Urological Management and Long-Term Complications in Patients with Spinal Cord Injury and Neurogenic Lower Urinary Tract Dysfunction in Thailand: A Retrospective Study
Keywords:neurogenic lower urinary tract dysfunction, neurogenic bladder, spinal cord injury, rehabilitation, complications
Objectives: To describe urological assessment, management and long-term complications in patients with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) in Thailand.
Study design: Retrospective study.
Setting: Two university hospitals and three A-level hospitals in Thailand.
Subjects: Patients with SCI and NLUTD.
Methods: Medical records of patients with traumatic and non-traumatic SCI and NLUTD from five tertiary/A-level hospitals were obtained and manually reviewed to evaluate urological assessment, management and related complications. Descriptive statistics were used for the evaluation.
Results: Among the 5,822 medical records retrieved, 1,066 cases had been diagnosed with SCI and NLUTD. In the initial NLUTD assessment, it was found that 51.9% of the patients had undergone urodynamic study (UDS). The last bladder emptying techniques included indwelling transurethral catheter (38%), reflex voiding (30.1%), and self-catheterization (clean intermittent catherization) (20.3%). Approximately 40% of patients had had no regular urological follow-up. Among the 760 patients who had undergone imaging, 36.9% had upper urinary tract complications. There were significant differences between the university hospitals and the Ministry of Public Health hospitals in terms of urological assessment, management and follow-up protocol.
Conclusions: There were differences in methods of initial assessment, management, and surveillance follow-up protocol for SCI and NLUTD patients in university hospitals and those in MOPH hospitals in Thailand. Among the patients who underwent surveillance and investigation, a substantial number were found to have upper urinary tract complications.
Keywords: neurogenic lower urinary tract dysfunction, neurogenic bladder, spinal cord injury, rehabilitation, complications
Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care. 2013;19:s191-6.
Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69:324-33.
Linsenmeyer TA. Neurogenic bladder following spinal cord injury. In: Kirshblum S, Campagnolo D, editors. Spinal Cord Medicine. 2nd ed. Philadelphia: Lippincott Williams and Wilkins; 2011. p. 232-6.
Allio BA, Peterson AC. Urodynamic and physiologic patterns associated with the common causes of neurogenic bladder in adults. Transl Androl Urol. 2016;5:31-8.
Abrams P, Agarwal M, Drake M, El-Masri W, Fulford S, Reid S, et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int. 2008;101:989-94.
Kuo HC, Chen SL, Chou CL, Chuang YC, Huang YH, Juan YS, et al. Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction. Urol Sci. 2014;25:35-41.
Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Med. 2006;29:527-73.
Cameron AP, Rodriguez GM, Schomer KG. Systematic review of urological followup after spinal cord injury. J Urol. 2012;187:391-7.
Razdan S, Leboeuf L, Meinbach D, Weinstein D, Gousse A. Current practice patterns in the urologic surveillance and management of patients with spinal cord injury. Urology. 2003;61:893-6.
Bycroft J, Hamid R, Bywater H, Patki P, Craggs M, Shah J. Variation in urological practice amongst spinal injuries units in the UK and Eire. Neurourol Urodyn. 2004;23:252-6.
Rikken B, Blok BFM. Management of neurogenic bladder patients in the Netherlands: do urologists follow guidelines? Neurourol Urodyn. 2008;27:758-62.
Burki JR, Omar I, Shah PJR, Hamid R. Long-term urological management in spinal injury units in the UK and Eire: A follow-up study. Spinal Cord. 2014;52:640-5.
Thongchim C, Tamnanthong N, Arayawichanont P. Prevalence of vesicoureteric reflux in neurogenic bladder dysfunction patients from spinal cord lesion. J Thai Rehabil Med. 2010;20:52-7.
Mantiang S, Vichiansiri R, Wattanapan P. The prevalence of vesicoureteric reflux in patients with myelomeningocele at Srinagarind Hospital. J Thai Rehabil Med. 2011;21:63-7.
Kovindha A, Na Chiang Mai W, Madersbacher H. Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men? Spinal Cord. 2004;42:638-42.
Laopairote K, Kovindha A. Prevalence of urinary tract infection in individuals with spinal cord injury using a re-usable silicone catheter for clean intermittent self catheterization. J Thai Rehabil Med. 2016;26:67-76.
Pongboriboon P, Tongprasert S, Kovindha A. Quality of life in persons with spinal cord injury: a comparative study between those with indwelling catheterization and intermittent catheterization. J Thai Rehabil Med. 2011;21:13-20.
Wyndaele JJ, Vo Thi H, Pham BC, Kovindha A, Huong VT, Weerts E. The use of one-channel water cystometry in patients with a spinal cord lesion: practicalities, clinical value and limitations for the diagnosis of neurogenic bladder dysfunction. Spinal Cord. 2009; 47:526-30.
Royal College of Physiatrists of Thailand (RCPhysiatrT). Entrustable Professional Activities (EPAs) and Workplace-based Assessment (WPBA) in Rehabilitation Medicine Residency Training. Bangkok: RCPhysiatrT. 2021. [cited 8 April 2022] available from https://rehabmed.md.chula.ac.th/wp-content/uploads/2020/07/EPAs-and-WPBA_Proof-IV_July-14-2020_Final-for-print.pdf.
Kovindha A. A textbook of spinal cord injury: comprehensive rehabilitation vol.2 viscera-sex-skin. Chiang Mai: Sutin Publishing; 2013. p. 266-9. [in Thai]
El-Masri WS, Chong T, Kyriakider AE, Wang D. Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of the Midlands Centre for Spinal Injuries in Oswestry. Spinal Cord. 2012;50:14-21.
Chen SF, Jiang YH, Jhang JF, Lee CL, Kuo HC. Bladder management and urological complications in patients with chronic spinal cord injuries in Taiwan. Tzu Chi Med J. 2014;26:25-8.
Ruffion A, Castro-Diaz D, Patel H, Khalaf K, Onyenwenyi A, Globe D, et al. Systematic review of the epidemiology of urinary incontinence and detrusor overactivity among patients with neurogenic overactive bladder. Neuroepidemiology. 2013;41:146-55.
Tonmukayakul U, Khampang R, Butchon R, Wattanadilokul U, Wongwisetkarn J, Krajaysri P, et al. Economic evaluation of disposable adult diapers for urinary and fecal incontinence with/without physical impairment. Nonthaburi; Health Intervention and Technology Assessment Program; 2012.
Kim YH, Bird ET, Priebe M, Boone TB. The role of oxybutynin in spinal cord injured patients with indwelling catheters. J Urol. 1997; 158:2083-6.
Taweel W Al, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Reports Urol. 2015;7:85-99.
Suksathien R, Ingkasuthi K, Bumrungna S. Factors associated with hydronephrosis and vesicoureteral reflux in spinal cord injured patients. ASEAN J Rehabil Med. 2019;29:51-7.
Thanakitjaru P. Current situation of chronic kidney disease in Thailand. J Dep Med Serv. 2015;40:5-18. [in Thai]
Fischer MJ, Krishnamoorthi VR, Smith BM, Evans CT, St. Andre JR, Ganesh S, et al. Prevalence of chronic kidney disease in patients with spinal cord injuries/disorders. Am J Nephrol. 2012;36: 542-8.
Kovindha A. People with Spinal Cord Injury in Thailand. Am J Phys Med Rehabil. 2017;96:S120-3.
Doungthipsirikul S, Sirisamutr T, Kotirum S, Pilasant S, Tantipisitkul K, Tantivess S, et al. Medical rehabilitation services for people living with disabilities in Thailand: current situations in public hospitals. J Heal Syst Res. 2015;9:334-43. [in Thai]
Srisuppaphon D. Spinal cord injury rehabilitation service system: Notes from the 16th ASCoN Conference and the proposal for Thai system development. J Thai Rehabil Med. 2018;28:2-3.
Pattanakuhar S, Kammuang-lue P, Kovindha A, Komaratat N, Mahachai R, Chotiyarnwong C. Is admission to an SCI specialized rehabilitation facility associated with better functional outcomes? Analysis of data from the Thai Spinal Cord Injury Registry. Spinal Cord. 2019;57:684-91.
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