Jörg Krebs

Urodynamic results, clinical efficacy, and complication rates of sacral intradural deafferentation and sacral anterior root stimulation in patients with neurogenic lower urinary tract dysfunction resulting from complete spinal cord injury

To investigate the outcome and complications of sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) in patients with neurogenic lower urinary tract dysfunction (NLUTD) resulting from complete spinal cord injury (SCI).

Functional outcome of supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction

To investigate the functional outcome after supratrigonal cystectomy and augmentation ileocystoplasty in adult patients with refractory neurogenic lower urinary tract dysfunction (NLUTD).

Bacterial Persistence in the Prostate After Antibiotic Treatment of Chronic Bacterial Prostatitis in Men With Spinal Cord Injury

OBJECTIVEnTo investigate the microbiologic outcome after antibiotic treatment of bacterial prostatitis in men with spinal cord injury (SCI).nnnMETHODSnA retrospective investigation was done in an SCI rehabilitation center. The microbiologic culture results of urine and ejaculate or prostatic fluid samples were collected from 34 men with SCI presenting with recurrent urinary tract infections and bacterial prostatitis. Furthermore, patient characteristics, bladder diary details, and the administered antibiotic treatment were collected.nnnRESULTSnThe median age of the 34 investigated men was 42.5 years (lower quartile, 31.8; upper quartile, 46.1 years), and they had sustained SCI a median of 15.2 years (lower quartile, 4.7; upper quartile, 22.9 years) ago. The majority (24 of 34 patients; 71%) evacuated their bladder with intermittent catheterization. The most commonly used antibiotics to treat bacterial prostatitis were fluoroquinolones (nxa0= 41) followed by trimethoprim-sulfamethoxazole (nxa0= 8) and second-generation cephalosporins (nxa0= 7). In merely 2 men, antibiotic treatment resulted in bacterial eradication from the prostate. A shift in the bacteria species identified in the ejaculate or prostatic fluid cultures was observed during the follow-up. Most men (28 of 34; 82%) presented with mostly the same bacteria (55 of 62, 89%) in the urine as in the ejaculate or prostate samples.nnnCONCLUSIONnAntibiotic treatment did not result in the eradication of bacteria from the prostate of men with SCI. The antibiotic treatment of bacterial prostatitis in men with SCI should aim at eradicating symptoms and not bacteria.

Immunosenescence in persons with spinal cord injury in relation to urinary tract infections -a cross-sectional study-

BackgroundIndividuals with a spinal cord injury (SCI), despite specialized rehabilitation and good health care, have a reduced life expectancy. Infectious diseases, such as pneumonias, infected pressure sores and urinary tract infections (UTI) have been identified as the leading causes of mortality. We hypothesise that a premature onset of immune frailty occurs in SCI, possibly caused also by recurrent urinary tract infections.A cross sectional study was performed comparing blood and urine samples between able bodied controls (nxa0=xa084) and persons with spinal cord injury (nxa0=xa085). The results were grouped according to age (below and above 60xa0years). Assessed were the abundancies of immune cells, the concentration of soluble biomarkers, the in vitro functioning of lymphocytes as well as phenotypic exhaustion of T-cells in blood and urine. Further, the leucocyte telomere length and the cytomegalovirus (CMV) serological status were compared between the groups.ResultsWe observed in people with SCI lower proportions of naïve T-cells, more memory T-cells, reduced T-cell proliferation and higher CMV prevalence compared to age-matched controls. SCI participants older than 60xa0years had a higher prevalence of UTI compared with SCI persons younger than 60xa0years.ConclusionThe immune system of people with SCI shows traits of an increased immunological strain and a premature onset of immune frailty. The role of UTI in the onset of immune frailty remains to be elucidated as we did not see significantly higher abundancies of circulating UTI-bacteria specific T-cell clones in persons with SCI. We assume that any impact of UTI on the immune system might be compartmentalized and locally restricted to the urinary tract.

Homeopathic prophylaxis for recurrent urinary tract infections following spinal cord injury: study protocol for a randomized controlled trial

Background: Virtually many patients with spinal cord injury (SCI) suffer from neurogenic lower urinary tract dysfunction (NLUTD). Although the most severe consequence of NLUTD, damage of renal function, can be treated effectively today, urinary tract infections (UTI) are the most common urologic problems in SCI patients. They severely impair the quality of life, and no evidence-based prophylaxis exists. The goal of this study is to assess the usefulness of adjunctive homeopathic treatment for the reduction of UTI in patients with SCI. Methods/Design: A prospective randomized controlled trial is designed to assess whether adjunctive treatment with classical homeopathy leads to a relevant reduction of the rate of UTI in patients with SCI. In addition, it will be assessed if homeopathic treatment will significantly improve patient satisfaction and quality of life. Fifty patients with SCI and recurrent (3 or more) UTI per year will be recruited from the patients of the neuro-urology of the Swiss paraplegic Centre in Nottwil, Switzerland. All patients will be randomly allocated into two groups: patients in the homeopathy group (n = 25) will receive standard of-care prophylaxis combined with homeopathic treatment; the control group (n = 25) will receive standard of-care prophylaxis alone. Standard of-care prophylaxis consists of cranberry products and urine acidification. Homeopathic treatment consists of a homeopathic medication; the remedy is chosen individually based on the homeopathic case taking. Patients do not routinely present to the homeopaths during the study, but can contact them if a UTI occurs during the course of the study. Primary outcome are the UTI rate, and secondary outcomes are quality of life and satisfaction with the treatment over a follow-up period of 1 year. Discussion: There is a high demand for effective UTI prophylaxis in patients with SCI, because UTI are associated with an increased morbidity and even mortality. The results of the study will significantly add to our knowledge not only about UTI prevention, but the clinical value of homeopathy. Trial registration: ClinicalTrials.gov identifier: NCT01477502, registered on 17 November 2011. Ethics: The Ethikkommission Nordwest- und Zentralschweiz (EKNZ): PB_2016-00054 approved this study protocol. Informed consent: Patients will sign an informed consent prior to participation in the study.

Chronic bacterial prostatitis in men with spinal cord injury.

PurposeRecurrent urinary tract infections (UTI) are a major problem affecting spinal cord injury (SCI) patients and may stem from chronic bacterial prostatitis. We have therefore investigated the presence of chronic bacterial prostatitis and its role in the development of recurrent symptomatic UTI in SCI men.MethodsThis study is a prospective cross-sectional investigation of bacterial prostatitis in SCI men in a single SCI rehabilitation center. In 50 men with chronic SCI presenting for a routine urologic examination, urine samples before and after prostate massage were taken for microbiologic investigation and white blood cell counting. Furthermore, patient characteristics, bladder diary details, and the annual rate of symptomatic UTI were collected retrospectively.ResultsNo participant reported current symptoms of UTI or prostatitis. In most men (39/50, 78xa0%), the microbiologic analysis of the post-massage urine sample revealed growth of pathogenic bacteria. The majority of these men (32/39, 82xa0%) also presented with mostly (27/39, 69xa0%) the same pathogenic bacteria in the pre-massage sample. There was no significant (pxa0=xa00.48) difference in the number of symptomatic UTI in men with a positive post-massage culture compared with those with a negative culture. No significant (pxa0=xa00.67) difference in the frequency distribution of positive versus negative post-massage cultures was detected between men with recurrent and sporadic UTI.ConclusionsMost SCI men are affected by asymptomatic bacterial prostatitis; however, bacterial prostatitis does not play a major role in the development of recurrent UTI. The indication for antibiotic treatment of chronic bacterial prostatitis in asymptomatic SCI men with recurrent UTI is questionable.

Salmonella prostatitis in a man with spinal cord injury

Abstract Context Prostatitis is a very unusual manifestation of Salmonella urinary tract infection and has not been reported in men with spinal cord injury (SCI). Findings A 57-year-old man with paraplegia and a history of recurrent symptomatic urinary tract infections presented with Salmonella typhimurium prostatitis. Clinical and sonographic examination of the urinary tract, as well as urinalysis including microbiologic examination, revealed no relevant abnormalities. The microbiologic analysis of the ejaculate revealed growth of monophasic Salmonella enterica ssp. enterica serotype 4,12:i:-. A 6-week course of antibiotic treatment was initiated. There were no recurrent symptomatic urinary tract infections during follow-up. Conclusion Salmonellosis is a reportable disease and carriers have to refrain from activities in the food sector. Therefore, Salmonella prostatitis should be considered and excluded in men with SCI and a history of recurrent urinary tract infection who use intermittent catheterization for bladder management.

Neuro-Urology in Spinal Cord Injury

Storage and evacuation of urine is regulated by a neural control system that precisely coordinates the reciprocal activity of these two functional phases of the lower urinary tract (LUT) to achieve continence and to ensure a periodic, controlled voiding. This complex control system includes the sympathetic, parasympathetic, and somatic nervous system, with close interaction of cortical, subcortical, spinal cord neural networks and peripheral nerves. Damage to spinal cord structures results in a dysfunction of storage and evacuation, which can lead to incontinence, incomplete bladder drainage, and deterioration of the upper urinary tract. A straightforward categorization of neurogenic lower urinary tract dysfunction (NLUTD) is almost impossible due to the heterogeneity of spinal cord injuries (SCI) in terms of segmental levels of injury and completeness. An individual diagnostic and therapeutic approach is mandatory for successful treatment of NLUTD. This chapter summarizes the physiological and pathophysiological aspects of a SCI and the diagnostic and therapeutic approaches in different phases after the SCI. The diagnostic assessment includes noninvasive procedures like clinical examinations and determination of post-voiding residual volume by ultrasound and invasive procedures such as urodynamic investigation and cystoscopy. The therapeutic interventions contain conservative therapies like drugs and percutaneous electrical stimulation and minimal invasive therapies such as injections of onabotulinumtoxin in the detrusor and sacral neuromodulation. In cases of failure of conservative treatment, invasive treatments among them bladder augmentation and implantation of an artificial sphincter might be necessary. A lifelong surveillance of the neuro-urological function of individuals with SCI is highly recommended to avoid complications and irreversible alterations of the lower urinary tract.