ascorbic-acid and Urinary-Bladder--Neurogenic

Urinary tract infections (UTI) remain one of the most prevalent and frustrating morbidities for neurogenic bladder patients, and death attributed to urosepsis in the spinal cord injury (SCI) patient is higher when compared to the general population. Risk factors include urinary stasis, high bladder pressures, bladder stones, and catheter use. While classic symptoms of UTI include dysuria, increased frequency and urgency, neurogenic bladder patients present differently with increased spasticity, autonomic dysreflexia, urinary incontinence, and vague pains. Multiple modalities have been assessed for prevention including catheter type, oral supplements, bladder irrigation, detrusor injections and prophylactic antimicrobials. Of these, bladder inoculation with E. coli HU2117, irrigation with iAluRil(®), detrusor injections, and weekly prophylaxis with alternating antibiotics appear to have a positive reduction in UTI but require further study. Ultimately, treatment for symptomatic UTI should account for the varied flora and possible antibiotic resistances including relying on urine cultures to guide antibiotic therapy.

Topics: Administration, Intravesical; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Antibiotic Prophylaxis; Antioxidants; Ascorbic Acid; Botulinum Toxins, Type A; Catheter-Related Infections; Escherichia coli; Escherichia coli Infections; Humans; Immunotherapy, Active; Mannose; Methenamine; Multiple Sclerosis; Neuromuscular Agents; Proanthocyanidins; Probiotics; Recurrence; Spinal Cord Injuries; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Catheters; Urinary Tract Infections

The effect of ascorbic acid on urine pH was studied in spinal cord injury patients. Their urine was not colonized by urease positive microorganisms. The study was designed to compare the baseline urine pH value and the urine pH value after the administration of placebo or ascorbic acid 500 mg/6 h. The diet and medical treatment were not controlled. A significant decrease in urine pH value was not obtained. There was no clinical benefit from the use of ascorbic acid.

Topics: Adolescent; Adult; Ascorbic Acid; Diet; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Single-Blind Method; Spinal Cord Injuries; Urease; Urinary Bladder, Neurogenic; Urinary Tract Infections

The ability of ascorbic acid to lower urinary pH in patients with spinal cord injury and neurogenic bladder was studied. Ascorbic acid (1 g four times daily) or placebo was administered for five days in a double-blind, crossover study to 20 patients with spinal cord injury and neurogenic bladder. Urine pH was measured for two days before and during administration of placebo or ascorbic acid. The mean decrease in urinary pH with ascorbic acid was 0.58, but this reduction was not statistically or clinically significant. Only 7 of 20 patients showed a mean urine pH of 5.5 or less (acidic) during treatment with ascorbic acid. The study suggests that an ascorbic acid dosage of 1 g four times daily should not be used to maintain an acidic urinary pH for control of urinary tract infections in patients with spinal cord injuries.

Topics: Adolescent; Adult; Ascorbic Acid; Female; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Spinal Cord Injuries; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections; Urine

The intermittent bladder catheterization technique has been proposed as an effective way of eliminating the need for an inlying. Foley catheter in patients with neurovesical dysfunction following spinal cord injury. In the study reported here, a group of 41 male patients with spinal cord injuries achieved a catheter-free state with this method. Of these 41 patients, 19 have been followed for 1 year. Data obtained from the 19 patients are presented here for comparison with data from other recent studies. In the present study, the patients' fluid intake was restricted to 2,000 cc daily. A detrusor reflex was triggered by lower abdominal percussion followed by a Credé maneuver. A 6-hour catheterization schedule was used unless autonomic dysreflexia required more frequent catheterizations. Ascorbic acid, methenamine mandelate and nitrofurantoin were routinely administered, and specific antibiotics were also given following trial off-catheter, depending on the results of urine cultures and sensitivity studies. All patients achieved a catheter-free state in an average time of 17.1 days; no late failures have occurred. Two patients developed vesicoureteral reflux, but no evidence of hydronephrosis was observed. At 1 year only 16% of the patients were found to have infected urine, as compared to 100% at initiation of the trial off-catheter.

Topics: Ascorbic Acid; Female; Follow-Up Studies; Humans; Methenamine; Nitrofurantoin; Spinal Cord Injuries; Time Factors; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections; Urine