Analysis for related factors of upper urinary tract deterioration in patients with intermittent catheterization_West China Medical Journal

Authors：

LUO Can ¹ , ZHANG Mengyang ¹ , LIU Jiawei ¹ , CHEN Zhong ² ,  XU Tao ¹

1. Department of Rehabilitation Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;
2. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P. R. China;

Corresponding author：

XU Tao, Email: rehabcc@163.com

Keywords：

Upper urinary tract deterioration; intermittent catheterization; spinal cord injury; risk factors

DOI：

10.7507/1002-0179.202403304

Video：

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Objective To explore the related factors of upper urinary tract deterioration (UUTD) in spinal cord injury patients using intermittent catheterization (IC-SCI) in the community. Methods Patients with spinal cord injury in the Chinese community were selected for investigation between August 3 and August 31, 2020. The included patients were divided into UUTD group and non-UUTD group. The basic information, intermittent catheterization practices, and urinary complications were compared between the two groups. Logistic regression was used to analyze the risk factors contributing to UUTD. Results A total of 431 patients were surveyed. Among them, there were 310 males and 121 females, 246 cases in the non-UUTD group and 185 cases in the UUTD group. There were statistically significant differences in the disease duration, gender, etiology, urinary incontinence, urinary tract infection, bladder calculi and nephrolithiasis between the two groups (P<0.05); there was no statistically significant difference in the other indicators between the two groups (P>0.05). The results of logistic regression analysis showed that urinary tract infection [odds ratio (OR)=3.229, 95% confidence interval (CI) (1.706, 6.110), P<0.001], nephrolithiasis [OR=4.846, 95%CI (2.617, 8.973), P<0.001], and urinary incontinence [OR=2.345, 95%CI (1.116, 4.925), P=0.024] were risk factors for UUTD. Conclusion Urinary tract infection, nephrolithiasis and urinary incontinence are independent risk factors for UUTD in community-based IC-SCI patients and deserve attention for preventive strategies.

Citation： LUO Can, ZHANG Mengyang, LIU Jiawei, CHEN Zhong, XU Tao. Analysis for related factors of upper urinary tract deterioration in patients with intermittent catheterization. West China Medical Journal, 2024, 39(6): 872-877. doi: 10.7507/1002-0179.202403304 Copy

1.	Chen YC, Ou YC, Hu JC, et al. Bladder management strategies for urological complications in patients with chronic spinal cord injury. J Clin Med, 2022, 11(22): 6850.
2.	Kozomara M, Birkhäuser V, Anderson CE, et al. Neurogenic lower urinary tract dysfunction in the first year after spinal cord injury: a descriptive study of urodynamic findings. J Urol, 2023, 209(1): 225-232.
3.	Zhang Z, Liao L. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a prospective study. Spinal cord, 2014, 52(6): 468-471.
4.	Liu J, Bi Y, Liu Y, et al. Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder. J Pediatr Urol, 2022, 18(4): 499.e1-499.e6.
5.	Liu J, Lou C, Xiao W, et al. Urinary tract infections and intermittent catheterization among patients with spinal cord injury in Chinese community. Sci Rep, 2023, 13(1): 17683.
6.	Welk B, Morrow S, Madarasz W, et al. The validity and reliability of the neurogenic bladder symptom score. J Urol, 2014, 192(2): 452-457.
7.	Biering-Sørensen F, Kennelly M, Kessler TM, et al. International spinal cord injury lower urinary tract function basic data set (version 2.0). Spinal Cord Ser Cases, 2018, 4(1): 60.
8.	Huang L, Zhang SW, Wu SL, et al. The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence. Neurourol Urodyn, 2008, 27(6): 522-524.
9.	Andresen EM, Fouts BS, Romeis JC, et al. Performance of health-related quality of life instruments in a spinal cord injured population. Arch Phys Med Rehabil, 1999, 80(8): 877-884.
10.	Önal B, Kırlı EA, Selçuk B, et al. Risk factors predicting upper urinary tract deterioration in children with spinal cord injury. Neurourol Urodyn, 2021, 40(1): 435-442.
11.	Giannantoni A, Scivoletto G, Di Stasi SM, et al. Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients. Spinal Cord, 1998, 36(1): 29-32.
12.	靖华芳, 廖利民, 付光, 等. 脊髓损伤患者上尿路功能损害的相关因素分析. 北京大学学报(医学版), 2014, 46(4): 544-547.
13.	Çetinel B, Önal B, Can G, et al. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a retrospective study. Neurourol Urodyn, 2017, 36(3): 653-658.
14.	Ku JH, Choi WJ, Lee KY, et al. Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study. Urol Res, 2005, 33(6): 435-439.
15.	Hsiao CY, Yang HY, Hsiao MC, et al. Risk factors for development of acute kidney injury in patients with urinary tract infection. PLoS One, 2015, 10(7): e0133835.
16.	Groen J, Pannek J, Castro Diaz D, et al. Summary of European Association of Urology (EAU) guidelines on neurourology. Eur Urol, 2016, 69(2): 324-333.
17.	Elmelund M, Oturai PS, Toson B, et al. Forty-five-year follow-up on the renal function after spinal cord injury. Spinal Cord, 2016, 54(6): 445-451.
18.	Yau AA, Hindi J, Uribarri J. Recurrent nephrolithiasis causing kidney failure. Am J Kidney Dis, 2021, 77(4): A18-A21.
19.	Skolarikos A, Straub M, Knoll T, et al. Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines. Eur Urol, 2015, 67(4): 750-763.
20.	Leslie SW, Sajjad H, Murphy PB. Renal Calculi, Nephrolithiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.
21.	Peerapen P, Thongboonkerd V. Differential bound proteins and adhesive capabilities of calcium oxalate monohydrate crystals with various sizes. Int J Biol Macromol, 2020, 163: 2210-2223.
22.	Zhao YW, Guo D, Li CY, et al. Comparison of the adhesion of calcium oxalate monohydrate to HK-2 cells before and after repair using tea polysaccharides. Int J Nanomedicine, 2019, 14: 4277-4292.
23.	辛文虎, 明星. 肾小管上皮细胞损伤与草酸钙肾结石形成机制的研究进展. 国际泌尿系统杂志, 2013, 33(4): 539-542.
24.	Liu H, Ye T, Yang X, et al. H19 promote calcium oxalate nephrocalcinosis-induced renal tubular epithelial cell injury via a ceRNA pathway. EBioMedicine, 2019, 50: 366-378.
25.	Sun XY, Ouyang JM, Gan QZ, et al. Renal epithelial cell injury induced by calcium oxalate monohydrate depends on their structural features: size, surface, and crystalline structure. J Biomed Nanotechnol, 2016, 12(11): 2001-2014.
26.	Liu Q, Tang J, Chen Z, et al. Polyunsaturated fatty acids ameliorate renal stone-induced renal tubular damage via miR-93-5p/Pknox1 axis. Nutrition, 2023, 105: 111863.
27.	Xie Z, Chen J, Chen Z. MicroRNA-204 attenuates oxidative stress damage of renal tubular epithelial cells in calcium oxalate kidney-stone formation via MUC4-mediated ERK signaling pathway. Urolithiais, 2022, 50(1): 1-10.
28.	Xie J, Ye Z, Li L, et al. Ferrostatin-1 alleviates oxalate-induced renal tubular epithelial cell injury, fibrosis and calcium oxalate stone formation by inhibiting ferroptosis. Mol Med Rep, 2022, 26(2): 256.
29.	Saboia DM, Firmiano MLV, Bezerra KC, et al. Impact of urinary incontinence types on women’s quality of life. Rev Esc Enferm USP, 2017, 51: e03266.
30.	Nitti V, Haag-Molkenteller C, Kennelly M, et al. Treatment of neurogenic detrusor overactivity and overactive bladder with Botox (onabotulinumtoxinA): development, insights, and impact. Medicine (Baltimore), 2023, 102(S1): e32377.
31.	Chung HJ, Lin AT, Lin CC, et al. Patients with urinary incontinence appear more likely to develop upper urinary tract stones: a nationwide, population-based study with 8-year follow-up. PLoS One, 2016, 11(8): e0161223.
32.	Ekberlİ G, Taner S. Risk determination for upper urinary tract damage in children with neuropathic bladder. J Paediatr Child Health, 2023, 59(7): 863-870.
33.	Ozkan B, Demirkesen O, Durak H, et al. Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction?. Urology, 2005, 66(1): 99-104.

1. Chen YC, Ou YC, Hu JC, et al. Bladder management strategies for urological complications in patients with chronic spinal cord injury. J Clin Med, 2022, 11(22): 6850.
2. Kozomara M, Birkhäuser V, Anderson CE, et al. Neurogenic lower urinary tract dysfunction in the first year after spinal cord injury: a descriptive study of urodynamic findings. J Urol, 2023, 209(1): 225-232.
3. Zhang Z, Liao L. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a prospective study. Spinal cord, 2014, 52(6): 468-471.
4. Liu J, Bi Y, Liu Y, et al. Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder. J Pediatr Urol, 2022, 18(4): 499.e1-499.e6.
5. Liu J, Lou C, Xiao W, et al. Urinary tract infections and intermittent catheterization among patients with spinal cord injury in Chinese community. Sci Rep, 2023, 13(1): 17683.
6. Welk B, Morrow S, Madarasz W, et al. The validity and reliability of the neurogenic bladder symptom score. J Urol, 2014, 192(2): 452-457.
7. Biering-Sørensen F, Kennelly M, Kessler TM, et al. International spinal cord injury lower urinary tract function basic data set (version 2.0). Spinal Cord Ser Cases, 2018, 4(1): 60.
8. Huang L, Zhang SW, Wu SL, et al. The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence. Neurourol Urodyn, 2008, 27(6): 522-524.
9. Andresen EM, Fouts BS, Romeis JC, et al. Performance of health-related quality of life instruments in a spinal cord injured population. Arch Phys Med Rehabil, 1999, 80(8): 877-884.
10. Önal B, Kırlı EA, Selçuk B, et al. Risk factors predicting upper urinary tract deterioration in children with spinal cord injury. Neurourol Urodyn, 2021, 40(1): 435-442.
11. Giannantoni A, Scivoletto G, Di Stasi SM, et al. Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients. Spinal Cord, 1998, 36(1): 29-32.
12. 靖华芳, 廖利民, 付光, 等. 脊髓损伤患者上尿路功能损害的相关因素分析. 北京大学学报(医学版), 2014, 46(4): 544-547.
13. Çetinel B, Önal B, Can G, et al. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: a retrospective study. Neurourol Urodyn, 2017, 36(3): 653-658.
14. Ku JH, Choi WJ, Lee KY, et al. Complications of the upper urinary tract in patients with spinal cord injury: a long-term follow-up study. Urol Res, 2005, 33(6): 435-439.
15. Hsiao CY, Yang HY, Hsiao MC, et al. Risk factors for development of acute kidney injury in patients with urinary tract infection. PLoS One, 2015, 10(7): e0133835.
16. Groen J, Pannek J, Castro Diaz D, et al. Summary of European Association of Urology (EAU) guidelines on neurourology. Eur Urol, 2016, 69(2): 324-333.
17. Elmelund M, Oturai PS, Toson B, et al. Forty-five-year follow-up on the renal function after spinal cord injury. Spinal Cord, 2016, 54(6): 445-451.
18. Yau AA, Hindi J, Uribarri J. Recurrent nephrolithiasis causing kidney failure. Am J Kidney Dis, 2021, 77(4): A18-A21.
19. Skolarikos A, Straub M, Knoll T, et al. Metabolic evaluation and recurrence prevention for urinary stone patients: EAU guidelines. Eur Urol, 2015, 67(4): 750-763.
20. Leslie SW, Sajjad H, Murphy PB. Renal Calculi, Nephrolithiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing, 2024.
21. Peerapen P, Thongboonkerd V. Differential bound proteins and adhesive capabilities of calcium oxalate monohydrate crystals with various sizes. Int J Biol Macromol, 2020, 163: 2210-2223.
22. Zhao YW, Guo D, Li CY, et al. Comparison of the adhesion of calcium oxalate monohydrate to HK-2 cells before and after repair using tea polysaccharides. Int J Nanomedicine, 2019, 14: 4277-4292.
23. 辛文虎, 明星. 肾小管上皮细胞损伤与草酸钙肾结石形成机制的研究进展. 国际泌尿系统杂志, 2013, 33(4): 539-542.
24. Liu H, Ye T, Yang X, et al. H19 promote calcium oxalate nephrocalcinosis-induced renal tubular epithelial cell injury via a ceRNA pathway. EBioMedicine, 2019, 50: 366-378.
25. Sun XY, Ouyang JM, Gan QZ, et al. Renal epithelial cell injury induced by calcium oxalate monohydrate depends on their structural features: size, surface, and crystalline structure. J Biomed Nanotechnol, 2016, 12(11): 2001-2014.
26. Liu Q, Tang J, Chen Z, et al. Polyunsaturated fatty acids ameliorate renal stone-induced renal tubular damage via miR-93-5p/Pknox1 axis. Nutrition, 2023, 105: 111863.
27. Xie Z, Chen J, Chen Z. MicroRNA-204 attenuates oxidative stress damage of renal tubular epithelial cells in calcium oxalate kidney-stone formation via MUC4-mediated ERK signaling pathway. Urolithiais, 2022, 50(1): 1-10.
28. Xie J, Ye Z, Li L, et al. Ferrostatin-1 alleviates oxalate-induced renal tubular epithelial cell injury, fibrosis and calcium oxalate stone formation by inhibiting ferroptosis. Mol Med Rep, 2022, 26(2): 256.
29. Saboia DM, Firmiano MLV, Bezerra KC, et al. Impact of urinary incontinence types on women’s quality of life. Rev Esc Enferm USP, 2017, 51: e03266.
30. Nitti V, Haag-Molkenteller C, Kennelly M, et al. Treatment of neurogenic detrusor overactivity and overactive bladder with Botox (onabotulinumtoxinA): development, insights, and impact. Medicine (Baltimore), 2023, 102(S1): e32377.
31. Chung HJ, Lin AT, Lin CC, et al. Patients with urinary incontinence appear more likely to develop upper urinary tract stones: a nationwide, population-based study with 8-year follow-up. PLoS One, 2016, 11(8): e0161223.
32. Ekberlİ G, Taner S. Risk determination for upper urinary tract damage in children with neuropathic bladder. J Paediatr Child Health, 2023, 59(7): 863-870.
33. Ozkan B, Demirkesen O, Durak H, et al. Which factors predict upper urinary tract deterioration in overactive neurogenic bladder dysfunction?. Urology, 2005, 66(1): 99-104.

West China Medical Journal

Analysis for related factors of upper urinary tract deterioration in patients with intermittent catheterization

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