RISK of recurrent urinary tract infections in patients with chronic spinal cord injury is significantly increased by several urological complications, including contracted bladder and autonomic dysreflexia. Long-term urological complications in SCI patients include recurrent urinary tract infections (rUTI), hydronephrosis, vesicoureteric reflux (VUR) and chronic kidney disease. Researchers in Taiwan recruited 864 patients with chronic spinal cord injury (SCI) and assessed urological complications at a 15-year follow-up. The aim was to identify predictive factors from video-urodynamic study (VUDS), a diagnostic test used to evaluate the function and structure of the bladder and urethra, and bladder management.
The most common long-term urological complication was rUTIs, affecting 72.2% of patients. Using multivariate logistic regression, it was determined that autonomic dysreflexia, detrusor sphincter dyssynergia, VUR, contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI) in SCI patients (adjusted odds ratio: 1.780, 1.535, 2.028, 3.156, 1.482, respectively). Low bladder compliance, VUR, and a contracted bladder also significantly increased the risk of hydronephrosis (adjusted odds ratio: 2.065, 10.342, 4.00, respectively). Additionally, a contracted bladder and the presence of both detrusor over-activity during filling and detrusor under-activity during voiding heightened the risk of chronic kidney disease (adjusted odds ratio: 4.975, and 9.148, respectively). It was also determined that volitional voiding reduced rUTI (adjusted odds ratio: 0.407) and VUR risk (adjusted odds ratio 0.153), whereas Valsalva manoeuvre-assisted voiding increased hydronephrosis risk in patients with spinal cord injury (adjusted odds ratio: 2.033).
Whilst previous research has addressed isolated aspects of post-SCI urological complications, this is one of the few studies to evaluate VUDS parameters, related bladder management strategies, and their impact on various long-term complications. The study also provides insight into the variation in long-term urological complications across SCI levels and the associations between initial VUDS findings and long-term complications. The findings may impact the development of future approaches to prevent and mitigate long-term urological complications in SCI patients.
Reference
Chen YC, Kuo HC. Risk factors of video urodynamics and bladder management for long-term complications in patients with chronic spinal cord injury. Sci Rep. 2024;14(1):12632.
