Urinary Symptoms Are Unrelated to Leukocyte Esterase and Nitrite Among Indwelling Catheter Users

Top Spinal Cord Inj Rehabil, 2023 · DOI: 10.46292/sci22-00095 · Published: January 1, 2023

Simple Explanation

This study investigates the relationship between urinary symptoms and urine dipstick results in individuals with spinal cord injury/disease (SCI/D) who use indwelling catheters. The research aims to determine if dipstick-determined bladder inflammation and the presence of nitrite are associated with urinary symptoms in this population. The findings suggest that urinary symptoms are not associated with positive dipstick results, indicating that a negative dipstick with the absence of key symptoms may be more informative for clinical decision-making.

Study Duration

12-month

Participants

52 spinal cord injury/disease (SCI/D) participants with neurogenic lower urinary tract dysfunction

Evidence Level

Level 2; Prospective observational cohort study

Key Findings

1
No association was observed between clinically actionable (A), bladder (B1), and urine quality (B2) symptoms and positive dipstick results.
2
Participants were asymptomatic with a strong positive dipstick an average of 30.2% of the weeks.
3
On average, 73% of the time a person had a negative dipstick, they also had no bladder (B1) or urine quality (B2) symptoms

Research Summary

This study explored the association between dipstick-determined bladder inflammation, presence of nitrite, and valid and reliable urinary symptoms among people with NLUTD using indwelling catheterization. The results show that among people with NLUTD due to SCI/D and who manage their bladders with IDC, none of the clinically actionable (A), bladder (B1), or urine quality (B2) symptoms are associated with the presence of NIT, LE levels, or combinations of these as determined by self-administered dipstick. Given the clear disassociation between the presence of a wide range of urinary symptoms and dipstick-determined inflammation (LE and NIT) in real time, we agree with the perspective that current clinical assessments to diagnose NLUTD-related UTI are likely inadequate, and consideration of other approaches is warranted.

Practical Implications

Rethinking UTI Diagnosis

Current clinical assessments for diagnosing UTIs in individuals with NLUTD may be inadequate, necessitating consideration of alternative diagnostic approaches.

Informed Clinical Decision-Making

A negative dipstick result combined with the absence of key urinary symptoms could offer a more reliable basis for clinical decisions in this patient population.

Understanding Bladder Inflammation

The study underscores the importance of recognizing that bladder inflammation is a common occurrence in individuals with NLUTD who rely on indwelling catheters.

Study Limitations

1
The study focused on 26 symptoms specific to IDC users rather than focusing on UTI as an outcome.
2
The dipstick reflected the LE and NIT on that specific day, but participants reported symptoms during the previous week.
3
Data was limited to self-reporting of both symptoms and objective (dipstick) results.

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