Aims
of
Study:
The optimal method of bladder management in
the
spinal
cord
injury
population
remains
controversial.
The
objective
of
the
current
study
was
to
determine
the
significance
of
bladder
management
and
other
factors
on
renal
function
in
this
population.
Methods:
The medical records and upper tract imaging
studies
of
308
patients
with
a
mean
follow-up
interval
since
injury
of
18.7
years
were
reviewed.
Renal
function
was
assessed
by
measurement
of
serum
creatinine,
creatinine
clearance,
proteinuria,
and
the
presence
or
absence
of
upper
tract
abnormalities,
as
evaluated
by
renal
ultrasound
and
nuclear
medicine
renal
scan.
Independent
variables
studied
to
determine
influence
on
renal
function
included
patient
age,
time
interval
since
injury,
level
of
injury,
completeness
of
injury,
presence
or
absence
of
vesicoureteral
reflux,
history
of
diabetes
mellitus,
and
bladder
management
method.
Results:
The mean (± standard deviation) serum creatinine levels
of
the
chronic
Foley
catheterization,
clean
intermittent
catheterization
(CIC),
and
spontaneous
voiding
groups
were
1.08
(±0.99),
0.84
(±0.23),
and
0.97
(±0.45)
mg/dl,
respectively
(ANOVA
p
<
0.01,
T
test
p
=
0.10). The mean creatinine clearance values of the
Foley,
CIC,
and
voiding
groups
were
91.1
(±46.5),
113.4
(±39.8),
115.0
(±49.0)
ml/min,
respectively
(ANOVA
p
<
0.01,
T
test
<
0.01). The number (percent) of patients with proteinuria
was
19
(6.2%)
in
the
Foley
group,
3
(1.0%)
in
the
CIC
group,
and
4
(1.3%)
in
the
spontaneous
voiding
group
(chi-square
p
<
0.01). Fifty-six (18.2%), 20 (6.5%), and 24 (7.8%)
patients
had
upper
tract
abnormalities
in
the
Foley,
CIC,
and
voiding
groups
(chi-square
p
<
0.01).
The
multiple
regression
analyses
indicated
no
significant
predictors
of
serum
creatinine
but
older
patient
age
and
Foley
catheterization
significantly
predicted
low
creatinine
clearance.
Additional
logistic
regression
analyses
showed
Foley
catheterization
associated
with
proteinuria
and
vesicoureteral
reflux
associated
with
upper
tract
abnormalities.
Conclusions:
While renal function can be preserved with
all
forms
of
bladder
management,
the
use
of
chronic
indwelling
catheters
is
an
independent
predictor
for
the
development
of
both
impaired
renal
function
and
pathological
proteinuria.
