Types of UTI in SCI  

  • The UTI is the most frequent secondary impairment in SCI individuals with neurogenic bladder and it is the most common cause of fever.
  • The increased incidence of UTIs is multifactorial and is caused in part by abnormal bladder emptying, urinary stasis, elevated intravesical pressure, bladder overdistention, VUR, and frequent instrumentation [Rubenstein 2003]. For more information, please refer to this
  • The UTI in SCI typically develop in a urinary tract with a structural or functional abnormality that would reduce the efficacy of antimicrobial therapy.
  • Patients with SCI often do not present with the classic symptoms and signs of UTI. This is caused in part by altered sensation and lack of normal voiding patterns. For example, pyelonephritis may occur without flank pain and urinary stone disease may occur without colic. In addition, the significance of pyuria on urinalysis is unclear and may be solely causes\d by urinary tract colonization [Rubenstein 2003]. For more information, please refer to this this
  • Following an episode of febrile UTI, possible contributing prior events should be reviewed [National Institute on Disability and Rehabilitation Research Consensus Statement 1992]. For more information, please refer to this

1. Urosepsis

  • A condition where bacteria enter the circulatory system from the urinary tract. This occurs when high pressures are present in the urinary tract from obstruction, or dysynergia between the bladder and the outlet, or poor compliance develops

2. Pyelonephritis

  • A condition where bacteria enter the renal medulla leading to papillary damage and or necrosis, often associated with high pressure vesicoureteral reflux

3. Urethritis

  • A microorganism caused infection and inflammation of the urethra usually the pedulous urethra in males. This need not be bacterial but in the population usually is

4. Epididymo-orchitis:

  • Epididymo-orchitis (E-O) is a common complication of SCI associated with neuropathic voiding dysfunction.
  • Nearly 40% of patients with SCI suffered E-O [Mirsadraee 2003]
  • Epididymo-orchitis (E-O) is associated with a 50% risk of azoospermia, and thus infertility in paraplegic patients [Allas 1991]

5. Prostatitis

  • Prostatitis can be a cause of recurrent UTI.
  • Either acute or chronic it is difficult to diagnose in patients with neurogenic bladder and special tests have been developed for this [Kuhlemeier 1982; Wyndaele 1985].
Key Points of This Section
  • Infectious complications in neurogenic vesical dysfunction are common
  • Most are in part related to the co-existence of chronic bacteriuira, treatment with antibiotics which results emergence of highly resistant organisms, and uncontrolled urinary tract pressures.
  • Of all these factors bladder pressure is the most controllable.

References

  • Rubenstein JN, Schaeffer AJ. Managing complicated urinary tract infections: the urologic view. Infect Dis Clin North Am. 2003 Jun;17(2):333-51.
  • The prevention and management of urinary tract infections among people with spinal cord injuries. National Institute on Disability and Rehabilitation Research Consensus Statement. January 27-29, 1992, J Am Paraplegia Soc. 1992 Jul;15(3):194-204.
  • Mirsadraee S, Mahdavi R, Moghadam HV, Ebrahimi MA, Patel HR. Epididymo-orchitis risk factors in traumatic spinal cord injured patients. Spinal Cord. 2003 Sep;41(9):516-20.
  • Allas T et al. Spermograms and epididymitis in paraplegic patients managed by chronic self-catheterisation. Ann Readapt Med Phys 1991; 34: 37-40.
  • Kuhlemeier KV, Lloyd LK, Stover SL. Localization of upper and lower urinary tract infections in patients with neurogenic bladders. SCI Digest 1982; 336-342.
  • Wyndaele JJ. Chronic prostatitis in spinal cord injury patients. Paraplegia 1985; 23: 164-169.

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