|Gu et al. 2015
|Population: Urinary retention; Mean age: 35.7 yr; Gender: males=80, females=27; ASIA classification: B=37, C=53, D=17.
Intervention: Individuals were randomized to Clean intermittent catheterization (CIC) (group 1) (n=35), Electroacupuncture combined with CIC (group 2) (n=38), or Sham acupuncture combined with CIC (group 3).
Outcome Measures: Residual urine volume, voided volume, bladder balance, frequency of CIC.
|1. At 1 mo follow-up, group 2 had a significantly higher number of bladder balance participants compared to group 1 (p=0.019) or group 3 (p=0.019).
2. At 1 mo follow-up, group 2 participants had significantly lower frequency of CIC compared to group 1 (p<0.001) or group 3 (p<0.001), and group 3 was also significantly lower than group 1 (p<0.01).
3. In terms of residual urine volume at 1 mo follow-up, group 2 was significantly lower than group 3 (p<0.001) and group 3 was significantly lower than group 1 (p=0.018).
4. At 1 mo follow-up, group 2 had a significantly higher voided volume compared to group 1 (p<0.001) and group 3 (p<0.001), with no significant differences between groups 1 and 3.
5. At 3 mo follow-up, significant differences were found between groups in terms of residual urine volume (p<0.001), with groups ordered as 1, 3, and 2 in terms of decreasing volume.
6. At 3 mo follow-up, significant differences were found between groups in terms of voided volume (p<0.001), with groups ordered as 1, 3, and 2 in terms of increasing volume.
|Giannantoni et al. 1998
Age: 35 yr; Gender: males=57, females=21; Severity of injury: AIS: A/B=68, C/D=10; Mean time post-injury=89 mo.
Group 1: Individuals using clean intermittent catheterisation (IC).
Group 2: Individuals using other methods of emptying (31 using Abdominal straining, tapping, or Crede manoeuvre, 5 indwelling catheter, 7 sponataneous voiding)
Outcome Measures: Urodynamic studies (UDS) (all anticholinergics were held); renal function (BUN, creatinine, creatinine clearance), ultrasound, intravenous pyelogram (IVP) and/or voiding cystourethrogram (VCUG).
|1. Both groups had similar clinical and UDS characteristics, and length of time treated with a foley catheter (67.9 versus 75 mo)
2. There were significantly more abnormalities on US or Cystourethrography in Group 2(22 versus 36 individuals) p=0.03
3. Upper urinary tract damage (hydronepphrosis, renal stones, reflux) occurred more commonly in group 2 (n=13) vs. group 1 (n=4) p=0.03.
4. Clean IC was believed to be the only explanation for the improved outcome in group 1
|Drake et al. 2005
|Population: Mean age: 57.4 yr; Gender: male=171; females=51. Mean time post-injury=33 yr.
Intervention: Individuals were divided according to their bladder management method: balanced reflex voiding; intermittent catheterization; indwelling urethral or suprapubic catheter; normal micturition.
Outcome Measures: Risk of urinary tract infection (UTI), other complications. Individuals were prospectively followed for 6 yr.
|1. Complications including renal failure were significantly related to both age and yr post injury.
2. No significant difference in risk of a urinary tract infection* was seen for the different bladder management methods (IDUC, p=-0.17; IC, p=0.45; straining, p=0.87; normal voiding, p=0.30. *UTI incidence=1 or more UTIs in yr prior to assessment.
3. 28.8% changed bladder management method during the study period, particularly those in balanced reflex voiding group.
4. Urodynamic studies were not done routinely
|Bartel et al. 2014
|Population: Bladder stone group (n=93): Mean age: 50 yr; Gender: males=69, females=24; Level of injury: cervical=34, thoracic=49, lumbar=9, sacral=1; Severity of injury: complete=75, incomplete=18; ASIA classification: A=53, B=22, C=13, D=5; Injury etiology: trauma=74, multiple sclerosis=10, other=9; Mean time post-injury: 9.5 yr.
Intervention: Charts were reviewed for spinal cord injury individuals who had a bladder stone.
Outcome Measures: Bladder management method, period to stone development, bladder stone recurrence rate.
|1. Of the 2825 SCI individuals, 93 had bladder stones (2.8%).
2. In terms of bladder management methods, bladder stones were observed in 11% of suprapubic catheter, 6.6% of transurethral catheter, 2% of intermittent catheterization, and 1.1% of reflex micturition.
3. In terms of period to stone development, the mean for suprapubic catheter was 59 mo, transurethral catheter was 31 mo, intermittent catheterization was 116 mo, and reflex micturition was 211 mo.
4. The bladder stone recurrence rate was 28% for suprapubic catheter, 40% for transurethral catheter, 22% for intermittent catheterization, and 0% for reflex micturition.
|Afsar et al. 2013
|Population: Mean age: 40.7 yr (range 23-65 yr); Gender: males=102, females=62; Level of injury: Tetraplegia=43, Paraplegia=87, Conus-Cauda Equina Syndrome=34; Time post-injury: 51.5 d (range 5-292 d).
Intervention: Retrospective review of bladder management and emptying methods.
Outcome Measures: Bladder management method, urinary tract infection (UTI) prevalence, functional independence measure (FIM) scores.
|1. Bladder emptying method at discharge was: indwelling catheter (n=16, 9.8%), clean intermittent catheterization (n=104, 63.4%), reflex voiding (n=25, 15.2%), and normal voiding (n=19, 11.6%). While at follow up emptying method was: indwelling catheter (n=21, 13.1%), clean intermittent catheterization (n=60, 37.5%), reflex voiding (n=57, 35.6%), and normal voiding (n=22, 13.8%).
2. 42% of individuals using clean intermittent catheterization changed their bladder emptying method. Also rate of reverting to urethral indwelling catheter usage was 21.4%.
3. The number of UTIs was highest in individuals using indwelling catheters.
|Gohbara et al. 2013
|Population: Mean age: 57.2±14 yr (range=13-87, median=61); Gender: males=195, females=39; Level of injury: Cervical; Etiology of injury: Traumatic=204, Non-traumatic=30.
Severity of Injury: ASIA B=23 (9.8%), C=90 (38.5%), D=120 (51.7%); Time post-injury: 1-10 mo.Intervention:Chart review.Outcome Measures:Urinary management, spontaneous voiding, urinary sensation, detrusor overactivity.
|1. Between admission and discharge, the number of individuals using:
- urethral catheterization declined (48.3% vs. 9.4%, respectively)
- suprapubic cystostomy with indwelling catheters increased (0.9% vs. 10.7%, respectively)
- nursing care clean IC (5.5% vs. 2.6%, respectively)
- self-IC increased (0.9% vs. 15.8%, respectively)
- spontaneously voiding increased (42.7% vs. 57.2%, respectively)
2. There was no difference in urinary management between the sexes.
3. At discharge, the spontaneous voiding rates of individuals with ASIA B,C and D classification were 13.0, 37.8 and 80.2% resp. (p<0.001)
Of the 113 individuals who had urethral catheterization at admission, 35 were spontaneously voiding at discharge.
|El-Masri et al. 2012
|Population: Mean age: 29±12 yr (range=16-63); Gender: male=99, female=20 Level of injury: paraplegic=60, tetraplegic=50; Neurological level: ASIA A=63, B=8, C=14, D=34.
Intervention: N/A – Data analysis of bladder management and urinary complications divided into
Phase 1: Preadmission to MCSI,
Phase 2: During first hospitalization at MCSI, and
Phase 3: Post discharge resp.
Review of results from routine clinical assessment, urine analyses, ultrasound scans or intra venous urograms (IVU) that were completed every 1 or 2 yr (cystoscopies also performed in individuals with suprapubic or indwelling catheters).
Outcome Measures: Bladder management (i.e. indwelling urethral catheterization (IndUC), assisted clean intermittent catheterization (A-IC), clean intermittent self-IC (S-IC), reflex voiding (RV) resp.), Urinary complications, Length of stay.
1. All individuals (119) were initially managed with IndUC; 81 had the method of urine drainage documented immediately before admission of which 56 (69%) had IndUC, 22 (27%) had A-IC, and 3 (4%) used RV and/or bladder expression resp.2. 2 male individuals that were admitted 15 and 38 d post injury resp. were suspected of having UTI.Phase 23. Soon after admission, bladder management was changed from IndUC to A-IC.4. Of the 119 individuals, 45 (38%) had complications: UTI (31), UTI plus reflux or hydronephrosis (n=7), and other (n=7).5. There was no significant difference in complications by ASIA scores, length of stay or level of injury.Phase 36. Of the 119 individuals, 73 (61%) developed complications, most commonly UTI.7. All ASIA D (n=24) subjects did not require intervention for urinary drainage; only 3 had a mild UTI.8. 60% of those individuals using RV with or without bladder expression developed complications.9. Of the 10 individuals who continued to use IndUC post-discharge, 6 had tetraplegia versus 4 with paraplegia.10. No significant difference in complications by level of injury but there was by severity of injury (p<0.01).
|Böthig et al. 2012
|Population: Mean age: 45 yr (range=17-78 yr); Gender: male=40, female=16; Level of injury: C0=11, C1=0, C2=29, C3=14, C4=2; Neurological level: ASIA A=46, B=4, C=6. All individuals had long-term-ventilation and bladder drainage was obtained using either suprapubic catheter (SPC) (male=28, female=10, mean age: 49.9 yr), intermittent catheter (IC) performed by home caregivers (male=8, female=4, mean age: 31.8 yr), or other methods such as transurethral catheter (2), reflex voiding by suprapubic tapping (2) or and IC per umbilical stoma (2) resp.
Intervention: N/A – Data analysis of a Quality of Life (QoL) questionnaire (ICIQ-SF) and urological morbidity of 3 groups: Suprapubic Catheter (SPC), Intermittent Catheter (IC) and Other resp.
Outcome Measures: Bladder management, Urological morbidity, Quality of Life (QoL).
|1. Only the data from SPC and IC individuals were used for analysis (N=50).
2. The difference in mean age between the SPC group and IC group was statistically significant. (p=0.0035)
3. There was no difference between the gender and method of bladder management (p=0.718).
4. During the follow-up period, 7 of the 50 individuals changed from IC to SPC due to urethral complications.
5. Of the SPC group, 10/38 had 15 urologicial interventions, while the other 28 had no complications or procedures.
6. Of the IC group (now=12+7), 11 individuals had a total of 19 readmissions, while only 8 had no complications or procedures.
7. The leading cause of readmission in the SPC versus IC groups was bladder stones versus urethral trauma resp.
8. Individuals with IC experienced significantly more urological complications than with SPC. (p<0.05)
9. 47/56 (84%) individuals completed the QoL questionnaire of which 43 were included for analysis (SPC=32, IC=11).
10. QoL scores for the SPC versus IC group were 3.06 versus 4.27 resp. which was not statistically significant (p=0.368) (ref: 0=best/16=worst)
|Hansen et al. 2007
|Population: Mean age: 50.5 yr; Gender: males=193, females=43; Mean follow-up time=24.1 yr; Level of injury: paraplegic=126, tetraplegic=110; Severity of injury: complete=102, incomplete=134.
Intervention: Retrospective analysis of renal calculi development associated with various factors including bladder management method (normal emptying, suprapubic tapping/crede, intermittent catheter (IC), indwelling catheter); individual questionnaire about kidney stones.
Outcome Measures: Prevalence of calculi, risk of calculi.
|1. At least 1 episode of renal calculi was seen in 47 individuals and at least 1 episode of bladder calculi was seen in 33 of individuals.
2. The first 6 mo after injury had the highest risk for getting renal and bladder calculus.
3. No significant difference was seen between the type of bladder emptying method and the prevalence of calculi (trend was towards more stones in those with indwelling catheters).
|Population: SCI: Mean age: 27 yr; Gender: males=383, females=96; Individuals admitted over a 10 yr period were chosen. 10 yr follow up data available for 426 individuals, 15 yr follow-up data available for 412 individuals.
Intervention: SCI individuals’ medical records were retrospectively reviewed to determine changes in bladder management techniques. Questionnaires were also sent.
Outcome Measures: Bladder management techniques.
|1. Of the individuals discharged with an intermittent catheterization program (ICP), 398 remained on the program at 1 yr follow-up.
2. At 5 yr follow up, 80% of individuals were catheter free (50% used an ICP).
3. At 15 yr follow up, of the 166 individuals, 42 changed to chronic indwelling catheters, while 111 were catheter-free state or used ICP.
|Ord et al. 2003
|Population: SCI with>6 mo on any 1 form of management: Mean age: 29-40 yr for various groups; Gender: males=402, females=55; Level of injury: T3 – T9; Severity of injury: complete, incomplete; Follow-up time=48-107 mo.
Intervention: Assessment of various bladder management methods (i.e., sphincterotomy, condom, intermittent catheter (IC), indwelling urethral catheter, suprapubic catheter+combinations of each).
Outcome measures: Bladder stone formation rate.
|1. Both forms of indwelling catheterization had an increased risk of getting bladder stones and requiring hospitalization for bladder stones over IC and condom drainage with or without sphincterotomy.
2. Relative to IC, hazard ratio was 10.5 for suprapubic catheters and 12.8 for indwelling urethral catheters.
3. Incidence density ratio (like odds ratio) was 40.7 for developing bladder stones for indwelling catheters relative to IC. Condom incidence density ratio was 7.5 relative to IC.
4. % Annual risk for stone formation: Condom & Sphincterotomy 0%; IC 0.2%; Expression voiding with or without condom 0.5%; Indwelling catheter 4% (first stone), 16% (subsequent stone).
|Groah et al. 2002
|Population: SCI with bladder cancer: Mean age: 48 yr; mean time post-injury=20 yr.
Intervention: SCI bladder cancer individuals’ data was analyzed to determine risk factors for bladder cancer.
Outcome Measures: Bladder management methods, prevalence of bladder cancer, risk for bladder cancer, mortality rate due to bladder cancer.
|1. Bladder management methods included:
- Indwelling catheters (IDC), 15 individuals.
- Non indwelling catheters (NIDC) spon. Void, condom, IC: 3 individuals.
- Both indwelling and nonindwelling catheters (Multi) duration of IDC use 20 yr, 3 individuals.
2. Development of bladder calculi was significantly higher in individuals using IDC than NIDC (p<0.001) 10 versus 2 individuals but bore no relationship to incidence of CA.
3. SCI individuals were 15.2x (95% CI, 9.2-23.3) more likely to develop bladder cancer than the general population. IDC 4.9x more likely to develop bladder cancer than NIDC
4. Bladder management method (p<0.02) and age at SCI (p<0.01) significantly predicted bladder cancer.
5. SCI individuals using IDC have a risk factor of 77 per 100,000 person yr of bladder cancer, starting at 12 yr post injury.
6. Of the 13 individuals that died, 12 were due to bladder cancer. Of these 12 individuals, 10 used IDC methods while 2 used Multi method.
7. No mortality rate was found in the NIDC group.
|Weld & Dmochowski 2000
|Population: SCI: Mean age: 33.9-41.0 yr; Gender: males=313, females=3; Level of injury: suprasacral=269, sacaral=47; Severity of injury: complete=45, incomplete=271; Mean follow-up=17.8-19.3 yr for various groups.
Intervention: Assessment of various bladder management methods (i.e., intermittent catheterization (IC), voiding spontaneously, indwelling urethral catheter, suprapubic catheter).
Outcome Measures: Urological complication rate (epididymitis, pyelonephritis, upper tract stone, bladder stone, urethral strictures, periurethral abscess, vesicoureteral reflux, abnormal upper tracts).
|1. Frequency of those managed by IC, voiding spontaneously, suprapubic and urethral catheterization was 92, 74, 36 and 114 subjects respectively.
2. Complication rates for the above groups were 27.2%, 32.4%, 44.4% and 53.5% respectively.
3. Urethral catheter users had the highest rates for epididymitis, pyelonephritis, upper tract stone, bladder stone, urethral strictures and periurethral abscess.
4. Suprapubic catheter users had the highest rates for vesicoureteral reflux and abnormal upper tracts.
|Yavuzer et al. 2000
|Population: SCI: Mean age: 38 yr; Gender: males=36, females=14; Level of injury: paraplegia=43, tetraplegia=7; Severity of injury: AIS: A-D; Time post- injury=124 d; Rehabilitation LOS=130 d; Follow-up time=24 mo.
Intervention: Follow-up of those with various bladder management methods.
Outcome Measures: Bladder management method, compliance.
|1. At admission 43 individuals used indwelling catheter and by discharge from rehabilitation, intermittent catheter (IC) was used by 37.
2. At 2 yr follow-up, of 38 people using IC, 20 had reverted back to indwelling catheter by 24 mo, 16 continued with IC.
3. Tetraplegics had lower compliance with IC than paraplegics (p<0.05) – majority of tetraplegics (80%) reverted to indwelling catheter versus only 40% of paraplegics.
4. More females (60% versus 50%) reverted to indwelling catheters but this was not significant.
5. More with complete injuries reverted to indwelling catheters (68% versus 31%, p<0.01).
6. Main reasons for changing method=dependence on care givers, severe spasticity, incontinence and inconvenience (females).
|Gallien et al. 1998
|Population: Mean age: 41.45 yr; Gender: males=129, females=53; Severity of injury: complete=69, incomplete=113; Mean time post- injury=8 yr.
Intervention: Bladder management method relative to urinary tract infection (UTI) and other complications was retrospectively reviewed and a questionnaire was sent to all individuals and attending physicians.
Outcome Measures: Method of bladder management; complication: lithiasis, urinary infections, orchiepidymitis, urethral trauma, vesicorenal reflux, renal failure.
|1. Prevalence of complications was related to:
- Type of bladder management at discharge: 129 individuals using clean IC, 137 using percussion and all individuals using indwelling catheters had at least one urologic complication.
- Gender, with males having a higher probability than females (p<0.0001).
2. Urinary infections were significantly higher in:
- Individuals with complete lesions (p=0.0001).
- Use of a protection or a urine collector (p=0.0022).
3. Urinary infections were not significantly related to:
- Time since injury.
- Method of bladder management (those on indwelling catheters were not part of UTI analysis).
4. Intermittent catheterization was the main method of bladder management.