Diagnostic evaluation and management of recurrent urinary tract infections in the spinal cord injury population - a retrospective evaluation at a tertiary care center.

Study design: Retrospective review.

Objectives: While most individuals with spinal cord injury (SCI) are expected to have 1-2 urinary tract infections (UTIs) per year, there is a subset with higher incidence. We evaluate our practice to characterize common causes of recurrent UTIs, hypothesizing that more frequent infections typically have addressable risk factors.

Setting: Tertiary urology clinic, San Jose, CA.

Methods: We reviewed patients with SCI referred to a tertiary urology clinic for evaluation and management of "recurrent UTIs" during the years 2015-2020. Following workup, the suspected cause of recurrent UTIs and number of post-specialty evaluation UTIs (patient reported) were noted.

Results: Forty persons with SCI with a mean of 4.8 UTI treatments in the prior year comprised our cohort with most performing CIC (80%). After workup, 37/40 (92.5%) had a likely cause for their reported recurrent UTIs. In 16/40 (40%), careful questioning determined that the patient was not having UTIs based on guideline definitions. In those with confirmed recurrent UTIs, a bladder diary (62.5%) or urodynamic study (64%) was more likely to identify a cause compared to imaging (2.6%) or cystoscopy (8%). With a minimum 1-year follow-up, 90% of our population had a 50% or more reduction in UTI incidence, mostly using non-antibiotic strategies.

Conclusion: In a referral SCI population with a chief complaint of "recurrent UTIs", over a third were not having UTIs. In addition to detailed history, a bladder diary +/- urodynamics are most useful in finding the cause and improving UTI.