The Stockholm Spinal Cord Uro Study: 1. Basic characteristics and problem inventory

Figures & data

Table 1. Study patients and patients not included (excluded and non-attendees).

	Study patients	Patients not included
Age, years, mean (SD), range (median)	49.1 (14.7), 18–88 (49.0)	50.6 (17.5), 19–85 (49.0)
Male/female, n (%)	320 (78%)/92 (22%)	31 (76%)/10 (24%)
Injury duration, years, mean (SD), range (median)	16.4 (11.8), 1–51 (13.2)	13.5 (11.1), 1–45 (8.0)
Neurological level of injury, n (%)
C3–C8	195 (47%)	22 (54%)
T1–T12	138 (33.5%)	12 (29%)
L1–L5	76 (18.5%)	7 (17%)
S1–S3	3 (1%)	0

Table 2. Study patients: neurological level of injury vs AIS grade A–D.

	Study patients
	A	B	C	D	Total
C3–C8	72	31	19	73	195
T1–T12	94	10	13	21	138
L1–L5	16	7	7	46	76
S1–S3				3	3
Total	182	48	39	143	412

Patients not included (n = 41) had a similar distribution of AIS grades of injury.

American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades:

A. Complete. No motor or sensory function is preserved in the sacral segments S4–S5.

B. Incomplete. Sensory function preserved but not motor function is preserved below the neurological level and includes the sacral segments S4–S5.

C. Incomplete. Motor function is preserved below the neurological level, and more than half of the key muscles below the neurological level have a muscle grade < 3.

D. Incomplete. Motor function is preserved below the neurological level and at least half of the key muscles below the neurological level have a muscle grade of 3 or more.

Table 3. Data collection.

Types of data	Manner of data collection
Information on past illnesses, concurrent medical conditions, current medication, bowel function, pain, spasticity, history of pressure ulcers, circulatory complications related to spinal cord injury	Individual structured interviews, medical file reviews
Complications of the urinary tract during the preceding year, prophylactic measures to avoid urinary tract infection, bladder management	Study-specific questionnaire completed by patient, medical file reviews	Supplement 1
Blood chemistry	S-creatinine and S-cystatin-C. Blood samples taken at check-up visit.
Residual urine	Measured by ultrasound or catheter immediately after patient-preferred method of voiding	[10]
Urine culture	Collected at check-up visit. Notes made on current symptoms
48-h voiding diary	Completed by patient at home, sent back in pre-stamped envelope
Physical and neuro-urological examination	Complete physical examination done by neuro-urology specialist
Examination of neurological level of injury and severity of lesion	Performed by neurologist according to International standards for neurological classification of spinal cord injury	[11]
Ultrasound of urinary tracts	Performed by radiologist
Urodynamic testing	Performed by urotherapist/nurse specialist according to Good Urodynamic Practice. Evaluation of graphs by specialists in neuro-urology	[12]

Table 4. Interpretation of data and reference values.

Types of data	Reference values used
S-creatinine, S-cystatin C, cystatin-C related glomerular filtration rate (GFR)	Reference intervals established by Karolinska University laboratory and national guidelines	[13]
Urine culture, positive	≥1000 cfu/mL of common uropathogenic bacteria	[13]
Urine culture, negative	<1000 cfu/mL of common uropathogenic bacteria
Urinary tract infection (UTI)	Positive urine culture AND infection related urinary tract symptoms^a
Asymptomatic bacteriuria (ABU)	Positive urine culture BUT NO current symptoms of UTI
Residual urine	>100 mL, measured by ultrasound or catheter, was interpreted as clinically meaningful residual urine	[10]
Ultrasound of kidneys and urinary tracts	Radiology specialists reviewed renal parenchyma, visible stones or calcifications, dilatation of the upper urinary tracts; urinary bladder
Urodynamics	Performed and evaluated according to Good Urodynamic Practice (ICS 2002)	[12]
48-h voiding diary	Routine chart, registered by patient

^aSymptoms related to infection of urinary tracts included dysuria, increased frequency and urgency, foul smell, pain in the lower abdomen or urogenital area, increased neurogenic pain, rise in body temperature, increased urinary leakage and increased spasticity.

Figure 1. Regional follow-up programme of neurogenic bladder dysfunction following spinal cord injury.

Figure 2. Process of data collection.

Table 5. Objective data.

Blood test	Abnormal n (%)		Mean (range)	Reference values
S-creatinine	15 (4)		130 (101–218)	<100 µmol/L
S-cystatin-C	59 (14)		1.43 (0.99–3.07)	<0.99 mg/L
Cystatin C-related GFR	63 (15)		47 (24–60)	>60 mL/min/1.73m^2
	Pathological n (%)	Normal n (%)
Ultrasound of kidneys	62 (17)	289 (84)
Pathology of kidney parenchyma	32 (8)
Dilatation of upper urinary tracts	30 (7)
	Positive n (%)	Negative n (%)
Urine culture	220 (56)	175 (44)
Ongoing UTI	13 (6)
Asymptomatic bacteriuria	207 (94)
	>100 ml n (%)	<100 ml
Residual urine	52 (13)	360 (87)	236 (101–500)	<100 ml
	nOAB n (%)	nUAB n (%)	Normal detrusor during filling phase, n (%)
Urodynamic studies	150 (36)	43 (10)	18 (4)

GFR, Glomerural filtration rate; UTI, urinary tract infection; nOAB, neurogenic overactive bladder; nUAB, neurogenic underactive bladder.

Figure 3. Patient reported types of bladder management.

Table 6. Patient reported complications during the preceding year.

Number of urinary tract infections (UTIs)	n (%)
1	34 (8)
2	35 (8.5)
3	51 (12.5)
>3 (4–15)	61 (15)
Other infections (epididymitis, orchitis, prostatitis)	13 (3)
Other complications (bladder stones, kidney stones, hematuria, neurogenic pain in urogenital area)	33 (8)

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Schäfer W, Abrams P, Liao L, et al. Good urodynamic practices: uroflowmetry, filling cystometry, and pressure-flow studies. Neurourol Urodyn. 2002;21(3):261–274.

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Instructions for blood and urine specimens Karolinska University Laboratory (Provtagningsanvisningar Karolinska Universitetslaboratoriet). http://www.karolinska.se/for-vardgivare/KarolinskaUniversitetslaboratoriet/sok-provtagningsanvisning/

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