Aging Table 9: Genitourinary and Gastrointestinal Systems

Author Year; Country
Score
Research Design
Total Sample Size

Methods

Outcome

Adriaansen et al. 2017;

The Netherlands

Level 5 evidence

Cross-sectional

N=282

 

Population: N=282 subjects with SCI acquired between 18-35 years of age and ≥10 YPI, current age 28-65 years; 74% male, 26% female;

3 groups: TSI 10-19 years N=107, TSI 20-29 years N=96, TSI ≥30 years N=79
Age (years), mean (SD): 48.3 (8.9); mean TSI (years): 22.0 (range 16.8-30.3)
Cervical 41%, thoracic 53%, lumbar 6%; AIS A 69%, AIS B 14%, AIS C 10%, AIS D 8%

Methodology: Random samples of eligible participants were drawn from 8 Dutch rehabilitation centers. In a one-day visit to the rehabilitation center, they went through a check-up, extensive medical assessment, physical examination, and oral interview, and several physical tests. 2 weeks before the visit to the center, participants completed a self-report questionnaire about their bladder management methods.

Outcome Measures: The International Lower Urinary Tract Function Basic SCI Data Set and the Short-Form Qualiveen (SF-Qualiveen).

  1. Clean intermittent catheterization (CIC) was the most common (42.6%) bladder emptying method in people with long-term SCI.
  2. Following CIC as the most common bladder emptying methods are: condom catheter drainage (11.3%), indwelling suprapubic catheterization (11.3%), and voluntary bladder reflex triggering (11.0%)
  3. The TSI 10-19 group had more participants with a continent urinary diversion compared to the other two TSI groups. More participants in the TSI ≥30 group had a transurethral catheter compared to the other two groups.
  4. Participants using a transurethral catheter reported the highest impact of neurogenic lower urinary tract dysfunction (NLUTD). Participants with a continent urinary diversion reported the lowest impact of NLUTD on QoL.
  5. Higher age and indwelling catheter use vs. CIC were associated with a higher impact of NLUTD QoL
Gao et al. 2017;

USA

Level 4 evidence

Retrospective chart study

N=43

Population: N=43 (28 M, 15 F), mean age of injury (y) = 20.6 (range 1-43); median follow-up (YPI) = 45 (range 40-50);

Injury characteristics: cervical (44%), thoracic (53%), lumbar (3%); AIS A (56%), AIS B (7%), AIS C (21%), AIS D (16%)

Methodology: Data was extracted from a chart review of patients with SCI who received long-term urologic care at the RLANRC urology clinic for ≥40 years. Urologic complications and bladder management were evaluated in 5-year intervals to assess the management and types of urologic complications in people with SCI and to explore the risk factors for these complications.

Outcome Measures: Urologic complications and bladder management methods.

  1. All patients suffered from at least one UTI, with a mean of 48.6 episodes over 40 YPI, with average 6.1 cases per 5 years per person.
  2. UTI episode peaks occurred in the 1st and 10th 5-year intervals, with an average incidence of 7.8 and 10.0 cases per 5 years per person, respectively
  3. Besides UTI, the most common complications were bladder stone (49%), hydronephrosis (47%), and vesicoureteral reflux (33%).
  4. The bladder managements used for the longest period were condom catheter in men (79%) and clean intermittent catheterization in women (33%), with an average maintenance of 23.6 and 38.0 years, respectively.
  5. Male gender, cervical injury, and condom catheter use were closely related to complications, particularly UTI and renal insufficiency.
Hwang et al. 2017;

USA

Level 2 Evidence

Longitudinal
N=131

Population: N=131 (84 M, 47 F), at first interview: mean age (y)= 33.4±6.1 (range 25-48); mean age at injury (y)=13.4±4.6 (range 0-18); Duration of SCI (y)=19.5±7 (range 8-41); Tetraplegia (58.8%)

Methodology: Participants were given a questionnaire and were given a follow-up annually between 2010-2015 (participants completed at least 2) to describe the long-term outcomes of neurogenic bowel dysfunction (NBD), determine changes over time in the type of bowel program, and to determine changes in psychosocial outcomes associated with NBD-related factors in adults with sustaining a SCI before 19 years of age. The mean interval in years between the first and last interview was 3.2±1.3 (range 1-5).

Outcome Measures: Type and evacuation time of bowel management programs; Satisfaction With Life Scale, Patient Health Questionnaire-9, Short Form-12 version 2 Health Survey, and the Craig Handicap Assessment and Reporting Technique (CHART); Generalized estimating equations were formulated to determine odds of change in outcomes over time.

  1. The odds of using manual evacuation, oral LAX, and colostomy increased 7.7%, 5.2%, and 7.1%, respectively, while the odds of using rectal suppositories/enemas decreased 6.7% with each passing year
  2. Over time, individuals with paraplegia were 5 times more likely to use manual evacuation and 90% and 65% less likely to continue using rectal suppositories/enemas and oral LAX, respectively, compared with those with tetraplegia.
  3. Individuals with complete injuries were 3 times more likely to use oral LAX over time compared with those with incomplete injuries.
  4. Participants using manual evacuation and DS were less likely to experience prolongation of bowel program duration over time; for those using rectal suppositories/enemas, the likelihood of increasing duration nearly doubled with each passing year.
  5. Participants using LAX had 3.9 times increased likelihood of having abdominal pain with each passing year.
Nielsen et al. 2017;

Denmark

Level 2 Evidence

Longitudinal

N=109

Population: N=109 (76% M. 26% F), median age (y)=55 (IQR 49-63), median TSI (y)=28 (IQR 24-34); cervical (9%), thoracic (30%), lumbar (61%); complete lesion (66%), incomplete lesion (34%)

Methodology: A questionnaire on bowel function was sent to members of the Danish SCI association in 1996, and was sent again to surviving members in 2006 and in 2015 to describe changes in the patterns of neurogenic bowel dysfunction and bowel management in a population of people with SCI followed for two decades.

Outcome Measures: Questionnaire describing age, gender, time since lesion, constipation, obstructed defecation, fecal incontinence, QoL, and abdominal pain and discomfort.

  1. The proportion of respondents using more than 30 min to defecate increased significantly from 1996 (21%) to 2015 (39%). Accordingly, more considered themselves to be constipated and more took oral laxatives
  2. There was no significant change in frequency of defecation, use of digital evacuation, help needed for bowel management or use of enemas. Constipation as a cause of some or major restrictions on daily life did not significantly change either.
  3. There was no significant change in fecal incontinence among our study population, except for an increased use of diapers for fecal incontinence.
    22/109 respondents had undergone surgery related to NBD (20%). Eleven (10%) had a stoma, including 5 (5%) with colostomy, 3 (3%) with appendicostomy, 1 (1%) with iliostomy and 2 (2%) with unspecified stomas.
Adriaansen et al. 2016;

The Netherlands

Level 5 evidence

Cross-sectional
N=282

Population: N=282 subjects with SCI acquired between 18-35 years of age and ≥10 YPI, current age 28-65 years; 74% male, 26% female;

3 groups: TSI 10-19 years n=107, TSI 20-29 years n=96, TSI ≥30 years n=79
Age (years), mean (SD): 48.3 (8.9); mean TSI (years): 22.0 (range 16.8-30.3)
Cervical 41%, thoracic 53%, lumbar 6%; AIS A 69%, AIS B 14%, AIS C 10%, AIS D 8%

Methodology: Random samples of eligible participants were drawn from 8 Dutch rehabilitation centers. In a one-day visit to the rehabilitation center, they went through a check-up, extensive medical assessment, physical examination, and oral interview, and several physical tests. 2 weeks before the visit to the center, participants completed a self-report questionnaire

Outcome Measures: Occurrence of 13 secondary health conditions (SHCs): neuropathic pain, musculoskeletal pain, pressure ulcers, problematic spasticity, autonomic dysreflexia (AD), hypotension, oedema, neurogenic heterotopic ossification (NHO), pneumonia, urinary tract infection (UTI), urinary incontinence, faecal incontinence, constipation; International SCI QoL Basic Data Set;
Scpinal Cord Independence Measure III (SCIM-III)

  1. The most prevalent secondary health conditions were: musculoskeletal pain (63.5%), edema (38.7%), neuropathic pain (34.1%) and urinary tract infections (33.3%). Only edema showed a significant association with increasing time since injury.
  2. Musculoskeletal pain was the most frequently reported SHC and was more common in the TSI ≥ 30 years group, compared with the TSI 20–29 years group.
  3. Edema was more common in the TSI ≥ 30 years group, compared with the TSI 10–19 years group.
  4. AD was less common in the TSI 20–29 years and ≥ 30 years group, compared with the TSI 10–19 years group.
Elmelund et al. 2016;

Denmark

Level 4 evidence

Retrospective Chart Review
N=116

Population: N=116 (100 M, 16 F);

Mean age at injury (y)= 22±8

Mean follow-up YPI= 39±7

Level of injury: Cervical (46.6%), thoracic (41.4%), lumbar (12.0%)

Death during follow-up: n=42

Methodology: 116 people admitted to a clinic in Denmark with traumatic SCI sustained between 1956-1975 were included in the study to investigate the extent of renal deterioration in patients with SCI and to identify risk indicators associated with renal deterioration up to 45 years after SCI. Cr-EDTA plasma clearances were collected from medical records from time of injury until 2012, and the occurrence of renal deterioration was analyzed by cumulative incidence curves. GFR results were converted to an age- and gender-adjusted relative GFR (r-GFR).
Outcome Measures: Renal deterioration using GFR results; urinary tract stones, dilatation of the upper urinary tract (UUT) and bladder-emptying methods.

  1. The cumulative incidence of moderate renal deterioration increases with a constant rate after 15 YPI and is 58% after 45 YPI. Severe renal deterioration occurs primarily after 23 YPI, and the cumulative incidence is 29% after 45 YPI.
  2. UUT dilation and a history of renal/ureter stones requiring removal were significant risk indicators of renal deterioration in all analyses. Patients who had sustained an SCI in the period 1970−1975 had a significantly higher risk of moderate renal deterioration than patients who had sustained an SCI in 1956–1969, but no difference was found between the groups in terms of severe renal deterioration or the level of r-GFR.
  3. The bladder-emptying methods used for the longest period were reflex triggering (63%), bladder expression (22%), indwelling catheter (5%), normal voiding (4%), ileal conduit (3%) and clean intermittent catheterisation (2%).
Nielsen et al. 2016;

Denmark

Level 2 evidence

Longitudinal survey

N=130

Population: N=130 (72% M, 28% F); mean age (y)=56.0±9.8 (range 35-82); mean TSI=30.5±9.8 (range 20-69);

125 participants answered the questions about abdominal pain where 41 experienced abdominal pain and discomfort in the past week and 84 did not.

Methodology: A questionnaire on chronic abdominal pain and discomfort was sent to participants who had been members of the Danish SCI association for 10 years twice: in 2006 and in 2015—to evaluate the prevalence of abdominal pain in long-term SCI.

Outcome Measures: Abdominal pain and discomfort with an intensity scale (1-10 NRS)

 

  1. The percentage of responders with abdominal pain in 2015 (32.8%) was almost identical to the percentage in 2006 (34.2%), and the median pain intensity was the same (6.0)
  2. 28 individuals (24%) had abdominal pain or discomfort at both time points, and 48 (42%) did not have abdominal pain or discomfort at either time point. Nine (8%) individuals had developed pain in 2015 that was not present in 2006, and 30 (26%) individuals with abdominal pain in 2006 no longer reported abdominal pain in 2015
  3. Among those responding to both the questionnaires, the proportion who used more than 15 min to defecate and the proportion who reported that constipation had an effect on their quality of life also had not changed from 2006 to 2015 but the use of laxatives increased from 32% in 2006 to 52% in 2015.
Adriaansen et al. 2015;

The Netherlands

Level 5 evidence

Cross-sectional
N=258

Population: N=258 (73% M); mean age (y)=48 (range 29-65); mean TSI (y)= 24±9 (range 10-47); TSI strata: 10-19y (36%), 20-29y (35%), ≥30y (29%); tetraplegia (40%), paraplegia (60%)

Methodology: TSI was stratified among subjects into 10-19, 20-29, and ≥30 years after SCI to describe long-term bowel management and neurogenic bowel dysfunction (NBD) in individuals who have been living with SCI for ≥10 years.

Outcome Measures: International SCI Bowel Function Basic Data Set, [CC1] neurogenic dysfunction (NBD) score, and a single item on satisfaction with bowel management.

  1. 74% used ≥1 conservative bowel management method, specifically digital evacuation (35%) and mini enemas (31%). Transanal irrigation (TAI) and surgical interventions were used by 11% and 8%, respectively. Perianal problems were reported by 45% of the participants. Conservative defecation methods were most frequently used among all 3 strata
  2. Severe NBD was present in 36% of all participants and in 40% of those using a conservative method. However, only 14% were (very) dissatisfied with their current bowel management.
  3. Dissatisfaction with bowel management was significantly associated with constipation and severe NBD.
  4. There was no indication of decreased bowel function over time. The proportion of participants with severe NBD decreased over time from 44% to 26%, and an increase in TSI was significantly correlated with a decrease in the total NBD score
Schöps et al. 2015;

Switzerland

Level 2 evidence

Longitudinal
N=246

Population: N=246 (191 M, 55 F); mean age (y)=51±14; AIS A (47%), AIS B (14%), AIS C (12%), AIS D (26%)

Methodology: To investigate long-term urodynamic findings in patients with SCI with neurogenic lower-urinary tract dysfunction (NLUTD), data of the latest and earliest available urodynamic investigation (mean 6±3 years in between) were compared in SCI patients that were ≥5 YPI. Participants were prospectively evaluated from 2010-2014 in the Spinal Cord Injury Center, Balgarist University Hospital, Zurich. Mean duration since SCI to the latest available urodynamic investigation was 17±10 years.

Outcome Measures: Urodynamic parameters, urinary tract ultrasound

  1. At the earliest and latest available urodynamic investigation, more than half of the patients relied on intermittent self-catheterisation.
  2. During the course of disease, there was a significant increase of patients undergoing onabotulinumtoxinA injections into the detrusor from 12% to 33%.
  3. Urodynamic findings at the earliest and latest available urodynamic investigation were within the safe limits and there were significant differences between both groups for maximum cystometric capacity, compliance and maximum detrusor pressure during storage phase. Vesico-uretero-renal reflux was detected in ~5% and it was generally low grade.
Bauman et al. 2014;

USA

Level 4 evidence

Cross-sectional w/ Retrospective AB
N SCI=243

Population: N=243 all males; Mean age (years): 48±15 (range 21-78); Duration of injury (years): 17±13 (range 1-56)

Testosterone (T) status: Low T n=113, normal T n=130;

Level of injury: Paraplegia N=138, tetraplegia n=105; Completeness of Injury: Incomplete n=125, complete n=113

Methodology: All participants in the SCI cohort of this study had blood drawn between 8:00am-10:00am from the anticubital vein to determine serum T, albumin, and SHBG concentrations. The rate of decline T levels were compared a healthy male control population in the Massachusetts Male Aging Study. Normative data on men with low T levels were taken from the data of healthy men in the Baltimore Longitudinal Study on Aging. All cohorts were categorized into decades of life (20-29; 30-39; 40-49; 50-59; 60-69; 70-79)

Outcome Measures: serum T (rate of decline, whether it is low), albumin, and SHBG concentrations

  1. The SCI group had a 50% greater decline in serum total T than that of the normative data in AB control group. There was a 13.1% annual increase of SHBG in men with SCI compared to 1.2% in the healthy general population
  2. For each decade of life (between 20-80 years), men with SCI had a 15, 39, 50, 53, 58, and 57% incidence rate of low serum total T concentration if determined for values of the serum total T concentration.
  3. For each decade of life (between 20-80 years) the incidence of hypogonadism was 4, 15, 28, 33, 56, and 76% by the free T index. Thus, for each decade of life, there was a substantial increase in the prevalence of low T in men with SCI compared to the historical general population sample
  4. Men with SCI who were <39 years old did not have an increased risk of low serum total T concentration, regardless of BMI and/or categorization for DOI.
  5. Men with SCI who were >40 years old had considerable increased likelihood of having a low serum total T concentration, dependent upon the categorization of BMI and/or DOI. Those who had higher BMIs (≥30 kg/m2) and longer DOI (≥25 years) had an odds ratio of having a low serum total T concentration of 8.9 times higher than those with the lower BMIs (<29.9 kg/m2) and shorter DOI (<24 years)
Elmelund et al. 2014;

Denmark

Level 4 evidence

Retrospective Chart Review
N=119

Population: N=119 (103 M, 16 F);

Mean age of injury (y)= 21 (range 18-25); Mean follow up YPI= 40 (range 36-44);

Level of injury: Cervical (47%), thoracic (40%), lumbar (13%)

Death during follow up: n=43

Methodology: A total of 119 individuals with a traumatic SCI during the years 1944–1975 from an SCI clinic in Denmark were included in the study to investigate the role of plasma creatinine (p-creatinine) in monitoring renal deterioration in patients up to 50 years after SCI.

Outcome Measures: P-creatinine measurements, results from renography and glomerular filtration rate (GFR) measured with Cr-EDTA clearance were obtained from medical records and analyzed using a linear mixed model and linear regression analyses.

  1. When compared with median p-creatinine level in the first 5-year period after injury, the level of p-creatinine was stable throughout the first 30 years and decreased significantly after the 30th until 45th year post injury.
  2. Only patients with a functional distribution outside the 30-70% limits on renography or a relative GFR ≤51% of that expected had a significantly elevated level of p-creatinine. Significance was not found for patients with a distribution outside the 40-60% limits on renography or relative GFR ≤75%.
  3. P-creatinine decreases over time in patients with SCI with a level below the upper reference limit and is a poor detector of early renal deterioration in patients with SCI.
Zhang et al. 2014;

China

Level 2 evidence

Longitudinal

N=112

Population: N=112 (91 M, 21 F); <45 y/o (n=90), ≥45 y/o (n=22), range 18-57; cervical (n=34), thoracic (n=51), lumbosacral (n=27)

Methodology: Between 2009-2011, people with SCI were recruited in Beijing to receive a urodynamic test after the end of spinal shock. All participants were followed up for an average of 24 months (range 6-36 months) to investigate the risk factors for predicting upper urinary tract  (UUT) deterioration in people with SCI. Medical records, UUT imagings, and video urodynamic data was reviewed.

Outcome Measures: Presence of adverse outcomes such as recurrent UTIs and bladder stones, total renal function (serum creatinine), renal ultrasound or MRI.

  1. Serum creatinine values were observed to be normal for each patient before and after follow-up. In total, 55 patients (49.1%) had UUT deterioration at the end (48 males and 7 females).
  2. The incidence of deterioration in the indwelling catheter group was 81.5%, which was much higher than that in catheter-free group (38.3%), indicating that an indwelling catheter is highly significantly correlated with UUT deterioration
  3. Lumbosacral spinal cord lesions likely contribute to UUT deterioration. UUT abnormalities were present in 23 patients (65.7%) in a spontaneous voiding group, 10 patients (20%) in a clean intermittent catheterization group, 15 patients (78.9%) in an indwelling urethral catheterization group and 7 patients (87.5%) in a suprapubic Foley catheterization group.

Alexandrino et al. 2011;

Brazil

Cross-sectional with AB comparison group

N SCI=24

N controls=24

Population: 24 men with SCI (Type A complete n=22, type C incomplete n=1, type D incomplete n=1); mean(SD) age 36.25(10.24) yrs; mean(SD) YPI 9.5(5.8), range 0.6-20 yrs; 24 age matched controls; mean(SD) age 36.5(10.31) yrs.

Methodology: Seminal zinc is considered to be a marker of prostate function. This study compared of seminal zinc concentration (SZC) between the SCI group and control group. Seminal zinc was determined by atomic absorption.

Outcome Measures:  seminal zinc concentration.

  1. Significant difference between groups; Mean SZC in study group is 85.20 mg l-1 and 147.16 mg l-1 in control group.

Faaborg et al. 2011;

Denmark

Longitudinal

N=22

Population: Group A: n=12 (8M 4F); mean age range 37.7-67.2 yrs; complete SCI N=4. Group B: n=10 (7M 3F); mean age range 29.7-71.9 yrs; complete SCI N=8.

Methodology: Assessed gastrointestinal transit times (GITTs) and colonic dimension changes in Group A; at 1 year after injury and again 12.8 years later; and Group B; at 18.7 years after injury and again 12.2 years later.

Outcome Measures:  GITTs, colonic diameters.

  1. Decrease in rectosigmoid transit time from 1-13 years after SCI (Group A).
  2. No other significant changes in GITT and segmental colonic transit times.
  3. No statistically significant changes in colonic dimension.

Ancha et al. 2010;

USA

Cross-sectional

N SCI=8

N controls=6

Population: 8 men with SCI (tetraplegia (C5 or below) n=3, paraplegia (T5 or below) n=5; < 2 spontaneous bowel movements/wk; mean(SD) age 59(13) yrs, mean(SD) YPI 13(4); 6 gender matched AB controls, mean(SD) age 57(10) yrs.

Methodology: Comparison of high amplitude propogating contractions (HAPC) and other measures of motility by fixing a manometric probe to the colonic wall at the splenic flexure. Measurements pre-sleep phase (1hr before sleep), sleep phase, and post-sleep phase.

Outcome Measures:  High amplitude propagating contractions (HAPC), Motility index (MI), and number of waves were measured.

  1. HAPC were absent in individuals with SCI during pre-sleep, sleep and post-sleep.
  2. HAPC were significantly increased after awakening in the control group.
  3. The MI was lower in the SCI group during pre- and post-sleep than in the controls.
  4. There was a sleep-induced depression of colonic motility in both the groups.

Kalpakjian et al. 2010;

USA

Prospective cohort

N=128

Population: 62 women with SCI (injury levels C6 through T12; >36 months post-injury). 66 gender matched AB controls; 45-60 years of age.

Methodology: Self-report surveys collected 4 times (9 mos apart) over 4 years. Monthly diaries indicate day of bleeding, heaviness of blood flow, absence of period.

Outcome Measures:  Mid Life Symptom Checklist, monthly diaries, self-report surveys.

  1. No significant differences between women with and without SCI for menopause status.
  2. No significant group differences for vaginal dryness, sleep problems or fatigue.
  3. Significant increase in bother ratings in vaginal dryness across menopause transition (premenopause vs. late postmenopause (PM); 1.30(0.6) vs. 1.73(1.1) (%).
  4. Women with SCI had significantly greater bother of diminished sexual arousal, somatic symptoms and bladder infections, and less bother of vasomotor symptoms.

Savic et al. 2010;

UK

Longitudinal

N=282

Population: 282 individuals with traumatic SCI injured prior to 1971; age at injury 15-55 yrs; mean age at enrollment 52.7 yrs; 86.7% males; 29.2% tetra ABC, 49.8% Para ABC, 21.0% Incomplete injuries.

Methodology: Full physical assessment, diagnostic procedures, detailed medical and psychosocial interview, retrospective medical records review.

Outcome Measures:  Medical History and Current Status; battery of outcomes including quality of life, depression, pain, and environmental factors.

  1. Most frequently reported medical problems: urinary tract infection (UTI), upper extremity pain, fatigue, pressure sores, constipation, and bowel accidents.
  2. Pressure sore prevalence remained stable.
  3. No significant change over time in number of patients with UTIs (48% in 1993, 54% in 1996, 48% in 1999, 2002, 2006).
  4. Number of UTIs requiring treatment went down significantly; 3.9 persons in 1990 to 1.2 in 2006.
  5. Bowel evacuation methods changed significantly over time – increase manual evacuation, colostomy methods in 2006.

Emmanuel et al. 2009;

UK

Cross-sectional

N=55

Population: 55 complete SCI subjects (45M 10F); mean age 36 (range 19-68); mean time post-injury 34 months (range 13-134).

Methodology: Comparison of rectal muscosal blood flow.

Outcome Measures:  Whole gut transit times; rectal electrosensitivity; stimulated defecation; laser Doppler studies of rectal mucosal blood flow; symptoms of constipation.

  1. 35 subjects (27M 8F, mean age 36, range 20-68) are symptomatically constipated, representing 75% of the subjects with lesion above T5 and 55% of those with lesion below T5.
  2. 32 subjects who were symptomatically constipated had slow whole gut transit.
  3. Transmucosal rectal electrical sensation was abnormally high in all SCI subjects, being significantly greater in those complaining of constipation (67.3mA in constipation, vs. 41.6mA in non-constipation SCI, vs. 36mA in control.
  4. 71% of subjects with lesion above T5, and 61% of those below T5 were unable to expel a water-filled balloon and showed paradoxical sphincter contraction.
  5. SCI subjects had significantly lower mucosal blood flow than asymptomatic SCI subjects (183 vs. 267 FU); SCI subjects with lesion above T5 had significantly lower resting blood flow than AB control, while SCI below T5 were similar to the control.

Faaborg et al. 2008;

Denmark

Longitudinal

N=159

Population: 159 subjects who participated in a survey in 1996 and a follow-up in 2006; mean age 37 yrs (range 15-70 yrs), mean YPI 10 (range 0-48 yrs), 63 cervical, 40 thoracic, and 56 lumbar.

Methodology: Assessed colorectal function over a 10 yr period.

Outcome Measures:  A questionnaire consisting of 34 items describing constipation, obstructed defecation, fecal incontinence and impact on quality of life (QoL) or social activities.

  1. All items regarding symptoms of constipation increased significantly.
  2. The number of correspondents reporting fecal incontinence at least once monthly decreased from 32 (22%) to 26 (17%).
  3. More correspondents report that their QoL or social activities were restricted by colorectal dysfunctions in general (39 vs. 60) and constipation (20 vs. 30).

Shim et al. 2008;

South Korea

Cross-sectional with AB controls

N SCI=31

N controls=31

Population: 31 men with SCI, median age 58 yrs, range 45-81 yrs; median YPI 32, range 5-55 yrs; age and gender matched AB controls.

Methodology: Comparison of serum prostate specific antigen (PSA).

Outcome Measures:  Serum levels of PSA; digital rectal examination; transrectal ultrasonography.

  1. No differences in PSA levels and prostate volume parameters between group with SCI and AB controls.

Alexandrino et al. 2004;

Brazil

Cross-sectional with AB controls

N SCI=44

N controls=44

Population:  44 men with SCI, mean(SD) age 33.98(9.12) yrs, range 18-58 yrs; age and gender matched AB controls.

Methodology: Comparison of total serum prostate specific antigen (PSA) and seminal PSA.

Outcome Measures:  Serum and seminal levels of PSA.

  1. No differences in total PSA levels between group with SCI and AB controls.
  2. Total seminal PSA was lower in the SCI group compared to AB controls.

Scott et al. 2004;

USA

Cross-sectional with AB controls

N SCI=636

N controls=20949

Population: 636 men with SCI; ages ³50; 945 men with prostate cancer and 20,949 AB controls.

Methodology: Comparison of incidence and characteristics of prostate cancer.

Outcome Measures:  SCI, cancer registry, and outpatient databases.

  1. 1.7% of SCI group had been diagnosed with prostate cancer compared to 4.4% of AB controls.
  2. Average serum prostate specific antigen (PSA) level at diagnosis was significantly higher in the group with SCI compared to AB controls.
  3. Group with SCI and prostate cancer (7; 63.6%) had locally advanced (stage T3) or metastactic prostate cancer compared to AB population (267; 29.1%).

Pannek et al. 2003;

Germany

Cross-sectional with AB controls

N SCI=100

N controls=575

Population:  100 men with SCI; mean(SD) age 53.7(11.3) yrs, range 35-71; age and gender matched AB controls.

Methodology: Comparison of prostate size and serum prostate specific antigen (PSA).

Outcome Measures:  Prostate size; serum levels of PSA.

  1. No differences in prostate size or PSA levels between group with SCI and AB controls.
  2. Mean serum PSA level in the AB controls was found to increase with age, but shown to be of a lesser extent in persons with SCI.

Pramjudi et al. 2002;

USA

Cross-sectional with AB controls

N SCI=366

N controls=371

Population: 366 men with SCI; age range 40-79 yrs (40-49 yrs, 50-59 yrs, 60-69 yrs, 70-79 yrs); age and gender matched AB controls.

Methodology: Comparison of serum prostate specific antigen (PSA).

Outcome Measures:  serum levels of PSA.

  1. No differences in PSA levels between group with SCI and AB controls.

Konety et al. 2000;

USA

Cross-sectional with AB controls

N SCI=79

N controls=501

Population: 79 men with SCI; age range 40-89 yrs (40-49 yrs, 50-59 yrs, 60-69 yrs, 70-79 yrs, 80-89 yrs); age and gender matched AB controls.

Methodology: Comparison of serum prostate specific antigen (PSA).

Outcome Measures:  Serum levels of PSA.

  1. No differences in PSA levels between group with SCI and AB controls.

Krogh et al. 2000;

Denmark

Cross-sectional with AB controls

N SCI=26

N controls=24

Population: 26 subjects with SCI (11M 15F); age range 17-69 yrs; YPI range 11-24 days

Methodology: Comparison of total gastrointestinal transit times (GITT) and segmental colorectal transit times (CTT).

Outcome Measures:  GITT and CTT.

  1. GITT and CTT are significantly prolonged in SCI patients than in AB controls.

 

Lynch et al. 2000;

New Zealand

Cross-sectional with AB controls

N SCI=467

N controls=467

Population: 467 subjects with SCI (384M 83F); mean age 43.5 yrs, range 15-89; mean YPI 14, range 0.7-42.1 yrs. 467 age and gender matched AB controls.

Methodology: Comparison of bowel functioning.

Outcome Measures:  Mean Fecal Incontinence Score, Bowel motion frequency, Haemorrhoidectomy, Time at toilet, Assistance at toilet.

  1. Group with SCI had higher rates of fecal incontinence, less frequent bowel motion, spent longer times on the toilet, and required more assistance.

Sekar et al. 1997;

USA

Longitudinal

N=1114

Population: 1114 subjects with SCI (915M 199F); mean(SD) age 31.25(13.79) yrs, range 1-87 yrs at injury.

Methodology: Evaluation of the effects of different bladder management on long term renal function who were followed for at least 10 YPI.

Outcome Measures:  Total and individual kidney effective renal plasma flow (ERPF).

  1. A decreasing trend in mean ERPF was detected over time after injury, except for a slight reversal at 10 YPI.

MacDiarmid et al. 1995;

New Zealand

Longitudinal

N=44

Population: 44 subjects with SCI (31M 13F); mean age 36 yrs, range 13-79 yrs.

Methodology: Reviewed the urological complications in patients treated with suprapubic catheterization at 12 to 15 mos post-injury.

Outcome Measures:  Urodynamic studies and ultrasound.

  1. None of the patients had renal deterioration, vesicoureteral reflux or bladder carcinoma.
  2. Incidences of incontinence, urinary tract infections, and calculi were acceptable.

Dewire et al. 1992;

USA

Longitudinal

N=57

Population: 57 men with cervical SCI.

Methodology: Comparison of incidence of urological complications and renal deterioration in SCI patients with and without a chronic indwelling urinary catheter from baseline to 10 YPI.

Outcome Measures:  Patients’ medical records excretory urogram.

  1. No significant difference found between patients with and without chronic indwelling urinary catheters.

Lamid et al. 1988;

USA

Longitudinal

N=32

Population: 32 men with SCI; mean age at injury: 29.72 yrs, range 19-66 yrs.

Methodology: Medical chart review of annual visits from SCI patients with vesicoureteral reflux until 12 YPI.

Outcome Measures:   Medical records with information on bladder function, including radiological and laboratory examinations.

  1. The majority of refluxes developed 1-2 YPI, and some disappeared spontaneously without causing damage to the urinary tract.
  2. After 4 YPI, the number of refluxes increased and progressed to grade II and IV, causing kidney damage with caliectasis.

Menardo et al. 1987;

Italy

Cross-sectional with AB controls

N SCI=11

N controls=37

Population: 11 subjects with SCI (8M 3F); age range 17-63 yrs; YPI range 2 mos-15 yrs. 37 age matched AB controls.

Methodology: Comparison of transit of contents through the large bowel

Outcome Measures:  Gastrointestinal transit times (GITT).

  1. Compared to AB controls, GITT was lower in all patients with paraplegia.
  2. Flow contents through the left colon were markedly lower in group with SCI compared to AB controls, and transit of contents in 8 persons with SCI were decreased, and below the normal range of the AB controls.

Viera et al. 1986;

USA

Longitudinal

N=99

Population: 99 subjects with SCI (77M 22F); age range 14-65 yrs at injury.

Methodology: Investigated the effect of current bladder management techniques on renal function at 6 to 60 mos post-injury.

Outcome Measures:  Serum creatinine; Excretory urogram; Determination of short renal clearance of iothalamate.

  1. In the indwelling catheter group (n=9), bladder calculi occurred in 3 patients at 7, 28, and 44 mos post-injury, and were the only group to develop bladder stones.
  2. Excretory urogram abnormalities tended to occur earlier in the intermittent self-catheterization group (first 18 mos) than in the bladder re-training group (third yr).

Kuhlemeier et al. 1984b;

USA

Cross-sectional with AB controls

N SCI=400

N controls=287

Population: 400 subjects with SCI (160 acute and 240 chronic); age range 16-60 yrs, YPI range for chronic 6-53 months.

Methodology: Comparison of renal function.

Outcome Measures:  Total and individual kidney effective plasma flow.

  1. Both individual and global kidney effective plasma flows were decreased in the acute SCI group for persons who were 21-50 yrs old, but no difference existed for persons younger than 20 or older than 50.
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