Management of UTI in SCI

1. What is the WBC cutoff for treatment (per high power field) in an asymptomatic patient with SCI? What are the exceptions to this rule?
2. What are the most common urinary tract complications in neurogenic bladder?
3. What is the best way to reduce complications?
4. What are some modalities used to reduce UTIs in SCI patients?

Answers:
1. Less than 50 WBC per HPF is not generally treated and in general, asymptomatic UTI in patients with indwelling catheters in not treated. The exception is if there is vesicoureteral reflux, hydronephrosis, or growth of urea-splitting organisms.
2. Early, there is thickened bladder, later there is reflux leading to pyelonephritis and renal stones. Hydronephrosis and hydroureter is caused by outlet obstruction. There is an overdistended areflexic bladder with markedly reduced compliance.
3. Draining bladder at pressure <40mmHg.
4. Prophylactic antibiotics (unproven), Vit C supp, cranberry juice, methenamine salts.