Author and Origin
Fan Q, Cavus O, Xiong L, Xia Y.
China
Summary
Review of the use of acupuncture in spinal cord injury.
Conclusions
Acupuncture seems to have an effect on motor and sensory dysfunction, pain, neurogenic bowel and bladder, pressure ulcers, spasticity, and osteoporosis. Physicians are recommended to consider it for management of complications related to spinal cord injury.
Comments and Access
Review suggesting possible bladder and bowel benefits associated with acupuncture for people with spinal cord injury.
Title
The ability of prior urinary cultures results to predict future culture results in neurogenic bladder patients.
https://www.ncbi.nlm.nih.gov/pubmed/29799144
Author and Origin
Clark R, Welk B.
Canada
Summary
Observational retrospective study of urinary cultures in 146 patients with neurogenic bladder.
Conclusions
Urine cultures close in time are likely to include the same bacterial species. For example, there was 56% concordance but this decreased over time. Also, the concordance with susceptibility to antibiotics was high but did not differ over time.
Comments and Access
Study suggesting benefits of monitoring previous urine cultures in people with neurogenic bladder. This may provide useful information about future susceptibility to organisms and antibiotics.
Title
How to establish a successful bowel management programme in children: A tertiary paediatric centre experience.
https://www.ncbi.nhl.nih.gov/pubmed/29725927
Author and Origin
Costigan AM, Orr S, Alshafei AE, Antao BA.
Ireland
Summary
A retrospective review of 192 children with fecal incontinence attending a bowel management clinic, measuring their ability to achieve a regular bowel pattern and remain socially clean.
Conclusions
Children with spina bifida and Hirschprung’s disease preferred Peristeen and children with anorectal malformation and idiopathic constipation preferred Willis washout. The program was successful in 94% of cases.
Comments and Access
A retrospective review of a successful bowel management clinic for children with fecal incontinence. Different washout systems are discussed.
Title
Fecal incontinence in patients with spina bifida: The target is the rectum.
https://www.ncbi.nlm.nih.gov/pubmed/28950040
Author and Origin
Brochard C, Ropert A, Peyronnet B, Ménard H, Manunta A, Neunlist M, Bouguen G, Siproudhis L.
France
Summary
Determination of anorectal physiology in an adult spina bifida cohort.
Conclusions
This study shows that fecal incontinence is correlated to rectum dysfunction rather than anal canal or external sphincter dysfunction.
Comments and Access
Fecal incontinence in people with spina bifida is likely to be due to rectal abnormalities, which should be taken into consideration to improve treatments.
Title
Assessment of neurogenic bowel dysfunction impact after spinal cord injury using the International Classification of Functioning, Disability and Health.
https://www.ncbi.nlm.nih.gov/pubmed/29745625
Author and Origin
Pires JM, Ferreira AM, Rocha F, Andrade LG, Campos I, Margalho P, Laíns J.
Portugal
Summary
A cross-sectional phone survey with 64 patients with spinal cord injury. The survey assesses current bowel management methods, neurogenic bowel dysfunction (NBD) score, and a Likert scale questionnaire based on the International Classification of Functioning, Disability and Health (ICF) domains and quality of life (QoL).
Conclusions
There is a significant association between severity of NBD and negative QoL. The greatest impact from NBD was in personal and environmental factors in areas such as financial cost, need for assistance, emotional health, and loss of privacy.
Comments and Access
A phone-survey of 64 patients with SCI investigating NBD score and QoL with ICF domains.
This blog post is an extract of the Science Alert from June 2018 (76040-USX-20180613)
