Management of lower urinary tract dysfunction in patients with spinal cord injury_West China Medical Journal

Authors：

 YANG Weixin

Department of Rehabilitation Medicine, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P. R. China;

Corresponding author：

YANG Weixin, Email: weixinsuda@163.com

Keywords：

Spinal cord injury; neurogenic lower urinary tract dysfunction; urodynamics; type A botulinum toxin; intermittent catheterization

DOI：

10.7507/1002-0179.202204007

Video：

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The management of neurogenic lower urinary tract dysfunction due to spinal cord injury is one of the most challenging tasks in rehabilitation. Considerable progress has been made in the management of lower urinary tract dysfunction in patients with spinal cord injury over the past few decades. However, urinary complications remain one of the most serious complications in patients with spinal cord injury. Lower urinary tract dysfunction in patients with spinal cord injury present with a variety of symptoms and signs that require comprehensive evaluation. The management of lower urinary tract dysfunction in patients with spinal cord injury require tailored and individualized treatment approaches. Based on the clinical practice of rehabilitation at home and abroad, this paper expounds the progress of the assessment and rehabilitation of lower urinary tract dysfunction after spinal cord injury, and puts forward some suggestions for the reference of clinical staff.

Citation： YANG Weixin. Management of lower urinary tract dysfunction in patients with spinal cord injury. West China Medical Journal, 2022, 37(5): 693-699. doi: 10.7507/1002-0179.202204007 Copy

1.	Donnelly J, Hackler RH, Bunts RC. Present urologic status of the World War Ⅱ paraplegic: 25-year followup. Camparison with status of the 20-year Korean war paraplegic and 5-year Vietnam paraplegic. J Urol, 1972, 108(4): 558-562.
2.	Borges PM, Hackler RH. The urologic status of the Vietnam war paraplegic: a 15-year prospective followup. J Urol, 1982, 127(4): 710-711.
3.	Noe BB, Stapelfeldt CM, Parner ET, et al. Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990-2012. Spinal Cord, 2017, 55(4): 373-377.
4.	Welk B, Liu K, Winick-Ng J, et al. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn, 2017, 36(3): 640-647.
5.	Andretta E, Pagliacci MC, Zuliani C, et al. A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy. J Spinal Cord Med, 2021, 13: 1-9.
6.	Savic G, DeVivo MJ, Frankel HL, et al. Long-term survival after traumatic spinal cord injury: a 70-year British study. Spinal Cord, 2017, 55(7): 651-658.
7.	Wyndaele JJ. The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nat Rev Urol, 2016, 13(12): 705-714.
8.	Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol, 2018, 50(6): 1005-1016.
9.	Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol, 2015, 14(7): 720-732.
10.	Wyndaele JJ. Investigating afferent nerve activity from the lower urinary tract: highlighting some basic research techniques and clinical evaluation methods. Neurourol Urodyn, 2010, 29(1): 56-62.
11.	Panicker JN. Neurogenic bladder: epidemiology, diagnosis, and management. Semin Neurol, 2020, 40(5): 569-579.
12.	Rosier PFWM, Schaefer W, Lose G, et al. International continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn, 2017, 36(5): 1243-1260.
13.	Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol, 2012, 188(Suppl 6): 2464-2472.
14.	Abrams P, Damaser MS, Niblett P, et al. Air filled, including “air-charged”, catheters in urodynamic studies: does the evidence justify their use?. Neurourol Urodyn, 2017, 36(5): 1234-1242.
15.	Marks BK, Goldman HB. Videourodynamics: indications and technique. Urol Clin North Am, 2014, 41(3): 383-391.
16.	Kocher NJ, Damaser MS, Gill BC. Advances in ambulatory urodynamics. Curr Urol Rep, 2020, 21(10): 41.
17.	Drossaerts J, Rademakers KLJ, Rahnama’i SM, et al. The value of ambulatory urodynamics in the evaluation of treatment effect of sacral neuromodulation. Urol Int, 2019, 102(3): 299-305.
18.	Wyndaele JJ, THi HV, Pham BC, et al. The use of one-channel water cystometry in patients with a spinal cord lesion: practicalities, clinical value and limitations for the diagnosis of neurogenic bladder dysfunction. Spinal Cord, 2009, 47(7): 526-530.
19.	Latthe PM, Foon R, Toozs-Hobson P. Prophylactic antibiotics in urodynamics: a systematic review of effectiveness and safety. Neurourol Urodyn, 2008, 27(3): 167-173.
20.	Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am, 2007, 18(2): 255-274.
21.	Romo PGB, Smith CP, Cox A, et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol, 2018, 36(10): 1555-1568.
22.	Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol, 2000, 163(3): 768-772.
23.	Milligan J, Goetz LL, Kennelly MJ. A primary care provider’s guide to management of neurogenic lower urinary tract dysfunction and urinary tract infection after spinal cord injury. Top Spinal Cord Inj Rehabil, 2020, 26(2): 108-115.
24.	Bennett CJ, Young MN, Adkins RH, et al. Comparison of bladder management complication outcomes in female spinal cord injury patients. J Urol, 1995, 153(5): 1458-1460.
25.	Lapides J, Diokno AC, Silber SJ, et al. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol, 2017, 197(2S): S122-S124.
26.	De Ridder DJ, Everaert K, Fernández LG, et al. Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial. Eur Urol, 2005, 48(6): 991-995.
27.	Ahluwalia RS, Johal N, Kouriefs C, et al. The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl, 2006, 88(2): 210-213.
28.	Mitsui T, Minami K, Furuno T, et al. Is suprapubic cystostomy an optimal urinary management in high quadriplegics?. A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol, 2000, 38(4): 434-438.
29.	Esclarín De Ruz A, García Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol, 2000, 164(4): 1285-1289.
30.	Schurch B, Stöhrer M, Kramer G, et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol, 2000, 164(3 Pt 1): 692-697.
31.	Leippold T, Reitz A, Schurch B. Botulinum toxin as a new therapy option for voiding disorders: current state of the art. Eur Urol, 2003, 44(2): 165-174.
32.	杨卫新, 苏敏, 张大伟, 等. 超声引导肉毒毒素注射尿道外括约肌治疗下尿路功能障碍. 中华物理医学与康复杂志, 2013, 35(4): 286-289.
33.	Hansen RB, Biering-Sørensen F, Kristensen JK. Bladder emptying over a period of 10-45 years after a traumatic spinal cord injury. Spinal Cord, 2004, 42(11): 631-637.
34.	Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: a urologist’s perspective. Low Urin Tract Symptoms, 2022, 14(3): 132-139.
35.	Kennelly M, Dmochowski R, Schulte-Baukloh H, et al. Efficacy and safety of onabotulinumtoxinA therapy are sustained over 4 years of treatment in patients with neurogenic detrusor overactivity: final results of a long-term extension study. Neurourol Urodyn, 2017, 36(2): 368-375.
36.	Wyndaele JJ, Maes D. Clean intermittent self-catheterization: a 12-year followup. J Urol, 1990, 143(5): 906-908.
37.	Šámal V, Paldus V, Fáčková D, et al. The prevalence of antibiotic-resistant and multidrug-resistant bacteria in urine cultures from inpatients with spinal cord injuries and disorders: an 8-year, single-center study. BMC Infect Dis, 2022, 22(1): 239.
38.	Vaidyanathan S, Soni BM, Dundas S, et al. Urethral cytology in spinal cord injury patients performing intermittent catheterisation. Paraplegia, 1994, 32(7): 493-500.
39.	Wyndaele JJ, Vodušek DB. Approach to the male patient with lower urinary tract dysfunction. Handb Clin Neurol, 2015, 130: 143-64.
40.	Bellucci CH, Wöllner J, Gregorini F, et al. Acute spinal cord injury-do ambulatory patients need urodynamic investigations?. J Urol, 2013, 189(4): 1369-1373.
41.	Bartel P, Krebs J, Wöllner J, et al. Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord, 2014, 52(4): 295-297.
42.	Antunes-Lopes T, Pinto R, Barros SC, et al. Urinary neurotrophic factors in healthy individuals and patients with overactive bladder. J Urol, 2013, 189(1): 359-365.
43.	Ni J, Suzuki T, Karnup SV, et al. Nerve growth factor-mediated Na⁺ channel plasticity of bladder afferent neurons in mice with spinal cord injury. Life Sci, 2022, 298: 120524.
44.	Liu HT, Chancellor MB, Kuo HC. Urinary nerve growth factor level could be a biomarker in the differential diagnosis of mixed urinary incontinence in women. BJU Int, 2008, 102(10): 1440-1444.
45.	Liu HT, Chancellor MB, Kuo HC. Urinary nerve growth factor levels are elevated in patients with detrusor overactivity and decreased in responders to detrusor botulinum toxin-A injection. Eur Urol, 2009, 56(4): 700-706.
46.	Liu HT, Liu AB, Chancellor MB, et al. Urinary nerve growth factor level is correlated with the severity of neurological impairment in patients with cerebrovascular accident. BJU Int, 2009, 104(8): 1158-1162.
47.	Frias B, Santos J, Morgado M, et al. The role of brain-derived neurotrophic factor (BDNF) in the development of neurogenic detrusor overactivity (NDO). J Neurosci, 2015, 35(5): 2146-2160.
48.	Saito T, Gotoh D, Wada N, et al. Time-dependent progression of neurogenic lower urinary tract dysfunction after spinal cord injury in the mouse model. Am J Physiol Renal Physiol, 2021, 321(1): F26-F32.

1. Donnelly J, Hackler RH, Bunts RC. Present urologic status of the World War Ⅱ paraplegic: 25-year followup. Camparison with status of the 20-year Korean war paraplegic and 5-year Vietnam paraplegic. J Urol, 1972, 108(4): 558-562.
2. Borges PM, Hackler RH. The urologic status of the Vietnam war paraplegic: a 15-year prospective followup. J Urol, 1982, 127(4): 710-711.
3. Noe BB, Stapelfeldt CM, Parner ET, et al. Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990-2012. Spinal Cord, 2017, 55(4): 373-377.
4. Welk B, Liu K, Winick-Ng J, et al. Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn, 2017, 36(3): 640-647.
5. Andretta E, Pagliacci MC, Zuliani C, et al. A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy. J Spinal Cord Med, 2021, 13: 1-9.
6. Savic G, DeVivo MJ, Frankel HL, et al. Long-term survival after traumatic spinal cord injury: a 70-year British study. Spinal Cord, 2017, 55(7): 651-658.
7. Wyndaele JJ. The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nat Rev Urol, 2016, 13(12): 705-714.
8. Przydacz M, Chlosta P, Corcos J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol, 2018, 50(6): 1005-1016.
9. Panicker JN, Fowler CJ, Kessler TM. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management. Lancet Neurol, 2015, 14(7): 720-732.
10. Wyndaele JJ. Investigating afferent nerve activity from the lower urinary tract: highlighting some basic research techniques and clinical evaluation methods. Neurourol Urodyn, 2010, 29(1): 56-62.
11. Panicker JN. Neurogenic bladder: epidemiology, diagnosis, and management. Semin Neurol, 2020, 40(5): 569-579.
12. Rosier PFWM, Schaefer W, Lose G, et al. International continence society good urodynamic practices and terms 2016: urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn, 2017, 36(5): 1243-1260.
13. Winters JC, Dmochowski RR, Goldman HB, et al. Urodynamic studies in adults: AUA/SUFU guideline. J Urol, 2012, 188(Suppl 6): 2464-2472.
14. Abrams P, Damaser MS, Niblett P, et al. Air filled, including “air-charged”, catheters in urodynamic studies: does the evidence justify their use?. Neurourol Urodyn, 2017, 36(5): 1234-1242.
15. Marks BK, Goldman HB. Videourodynamics: indications and technique. Urol Clin North Am, 2014, 41(3): 383-391.
16. Kocher NJ, Damaser MS, Gill BC. Advances in ambulatory urodynamics. Curr Urol Rep, 2020, 21(10): 41.
17. Drossaerts J, Rademakers KLJ, Rahnama’i SM, et al. The value of ambulatory urodynamics in the evaluation of treatment effect of sacral neuromodulation. Urol Int, 2019, 102(3): 299-305.
18. Wyndaele JJ, THi HV, Pham BC, et al. The use of one-channel water cystometry in patients with a spinal cord lesion: practicalities, clinical value and limitations for the diagnosis of neurogenic bladder dysfunction. Spinal Cord, 2009, 47(7): 526-530.
19. Latthe PM, Foon R, Toozs-Hobson P. Prophylactic antibiotics in urodynamics: a systematic review of effectiveness and safety. Neurourol Urodyn, 2008, 27(3): 167-173.
20. Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am, 2007, 18(2): 255-274.
21. Romo PGB, Smith CP, Cox A, et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urol, 2018, 36(10): 1555-1568.
22. Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol, 2000, 163(3): 768-772.
23. Milligan J, Goetz LL, Kennelly MJ. A primary care provider’s guide to management of neurogenic lower urinary tract dysfunction and urinary tract infection after spinal cord injury. Top Spinal Cord Inj Rehabil, 2020, 26(2): 108-115.
24. Bennett CJ, Young MN, Adkins RH, et al. Comparison of bladder management complication outcomes in female spinal cord injury patients. J Urol, 1995, 153(5): 1458-1460.
25. Lapides J, Diokno AC, Silber SJ, et al. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urol, 2017, 197(2S): S122-S124.
26. De Ridder DJ, Everaert K, Fernández LG, et al. Intermittent catheterisation with hydrophilic-coated catheters (SpeediCath) reduces the risk of clinical urinary tract infection in spinal cord injured patients: a prospective randomised parallel comparative trial. Eur Urol, 2005, 48(6): 991-995.
27. Ahluwalia RS, Johal N, Kouriefs C, et al. The surgical risk of suprapubic catheter insertion and long-term sequelae. Ann R Coll Surg Engl, 2006, 88(2): 210-213.
28. Mitsui T, Minami K, Furuno T, et al. Is suprapubic cystostomy an optimal urinary management in high quadriplegics?. A comparative study of suprapubic cystostomy and clean intermittent catheterization. Eur Urol, 2000, 38(4): 434-438.
29. Esclarín De Ruz A, García Leoni E, Herruzo Cabrera R. Epidemiology and risk factors for urinary tract infection in patients with spinal cord injury. J Urol, 2000, 164(4): 1285-1289.
30. Schurch B, Stöhrer M, Kramer G, et al. Botulinum-A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol, 2000, 164(3 Pt 1): 692-697.
31. Leippold T, Reitz A, Schurch B. Botulinum toxin as a new therapy option for voiding disorders: current state of the art. Eur Urol, 2003, 44(2): 165-174.
32. 杨卫新, 苏敏, 张大伟, 等. 超声引导肉毒毒素注射尿道外括约肌治疗下尿路功能障碍. 中华物理医学与康复杂志, 2013, 35(4): 286-289.
33. Hansen RB, Biering-Sørensen F, Kristensen JK. Bladder emptying over a period of 10-45 years after a traumatic spinal cord injury. Spinal Cord, 2004, 42(11): 631-637.
34. Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: a urologist’s perspective. Low Urin Tract Symptoms, 2022, 14(3): 132-139.
35. Kennelly M, Dmochowski R, Schulte-Baukloh H, et al. Efficacy and safety of onabotulinumtoxinA therapy are sustained over 4 years of treatment in patients with neurogenic detrusor overactivity: final results of a long-term extension study. Neurourol Urodyn, 2017, 36(2): 368-375.
36. Wyndaele JJ, Maes D. Clean intermittent self-catheterization: a 12-year followup. J Urol, 1990, 143(5): 906-908.
37. Šámal V, Paldus V, Fáčková D, et al. The prevalence of antibiotic-resistant and multidrug-resistant bacteria in urine cultures from inpatients with spinal cord injuries and disorders: an 8-year, single-center study. BMC Infect Dis, 2022, 22(1): 239.
38. Vaidyanathan S, Soni BM, Dundas S, et al. Urethral cytology in spinal cord injury patients performing intermittent catheterisation. Paraplegia, 1994, 32(7): 493-500.
39. Wyndaele JJ, Vodušek DB. Approach to the male patient with lower urinary tract dysfunction. Handb Clin Neurol, 2015, 130: 143-64.
40. Bellucci CH, Wöllner J, Gregorini F, et al. Acute spinal cord injury-do ambulatory patients need urodynamic investigations?. J Urol, 2013, 189(4): 1369-1373.
41. Bartel P, Krebs J, Wöllner J, et al. Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord, 2014, 52(4): 295-297.
42. Antunes-Lopes T, Pinto R, Barros SC, et al. Urinary neurotrophic factors in healthy individuals and patients with overactive bladder. J Urol, 2013, 189(1): 359-365.
43. Ni J, Suzuki T, Karnup SV, et al. Nerve growth factor-mediated Na⁺ channel plasticity of bladder afferent neurons in mice with spinal cord injury. Life Sci, 2022, 298: 120524.
44. Liu HT, Chancellor MB, Kuo HC. Urinary nerve growth factor level could be a biomarker in the differential diagnosis of mixed urinary incontinence in women. BJU Int, 2008, 102(10): 1440-1444.
45. Liu HT, Chancellor MB, Kuo HC. Urinary nerve growth factor levels are elevated in patients with detrusor overactivity and decreased in responders to detrusor botulinum toxin-A injection. Eur Urol, 2009, 56(4): 700-706.
46. Liu HT, Liu AB, Chancellor MB, et al. Urinary nerve growth factor level is correlated with the severity of neurological impairment in patients with cerebrovascular accident. BJU Int, 2009, 104(8): 1158-1162.
47. Frias B, Santos J, Morgado M, et al. The role of brain-derived neurotrophic factor (BDNF) in the development of neurogenic detrusor overactivity (NDO). J Neurosci, 2015, 35(5): 2146-2160.
48. Saito T, Gotoh D, Wada N, et al. Time-dependent progression of neurogenic lower urinary tract dysfunction after spinal cord injury in the mouse model. Am J Physiol Renal Physiol, 2021, 321(1): F26-F32.

West China Medical Journal

Management of lower urinary tract dysfunction in patients with spinal cord injury

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