Spinal Cord Injury Case Study

Prevention of Urinary Tract Infections in Patients with Spinal Cord Injury
Urinary tract infections [UTIs] are the most frequent infections in patients with both traumatic and nontraumatic spinal cord injury [SCI] and occurs at a rate of 2.5 events per patient per year.1 The majority of cases of septicemia can be attributed to the urinary tract with a mortality rate of about 15 percent.1 Systematic reviews and randomized controlled trials have shown that several modalities are effective in UTI prevention; catheter insertion only when appropriate, early catheter discontinuation, and the use of aseptic techniques are vital in lowering the rates of catheter-related UTIs, Hydrogel-coated catheters are associated with better patients’ comfort and

Hydrogel-coated catheters
Urinary catheters can be manufactured from latex, plastic, silicone or Teflon®. None of these materials is entirely biocompatible or complication-free. The surface of latex catheters is much more uneven than silicone counterparts, which predisposes to bacterial adherence.22 Moreover, toxic effects in vitro and proinflammatory responses in vivo, are more common in latex catheters, and long-term exposure can lead to polypoid cystitis.23-25 Silicone catheters have larger lumen and are less associated with infection compared to latex catheters. However, they are less comfortable due to increased rigidity.26,27
The use of hydrogel-coated catheters is a novel technique that leads to better patient comfort and satisfaction, decreased microbial adherence, and reduced encrustation. Hydrogel-coated catheters have been associated to lower rates of symptomatic UTI in patients with acute SCI, UTI-related complications, inflammatory episodes at scrotal level, number of post/intra/inter-catheterization bleeding episodes, treatment costs, rehabilitation days, and the emergence of antibiotic-resistant

Reflux and stasis will eventually result in UTIs. Anticholinergic drugs can lower detrusor pressure, unfortunately about one third of patients may not tolerate or fail therapy.38
Botulinum toxin A detrusor injections can lower the frequency of symptomatic UTIs by ameliorating detrusor overactivity which leads to improvement in urodynamic parameters with improved reservoir capacity of the urinary bladder while maintaining low intra-bladder pressure.39
Sacral neuromodulation
Early surgical implantation of the sacral nerve stimulation system can help reduce the frequency of UTIs by preventing detrusor overactivity. Not only normal bladder capacity, avoiding incontinence, and longer self-catheterization time intervals can be achieved which in turn help avoid UTIs, but also bowel and erectile functions are anticipated to be improved. The exact mechanism of action for sacral neuromodulation is poorly understood and requires more research.