Table 4 - uploaded by Jörg Krebs
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Source publication
Study design:
Retrospective follow-up study.
Objectives:
To assess the occurrence of bladder stones in patients with spinal cord injury (SCI).
Setting:
Single SCI rehabilitation center in Switzerland.
Methods:
We searched our database for SCI patients who had undergone surgery due to bladder stones between 2004 and 2012. In all patients retr...
Context in source publication
Context 1
... observed a bladder stone recurrence rate of 23% after 19 (2-79) months, most frequently in the TC group (40%), followed by the SPC group (28%) and patients with IC (22%), whereas no recurrence was found in patients with RM. The shortest time to recurrence was detected in the SPC group 14 (2-48) months, followed by persons on IC 26 (4-79) months and patients with TC 31 (3-60) months (Table 4). ...
Similar publications
Purpose:
The main treatment options of neurogenic bladder remains catheterization and long-term oral medications. Metabolic interventions have shown good therapeutic results in many diseases. To date, no studies have characterized the metabolites of the detrusor muscle during neurogenic bladder. Using metabolomics, new muscle metabolomic signature...
Study design:
Retrospective investigation.
Objectives:
To investigate the association of patient and injury characteristics, as well as bladder management, with the occurrence of patient-reported, symptomatic urinary tract infection(s) UTI(s) in patients with chronic neurogenic lower urinary tract dysfunction (NLUTD).
Setting:
Tertiary urologi...
Study design:
Cross-sectional study.
Objectives:
Our aim was to compare the effects of repeated cystometric measurements in spinal cord injury (SCI) patients with neurogenic detrusor overactivity (NDO) who use indwelling catheters (IDC) or intermittent catheterization (IC).
Setting:
Turkey.
Methods:
A total of 20 SCI patients with NDO, 9 pat...
Background
For patients suffering from urinary retention due to neurogenic [e.g., spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS)] or non-neurogenic [e.g., cancer, benign prostate hypertrophy (BPH)] causes, intermittent catheterization is the primary choice for bladder emptying. This scoping review compared hydrophilic-coated i...
Purpose
The purpose of this study was to investigate the course of bladder evacuation and the predictors of intermittent self-catheterization (ISC) in individuals with neurogenic lower urinary tract dysfunction (NLUTD) during and after primary rehabilitation.
Methods
The patient database of a single spinal cord injury rehabilitation center was scr...
Citations
... The limitations of previous studies were the lack of distinction between the bladder and upper urinary tract, date of recurrence and stone analysis, and inclusion of only one neurological disease, without considering the entire NLUTD spectrum. 6,13,14 The real-world cohort in the present study consisted of 49% of patients with acquired or congenital SCI, 28% with various brain injuries up to wakeful coma and 23% with MS, representing a broad NLUTD spectrum. This cohort composition allows for the assessment of neurological diseases as risk factors for stone formation. ...
... still, recurrence did not increase compared with CIC. Regarding the risk of stone recurrence in SCI patients, Bartel et al. 6 reported the highest recurrence rates in patients with transurethral catheters, followed by SPC and CIC, with no increased risk of reflex emptying with the use of urinary condoms. Therefore, CIC is a reliable risk factor for recurrent stones because of the significantly increased rate of rUTI. ...
Objective
The objective of this study is to investigate the incidence and risk factors for stone formation and recurrence in patients with neurogenic lower urinary tract dysfunction (NLUTD) in a real‐world cohort.
Materials and methods
A retrospective cohort study was conducted on all patients with NLUTD who underwent bladder stone treatment between 2010 and 2022. Univariate and multivariate Cox models were used to identify the potential risk factors for stone recurrence.
Results
Among 114 patients included in the study, 30% experienced stone recurrence. The most common stone components were carbonate apatite phosphate and magnesium ammonium phosphate. The overall recurrence rate was 14 cases per 100 patient years. Neurogenic detrusor overactivity had the highest recurrence rate. Risk factors for stone recurrence in the multivariate analysis were intermittent and suprapubic catheterization, and recurrent urinary tract infection (rUTI).
Conclusions
Patients experienced multiple bladder stone recurrences. Close monitoring of bladder pressure and UTI with restrictive catheter application may reduce the risk of stone recurrence.
... The incidence of bladder stones in SCI patients is variable, ranging from 3% to 36% [89][90][91][92]. Overall, 98% of stones in patients with SCI were reported to be apatite or struvite in composition. ...
... The rate of bladder stones is 9-20 times higher with indwelling catheters (transurethral catheter or suprapubic cystostomy) than with patients with CIC or continent patients who are free of catheters [90,91]. Among the indwelling catheters, the rates of bladder stones in SCI patients with suprapubic cystostomy and transurethral catheters have been reported to be 4-25% and 4-6.6%, respectively, whereas the stone formation rates decreased to 2% and 1.1% in patients with CIC and reflex micturition, respectively [89][90][91]. Regarding the time between SCI and bladder stone development, the shortest time interval (2.6 years) was found in patients with transurethral catheters, followed by those with suprapubic cystostomy (4.9 years), CIC (9.7 years), and reflex voiding (17.6 years) [89]. Furthermore, the risk of recurrence of bladder stone formation increased if an SCI patient previously had a bladder stone. ...
... Among the indwelling catheters, the rates of bladder stones in SCI patients with suprapubic cystostomy and transurethral catheters have been reported to be 4-25% and 4-6.6%, respectively, whereas the stone formation rates decreased to 2% and 1.1% in patients with CIC and reflex micturition, respectively [89][90][91]. Regarding the time between SCI and bladder stone development, the shortest time interval (2.6 years) was found in patients with transurethral catheters, followed by those with suprapubic cystostomy (4.9 years), CIC (9.7 years), and reflex voiding (17.6 years) [89]. Furthermore, the risk of recurrence of bladder stone formation increased if an SCI patient previously had a bladder stone. ...
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients’ quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
... Bladder stones are common in patients with neurogenic lower urinary tract dysfunction. 1 In one study the incidence of bladder stones in patients with spinal cord injury was 3.3%, with higher incidence, in those with suprapubic and transurethral catheter than those practicing intermittent catheterisation or reflex voiding. 2 In MS, the central nervous system (CNS) lesions disrupt the nerve pathways between the pons and the sacral nerves that result in a neurogenic bladder. This manifests in the form of urinary symptoms such as increased urgency, frequency, urge incontinence, voiding dysfunction and urinary retention. ...
Bladder stone is a known complication in a neurogenic bladder that can very rarely cause vesicovaginal fistula (VVF). We are presenting the case of a woman in her late 70s, bed bound with progressive multiple sclerosis (MS), who was referred to urology for consideration of suprapubic catheter due to difficulty in managing her indwelling urethral catheter. The ultrasonogram (USG) identified a 4.7 cm bladder stone with right-sided hydronephrosis (HN) and left atrophic kidney. A CT scan later showed that a 5 cm bladder stone has migrated through a VVF into her vagina. She had a cystoscopy and transvaginal retrieval of the stone. Given her performance status and intraoperative finding of a small contracted bladder, it was agreed to manage her VVF conservatively.
To the best of our knowledge, this is the first case of a primary bladder stone migrating into the vagina through a VVF.
... Thus, the likeliness of developing a calculus translates to being up to six times higher than in the general population [1,2]. In contrast to bladder stones, the way of bladder management does not relate to renal stone formation regarding the mean number of renal calculi [3]. Also, age at SCI/D, level of injury, and AIS classification do not appear to have a significant impact on the total stone burden of the kidney [4]. ...
For individuals with spinal cord injury/disease (SCI/D) the risk of developing a stone in the upper urinary tract is up to six times higher than in the able-bodied population. Upper urinary tract carcinomas, in general, are rare and account for only 5–10% of all urinary tract carcinomas. It is believed that chronic upper urinary tract irritation caused by e.g., kidney stones or recurrent upper urinary tract infections may be associated with an increased risk of renal squamous cell carcinoma (RSCC).
We report on a 64-year-old male who suffered a spinal cord injury in 1981 resulting in a complete sensory and motor impairment below T6, AIS A. Recurrent left-sided kidney stone disease had to be treated repeatedly from 1984 onwards. Despite repeated surgical attempts, it was ultimately not possible to achieve stone clearance in the long term. Within the concept of life-long surveillance of SCI/D, the patient was examined regularly, including ultrasound examinations of the kidneys. Six months after the last control examination, the patient was admitted to our hospital with a locally advanced tumor of the left kidney, so that only the option of palliative treatment remained. Histologically an RSCC was found.
As people with SCI/D have a higher risk of developing kidney stones, it is of utmost importance to check regularly for stone disease and, if necessary, treat with the aim of long-term stone clearance in order to protect renal function and to avert potentially malignant changes at an early stage.
... Intermittent urinary catheterisation is the reference method for urine drainage in SCI patients as it is associated with a long-term reduction in the risk of urinary tract infection and urolithiasis, and an increased probability of urination continence [103][104][105][106][107][108]. Selfintermittent urethral catheterisation is recommended by national and international neuro-urology societies [109][110][111][112]. ...
Objectives
To update the French guidelines on the management of trauma patients with spinal cord injury or suspected spinal cord injury.
Design
A consensus committee of 27 experts was formed. A formal conflict-of-interest (COI) policy was developed at the outset of the process and enforced throughout. The entire guidelines process was conducted independently of any industrial funding (i.e. pharmaceutical, medical devices). The authors were advised to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasised.
Methods
The committee studied twelve questions: (1) What are the indications and arrangements for spinal immobilisation? (2) What are the arrangements for pre-hospital orotracheal intubation? (3) What are the objectives of haemodynamic resuscitation during the lesion assessment, and during the first few days in hospital? (4) What is the best way to manage these patients to improve their long-term prognosis? (5) What is the place of corticosteroid therapy in the initial phase? (6) What are the indications for magnetic resonance imaging in the lesion assessment phase? (7) What is the optimal time for surgical management? (8) What are the best arrangements for orotracheal intubation in the hospital environment? (9) What are the specific conditions for weaning these patients from mechanical ventilation for? (10) What are the procedures for analgesic treatment of these patients? (11) What are the specific arrangements for installing and mobilising these patients? (12) What is the place of early intermittent bladder sampling in these patients? Each question was formulated in a PICO (Patients, Intervention, Comparison, Outcome) format and the evidence profiles were produced. The literature review and recommendations were made according to the GRADE® Methodology.
Results
The experts’ work synthesis and the application of the GRADE method resulted in 19 recommendations. Among the recommendations formalised, 2 have a high level of evidence (GRADE 1+/−) and 12 have a low level of evidence (GRADE 2+/−). For 5 recommendations, the GRADE method could not be applied, resulting in expert advice. After two rounds of scoring and one amendment, strong agreement was reached on all the recommendations.
Conclusions
There was significant agreement among experts on strong recommendations to improve practices for the management of patients with spinal cord injury.
... We identified 5 studies that investigated the incidence of bladder stones in patients using IC (Table 6). Bartel and colleagues 70 compared the occurrence of stones in patients using different methods to empty their bladder. Two percent of patients using IC had bladder stones documented on endoscopy or imaging studies. ...
... The time to occurrence of stones was also much longer in patients using IC (mean = 116 months) compared to suprapubic (mean = 59 months) and indwelling urethral (mean = 31 months) catheters. 70 The remaining 4 studies reported the rates of bladder stones only in patients using IC. Hakansson and associates 38 reported an annual rate of bladder stones was .6%. ...
Purpose:
The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life.
Problem:
Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence.
Methods:
Scoping review.
Search strategy:
We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management.
Findings:
Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC.
Conclusions:
Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.
... Assistive devices are of paramount importance to persons with SCI, particularly in self-care, bladder management and mobility. Improper bladder emptying has also been reported to cause massive damage to the kidneys following urine reflux as a result of bladder stone formation (Bartel, Krebs, Wollner, Gocking, & Pannek, 2014). Persons with TSCI in low-income countries such as Tanzania face unavailability and unaffordability of bladder management devices as well as appropriate wheelchairs (Oderud, 2014;WHO, ISPO, & USAID, 2008b). ...
Aim: To describe the quality of life of persons with traumatic spinal cord injury (TSCI) in a rural area of a low-income country.
Methods: This was a cross-sectional descriptive study in which snowballing was used to identify persons with TSCI in their homes. A Kiswahili version of the short version of the World Health Organization quality of life questionnaire was used for data collection. Data were analyzed descriptively and independent samples t-tests were used to calculate the difference in the mean scores between groups.
Results: Eighty persons with TSCI with a mean age of 42.29 ± 11.4 years were identified, 68.8% of whom were males. The highest scoring domains were psychological (12.76 ± 2.55) and social relationships (12.62 ± 2.95). The lowest scores were for physical (11.48 ± 2.74) and environment (9.59 ± 2.68) domains. Significantly higher scores were associated with younger age in: physical (0.05), social relationships (0.01), and environment (0.02) domains (p value < 0.05).
Conclusions: Persons with TSCI in the Kilimanjaro rural area registered a relatively low quality of life in which the most affected domains are physical health and environment.
• Implications for rehabilitation
• Quality of life is the ultimate goal in the rehabilitation of persons with any irreversible disability such as spinal cord injury.
• It is important for rehabilitation professionals to know which domains of quality of life are most affected among persons with spinal cord injury.
• Rehabilitation professionals ought to understand and address physical health and environmental issues that affect persons with traumatic spinal cord injury in rural resource-constrained areas.
• Addressing physical health and environmental challenges for persons with spinal cord injury in resource-constrained rural areas require involvement of the family, rehabilitation personnel, policy makers, and the community.
... As a consequence of negligence and misjudgment of clinical infections, treatment delay is very likely to happen and thus increase hospitalization days and costs [9]. CIC performed with voiding diary helps restore and retain the function and compliance of the bladder, as well as release the intravesical pressure and increase the blood flow of the bladder wall, enabling the bladder to perform antibacterial activities and lessen the chance of complications [10][11][12][13][14][15][16][17]. Voiding diary is a simple and primary tool used to understand urinary tract function and assess urinary symptoms, with a view to providing doctors with sufficient data for an appropriate clinical diagnosis. ...
Background: Clean intermittent catheterization (CIC) is one of the methods currently used to prevent overdistention of the bladder in patients with neurogenic bladder dysfunction (NBD). It is also helpful in preventing urinary tract infection and retaining the function of the bladder. Voiding diary and social behavior are necessary for the patients to maintain their physical and mental health, nevertheless there are currently no good assistant systems to help them achieve these goals. Methods: In this study, we propose a CIC assistant system with the functions of recording and tracking the voided volume and accessible lavatory. The aim of this study is to assess the effects from the 12 patients who joined the proposed system. Information collected from participants included their demographics, past medicals, injury characteristics, current and past bladder managements, and any NBD related complications. Results: The results indicate that most patients felt relieved that they could know the voided volume and track their history easily. Moreover, the accessible lavatory function of the proposed system could reduce time consumption by 43.1% in finding the suitable lavatory, thus the desire and willingness of patients to travel increased from 25% to 75% after using the system. Conclusions: The proposed system could help doctors with clinical diagnoses, and help patients to understand more about the history of their catheterization volume and time period. This study provided essential information and design for future investigation.
... The overall incidence of bladder calculi in patients with SCI is variable, with rates ranging from 3.3 to 29%, and is impacted by the type of bladder management [40]. The highest risk patients are those managed with an indwelling catheter (i.e., urethral or SPT), with as high as a ninefold increase in stone formation in these patients compared to continent patients who are catheter-free [41]. ...
... compared to an SPT, which have been reported at between 4 and 25% [42]. Patients who perform IC have an overall risk of stone formation of approximately 2% or an annual risk of 0.2% [40,42]. ...
Purpose:
Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management.
Methods:
This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs).
Results:
At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population.
Conclusions:
There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.
... 28 IC users are at greater risk of bladder stones than the general population but less than indwelling UC users. 39 UTI: urinary tract infection; UC: urethral catheter; IC: intermittent catheter. ...
... 38 Minimise harms (infection, pain, trauma, damage to bladder health): these harms are summarised in Table 1. 14,15,[17][18][19][20][21][22][24][25][26][27][28]39 IDCs To be effective and avoid harm, an IDC (urethral or suprapubic) must have the following features: ...
... Minimise harms (infection, blockage, leakage, pain, trauma, damage to bladder health) -Few catheter users will have a trouble free experience. 2 The main physical harms are summarised in Table 1. 14,15,[17][18][19][20][21][22][24][25][26][27][28]39 Maximise quality of life -Be easy to manage on a day-to-day basis: comfortable and causes minimal harm, easy to drain urine (e.g. drainage tap on a valve or collection bag is designed for a range of dexterity levels), minimal impact on daily activities (e.g. ...
