Farrelly Elisabeth, Lindbo Lena, Wijkström Hans, Seiger Åke
Department NVS Division of Clinical Geriatrics, Karolinska Institutet, Solna, Sweden.
Department of Urology, Stockholm South General Hospital, Stockholm, Sweden.
Scand J Urol. 2019 Dec;53(6):403-410. doi: 10.1080/21681805.2019.1673812. Epub 2019 Oct 21.
To assess urinary tract function and complications in a regional prevalence group of patients with traumatic spinal cord injury (SCI), and to estimate risk factors for recurring complications. A total of 412 patients who attended a yearly check-up at the Spinalis SCI clinic were included. A regional follow-up programme for neurogenic bladder dysfunction was applied, including S-creatinine and S-cystatin-C, urine culture, residual urine, ultrasound of kidneys, urodynamic studies, and a questionnaire regarding complications during the preceding year. Descriptive statistics and logistic regression were used to estimate risk factors. All patients completed blood tests and the questionnaire. A urine culture was completed by 96%, ultrasound by 88%, residual urine by 75%, urodynamics by 51%, and all parts of the study by 47%. One quarter of patients displayed pathological findings regarding kidney function. Urodynamics verified neurogenic overactive bladder in a majority, and a high proportion with intravesical filling pressures above 40 cm HO, a commonly used cut-off level for kidney safety. Subjectively, 47% of patients reported complications during the past year with urinary tract infection (UTI) as the most common one. Other complications were rare. With the aid of a regular follow-up programme, SCI patients can achieve a relatively stable situation regarding urinary tract function. UTI is the most common complication. Indicators of renal complications are frequent but not clearly related to the number of UTIs, nor to intravesical filling pressures. Main risk factors for complications are cervical levels and more complete neurological lesions.
评估创伤性脊髓损伤（SCI）患者区域患病率群体的尿路功能及并发症，并估计复发性并发症的危险因素。纳入了412名在Spinalis SCI诊所进行年度检查的患者。应用了一项针对神经源性膀胱功能障碍的区域随访计划，包括血清肌酐和血清胱抑素-C、尿培养、残余尿量、肾脏超声、尿动力学研究以及一份关于前一年并发症的问卷。采用描述性统计和逻辑回归来估计危险因素。所有患者均完成了血液检查和问卷。96%的患者完成了尿培养，88%完成了超声检查，75%完成了残余尿量检查，51%完成了尿动力学检查，47%完成了研究的所有部分。四分之一的患者显示出肾功能的病理结果。尿动力学检查证实大多数患者存在神经源性膀胱过度活动症，且很大一部分患者膀胱内充盈压高于40 cmH₂O，这是肾脏安全常用的临界值。主观上，47%的患者报告在过去一年出现并发症，其中尿路感染（UTI）最为常见。其他并发症较少见。借助定期随访计划，SCI患者在尿路功能方面可实现相对稳定的状况。UTI是最常见的并发症。肾脏并发症的指标很常见，但与UTI的次数以及膀胱内充盈压均无明显关联。并发症的主要危险因素是颈椎损伤水平和更完全的神经损伤。
