Kalpakjian et al. 2010; USA

Downs & Black = 17

Prospective cohort

Population: 62 females with SCI (injury levels C6 through T12; >36 months post-injury); 66 gender matched AB controls; 45-60 years of age

Methodology: Self report surveys collected 4 times (9months apart) over 4 years. Monthly diaries indicate day of bleeding, heaviness of blood flow, absence of period

1. No significant differences between women with and without SCI for menopause status (p=0.856)
2. No significant group differences for vaginal dryness, sleep problems or fatigue
3. Increase in bother ratings in vaginal dryness across menopause transition (premenopause vs. late PM; 1.30±0.6 vs. 1.73±1.1 (%))
4. Women with SCI had significantly greater bother of diminished sexual arousal (p=0.012), somatic symptoms (p<0.001) and bladder infections (p<0.001), and less bother of vasomotor symptoms (p=0.020)

Dewire et al. 1992;
USA
Downs & Black = 16
Longitudinal
N = 57

Population: All males with cervical SCI
Methodology: Comparison of incidence of urological complications and renal deterioration in SCI patients with and without a chronic indwelling urinary catheter from baseline to 10 YPI
Outcome Measures: Patients’ medical records excretory urogram.

1. No significant difference found between patients with and without chronic indwelling urinary catheters.

Sekar et al. 1997;
USA
Downs & Black = 16
Longitudinal
N = 1114

Population: 915 men and 199 women; mean age 31.25 + 13.79 (range 1 – 87 yrs) at injury
Methodology: Evaluation of the effects of different bladder management on long-term renal function who were followed for at least 10 YPI
Outcome Measures: Total and individual kidney effective renal plasma flow (ERPF).

1. A decreasing trend in mean ERPF was detected over time after injury, except for a slight reversal at 10 YPI.

MacDiarmid et al. 1995;
New Zealand
Downs & Black = 16
Longitudinal
N = 44

Population: 31 males and 13 females; mean age 36, age range 13 – 79
Methodology: Reviewed the urological complications in patients treated with suprapubic catheterization at 12 to 15 mos post-injury
Outcome Measures: Urodynamic studies and ultrasound

1. None of the patients had renal deterioration, vesicoureteral reflux or bladder carcinoma.
2. Incidences of incontinence, urinary tract infections, and calculi were acceptable.

Lynch et al. 2000;

New Zealand

Downs & Black = 16

Cross-sectional with AB controls

N SCI = 467

Population: 384 males and 83 females; mean age 43.5 (15 – 89 yrs); mean YPI 14 (0.7 – 42.1 yrs); age and gender matched AB controls

Methodology:  Comparison of bowel functioning

1. Group with SCI had ↑ fecal incontinence, less frequent bowel motion, spent longer times on the toilet, and required more assistance.

Krogh et al. 2000;

Denmark

Downs & Black = 16

Cross-sectional with AB controls

N SCI = 36

Population: 11 males and 15 females; age range 17 – 69 yrs; YPI range 11 – 24 days

Methodology:  Comparison of total gastrointestinal transit times (GITT) and segmental colorectal transit times (CTT)

1. GITT and CTT are significantly prolonged in SCI patients than in AB controls.

Viera et al. 1986;

USA

Downs & Black = 15

Longitudinal

Population: 77 males and 22 females; age range 14-65 yrs at injury

Methodology:  Investigated the effect of current bladder management techniques on renal function at 6 to 60 months post-injury

1. In the indwelling catheter group (n= 9), bladder calculi occurred in 3 patients at 7, 28, and 44 mos post-injury, and were the only group to develop bladder stones.
2. Excretory urogram abnormalities tended to occur earlier in the intermittent self-catheterization group (first 18 mos) than in the bladder retraining group (3^rd yr).

Faaborg et al. 2011; Denmark

Downs & Black= 15

Longitudinal

Population: Group A: n= 12; 8 males, 4 females; age 37.7-67.2; complete SCI N= 4. Group B: n= 10; 7 males, 3 females; age 29.7-71.9 years; complete SCI N=8. 

Methodology: Assessed gastrointestinal times (GITTs) and colonic dimension changes in Group A; at 1 year after injury and again 12.8 years later; and Group B; at 18.7 years after injury and again 12.2 years later.

1. Decrease in rectosigmoid transit time from 1-13 years after SCI (Group A: p=0.026).
2. No other significant changes in GITT and segmental colonic transit times.
3. No statistically significant changes in colonic dimension.

Alexandrino et al. 2011;

Brazil

Downs & Black = 15

Cross-sectional with AB comparison group

SCI N= 24

Population: 24 males with SCI (Type A complete n=22, type C incomplete n=1, type D incomplete n=1); mean age 36.25 ±10.24; YPI 9.5 ±5.8 (0.6-20 yrs). 24 age matched controls; mean age 36.5 ±10.31

Methodology: Seminal zinc is considered to be a marker of prostate function. This study compared of seminal zinc concentration (SZC) between the SCI group and control group. Seminal zinc was determined by atomic absorption.

1. Significant difference between groups; Mean SZC in study group is 85.20 mg l-1 and 147.16 mg l-1 in control group (p= 0.0035).

Alexandrino et al. 2004;

Brazil

Downs & Black = 13
Cross-sectional with AB controls
N SCI = 44
N controls = 44

Population: All males with SCI, mean age 33.98 + 9.12 (18 – 58 yrs); age and gender matched AB control
Methodology: Comparison of total serum prostate specific antigen (PSA) and seminal PSA
Outcome Measures: Serum and seminal levels of PSA

1. No differences in total PSA levels between group with SCI and AB controls.
2. Total seminal PSA was ↓ (p = 0.0012) in group with SCI compared to AB controls.

Lamid et al. 1988;

USA

Downs & Black = 13

Longitudinal

Population:  All males; mean age 29.72 (19 – 66 yrs) at injury.

Methodology:  Medical chart review of annual visits from SCI patients with vesicoureteral reflux until 12 YPI

1. The majority of refluxes developed 1-2 YPI, and some disappeared spontaneously without causing damage to the urinary tract.
2. After 4 YPI, the number of refluxes ↑ and progressed to grade II and IV, causing kidney damage with caliectasis.

Pramjudi et al. 2002;
USA
Downs & Black = 13
Cross-sectional with AB controls
N SCI = 366
N controls = 371

Population: 366 males with SCI; age range 40 – 79 (40 – 49 yrs, 50 – 59 yrs, 60 – 69 yrs, and 70 – 79 yrs); age and gender matched AB controls
Methodology: Comparison of serum prostate specific antigen (PSA)
Outcome Measures: serum levels of PSA

1. No differences in PSA levels between group with SCI and AB controls.

Faaborg et al. 2008;

Denmark

Downs & Black = 12

Longitudinal

Population: 159 subjects who participated in a survey in 1996 and a follow-up in 2006; mean age 37 (range 15-70), mean YPI 10 (range 0-48), 63 cervical, 40 thoracic, and 56 lumbar

Methodology:  Assessed colorectal function over a 10 year period

1. All items regarding symptoms of constipation increased significantly.
2. The number of correspondents reporting fecal incontinence at least once monthly decreased from 32 (22%) to 26 (17%).
3. More correspondents report that their QoL or social activities were restricted by colorectal dysfunctions in general (39 vs. 60) and constipation (20 vs. 30).

Konety et al. 2000;
USA
Downs & Black = 12
Cross-sectional with AB controls
N SCI = 79
N controls = 501

Population: All males with SCI; age range 40 – 89 yrs (40 – 49 yrs, 50 – 59 yrs, 60 – 69 yrs, 70 – 79 yrs, and 80 – 89 yrs); age and gender matched AB control
Methodology: Comparison of serum prostate specific antigen (PSA)
Outcome Measures: Serum levels of PSA

1. No differences in PSA levels between group with SCI and AB controls.

Shim et al. 2008;
Korea
Downs & Black = 12
Cross-sectional with AB controls
N SCI = 31
N controls = 31

Population: All males with SCI, median age 58 (45 – 81 yrs); median YPI 32 (5 – 55 yrs); age and gender matched AB controls
Methodology: Comparison of serum prostate specific antigen (PSA)
Outcome Measures: Serum levels of PSA;  digital rectal examination; transrectal ultrasonography.

1. No differences in PSA levels and prostate volume parameters between group with SCI and AB controls.

Ancha et al. 2010;

USA

Downs & Black = 12

Cross-Sectional

N SCI= 8

Population: 8 males with SCI (tetraplegia (C5 or below) n=3, paraplegia (T5 or below) n=5; < 2 spontaneous bowel movements/wk); mean age 59±13, mean YPI 13 ±4. 6 gender matched AB controls, mean age 57 ±10

Methodology: Comparison of high amplitude propogating contractions (HAPC) and other measures of motility by fixing a manometric probe to the colonic wall at the splenic flexure. Measurements pre-sleep phase (1hr before sleep), sleep phase, and post-sleep phase.

1. HAPC were absent in individuals with SCI during pre-sleep, sleep and post-sleep.
2. HAPC were significantly increased after awakening in the control group.
3. The MI was lower in the SCI group during pre- and post-sleep than in the controls.
4. There was a sleep-induced depression of colonic motility in both the groups.

Scott et al. 2004;
USA
Downs & Black = 11
Cross-sectional with AB controls
N SCI = 636
N controls = 20949

Population: All males with SCI; ages 50 +; 945 males with prostate cander and 20,949 AB controls
Methodology: Comparison of incidence and characteristics of prostate cancer
Outcome Measures: SCI, cancer registry, and outpatient databases.

1. 1.7% of SCI group had been diagnosed with prostate cancer compared to 4.4% of AB controls.
2. Average serum prostate specific antigen (PSA) level at diagnosis was significantly ↑ (p = 0.043) in group with SCI compared to AB controls.
3. Group with SCI + prostate cancer (7; 63.6%) had locally advanced (stage T3) or metastactic prostate cancer (p = 0.012) compared to AB population (267; 29.1%).

Menardo et al. 1987;
Italy
Downs & Black = 10
Cross-sectional with AB controls
N SCI = 11
N controls = 37

Population: 8 males and 3 females with SCI; age range 17 – 63 yrs; YPI range 2mos – 15 yrs; age matched AB controls
Methodology: Comparison of transit of contents through the large bowel
Outcome Measures: Gastrointestinal transit times (GITT)

1. Compared to AB controls, GITT was ↓ in all patients with paraplegia.
2. Flow contents through the left colon were markedly ↓ in group with SCI compared to AB controls, and transit of contents in 8 persons with SCI were ↓, and below the normal range of the AB controls.

Pannek et al. 2003;
Germany
Downs & Black = 10
Cross-sectional with AB controls
N SCI = 100
N controls = 575

Population: All males with SCI, mean age 53.7 + 11.3 (35 – > 71 yrs); age and gender matched AB controls
Methodology: Comparison of prostate size and serum prostate specific antigen (PSA)
Outcome Measures: Porstate size; serum levels of PSA

1. No differences in prostate size or PSA levels between group with SCI and AB controls.
2. Mean serum PSA level in the AB controls was found to ↑ with age, but shown to be of a lesser extent in persons with SCI.

Kuhlemeier et al. 1984b;
USA
Downs & Black = 9
Cross-sectional with AB controls
N SCI = 400
N controls = 287

Population: 160 acute and 240 chronic; age range 16-60 yrs, YPI range for chronic 6-6mos
Methodology: Comparison of renal function
Outcome Measures: Total and individual kidney effective plasma flow

1. Both individual and global kidney effective plasma flows were ↓ in the acute SCI group for persons who were 21-50 yrs old, but no difference existed for persons younger than 20 or older than 50.

Emmanuel et al. 2009;
UK
Downs & Black = 9
Cross-sectionall
N = 55

Population: 55 complete SCI subjects, 45 male and 10 female, mean age 36 (range 19-68), mean time post-injury 34 months (range 13-134)
Methodology: Comparison of rectal muscosal blood flow
Outcome Measures: Whole gut transit times; rectal electrosensitivity; stimulated defecation; laser Doppler studies of rectal mucosal blood flow; symptoms of constipation

1. 35 subjects (27 male, mean age 36, range 20-68) are symptomatically constipated, representing 75% of the subjects with lesion above T5 and 55% of those with lesion below T5.
2. 32 subjects had slow gut transit, all of whom were symptomatically constipated.
3. Transmucosal rectal electrical sensation was abnormally high in all SCI subjects, being significantly greater in those complaining of constipation (67.3mA in constipation, vs. 41.6mA in non-constipation SCI, vs. 36mA in control.
4. 71% of subjects with lesion above T5, and 61% of those below T5 were unable to expel a water-filled balloon and showed paradoxical sphincter contraction.
5. SCI subjects had significantly lower mucosal blood flow than asymptomatic SCI subjects (183 vs. 267 FU); SCI subjects with lesion above T5 had significantly lower resting blood flow than AB control, while SCI below T5 were similar to the control.