Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

Near-Infrared Spectroscopy for Bladder Monitoring: A Machine Learning Approach

Patients living with neurogenic bladder dysfunction can lose the sensation of their bladder filling. To avoid over-distension of the urinary bladder and prevent long-term damage to the urinary tract, the gold standard treatment is clean intermittent catheterization at predefined time intervals. However, the emptying schedule does not consider actual bladder volume, meaning that catheterization is performed more often than necessary which can lead to complications such as urinary tract infections. Time-consuming catheterization also interferes with patients' daily routines and, in the case of an empty bladder, uses human and material resources unnecessarily. To enable individually tailored and volume-responsive bladder management, we design a model for the continuous monitoring of bladder volume. During our design science research process, we evaluate the model's applicability and usefulness through interviews with affected patients, prototyping, and application to a real-world in vivo dataset. The developed prototype predicts bladder volume based on relevant sensor data (i.e., near-infrared spectroscopy and acceleration) and the time elapsed since the previous micturition. Our comparison of several supervised state-of-the-art machine and deep learning models reveals that a long short-term memory network architecture achieves a mean absolute error of 116.7 ml that can improve bladder management for patients.

Erectile Dysfunction Is the Main Correlate of Depression in Men with Chronic Spinal Cord Injury

Depression is the most prevalent psychological issue after a spinal cord injury (SCI) and is associated with noticeable disability, mortality and health expenditure. As SCI mainly occurs in sexually active men at a young age, and can lead to them suffering from an organic neurogenic erectile dysfunction (ED), we supposed that ED could be a major correlate of depressive status in men with SCI. As documented by a Beck Depression Inventory-II (BDI-II) score ≥14, depression was reported in 17 out of 57 men with a chronic SCI (29.8%). They exhibited a significantly higher prevalence of ED and a more severe bowel and bladder dysfunction when compared to the group without depression. At the multiple logistic regression analysis, depression showed a significant independent association with ED (OR = 19.0, 95% CI: 3.1, 203.3; p = 0.004) and, to a lesser extent, with a severe impairment of bowel and bladder function (OR = 0.84; 95% CI: 0.72, 0.94; p = 0.01). Depression was observed in 43.7% of men with ED and only in 12.0% of those without ED (p = 0.002). In conclusion, healthcare providers should give the right level of importance to the management of ED in men with SCI, as this represents a major independent correlate of depression, which, in turn, might hinder physical rehabilitation and exacerbate physical health issues related to SCI.

Chronic Back Pain in a Young Female Patient: A Case of Ependymoma Originating from the Conus Medullaris

We present the case of a 14-year-old Malay girl with an ependymoma of the conus medullaris who presented to multiple general practitioner clinics with a 24-month history of chronic low back pain. The pain was symptomatically managed as a simple musculoskeletal pain and sciatica. Further imaging to aid diagnosis was delayed until the appearance of severe pain with neurological deficits. Magnetic resonance imaging revealed an enhancing spinal mass at L1 through L3, and histopathological investigations confirmed the grade II ependymoma according to the World Health Organization classification. She underwent gross resection of the tumor. After the surgery, she developed neurogenic urinary bladder and bowel, which required intermittent self-catheterization, intermittent enema use, and intensive physical therapy.

The use of mirabegron in neurogenic bladder: a systematic review

PURPOSE

To evaluate the use of mirabegron in patients with neurogenic bladder.

METHODS

A systematic review of the literature was conducted using four databases (Medline via PubMed, Scopus, Cochrane, and EMBASE). Articles evaluating mirabegron in neurogenic bladder patients were collected, and assessment of the drug's efficacy was reviewed according to clinical and urodynamic parameters.

RESULTS

Seven studies were selected and a total of 302 patients with NB were evaluated, ranging from 15 to 66 patients per study. All of the patients had received antimuscarinics as a previous treatment modality. Mirabegron was used as a second-line treatment after antimuscarinics lacked efficacy or caused adverse effects. The duration of the treatments ranged from 4 to 12 weeks. Reported in two studies each, bladder compliance and maximal cystometric capacity were the most commonly improved urodynamic parameters. In the majority of the studies, positive outcomes were reported for clinical scores. Additionally, analysis of the IPSS subscores revealed an improvement of storage symptoms as opposed to voiding symptoms. In all of the studies, mirabegron was well tolerated.

CONCLUSION

Mirabegron appears to be an effective treatment in the management of neurogenic bladder unresponsive to antimuscarinics, particularly in patients presenting with storage symptoms. There is still no evidence concerning the use of mirabegron as a first-line therapy for neurogenic bladder.

Psychological morbidity in soldiers after spinal cord injury

BACKGROUND

Spinal cord injury (SCI) patients usually experience multiple and ongoing, neurological, and other medical problems with significant damage to the social and psychological well-being of themselves and their families.

MATERIALS AND METHODS

Soldiers with SCI transferred to the regional centre after suitable stabilization of their fractures and general physical condition were included in the study. The baseline assessment included a diagnostic interview and review of case notes for a comprehensive, multi-axial diagnosis. The participants were assessed using the Barthel's Index, the Hospital Anxiety and Depression Scale, the General Health Questionnaire, Quality of life (QOL) Index, AFMC stressful life event Scale, and the Social Support Survey with the current defense or coping style also being recorded. Similar assessments were repeated at 1 month, 6 months, and at 1 year after intake.

RESULTS

It was noticed that the mean scores on the Hospital Anxiety and Depression Scale were below the cut-off point for diagnosable disorder, or in the mild end of the spectrum. However, the measures of psychological distress and QOL showed significantly high mean scores. Anxiety Scores showed little variation over time initially, and none of the mean differences (t values) reached statistical significance. However, when the scores of intake and those at 6 months are compared, there was a statistically significant improvement. Depression scores, on the other hand, showed a steady improvement with each assessment. General lack of well-being and psychological distress along with poor QOL remained high throughout the period of assessment with little variation over time .These morbidity measures could not be accounted for by variations in stressful life-event scores or by variations in degree of disability. Although the negative correlation between anxiety and depression scores and those on the QOL index approached conventional levels of significance, there was little correlation overall between morbidity measures and the putative modifying variables at any stage of assessment.

CONCLUSIONS

Although psychological symptoms of depressive and anxious spectrum was virtually universal, psychiatric illness at syndromal intensity warranting a formal psychiatric referral and management was rare in patients with SCI in the 1st year. The general well-being and QOL were expectedly dismal throughout. Expected correlations between the measures of social support and degree of disability with the measures of anxiety, depression, subjective distress, and QOL were not demonstrated .There is a need to look beyond these and explore factors such as lack of information, physical morbidity, quality of social support, and dependence for the activities of daily living to evolve a nuanced approach toward the challenge that these clientele represent.

Evaluate the impact of neurogenic bladder in veterans with traumatic spinal cord injury

OBJECTIVE

This observational study aimed to determine the prevalence of neurogenic bladder (NGB), and its impact (frequency of urinary tract infection [UTI], autonomic dysreflexia (AD) pressure ulcers, spasticity, and hospitalization rates) on veterans with traumatic spinal cord injury (SCI).

BACKGROUND

NGB (detrusor muscle and urethral sphincter dysfunction with loss of bladder sensation to void), secondary to SCI, is commonly encountered in daily practice; however, its impact on veterans' overall health has been less well studied.

METHOD

We retrospectively reviewed the electronic charts of veterans with SCI enrolled in our program and regularly followed in our SCI clinic. Demographic data collected included: age, sex, race/ethnicity, and age, level, severity and cause of spinal injury. Also noted was presence of NGB, episodes of UTI, presence of pressure ulcers, AD, spasticity, and hospitalization rate. Differences between those with and without NGB were evaluated using Generalized Linear Models.

RESULTS

Of 161 veterans with SCI, symptoms of NGB was present in 133 (83%). Presence of NGB was associated with severe spinal cord injury. Veterans with NGB had more frequent UTI and presence of pressure ulcers (P < 0.05). They also were more likely to need hospitalization and were at an increased risk of dying.

CONCLUSION

Incidence of NGB in veterans with SCI is high, is mainly associated with severe spinal cord injury, and severely impacts veterans' health by frequently causing UTIs, increasing hospitalization rate, and increases risk of death.

Management of bladder dysfunction in Wolfram syndrome with Mitrofanoff appendicovesicostomy: long-term follow-up

PURPOSE

To present the long-term outcomes of appendicovesicostomy using the Mitrofanoff principle for end-stage Wolfram bladder dysfunction as an alternative to clean intermittent self-catheterization (CIC) per urethra mainly following blindness.

METHODS

Twelve Wolfram patients presenting with bilateral hydroureteronephrosis and advanced bladder dysfunction were included in this study. All patients were managed initially by CIC per urethra. All of these patients became blind during follow-up and were unable to perform urethral CIC independently. Out of these patients, six patients agreed to proceed to appendicovesicostomy. Appendicovesicostomy urinary diversion using the Mitrofanoff principle was performed in these six blind patients. The rest of the patients stopped CIC or performed CIC irregularly.

RESULTS

Severe hydroureteronephrosis and large bladders were found in all patients prior to intervention. All patients were able to conduct CIC independently through the stoma and maintained overnight bladder free drainage. In all patients with urinary diversion and CIC, the hydroureteronephrosis was reduced and renal function returned to normal. However, the non-intervention group ended with different degrees of progressive renal failure with three mortalities during the follow-up.

CONCLUSIONS

We suggest appendicovesicostomy as a safe and lifesaving procedure for long-term management of bladder dysfunction in Wolfram syndrome particularly after progression to blindness.

Neurogenic bladder in spinal cord injury patients

Neurogenic bladder dysfunction due to spinal cord injury poses a significant threat to the well-being of patients. Incontinence, renal impairment, urinary tract infection, stones, and poor quality of life are some complications of this condition. The majority of patients will require management to ensure low pressure reservoir function of the bladder, complete emptying, and dryness. Management typically begins with anticholinergic medications and clean intermittent catheterization. Patients who fail this treatment because of inefficacy or intolerability are candidates for a spectrum of more invasive procedures. Endoscopic managements to relieve the bladder outlet resistance include sphincterotomy, botulinum toxin injection, and stent insertion. In contrast, patients with incompetent sphincters are candidates for transobturator tape insertion, sling surgery, or artificial sphincter implantation. Coordinated bladder emptying is possible with neuromodulation in selected patients. Bladder augmentation, usually with an intestinal segment, and urinary diversion are the last resort. Tissue engineering is promising in experimental settings; however, its role in clinical bladder management is still evolving. In this review, we summarize the current literature pertaining to the pathology and management of neurogenic bladder dysfunction in patients with spinal cord injury.

Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale

OBJECTIVE

To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale.

DESIGN

Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning.

SETTING

Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY.

PARTICIPANTS

Seven hundred fifty-seven adults with traumatic SCI.

RESULTS

The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale.

CONCLUSION

The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.

Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review

STUDY DESIGN

Scoping review.

OBJECTIVES

To gain a better understanding of the prevalence, course and association with age of secondary health conditions in individuals with spinal cord injury (SCI).

SETTING

Seattle, Washington, USA.

METHODS

We performed searches of electronic databases for studies published from 1986-2011 that provided information regarding the prevalence, course or associations with age and duration of secondary health conditions in individuals with SCI.

RESULTS

Ninety-two studies were included. The findings indicate that: (1) individuals with SCI experience a number of secondary health conditions, many of which occur at a higher rate in those with SCI than the normative population; (2) the most common conditions or symptoms are pain, bowel and bladder regulation problems, muscle spasms, fatigue, esophageal symptom and osteoporosis; (3) a number of conditions, including cardiovascular disease, diabetes, bone mineral density loss, fatigue and respiratory complications or infections, occur with higher frequency in older individuals or those with longer SCI duration, relative to younger individuals or those with shorter SCI duration; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in individuals aging with SCI.

CONCLUSIONS

The findings support the conclusion that individuals with SCI show signs of 'premature aging' in different organ systems. Longitudinal research is needed to understand when problems are most likely to emerge, and to develop and test the efficacy of interventions to prevent these health conditions and their negative impact.

Association of internet use and depression among the spinal cord injury population

OBJECTIVE

To examine the relation between the frequency of Internet use and depression among people with spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

SCI Model Systems.

PARTICIPANTS

People with SCI (N=4618) who were interviewed between 2004 and 2010.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The frequency of Internet use and the severity of depressive symptoms were measured simultaneously by interview. Internet use was reported as daily, weekly, monthly, or none. The depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9), with 2 published criteria being used to screen for depressive disorder. The diagnostic method places more weight on nonsomatic items (ie, items 1, 2, and 9), and the cut-off method that determines depression by a (PHQ-9) score ≥10 places more weight on somatic factors. The average scores of somatic and nonsomatic items represented the severity of somatic and nonsomatic symptoms, respectively.

RESULTS

Our multivariate logistic regression model indicated that daily Internet users were less likely to have depressive symptoms (odds ratio=.77; 95% confidence interval, .64-.93), if the diagnostic method was used. The linear multivariate regression analysis indicated that daily and weekly Internet usage were associated with fewer nonsomatic symptoms; no significant association was observed between daily or weekly Internet usage and somatic symptoms.

CONCLUSIONS

People with SCI who used the Internet daily were less likely to have depressive symptoms.

Psychological coping with intermittent self-catheterisation (ISC) in people with spinal injury: a qualitative study

BACKGROUND

Management of bladder function is important in rehabilitation of spinal injury. Failure to comply with bladder management techniques, such as intermittent catheterisation, can have long-term consequences leading to renal failure. It is important, therefore, that spinal injured people adapt to the therapy at an early stage, but there is little research aimed at exploring patient experiences of ISC.

OBJECTIVES

This study explores the experiences of patients who have a spinal cord injury and who carry out ISC in order to identify psychological coping factors that might affect therapy adherence.

DESIGN

A qualitative study using a Grounded Theory framework involving individual interviews.

SETTING AND PARTICIPANTS

There were 15 participants (11 men and 4 women), median age 52 years (range 24-68) who were discharged from spinal rehabilitation, living in the community and using ISC. The sample was recruited from the patient lists of a tertiary spinal injury unit and a Specialist Continence Service.

METHODS

In-depth interviews were carried out in participants' own homes by a trained interviewer. Interviews were audio-recorded, transcribed and analysis carried out using NUD*IST6 software.

RESULTS

A core category of 'normalisation' was identified and the causes and consequences related to this category are reported. Categories of 'independence' and 'control' were closely related to, and were interdependent with, 'normalisation'. Participants were relieved of worry when they could exert control over their bladder function, and a feeling of normalisation helped them to maintain the integrity of their self-image. The ultimate outcome was either adaptation or maladaptation. Adaptation was dependent on positive acceptance of intermittent catheterisation and the need for good bladder management at the outset, whereas maladaptation was a result of avoidance and denial.

CONCLUSIONS

Adherence to ISC is related to early psychological coping strategies of active acceptance rather than denial and avoidance in relation to bladder management. It is important to support positive appraisals of ISC, particularly from the patient perspective, which suggest that it is the first step to independence and that it also provides normalisation and control of bladder function. ISC can contribute to a good quality of life, dignity, privacy and self-esteem.

The influence of depression on physical complications in spinal cord injury: behavioral mechanisms and health-care implications

STUDY DESIGN

This study is a literature review and a proposed conceptual model.

OBJECTIVES

The objective of this study is to develop a conceptual model to explore the relationship between the presence of depressive symptoms and secondary physical complications such as pressure ulcers, urinary tract infections and autonomic dysreflexia in spinal cord injury (SCI).

SETTING

Community setting for individuals with SCI.

METHODS

A conceptual model explaining the mechanism underlying the relationship between depression and secondary physical SCI complications was developed based on the International Classification of Functioning, Disability and Health (ICF). A literature review was conducted to develop the model and to identify potential mechanisms responsible for the association.

RESULTS

A conceptual model based on ICF was created, informed by the literature discussing the link between depression and secondary physical SCI complications. Evidence in the literature was located that supports both a causal connection between depression and increased physical complications and/or the potential mechanisms mediating that connection.

CONCLUSION

The proposed model can be utilized to encourage further research on the influence of depression on SCI outcomes and the importance of prompt and effective identification and treatment of depressive symptoms. Additional research is needed to assess the relationship between depression and secondary physical SCI complications, and to test the validity of the model.

Factors predicting depression among persons with spinal cord injury 1 to 5 years post injury

OBJECTIVES

Estimate changes in prevalence of Major Depressive Disorder (MDD) 1 to 5 years post spinal cord injury (SCI); Identify demographic, injury, and discharge factors associated with MDD at 1 and 5 years post-injury; Identify modifiers of changes in MDD.

DESIGN

Retrospective.

SETTING

Model Spinal Cord Injury System.

PARTICIPANTS

2,256 adult participants enrolled in the National Spinal Cord Injury Statistical Center between 1999 and 2004.

MAIN OUTCOME MEASURE

MDD as determined by the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Prevalence of MDD was 11.9% at 1 year and 9.7% at 5 years post SCI. Odds of MDD decreased significantly 1 to 5 years post-injury (odds ratio=1.26, 95% confidence interval=1.02, 1.56). At 1 year post-injury, the odds of MDD was greater for persons 35-55 years old at injury, unemployed, having an indwelling catheter or voiding bladder management at discharge, and higher scores on ASIA motor index. At 5 years post-injury, the odds of MDD were greater for females, persons 35-55 years old at injury, those with a high school education or less, those having an indwelling catheter, voiding, and no bladder management at discharge, and higher scores on ASIA motor index. Sex was the only significant modifier.

CONCLUSIONS

MDD occurs commonly 1 to 5 years post SCI. Sociodemographic, injury, and discharge factors are associated with the development and changes in depression. Future research should expand upon current findings in order to identify, prevent, and reduce the prevalence of MDD after SCI.

Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention

AIMS

Neurogenic bladder can be effectively managed with intermittent catheterization (IC) to improve or restore continence, but there is no consensus on which type of catheter is preferred. Hydrophilic catheters were developed to reduce urethral friction, thereby minimizing trauma and sticking, and making them more acceptable to the patient, and easier and safer to use. The objective of this article was to review the literature on the benefits of hydrophilic catheters in patients with neurogenic bladder.

METHODS

A large body of experimental and observational evidence, including randomized controlled trials, was identified using PubMed.

RESULTS

Compared with plastic catheters that have been manually lubricated with gel, hydrophilic catheters reduce urinary tract infection and microhematuria. Hydrophilic catheters are also associated with high levels of patient satisfaction because they are comfortable to use.

CONCLUSIONS

There is a wealth of evidence, including randomized controlled trials, to support the benefits of hydrophilic catheters in terms of safety and quality of life, especially in men with spinal cord injury. More data are required for spina bifida, multiple sclerosis, and in women. Further research is warranted, especially large-scale and long-term robust comparisons of different types of catheter, and in well-defined and stratified populations.

Comparison of the Patient Health Questionnaire and the Older Adult Health and Mood Questionnaire for self-reported depressive symptoms after spinal cord injury

OBJECTIVE

To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI).

RESEARCH DESIGN

727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted.

RESULTS

The PHQ-9 and OAHMQ were significantly correlated (r = .78), and both were correlated with satisfaction with life (r = -.48, -.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9; 9.3% met the criteria for major depression based on PHQ-9 > or = 10; and 19.7% based on PHQ-9 > or = 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology.

CONCLUSIONS

The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the 2 instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves.

Lebensqualität bei deutschsprachigen Patienten mit Rückenmarkverletzungen und Blasenfunktionsstörungen

BACKGROUND

Neurogenic bladder dysfunctions in patients with spinal cord lesions may cause severe limitations in the quality of life (QoL). For assessment of QoL, a validated questionnaire in French is available. The goal of the study was to validate the German version of the questionnaire.

METHODS

Translation and intercultural adaptation were achieved in cooperation with an institute for health system research. The resulting German version was filled in by 439 patients in 18 centers in Germany, Austria, and Switzerland. Data were analyzed regarding clinical and sociodemographic characteristics. Quality criteria of the items and scales were tested by a detailed scale analysis.

RESULTS

Of the patients 65.8% were paraplegic and 32.8% were tetraplegic. Internal consistency, reliability, and validity of the questionnaire were very good. Differential effects could be displayed in all clinical variables that were tested.

CONCLUSIONS

The Qualiveen questionnaire is now available as the first instrument in the German language for the evaluation of the influence of bladder dysfunction on QoL in patients with spinal cord lesions.