Recurrent urinary tract infection (UTI) is a common problem for people with spinal cord injury (SCI). In fact, UTIs are still among the leading causes of death in people with a neurogenic bladder who experience on average 2 UTI events every year.
The great need for antibiotic treatment and the high prevalence of antibiotic-resistant bacteria mean that UTIs are getting more expensive and more difficult to treat, and alternative solutions are needed. Bladder irrigations are one of the alternative treatments that have been investigated, and recent research suggests possible benefits from using chlorhexidine on people with spinal cord injury and recurrent UTI. The results showed that bacteriuria was temporarily reduced by daily bladder irrigations, but further research is needed to verify the possible clinical benefits of such an effect.
Occurrence of UTI in people with spinal cord injury is often linked to bladder management method; today's standard treatment involves intermittent catheterization (with single-use hydrophilic catheters) in favor of indwelling urethral catheters. The latter have been shown to increase the risk of UTI and other complications. However, actual practice differs from region to region, and the reality in developing countries is exemplified by a recent report showing a high degree of reuse of disposable catheters and use of indwelling catheters for people with spinal cord injury.
Bladder and bowel management after spinal cord injury is essential, and treatment alternatives are being continuously explored and evaluated. There is also ongoing work in evaluation of diagnostic tools in neurogenic bowel dysfunction. Initial testing of genital nerve stimulation for overactive bladder has yielded promising results and ongoing research is exploring the impact on health-related quality of life of intermittent catheterization in general and hydrophilic coated catheters in particular.
Summary of Publications
Bladder irrigation with Chlorhexidine reduces bacteriuria in persons with spinal cord injury.
https://www.ncbi.nlm.nih.gov/pubmed/29355293
Author and Origin
Wikström M, Levi R, Antepohl W.
Sweden
Summary
Prospective study of bacteriuria in 19 people with spinal cord injury receiving bladder irrigation with 120 ml of 0.2% chlorhexidine twice daily.
Conclusions
Chlorhexidine bladder irrigation seemed to temporarily reduce levels of bacteriuria in 74% of the patients.
Comments and Access
Study proposing possible benefits of chlorhexidine bladder irrigation in people with spinal cord injury and recurrent urinary tract infections. Open access.
Bladder management practices in spinal cord injury patients: A single center experience from a developing country.
https://www.ncbi.nlm.nih.gov/pubmed/29323623
Author and Origin
Mansoor SN, Rathore FA.
Pakistan
Summary
Observational survey evaluating bladder management methods in 34 men with spinal cord injury.
Conclusions
The most common bladder management methods were intermittent catheterization (44%) and indwelling catheter (38%). Half of patients using intermittent catheterization practiced reuse of disposable catheters for 5-7 days.
Comments and Access
Study showing high degree of reuse of disposable catheters and indwelling catheter use for people with spinal cord injury in a developing country.
At-home genital nerve stimulation for individuals with SCI and neurogenic detrusor overactivity: A pilot feasibility study.
https://doi.org/10.1080/10790268.2017.1422881
Author and Origin
Bourbea DJ, Gustafson KJ, Brose SW.
US
Summary
Case series of 5 people with spinal cord injury and neurogenic detrusor overactivity who tested genital nerve stimulation.
Conclusions
Genital nerve stimulation seemed to reduce the number of leakage events from 1.0 ± 0.5 to 0.1 ± 0.4 leaks per day.
Comments and Access
Case series presenting initial data on genital nerve stimulation use for overactive bladder in people with spinal cord injury.
Quality of life in patients with clean intermittent selfcatheterization with spinal cord injury.
https://doi.org/10.1007/s00192-017-3337-0
Author and Origin
Morales Gomez M, Ureta Sanchez S, Gomez-Chavarin M, Rojano Mejia D, Gonzalez Mendoza D.
Mexico
Summary
Observational survey investigating quality of life with the intermittent selfcatheterization questionnaire (ISC-Q) in 71 patients with spinal cord injury.
Conclusions
Intermittent catheterization was considered to be simple and to provide satisfaction in quality of life. The ISC-Q was considered to be useful for the Mexican population.
Comments and Access
Conference abstract reporting on quality of life associated to intermittent catheterization use among people with spinal cord injury.
Randomized, cross-over study comparing hydrophilic compact catheters vs. standard catheters for using intermittent self catheterization.
https://doi.org/10.1007/s00192-017-3337-0
Author and Origin
Yamanishi T, Kaga K, Kaga M, Fuse M.
Japan
Summary
Randomized controlled trial comparing hydrophilic coated vs non-hydrophilic catheters in 32 people with spinal cord injury using the intermittent self-catheterization questionnaire (ISC-Q).
Conclusions
No statistically significant differences between catheter types were detected in the ISC-Q total scores, but the scores for individual questions pointed to advantages in using hydrophilic catheters.
Comments and Access
Conference abstract showing preliminary results on health-related quality of life associated with hydrophilic and non-hydrophilic catheters in people with spinal cord injury.
International standards to document remaining autonomic Function in persons with SCI and neurogenic bowel dysfunction: Illustrative cases.
https://www.nature.com/articles/s41394-017-0030-y
Author and Origin
Goetz L, Emmanuel A, Krogh K.
US and EU
Summary
Three case presentations used to discuss the documentation of remaining autonomic function in people with neurogenic bowel dysfunction following spinal cord injury, according to the bowel subsection of the international standards.
Conclusions
When assessing autonomic function it is not enough to determine the neurological level of injury. The bowel subsection of the international standards to document the remaining autonomic function in people with SCI is a good additional tool for this kind of assessment.
Comments and Access
A series of three patient cases assessing an international standard tool to evaluate bowel dysfunction in people with SCI.
This blog post is an extract of the Science Alert from February 2018 (76070-USX-1802)
