Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Urologic surveillance of persons with spinal cord injuries – a scoping review

Spinal Cord volume 62, pages 91–98 (2024)Cite this article

Subjects

Abstract

Study design

Scoping review - standardized according to the Equator-network and the Prisma-Statement guidelines with PRISMA-ScR.

Objectives

Review the literature concerning surveillance of the urinary- and renal systems in persons with spinal cord injuries (SCI). Specifically, to assess: #1 the usability of non-invasive and non-ultrasound methods, #2 the usage of systematic ultrasound surveillance #3 patient characteristics which predispose to urinary tract abnormalities (UTA) or renal function deterioration.

Methods

The literature assessed was collected from PubMed by creating a search string comprised of three main phrases: #1 persons with SCI, #2 kidney function and #3 surveillance program. The final search resulted in 685 studies. Eligibility criteria were defined prior to the search to assess the studies systematically.

Results

Four studies found serum cystatin C (s-cysC) to be accurate in estimating the glomerular filtration rate in persons with SCI. One study found no difference in UTA between surveillance adherent and surveillance non-adherent persons up to 30 years post injury. UTA and especially renal function deterioration seems rare the first 15 years post-injury. Non-traumatic SCI, time since injury, high detrusor pressure, upper urinary tract dilation, vesicourethral reflux, trabeculated bladder, history of calculi removal are significant risk factors for developing UTA or renal function deterioration.

Conclusion

Measurements of S-cysC should be considered to replace serum creatinine in most cases. Surveillance non-adherent persons are not at higher risk of developing UTA. A selective surveillance based on a baseline risk profile may be beneficial for patients and caretakers.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Article inclusion.

Similar content being viewed by others

Data availability

Tables with an overview of the included papers and their references are provided in the supplementary files page 2–13.

References

  1. Sweis R, Biller J. Systemic complications of spinal cord injury. Curr Neurol Neurosci Rep. 2017;17:8.

    PubMed  Google Scholar 

  2. Hartkopp A, Brønnum-Hansen H, Seidenschnur AM, Biering-Sørensen F. Survival and cause of death after traumatic spinal cord injury. A long-term epidemiological survey from Denmark. Spinal Cord. 1997;35:76–85.

    CAS  PubMed  Google Scholar 

  3. National Spinal Cord Injury Statistical Center. Complete public version of the 2019 annual statistical report for the spinal cord injury model systems. 2019. https://www.nscisc.uab.edu/public/2019%20Annual%20Report%20-%20Complete%20Public%20Version.pdf. Accessed: March 15, 2021.

  4. Greenwell MW, Mangold TM, Tolley EA, Wall BM. Kidney disease as a predictor of mortality in chronic spinal cord injury. Am J Kidney Dis. 2007;49:383–93.

    CAS  PubMed  Google Scholar 

  5. Vaidyanathan S, Singh G, Soni BM, Hughes P, Watt JW, Dundas S, et al. Silent hydronephrosis/pyonephrosis due to upper urinary tract calculi in spinal cord injury patients. Spinal Cord. 2000;38:661–8.

    CAS  PubMed  Google Scholar 

  6. EAU Guidelines on neuro-urology. Edition 2020. Accessed March 15, 2021.

  7. Abrams P, Agarwal M, Drake M, El-Masri W, Fulford S, Reid S, et al. A proposed guideline for the urological management of patients with spinal cord injury. BJU Int. 2008;101:989–94.

    PubMed  Google Scholar 

  8. Cameron AP, Rodriguez GM, Schomer KG. Systematic review of urological followup after spinal cord injury. J Urol. 2012;187:391–7.

    PubMed  Google Scholar 

  9. Sipski ML, Estores IM, Alexander CJ, Guo X, Chandralapaty SK. Lack of justification for routine abdominal ultrasonography in patients with chronic spinal cord injury. J Rehabil Res Dev. 2004;41:101–8.

    PubMed  Google Scholar 

  10. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169:467–73.

    PubMed  Google Scholar 

  11. Erlandsen EJ, Hansen RM, Randers E, Petersen LE, Abrahamsen J, Johannesen IL. Estimating the glomerular filtration rate using serum cystatin C levels in patients with spinal cord injuries. Spinal Cord. 2012;50:778–83.

    CAS  PubMed  Google Scholar 

  12. Jenkins MA, Brown DJ, Ierino FL, Ratnaike SI. Cystatin C for estimation of glomerular filtration rate in patients with spinal cord injury. Ann Clin Biochem. 2003;40:364–8.

    CAS  PubMed  Google Scholar 

  13. Thomassen SA, Johannesen IL, Erlandsen EJ, Abrahamsen J, Randers E. Serum cystatin C as a marker of the renal function in patients with spinal cord injury. Spinal Cord. 2002;40:524–8.

    CAS  PubMed  Google Scholar 

  14. Kocak H, Oner-Iyidogan Y, Gurdol F, Kocak T, Esin D. The relation between serum MDA and cystatin C levels in chronic spinal cord injury patients. Clin Biochem. 2005;38:1034–7.

    CAS  PubMed  Google Scholar 

  15. Elmelund M, Oturai PS, Biering-Sorensen F. 50 years follow-up on plasma creatinine levels after spinal cord injury. Spinal Cord. 2014;52:368–72.

    CAS  PubMed  Google Scholar 

  16. MacDiarmid SA, McIntyre WJ, Anthony A, Bailey RR, Turner JG, Arnold EP. Monitoring of renal function in patients with spinal cord injury. BJU Int. 2000;85:1014–8.

    CAS  PubMed  Google Scholar 

  17. Sawyer WT, Hutchins K. Assessment and predictability of renal function in spinal cord injury patients. Urology. 1982;19:377–80.

    CAS  PubMed  Google Scholar 

  18. Kuhlemeier KV, McEachran AB, Lloyd LK, Stover SL, Fine PR. Serum creatinine as an indicator of renal function after spinal cord injury. Arch Phys Med Rehabil. 1984;65:694–7.

    CAS  PubMed  Google Scholar 

  19. Goto T, Kawasaki Y, Takemoto J, Abe Y, Namima T. Evaluating estimated glomerular filtration rates of creatinine and cystatin C for male patients with chronic spinal cord injury. Spinal Cord. 2018;56:447–52.

    PubMed  Google Scholar 

  20. Sepahpanah F, Burns SP, McKnight B, Yang CC. Role of creatinine clearance as a screening test in persons with spinal cord injury. Arch Phys Med Rehabil. 2006;87:524–8.

    PubMed  Google Scholar 

  21. Waites KB, Canupp KC, DeVivo MJ, Lloyd LK, Dubovsky EV. Compliance with annual urologic evaluations and preservation of renal function in persons with spinal cord injury. J Spinal Cord Med. 1995;18:251–4.

    CAS  PubMed  Google Scholar 

  22. Adriaansen JJE, van Asbeck FWA, Bongers-Janssen HMH, Spijkerman D, Allrisc, Visser-Meily JMA, et al. Description of urological surveillance and urologic ultrasonography outcomes in a cohort of individuals with long-term spinal cord injury. Top Spinal Cord Inj Rehabil. 2017;23:78–87.

    PubMed  PubMed Central  Google Scholar 

  23. Elmelund M, Oturai PS, Toson B, Biering-Sorensen F. Forty-five-year follow-up on the renal function after spinal cord injury. Spinal Cord. 2016;54:445–51.

    CAS  PubMed  Google Scholar 

  24. Hansen RB, Biering-Sorensen F, Kristensen JK. Urinary calculi following traumatic spinal cord injury. Scand J Urol Nephrol. 2007;41:115–9.

    PubMed  Google Scholar 

  25. Gao Y, Danforth T, Ginsberg DA. Urologic management and complications in spinal cord injury patients: a 40- to 50-year follow-up study. Urology. 2017;104:52–58.

    PubMed  Google Scholar 

  26. Price M. Follow-up studies of renal function in patients with spinal cord injuries of traumatic origin. Paraplegia 1968;6:22–28.

    CAS  PubMed  Google Scholar 

  27. Price M, Kottke FJ, Olson ME. Renal function in patients with spinal cord injury: the eighth year of a ten-year continuing study. Arch Phys Med Rehabil. 1975;56:76–79.

    CAS  PubMed  Google Scholar 

  28. Klingensmith WC 3rd, Lammertse DP, Briggs DE, Smith WI, Roberts JF, Froelich JW, et al. Technetium-99m-MAG3 renal studies in spinal cord injury patients: normal range, reproducibility, and change as a function of duration and level of injury. Spinal Cord. 1996;34:338–45.

    PubMed  Google Scholar 

  29. Farrelly E, Lindbo L, Wijkstrom H, Seiger A. The Stockholm spinal cord uro study: 1. Basic characteristics and problem inventory. Scand J Urol. 2019;53:403–10.

    CAS  PubMed  Google Scholar 

  30. Kuhlemeier KV, Lloyd LK, Stover SL. Long-term followup of renal function after spinal cord injury. J Urol. 1985;134:510–3.

    CAS  PubMed  Google Scholar 

  31. Vaidyanathan S, Hughes PL, Soni BM. A comparative study of ultrasound examination of urinary tract performed on spinal cord injury patients with no urinary symptoms and spinal cord injury patients with symptoms related to urinary tract: do findings of ultrasound examination lead to changes in clinical management? Sci World J. 2006;6:2450–9.

    Google Scholar 

  32. Changlai SP, Bih LI, Lin DB. Tc-99m MAG3 renal studies: renogram and effective renal plasma flow in spinal cord injury patients. Urol Int. 1999;63:224–7.

    CAS  PubMed  Google Scholar 

  33. Guzelkucuk U, Demir Y, Kesikburun S, Aras B, Yasar E, Tan AK. Ultrasound findings of the urinary tract in patients with spinal cord injury: a study of 1005 cases. Spinal Cord. 2015;53:139–44.

    CAS  PubMed  Google Scholar 

  34. Lloyd LK, Kuhlemeier KV, Fine PR, McEachran AB, Stover SL. Prediction of pyelocaliectasis in follow-up of patients with spinal cord injury. Br J Urol. 1987;59:122–6.

    CAS  PubMed  Google Scholar 

  35. Morales PA, Hotchkiss RS, Sullivan JF. Renal clearance studies in paraplegics. J Urol. 1956;76:714–22.

    PubMed  Google Scholar 

  36. Gerridzen RG, Thijssen AM, Dehoux E. Risk factors for upper tract deterioration in chronic spinal cord injury patients. J Urol. 1992;147:416–8.

    CAS  PubMed  Google Scholar 

  37. Najenson T, Mendelson L, Sabransky H, Selibiansky H, Jakubovitch E, Solzi P, et al. Upper urinary tract in patients after traumatic spinal cord injury. Paraplegia 1969;7:85–96.

    CAS  PubMed  Google Scholar 

  38. Ku JH, Choi WJ, Lee KY, Jung TY, Lee JK, Park WH, et al. Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study. Urol Res. 2005;33:435–9.

    PubMed  Google Scholar 

  39. Pettersson-Hammerstad K, Jonsson O, Svennung IB, Karlsson AK. Impaired renal function in newly spinal cord injured patients improves in the chronic state-effect of clean intermittent catheterization? J Urol. 2008;180:187–91.

    PubMed  Google Scholar 

  40. Shin JC, Lee Y, Yang H, Kim DH. Clinical significance of urodynamic study parameters in maintenance of renal function in spinal cord injury patients. Ann Rehabil Med. 2014;38:353–9.

    PubMed  PubMed Central  Google Scholar 

  41. Weld KJ, Wall BM, Mangold TA, Steere EL, Dmochowski RR. Influences on renal function in chronic spinal cord injured patients. J Urol. 2000;164:1490–3.

    CAS  PubMed  Google Scholar 

  42. Hotchkiss RS, Morales PA, Sullivan JF. Renal clearance studies in paraplegics. J Urol. 1956;76:714–22.

    CAS  PubMed  Google Scholar 

  43. Cameron AP, Lai J, Saigal CS, Clemens JQ, Project NUDiA. Urological surveillance and medical complications after spinal cord injury in the United States. Urology. 2015;86:506–10.

    PubMed  Google Scholar 

  44. Ebert N, Shlipak MG. Cystatin C is ready for clinical use. Curr Opin Nephrol Hypertens. 2020;29:591–8.

    PubMed  Google Scholar 

  45. Canupp KC, Waites KB, DeVivo MJ, Richards JS. Predicting compliance with annual follow-up evaluations in persons with spinal cord injury. Spinal Cord. 1997;35:314–9.

    CAS  PubMed  Google Scholar 

  46. Shavelle RM, DeVivo MJ, Brooks JC, Strauss DJ, Paculdo DR. Improvements in long-term survival after spinal cord injury? Arch Phys Med Rehabil. 2015;96:645–51.

    PubMed  Google Scholar 

  47. Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S. Long-term survival after traumatic spinal cord injury: a 70-year British study. Spinal Cord. 2017;55:651–8.

    CAS  PubMed  Google Scholar 

  48. Ozer MN, Shannon SR. Renal sonography in asymptomatic persons with spinal cord injury: a cost-effectiveness analysis. Arch Phys Med Rehabil. 1991;72:35–37.

    CAS  PubMed  Google Scholar 

  49. McMahon LF Jr., Hayward R, Saint S, Chernew ME, Fendrick AM. Univariate solutions in a multivariate world: can we afford to practice as in the “good old days”? Am J Manag Care. 2005;11:473–6.

    PubMed  Google Scholar 

  50. Ginsberg DA, Boone TB, Cameron AP, Gousse A, Kaufman MR, Keays E, et al. The AUA/SUFU guideline on adult neurogenic lower urinary tract dysfunction: treatment and follow-up. J Urol. 2021;206:1106–13.

    PubMed  Google Scholar 

  51. Wahman K, Nash MS, Lewis JE, Seiger A, Levi R. Increased cardiovascular disease risk in Swedish persons with paraplegia: the Stockholm spinal cord injury study. J Rehabil Med. 2010;42:489–92.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Spinal Cord Injury Center of Western Denmark, Viborg, Denmark

    Christian Bødker, Maja F. Riisbøl, Benjamin Y. A. Khan, Rikke M. Hansen & Kaare E. Severinsen

Authors
  1. Christian Bødker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maja F. Riisbøl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Benjamin Y. A. Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rikke M. Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaare E. Severinsen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CB was responsible for designing the protocol in cooperation with KES, conducting full text readings of selected papers, extracting, and analysing data as well as writing the final report. MFR was responsible for creating the initial search string and excluding papers by assessment of the titles and abstracts. BYAK provided important feedback in the last stages before submitting. RMH provided feedback in all steps, from assessing studies to completing the final report. KES was responsible for designing the protocol and providing feedback in all steps, from assessing studies to completing the final report.

Corresponding author

Correspondence to Christian Bødker.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bødker, C., Riisbøl, M.F., Khan, B.Y.A. et al. Urologic surveillance of persons with spinal cord injuries – a scoping review. Spinal Cord 62, 91–98 (2024). https://doi.org/10.1038/s41393-023-00955-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-023-00955-6

Search

Advanced search

Quick links