Independence of Urinary Symptoms and Urinary Dipstick Results in Voiders With Neurogenic Bladder

Top Spinal Cord Inj Rehabil, 2022 · DOI: 10.46292/sci21-00006 · Published: July 1, 2022

Simple Explanation

This study investigates the relationship between urinary symptoms and urine dipstick results in people with spinal cord injury (SCI) or multiple sclerosis (MS) who void. The aim was to see if dipstick results can reliably inform clinical decisions based on reported symptoms. Participants completed a urinary symptom questionnaire and performed urine dipstick tests biweekly for 12 months. The study analyzed whether specific symptoms coincided with positive dipstick results, indicating a potential UTI. The findings suggest that urinary symptoms and dipstick results provide independent information. In many cases, strong positive dipstick results did not coincide with reported symptoms, suggesting dipsticks alone may not be sufficient for UTI diagnosis in this population.

Study Duration

12 Months

Participants

76 participants with SCI or MS who manage their bladders by voiding

Evidence Level

Not specified

Key Findings

1
No evidence of associations was found between key bladder symptoms and urine quality symptoms with composite dipstick outcomes in SCI and MS patients who void.
2
Negative dipstick results did not consistently align with the absence of symptoms, indicating that people experienced symptoms even when dipstick results were negative.
3
High levels of positivity in dipstick results are common and often co-occur without any urine quality, bladder, or clinically actionable symptoms.

Research Summary

The study explored the associations between urinary symptoms reported via the USQNB-V questionnaire and urine dipstick results in individuals with SCI or MS who void. The goal was to determine if dipstick results could reliably inform clinical decisions regarding UTIs based on patient-reported symptoms. The findings indicated a lack of association between specific urinary symptoms and dipstick results. Positive dipstick results frequently occurred without corresponding symptoms, and negative dipstick results did not guarantee the absence of symptoms. The study suggests that urine dipstick outcomes and urinary symptoms are not associated among voiders with NLUTD due to SCI or MS and that urine dipsticks do not contribute information about decision making around urinary symptoms among people with NLUTD due to SCI or MS and who void.

Practical Implications

Clinical Decision Making

Clinicians should not rely solely on urine dipstick results to guide decisions about urinary symptoms in SCI/MS voiders. Patient-reported symptoms, assessed using validated questionnaires, should be considered alongside dipstick results.

Home Assessment

An individualized change from baseline approach, as opposed to absolute cut points for positivity, may be needed when using dipsticks for at-home monitoring of UTIs.

Future Research

Future studies should assess different and newer dipstick technology and an individualized change from baseline approach, as opposed to absolute cut points for positivity.

Study Limitations

1
The study was unable to confirm definitively (by urodynamic assessment) whether participants had NLUTD and, if so, whether bladder dysfunction was characterized by overactivity, retention, or both.
2
The use of B2 symptoms experience as a proxy for NLUTD may not have fully captured the nuances of bladder dysfunction in all participants.
3
The stratification of the sample, while intended to create more homogeneous subgroups, did not reduce the variability observed over the yearlong study.

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