Renal tract ultrasonography for routine surveillance in spinal cord injury patients

To report the efficacy of a urinary tract surveillance regime based on annual renal tract ultrasound without routine use of urodynamic testing (UDS) in our population of spinal cord injury (SCI) patients managed with clean intermittent catheterization (CIC).

Data was gathered retrospectively from the records of 48 SCI patients (40 males and 8 females). After establishing a safe system with initial urodynamics, renal ultrasonography was done annually for surveillance. UDS was repeated only when patients presented with new symptoms. The primary endpoint was the report of ultrasound findings at last follow-up. Findings of dilatation, calculi, scarring, and reflux were noted.

Mean follow-up was 6.8 years. By final follow-up, pelvicaliectasis was present in 4 (8%) subjects. Mild-moderate hydronephrosis was present in 3 (6%) subjects: 1 stable and 2 (4%) new compared to initial assessment. No severe cases of hydronephrosis were noted. Six (13%) subjects had renal/ureteral calculi. No new cases of renal cortical scarring or thinning were noted. One (2%) subject had high-grade reflux on UDS secondary to a double J stent.

Data relating to the efficacy of sequential surveillance studies in SCI patients are scarce, thus there is great variability in urologic surveillance methods worldwide. Upper tract abnormalities detected in our patients were early consequences of acute obstruction rather than late manifestations of detrusor changes and could not have been prevented with more regular urodyamic testing. These results suggest that annual ultrasound monitoring without routine urodynamic testing is an effective surveillance strategy in SCI patients managed with CIC.