Presentation Authors: Lynn Stothers*, Emily Deegan, Alex Kavanagh, Vancouver, Canada, Blayne Welk, London, Canada, Mark Nigro, Vancouver, Canada
Introduction: Urinary tract infection (UTI) is a serious complication of neurogenic bladder (NB), is associated with resistant organisms and causes autonomic dysreflexia & reduced quality of life. UTI diagnosis in NB is difficult due to sensory changes prohibiting reports of traditional LUTS. Near Infrared spectroscopy (NIRS) has previously reported diagnostic capabilities in pediatric UTI. Objective: examine telemedicine with home monitoring of bladder parameters including NIRS for early UTI diagnosis & symptom reduction.
Methods: Prospective cohort study (NLUTD with recurrent UTI). Subjects served as their own controls x 6 months run in then completed adaptive telemedicine. Measures at 3 time points in clinic included: Neurogenic Bladder Symptom Score (NBSS), SFâˆ’36 and Qualiveenâˆ’30, urine culture & bladder NIRS. Home-monitoring telemedicine conducted monthly x 6âˆ’months including BP, temperature, & urinalysis. A subset of 7 conducted home bladder NIRS for tissue saturation index (TSI%) during natural filling & x 30 min. post emptying. Asymptomatic urine cultures obtained at 3 time points & with symptomatic UTI had bacteria frozen for genetic analysis.
Results: N=62; 75% male, 25% female (median 49 & 46 yrs respectively) SCI 87% (ASIA 64%, B 20%, C 9%, D 3.7%, E 2%), MS 7%, spina bifida 5%, other injury 13%; median time since injury 16 yrs. Bladder management: CIC 64%, indwelling cath 29%, spontaneous voiding 7%. 2 used adaptive mouth technology to operate telemedicine independently. 190 urine cultures revealed 135 isolates; 18 strains, antimicrobial resistance (AMR) in 54%. 324 visits demonstrated 91% compliance. 7 SCI subjects completed home NIRS independently capturing TSI%. Urinary incontinence (UI) showed statistically significant reduction on NBSS following telemedicine (p=0.02).
Conclusions: Subjects on telemedicine with home monitoring experienced a significant reduction in UI & high compliance with visits even in high tetraplegia. Home monitoring of blood pressure and acquisition of bladder NIRS was feasible. Telemedicine can improve NB management and increase healthcare access. Bladder NIRS in the SCI population is feasible and could provide an adjunctive method for early UTI detection in this population with high AMR.
Source of Funding: Rick Hansen Foundation