Introduction
Spinal cord injury (SCI) is a devastating condition that has a significant socioeconomic impact on both the afflicted parties and the healthcare industry. There are 12,500 new cases of spinal cord injury (SCI) in North America each year, according to the National Spinal Cord Injury Statistical Center. Traumatic events like falls, sports injuries, violent crimes, and car accidents account for more than 90 percent of SCI cases.
What Is Spinal Cord Injury?
Damage to the bundle of nerves and nerve fibers that transmit and get information from the brain is a spinal cord injury. The lower back holds the spinal cord, which goes from the lower part of the brain. Spinal cord injuries can be due to trauma to the spinal cord itself or from conditions affecting the surrounding tissues and bones (vertebra). This damage may cause changes in sensation, movement, strength, and functions of the body below the injury site. It can be temporary or permanent.
What Are the Common Urologic Symptoms Seen After Spinal Cord Injury?
The risk of premature death is two to five times higher in SCI patients than in non-SCI patients. The chance of death rises with the severity and level of the injury, peaking in the first year following the injury. Reduction of renal function, urinary tract infections (UTIs), urolithiasis (kidney stones), bladder cancer, and catheter-induced injuries are among the common urinary tract problems. Chronic SCI causes neurogenic lower urinary tract dysfunction (NLUTD), which is the root cause of all problems. NLUTD primarily affects those with storage and voiding (emptying) dysfunctions. Urinary incontinence, urine retention, upper urinary tract injury, and low bladder compliance are common in patients, and they may increase morbidity or death. The everyday and social activities of the patients, as well as their quality of life, are negatively impacted by NLUTD.
Urinary tract dysfunction is treated with great care to prevent the consequences in patients with spinal cord injury. Maintaining kidney function is the main objective. As a result, in all bladder management regimens, the major goals of treatment are to prevent urinary tract infections, promote bladder drainage, and maintain a low intravesical pressure for continence and full bladder emptying. Patients frequently rely on catheterization for voiding to achieve adequate bladder emptying and continence. In addition, they may also need medication or surgery. However, no surgery is risk-free or appropriate for every patient. For instance, following bladder augmentation (a surgical procedure that helps the bladder hold more urine), patients may have major side effects such as adherent ileus, urine extravasation, or even death.
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Urine Retention: The other prevalent and annoying symptom in people with chronic SCI who have detrusor underactivity is urine retention. It has been suggested that cholinergic medications like Distigmine and Bethanechol increase detrusor contractility. However, there is currently insufficient data to justify the use of cholinergic drugs in patients with underactive bladders.
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Reflex Voiding: Patients suffering from supra sacral cord damage frequently exhibit detrusor hyperreflexia and detrusor sphincter dyssynergia (DSD, a condition caused by SCI), leading to elevated pressure during voiding. The most common method used by patients with upper motor neuron SCI to cause a detrusor contraction is suprapubic tapping (a procedure done to remove urine in patients who are unable to do so). Patients may not have sufficient detrusor contractility to finish emptying their bladders, which is the main cause of reflex voiding.
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Clean Intermittent Catheterization (CIC): When satisfactory bladder capacity and low intravesical pressure can be achieved, CIC is the recommended method of bladder control. This technique aligns more with the physiological state and eliminates the need for a persistent foreign body. In addition, it is a reversible and noninvasive procedure in contrast to other bladder control techniques. CIC is still not the best bladder management option for every SCI patient despite its benefits.
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Indwelling Catheterization: Approximately one-third of SCI patients receive indwelling catheterization, which includes suprapubic and urethral catheterization. Urinary blockage that cannot be resolved surgically and resistant incontinence are the two most frequent reasons for long-term catheterization. Bacteriuria (presence of bacteria in urine) is usually a drawback of indwelling urine catheters.
What Are the Long-Term Urologic Complications Seen After Spinal Cord Injury?
Recurrent UTIs, bladder cancer, loss of renal function, urolithiasis, vesicourethral reflex (VUR), and catheter-induced damage are among the common complications of chronic SCI. UTIs in people with SCI are typically brought on by higher residual urine and poorer bladder compliance. Other potential causes include immunological abnormalities, immobile everyday activities, and wet perineal circumstances, particularly in those with urine incontinence.
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Bladder Cancer: Individuals suffering from spinal cord injuries are more susceptible to bladder cancer. They are more likely to receive a diagnosis later in life. Several diagnostic techniques, including routine surveillance cystoscopy, have been applied to SCI patients to detect cancer early.
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Urolithiasis: Patients suffering from SCI also frequently have urolithiasis. The risk of renal stones increases with time and is a progressive condition. The risk of stone development is greatest in the first three to six months following the initial SCI. This is assumed to be due to extended immobility, which causes bone resorption and subsequent hypercalciuria (increased calcium release through urine).
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Vesicourethral Reflex (VUR): A condition in which urine flows backward from the bladder to the ureter and the kidney is called vesicourethral reflux. It frequently happens after a period of high intravesical pressure. VUR usually develops four years after SCI. Poor VUR control may result in recurring UTIs, hydronephrosis, renal failure, or even death.
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Loss of Renal Functions: The major goal of treating neurogenic bladder dysfunction is to keep renal function from deteriorating. This should be the priority for all bladder management strategies. Studies showed a decrease in kidney functions with age in chronic SCIs.
Conclusion
Patients with chronic SCI have varying voiding dysfunctions, and the urinary tract condition frequently worsens over time. Many efforts have been undertaken to protect patients' urine function and avert problems. Recurrent UTIs, bladder malignancy, renal function loss, urolithiasis, VUR, and catheter-induced damage have all been recorded as long-term problems in SCI patients. Although NLUTD can be diagnosed and treated, all patients should be watched for the rest of their lives to avoid the complications of urological problems and challenging lower urinary tract symptoms.
