Lee et al. 2007
Australia
PEDro=7
RCT
N=305

Population: SCI with Neurogenic bladder and stable management: Mean age = 43.5 yrs; Gender: males = 83%, females = 17%; Level of injury: paraplegia = 45%, tetraplegia = 55%; Severity of injury: complete = 49%, incomplete = 51%.
Treatment: Double-blinded comparison of methenamine hippurate (MH, 2g) with cranberry (1600mg), MH (2g) with cranberry placebo, cranberry (1600mg) with MH placebo or MH placebo with cranberry placebo).
Outcome Measures: Time to symptomatic UTI (culture), adverse events collected for up to 6 months.

• The Kaplan-Meier curves for MH and Cranberry compared to placebo showed no evidence of a treatment effect.
• The unadjusted analysis confirms that there was no statistically significant effect of MH tablets (HR 0.94, 95% confidence interval 0.68-1.32) or cranberry tables (HR 0.93, 95% CI 0.66-1.29).
• The only significant predictor of a future UTI was found to be the number of UTIs in the preceding 6 months.
• Common adverse effects included diarrhea or constipation.
• There was no difference in adverse event rates between the groups.

Waites et al. 2006
USA
PEDro=6
RCT
N=89/52

Population: SCI or other neurological disease with indwelling or suprapubic catheter with bacteriuria and pyuria: Mean age = 45.8 yrs; Gender: males = 49, females = 40; Mean time since injury = 11.2 yrs.
Treatment: Comparison of twice daily bladder irrigation with normal saline vs 0.25% acetic acid vs neomycin-polymyxin (N-P) GU irrigant for treatment of bacteriuria for 8 weeks.
Outcome Measures: Numbers and types of bacteria (culture and susceptibility), urinary pH, urinary leukocytes, generation of antimicrobial-resistant organisms collected at baseline, 2, 4, and 8 weeks.

• No difference among 3 irrigation solutions for bacteriuria.
• Overall, no difference in bacteriuria for any 7 of 8 species (p>0.1) other than Enterococcus spp. which increased significantly from week 0 to 8 (p=0.0006) and between solutions was significant for N-P group only (p=0.02)
• Mean urinary pH for all 3 groups increased from mean of 6.6 to 7.0—7.2 range (p=0.01) at wk 8.
• No sig increase in urinary leukocytes in any group (p≥0.6), MRSA (p≥0.37) or gram-negative resistance to common UTI antimicrobials (p≥0.11).

Krebs et al. 1984
USA
PEDro=4
RCT
N=40

Population: Inpatient SCI ( ≤6 months post-injury) with intermittent catheterization; Gender: males = 40; Level of injury: T6 & above = 27, T7 & below = 13.
Treatment: Instillation of 45 ml. 5% hemiacidrin solution at each catheterization and 2 mg methanamine mandelate orally 4*daily vs no bacterial prophylaxis.
Outcome Measures: Urinary pH determination culture and antibiotic susceptibility collected weekly during length of hospital stay.

• Urine pH lower in methenamine and hemiacidrin group (p<0.01). 
• Control group had double the number of positive cultures (p<0.001).
• UTI higher in controls (p<0.02). 
• Higher rate of symptomatic UTI in controls (chi-square 3.84, p<0.05).

Sanderson and Weissler 1990a
UK
PEDro=4
RCT
N=19

Population: SCI rehabilitation inpatients: Gender: males = 16, females = 3.
Treatment: Patients washed daily in chlorhexide vs unmedicated soap for 8 weeks with crossover. Individuals receiving antibiotics for either UTIs or skin infections were analysed separately as 3rd and 4th groups depending on their initial treatment (chlorhexide vs soap).
Outcome Measures: Bacteriuria assessed by urine culture, perineal colonization (swab), bedsheet, pillow case and environmental swab samples collected each week day.

• Bacteriuria reduced by washing with chlorhexidine vs soap. (p<0.01). 
• Bacteriuria less for those on antibiotics and using chlorhexidine (0.05<p<0.01). 
• Proportion of negative cultures progressively rose for those on soap alone, to those on chlorhexidene alone, to those on antibiotics with soap, to those on antibiotics with chlorhexidene.
• Antibiotics usage resulted in significant increase in perineal swabs negative for coliforms (p<0.01).

Castello et al. 1996 Spain
PEDro=4
RCT
Initial N=38; Final N=13

Population: SCI: Mean age = 27.83 yrs; Gender: males = 9, females = 4; Level of injury: paraplegia = 12, tetraplegia = 1.
Treatment: Ascorbic acid vs placebo (lactose) for UTI prophylaxis for an unspecified duration.
Outcome Measures: Urine pH, culture.

• No significant difference in:
• Baseline or post- treatment urine pH for ascorbic acid or placebo.
• Number of patients developing UTI between groups.

Pearman et al. 1988 Australia
PEDro=3
RCT
Initial N=18; Final N=15

Population: SCI inpatient: Age = 18-49 yrs; Gender: males = 15.
Treatment: Trisdine bladder instillation following intermittent catheterisation vs kanamycin + colistin bladder instillation.
Outcome Measures: Episodes of bacteriuria, number of catheterizations, duration of catheterizations.

• No significant difference (chi square, no p value given) in number of episodes of bacteriuria between Trisdine vs kanamycin-colistin bladder instillations;
• 0.56% (9 of 1609) vs 0.53% (9 of 1704) of instillations were associated with episodes of bacteriuria for Trisdine vs kanamycin-colistin respectively.

Schlager et al. 2005
USA
Downs & Black score=14
Pre-post
N=7

Population: Neurogenic bladder caused by myelomeningocele (N=5), and traumatic SCI (N=2), and using clean intermittent catheterization: Age = 18-29 yrs; Gender: males = 3, females = 4; Level of Injury:  L2 & 4, T6, 8 & 12(x2); Time since injury >2 yrs.
Treatment: Phosphorus supplement (Neutra-phos®) as urine-acidifying agent. Wk 2 and 3, patient drank a phosphorus supplement 3x/day over 4 wk study period.
Outcome Measures: Urinalysis (Urine pH) measured 3x/day (1st morning, afternoon, evening) for 4 wks; urine sample (cultured) 2x/wk over 4 wks.

• No significant change in urine pH during the 2-week period when patient was on phosphorus supplement (vs when off supplement).
• Urine acidification not achieved with phosphate suppl.
• Frequency of bacteriuria in an individual patient was similar on and off supplementation.