Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.

Abstract

Retrospective review. While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors. Tertiary urology clinic, San Jose, CA. We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted. Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies. In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.