Urological situation five years after spinal cord injury

OBJECTIVE: To evaluate bladder emptying methods and urinary tract problems five years after spinal cord injury (SCI).

MATERIAL AND METHODS: Neurological level, method of bladder emptying and urological investigations were retrieved from the records for all 165 patients admitted to our Centre for Spinal Cord Injured with a traumatic SCI sustained from 1984 to 1988.

RESULTS: A total of 77 patients with completed 5-year control were included in the final analyses. We found that 64% had suprasacral bladder dysfunction, while 23% had infrasacral bladder dysfunction. Plasma-creatinine was normal, both at the initial examination and the 5-year control. From the time in the SCI centre to the 5-year control a trend towards less intermittent catheterization and more use of abdominal pressure was observed. During the follow-up period nine patients (12%) experienced urinary calculi. Six bladder- stones were removed endoscopically. Five had kidney stones; three were left untreated, one was removed by extracorporeal shock wave lithotripsy and one by open surgery. Four patients (5%) had renograms with functional distribution outside the limits 40-60%. Three patients had bladder neck incision performed, one had a sacral anterior root stimulator implanted and one had a continent Kock reservoir. No sphincterotomies were performed. Fifty-one had received medicine to facilitate bladder emptying. Eighty-one percent had been treated for at least one urinary tract infection (UTI), 22% had 2-3 UTI/year, and 12% 4 or more UTI/year. Twelve percent had been on prophylactic low-dose antibiotics.

CONCLUSION: The final outcome regarding urological complications is satisfactory even with our conservative handling of the SCI individuals.