Medical Advances Result in Dramatic Drops of UTI/Kidney Failure Related Deaths for SCI Patients
Urinary tract infections (UTIs) used to be the leading cause of death for those with SCI. In the 1940s, UTI related death came as swiftly – within months of the injury. Once antibiotics were invented, people started living longer but kidney failure became the leading cause of death. Now, with advances in modern medicine, less than three percent of those with SCI die from kidney failure.
Under normal conditions, the bladder is either filling or emptying. When it is relaxed it fills and the sphincter stays closed so there is no leakage. When it is time to empty, the bladder contracts and the sphincter relaxes so the urine can flow out. The bladder and sphincter muscles are coordinated to contract and relax at the correct time. These reflexes are “wired” into the brainstem and spinal cord. After SCI, these reflex patterns no longer work and two basic problems can occur:
1. Filling problems (incontinence or leaking) when the bladder is overactive and contracts too much or at the wrong time, of the sphincter doesn’t contract enough to keep the urine from leaking out.
2. Emptying problems (retention) when the bladder doesn’t contract enough or the sphincter won’t relax.
The goals of medical management are to establish a method of bladder drainage that is the simplest, most convenient and expensive method to keep the patient dry, avoid serious complications and treatment side effects, and to preserve the kidneys for life. The methods are different depending upon factors like: the amount of nerve preservation, the amount of hand function, gender, the amount of mobility required, likelihood of compliance, remote location, amount of daily time time available.
This information is from a presentation at the SCI Forum by Stephen Burns, MD, SCI Service, VA Puget Sound Health Care System and associate professor, Department of Rehabilitation Medicine, University of Washington October 13, 2009. For the full report and video.