Abstract
Purpose
To review currently available guidelines and recommendations regarding urological follow-up of patients after spinal cord injury (SCI) and present an evidence-based summary to support clinicians in their clinical practice.
Methods
Maximum data were collected according to different methods, including searches with multiple and specific keywords, reference checks, gray literature searches (congress reports, working papers, statement documents), and browsing-related Web site access. Obtained data were analyzed with the modified version of the Oxford grading system for recommendations using levels of evidence (LE) and grades of recommendation (GR).
Results
Different surveillance strategies exist, but there is no consensus among authors and organizations. As a result, practice patterns vary around the world. The present review indicates that proper urological follow-up of SCI patients should consist of medical history (LE 1-4, GR B-C), clinical examination (LE 4, GR C), renal laboratory tests (LE 1-3, GR B), imaging surveillance of the upper urinary tract (LE 1-3, GR A-B), urodynamic study (LE 2-4, GR B-C), and cystoscopy/cytology (LE 1-4, GR D). Clinicians agree that SCI patients should be followed up regularly with an individually tailored approach. A 1-year follow-up schedule seems reasonable in SCI patients without additional risk factors of renal deterioration (LE 3-4, GR C). In those who manifest risk factors, report changes in bladder behavior, or present with already developed complications of neurogenic bladder dysfunction, follow-up plans should be modified with more frequent checkups (LE 4, GR C). Urodynamic study should be repeated and considered as a routine monitoring strategy.
Conclusion
Individuals with neurogenic lower urinary tract dysfunction are at increased risk of multiple complications. Nevertheless, proper follow-up after SCI improves the prognosis for these patients and their quality of life.
Similar content being viewed by others
References
Hassouna M, Hassouna T, Elmayergi N, Abdelhady M (2016) Pathophysiology of spinal shock. In: Corcos J, Ginsberg D, Karsenty G (eds) Textbook of the neurogenic bladder, 3rd edn. CRC Press, Boca Raton, pp 145–150
Stover SL, DeVivo MJ, Go BK (1999) History, implementation, and current status of the National Spinal Cord Injury Database. Arch Phys Med Rehabil 80(11):1365–1371
National Spinal Cord Injury Statistical Center (2013) Facts and figures at a glance. www.nscisc.uab.edu/publicdocuments/fact_figures_docs/facts%202013.pdf. Accessed June 2017
Sahai A, Cortes E, Seth J, Khan MS, Panicker J, Kelleher C et al (2011) Neurogenic detrusor overactivity in patients with spinal cord injury: evaluation and management. Curr Urol Rep 12(6):404–412
Cameron AP, Lai J, Saigal CS, Clemens JQ, Project NUDiA (2015) Urological surveillance and medical complications after spinal cord injury in the United States. Urology 86(3):506–510
Welk B, Tran KC, Liu K, Shariff S (2014) The pattern of urologic care among traumatic spinal cord injured patients. Can Urol Assoc J Journal de l’Association des urologues du Canada 8(11–12):E805–E809
Noe BB, Stapelfeldt CM, Parner ET, Mikkelsen EM (2017) Survival after traumatic spinal cord injury in Denmark: a hospital-based study among patients injured in 1990–2012. Spinal Cord 55(4):373–377
Welk B, Liu K, Shariff SZ (2016) The use of urologic investigations among patients with traumatic spinal cord injuries. Res Rep Urol 8:27–34
Welk B, Liu K, Winick-Ng J, Shariff SZ (2017) Urinary tract infections, urologic surgery, and renal dysfunction in a contemporary cohort of traumatic spinal cord injured patients. Neurourol Urodyn 36(3):640–647
Elmelund M, Oturai PS, Toson B, Biering-Sorensen F (2016) Forty-five-year follow-up on the renal function after spinal cord injury. Spinal Cord 54(6):445–451
Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S (2017) Long-term survival after traumatic spinal cord injury: a 70-year British study. Spinal Cord 55(7):651–658
Vaidyanathan S, Singh G, Soni B, Hughes P, Pulya K (2014) Substandard urological care of elderly patients with spinal cord injury: an unrecognized epidemic? Patient Saf Surg 8(1):4
Przydacz M, Denys P, Corcos J (2017) What do we know about neurogenic bladder prevalence and management in developing countries and emerging regions of the world? Ann Phys Rehabil Med. 60(5):341–346
University of Oxford, Graduate School in EBM and Research Methods, Centre for Evidence-Based Medicine [Internet] Oxford Centre for Evidence-based Medicine—Levels of Evidence and Grades of Recommendation. Published 2009. http://www.cebm.net/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed June 2017
Hartkopp A, Bronnum-Hansen H, Seidenschnur AM, Biering-Sorensen F (1997) Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark. Spinal Cord 35(2):76–85
Frankel HL, Coll JR, Charlifue SW, Whiteneck GG, Gardner BP, Jamous MA et al (1998) Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord 36(4):266–274
Osterthun R, Post MW, van Asbeck FW, van Leeuwen CM, van Koppenhagen CF (2014) Causes of death following spinal cord injury during inpatient rehabilitation and the first five years after discharge. A Dutch cohort study. Spinal Cord 52(6):483–488
Soden RJ, Walsh J, Middleton JW, Craven ML, Rutkowski SB, Yeo JD (2000) Causes of death after spinal cord injury. Spinal Cord 38(10):604–610
Consortium for Spinal Cord M (2006) Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med 29(5):527–573
Goldmark E, Niver B, Ginsberg DA (2014) Neurogenic bladder: from diagnosis to management. Curr Urol Rep 15(10):448
Averbeck MA, Madersbacher H (2015) Follow-up of the neuro-urological patient: a systematic review. BJU Int 115(Suppl 6):39–46
Abrams P, Agarwal M, Drake M, El-Masri W, Fulford S, Reid S et al (2008) A proposed guideline for the urological management of patients with spinal cord injury. BJU Int 101(8):989–994
US Department of Veterans Affairs (VA), VHA Handbook 1176.01 [Internet]; Spinal Cord Injury And Disorders (Sci/D) System Of Care, Published: 2011. https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2365. Accessed June 2017
National Institute for Health and Care Excellence (NICE), National Clinical Guideline Centre [Internet]; Urinary incontinence in neurological disease: management of lower urinary tract dysfunction in neurological disease, Published: 2012. https://www.nice.org.uk/guidance/cg148/evidence/full-guideline-188123437. Accessed June 2017
Patki P, Woodhouse J, Hamid R, Shah J, Craggs M (2006) Lower urinary tract dysfunction in ambulatory patients with incomplete spinal cord injury. J Urol. 175(5):1784–1787 (discussion 7)
Nosseir M, Hinkel A, Pannek J (2007) Clinical usefulness of urodynamic assessment for maintenance of bladder function in patients with spinal cord injury. Neurourol Urodyn 26(2):228–233
European Association of Urology (EAU), Non-Oncology Guidelines [Internet]; Neuro-urology, Published: 2017. https://uroweb.org/guideline/neuro-urology/. Accessed Sept 2017
Fort ML, Perrouin-Verbe MA, Labat JJ (2016) Evolution and follow-up of lower urinary tract dysfunction in spinal cord–injured patients. In: Corcos J, Ginsberg D, Karsenty G (eds) Textbook of the neurogenic bladder, 3rd edn. CRC Press, Boca Raton, pp 773–780
Cameron AP, Rodriguez GM, Schomer KG (2012) Systematic review of urological followup after spinal cord injury. J Urol 187(2):391–397
Wyndaele JJ (2016) The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nat Rev Urol 13(12):705–714
Bellucci CH, Wollner J, Gregorini F, Birnbock D, Kozomara M, Mehnert U et al (2012) Neurogenic lower urinary tract dysfunction—do we need same session repeat urodynamic investigations? J Urol 187(4):1318–1323
Light JK, Beric A, Wise PG (1987) Predictive criteria for failed sphincterotomy in spinal cord injury patients. J Urol 138(5):1201–1204
Kim YH, Kattan MW, Boone TB (1998) Bladder leak point pressure: the measure for sphincterotomy success in spinal cord injured patients with external detrusor-sphincter dyssynergia. J Urol. 159(2):493–496 (discussion 6–7)
Wang SC, McGuire EJ, Bloom DA (1988) A bladder pressure management system for myelodysplasia—clinical outcome. J Urol 140(6):1499–1502
Navon JD, Soliman H, Khonsari F, Ahlering T (1997) Screening cystoscopy and survival of spinal cord injured patients with squamous cell cancer of the bladder. J Urol 157(6):2109–2111
El Masriy WS, Patil S, Prasanna KV, Chowdhury JR (2014) To cystoscope or not to cystoscope patients with traumatic spinal cord injuries managed with indwelling urethral or suprapubic catheters? That is the question! Spinal Cord. 52(1):49–53
Yang CC, Clowers DE (1999) Screening cystoscopy in chronically catheterized spinal cord injury patients. Spinal Cord. 37(3):204–207
Hamid R, Bycroft J, Arya M, Shah PJ (2003) Screening cystoscopy and biopsy in patients with neuropathic bladder and chronic suprapubic indwelling catheters: is it valid? J Urol 170(2 Pt 1):425–427
Sammer U, Walter M, Knupfer SC, Mehnert U, Bode-Lesniewska B, Kessler TM (2015) Do we need surveillance urethro-cystoscopy in patients with neurogenic lower urinary tract dysfunction? PLoS ONE 10(10):e0140970
Stonehill WH, Goldman HB, Dmochowski RR (1997) The use of urine cytology for diagnosing bladder cancer in spinal cord injured patients. J Urol 157(6):2112–2114
Ghoniem G (2016) Complications related to neurogenic bladder dysfunction I: infection, lithiasis, and neoplasia. In: Corcos J, Ginsberg D, Karsenty G (eds) Textbook of the neurogenic bladder, 3rd edn. CRC Press, Boca Raton, pp 699–708
Gui-Zhong L, Li-Bo M (2017) Bladder cancer in individuals with spinal cord injuries: a meta-analysis. Spinal Cord. 55(4):341–345
Pannek J, Rademacher F, Wollner J (2017) Clinical usefulness of urine cytology in the detection of bladder tumors in patients with neurogenic lower urinary tract dysfunction. Res Rep Urol. 9:219–223
Danforth TL, Ginsberg DA (2014) Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics? Urol Clin North Am. 41(3):445–452
Blok BF, Karsenty G, Corcos J (2006) Urological surveillance and management of patients with neurogenic bladder: results of a survey among practicing urologists in Canada. Can J Urol 13(5):3239–3243
Kitahara S, Iwatsubo E, Yasuda K, Ushiyama T, Nakai H, Suzuki T et al (2006) Practice patterns of Japanese physicians in urologic surveillance and management of spinal cord injury patients. Spinal Cord. 44(6):362–368
Rikken B, Blok BF (2008) Management of neurogenic bladder patients in The Netherlands: do urologists follow guidelines? Neurourol Urodyn 27(8):758–762
Bycroft J, Hamid R, Bywater H, Patki P, Craggs M, Shah J (2004) Variation in urological practice amongst spinal injuries units in the UK and Eire. Neurourol Urodyn. 23(3):252–256 (discussion 7)
Razdan S, Leboeuf L, Meinbach DS, Weinstein D, Gousse AE (2003) Current practice patterns in the urologic surveillance and management of patients with spinal cord injury. Urology 61(5):893–896
Feifer A, Corcos J (2008) Contemporary role of suprapubic cystostomy in treatment of neuropathic bladder dysfunction in spinal cord injured patients. Neurourol Urodyn 27(6):475–479
Biering-Sorensen F, Bagi P, Hoiby N (2001) Urinary tract infections in patients with spinal cord lesions: treatment and prevention. Drugs 61(9):1275–1287
Everaert K, Lumen N, Kerckhaert W, Willaert P, van Driel M (2009) Urinary tract infections in spinal cord injury: prevention and treatment guidelines. Acta Clin Belg 64(4):335–340
Corcos J, Przydacz M (2017) Urinary tract infection. In: Corcos J, Przydacz M (eds) Consultation in neurourology: a practical evidence-based guide, 1st edn. Springer, Cham, pp 179–197
Weld KJ, Dmochowski RR (2000) Association of level of injury and bladder behavior in patients with post-traumatic spinal cord injury. Urology 55(4):490–494
Kaplan SA, Chancellor MB, Blaivas JG (1991) Bladder and sphincter behavior in patients with spinal cord lesions. J Urol 146(1):113–117
Tsang B, Stothers L, Macnab A, Lazare D, Nigro M (2016) A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder. Neurourol Urodyn 35(3):354–364
Elmelund M, Oturai PS, Biering-Sorensen F (2014) 50 years follow-up on plasma creatinine levels after spinal cord injury. Spinal Cord. 52(5):368–372
Sepahpanah F, Burns SP, McKnight B, Yang CC (2006) Role of creatinine clearance as a screening test in persons with spinal cord injury. Arch Phys Med Rehabil 87(4):524–528
MacDiarmid SA, McIntyre WJ, Anthony A, Bailey RR, Turner JG, Arnold EP (2000) Monitoring of renal function in patients with spinal cord injury. BJU Int 85(9):1014–1018
Kaji D, Strauss I, Kahn T (1990) Serum creatinine in patients with spinal cord injury. Mt Sinai J Med 57(3):160–164
Mirahmadi MK, Byrne C, Barton C, Penera N, Gordon S, Vaziri ND (1983) Prediction of creatinine clearance from serum creatinine in spinal cord injury patients. Paraplegia 21(1):23–29
Mingat N, Villar E, Allard J, Castel-Lacanal E, Guillotreau J, Malavaud B et al (2013) Prospective study of methods of renal function evaluation in patients with neurogenic bladder dysfunction. Urology 82(5):1032–1037
Filler G, Gharib M, Casier S, Lodige P, Ehrich JH, Dave S (2012) Prevention of chronic kidney disease in spina bifida. Int Urol Nephrol 44(3):817–827
Lee CK, Swinford RD, Cerda RD, Portman RJ, Hwang W, Furth SL (2012) Evaluation of serum creatinine concentration-based glomerular filtration rate equations in pediatric patients with chronic kidney disease. Pharmacotherapy 32(7):642–648
[International Society of Nephrology (ISN), Kidney Disease: Improving Global Outcomes (KDIGO) [Internet]; Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease, Published: 2012. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf. Accessed May 2017
Thomassen SA, Johannesen IL, Erlandsen EJ, Abrahamsen J, Randers E (2002) Serum cystatin C as a marker of the renal function in patients with spinal cord injury. Spinal Cord. 40(10):524–528
Jenkins MA, Brown DJ, Ierino FL, Ratnaike SI (2003) Cystatin C for estimation of glomerular filtration rate in patients with spinal cord injury. Ann Clin Biochem 40(Pt 4):364–368
Fox JA, Dudley AG, Bates C, Cannon GM Jr (2014) Cystatin C as a marker of early renal insufficiency in children with congenital neuropathic bladder. J Urol 191(5 Suppl):1602–1607
Erlandsen EJ, Hansen RM, Randers E, Petersen LE, Abrahamsen J, Johannesen IL (2012) Estimating the glomerular filtration rate using serum cystatin C levels in patients with spinal cord injuries. Spinal Cord. 50(10):778–783
Meldrum KK (2016) Pathophysiology of urinary tract obstruction. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds) Campbell-Walsh urology, 11th edn. Elsevier, Philadelphia, pp 1089–1103
Corcos J, Przydacz M (2017) Hydronephrosis. In: Corcos J, Przydacz M (eds) Consultation in neurourology: a practical evidence-based guide, 1st edn. Springer, Cham, pp 213–228
Hackler RH, Hall MK, Zampieri TA (1989) Bladder hypocompliance in the spinal cord injury population. J Urol 141(6):1390–1393
Weld KJ, Graney MJ, Dmochowski RR (2000) Differences in bladder compliance with time and associations of bladder management with compliance in spinal cord injured patients. J Urol 163(4):1228–1233
Schops TF, Schneider MP, Steffen F, Ineichen BV, Mehnert U, Kessler TM (2015) Neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury: long-term urodynamic findings. BJU Int 115(Suppl 6):33–38
Bothig R, Fiebag K, Thietje R, Faschingbauer M, Hirschfeld S (2013) Morbidity of urinary tract infection after urodynamic examination of hospitalized SCI patients: the impact of bladder management. Spinal Cord. 51(1):70–73
Foon R, Toozs-Hobson P, Latthe P (2012) Prophylactic antibiotics to reduce the risk of urinary tract infections after urodynamic studies. Cochrane Database Syst Rev. 10:CD008224
Hwang SI, Lee BS, Han ZA, Lee HJ, Han SH, Kim MO (2016) Factors related to the occurrence of urinary tract infection following a urodynamic study in patients with spinal cord injury. Ann Rehabil Med. 40(4):718–724
Darouiche RO, Smith MS, Markowski J (1994) Antibiotic prophylaxis for urodynamic testing in patients with spinal cord injury: a preliminary study. J Hosp Infect 28(1):57–61
Weglinski L, Rouzaud C, Even A, Bouchand F, Davido B, Duran C et al (2016) Prospective evaluation of antibiotic treatment for urological procedure in patients presenting with neurogenic bladder. Med Mal Infect. 46(6):300–307
Pannek J, Nehiba M (2007) Morbidity of urodynamic testing in patients with spinal cord injury: is antibiotic prophylaxis necessary? Spinal Cord. 45(12):771–774
Watanabe T, Chancellor M (1998) Neurogenic voiding dysfunction. In: Nitti VW (ed) Practical urodynamics. W.B. Saunders, Philadelphia, pp 142–155
Mirkin K, Casey JT, Mukherjee S, Kielb SJ (2013) Risk of bladder cancer in patients with spina bifida: case reports and review of the literature. J Pediatr Rehabil Med 6(3):155–162
Gormley EA (2010) Urologic complications of the neurogenic bladder. Urol Clin North Am 37(4):601–607
Austin JC, Elliott S, Cooper CS (2007) Patients with spina bifida and bladder cancer: atypical presentation, advanced stage and poor survival. J Urol 178(3 Pt 1):798–801
Welk B, McIntyre A, Teasell R, Potter P, Loh E (2013) Bladder cancer in individuals with spinal cord injuries. Spinal Cord. 51(7):516–521
Hollingsworth JM, Rogers MA, Krein SL, Hickner A, Kuhn L, Cheng A et al (2013) Determining the noninfectious complications of indwelling urethral catheters: a systematic review and meta-analysis. Ann Intern Med 159(6):401–410
Kalisvaart JF, Katsumi HK, Ronningen LD, Hovey RM (2010) Bladder cancer in spinal cord injury patients. Spinal Cord. 48(3):257–261
Bothig R, Kurze I, Fiebag K, Kaufmann A, Schops W, Kadhum T et al (2017) Clinical characteristics of bladder cancer in patients with spinal cord injury: the experience from a single centre. Int Urol Nephrol 49(6):983–994
Mulhall AB, Chapman RG, Crow RA (1988) Bacteriuria during indwelling urethral catheterization. The Journal of hospital infection. 11(3):253–262
Stamm WE (1991) Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 91(3B):65S–71S
Nicolle LE (2001) The chronic indwelling catheter and urinary infection in long-term-care facility residents. Infect Control Hosp Epidemiol 22(5):316–321
Bakke A, Digranes A (1991) Bacteriuria in patients treated with clean intermittent catheterization. Scand J Infect Dis 23(5):577–582
Goode PS, Locher JL, Bryant RL, Roth DL, Burgio KL (2000) Measurement of postvoid residual urine with portable transabdominal bladder ultrasound scanner and urethral catheterization. Int Urogynecol J Pelvic Floor Dysfunct. 11(5):296–300
Griffiths DJ, Harrison G, Moore K, McCracken P (1996) Variability of post-void residual urine volume in the elderly. Urol Res 24(1):23–26
Marks LS, Dorey FJ, Macairan ML, Park C, deKernion JB (1997) Three-dimensional ultrasound device for rapid determination of bladder volume. Urology 50(3):341–348
Ouslander JG, Simmons S, Tuico E, Nigam JG, Fingold S, Bates-Jensen B et al (1994) Use of a portable ultrasound device to measure post-void residual volume among incontinent nursing home residents. J Am Geriatr Soc 42(11):1189–1192
World Health Organization (WHO), [Internet] International perspectives on spinal cord injury, Published 2013. http://apps.who.int/iris/bitstream/10665/94190/1/9789241564663_eng.pdf?ua=1. Accessed June 2017
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Przydacz, M., Chlosta, P. & Corcos, J. Recommendations for urological follow-up of patients with neurogenic bladder secondary to spinal cord injury. Int Urol Nephrol 50, 1005–1016 (2018). https://doi.org/10.1007/s11255-018-1852-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-018-1852-7