Urologic Management and Complications in Spinal Cord Injury Patients: A 40- to 50-year Follow-up Study

Objective: To assess the management and types of urologic complications in spinal cord injury (SCI) patients and to explore the risk factors for these complications.

Methods: A total of 43 SCI patients with a median follow-up of 45 (range 40-50) years were included in this retrospective study. All medical charts were reviewed for demographics, urologic complications, and bladder management.

Results: Recurrent urinary tract infection (UTI) was noted in all patients, with an average incidence of 6.1 cases per 5 years per person. UTI incidence peaked in the 1st and 10th 5-year intervals. Besides UTI, the most common complications were bladder stone (49%), hydronephrosis (47%), and vesicoureteral reflux (33%). Most complications initially occurred during the first 25 years post injury. Male gender, cervical injury, and condom catheter use were closely related to complications, particularly UTI and renal insufficiency. 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.

Conclusion: With long follow-up, a wide and complex range of urologic complications occurred in SCI patients and continued to do so throughout the period of follow-up. A greater risk of urologic complications may be seen with certain factors (male gender, cervical SCI, and condom catheter use); however, all patients with SCI are at risk of urinary complications over time. Thus, even long-term patients who are thought to be "stable" require regular follow-up and surveillance.