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 · DOI: 10.46292/sci2602-108 · Published: April 1, 2020

Simple Explanation

Neurogenic lower urinary tract dysfunction (NLUTD) is a common complication after spinal cord injury (SCI) affecting bladder control. Primary care providers (PCPs) play a key role in managing this condition to maintain health. The main concerns in NLUTD management are preventing kidney damage, maintaining continence, and preventing urinary tract infections (UTIs), all of which significantly impact quality of life. Individuals with SCI are prone to UTIs, but distinguishing between a harmless presence of bacteria (asymptomatic bacteriuria) and an actual infection requiring antibiotics is crucial to avoid antibiotic resistance.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
NLUTD is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality in individuals with SCI.
2
The goals of NLUTD management include prevention of upper urinary tract deterioration, maintenance of continence, preservation of quality of life, and prevention/early recognition of symptomatic UTI.
3
Asymptomatic bacteriuria is very common in SCI-related NLUTD, and overtesting and treating it is critical to avoid antibiotic resistance.

Research Summary

This article reviews NLUTD in SCI, its complications, surveillance, and management, aiming to provide PCPs with insights into SCI-related NLUTD and its management. The management approach for NLUTD depends on factors such as the level and completeness of SCI, gender, individual preference, cognitive ability, and cost. Urohealth monitoring, including regular reviews, renal function tests, and imaging, is crucial for detecting and managing complications of NLUTD.

Practical Implications

Annual Review of Bladder Management

Regularly assess the patient's bladder care program, continence, satisfaction, and complications (e.g., UTIs, hematuria).

Renal Function Monitoring

Conduct annual creatinine tests to assess renal function, being mindful that creatinine levels may be unreliable due to low muscle mass.

Judicious Use of Antibiotics

Avoid routine urinalysis and cultures in asymptomatic individuals to prevent overtreatment and reduce the risk of antibiotic resistance; only treat symptomatic UTIs based on culture and sensitivity results.

Study Limitations

1
Lack of clear evidence-based guidelines for NLUTD management.
2
Challenges in distinguishing clinically significant UTI from asymptomatic bacteriuria in the context of SCI.
3
Inconclusive data regarding recommended frequency of catheter replacement.

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