Urinary tract infections (UTIs) are a leading cause of morbidity and mortality in patients with chronic spinal cord injury (SCI). These infections pose significant challenges due to altered bladder function and management needs in this population. Despite advances in care, UTIs remain prevalent, necessitating a deeper understanding of their incidence and associated risk factors. This study aimed to investigate the frequency of UTIs and identify key risk factors, particularly in relation to different bladder drainage methods, among individuals with long-term SCI.

We conducted a longitudinal study of 113 SCI patients followed for at least 5 years. The cohort included 82 males and 31 females, with a mean age of 48.8 ± 13.6 years and an average injury duration of 14.9 ± 8.3 years. Injuries were classified as 58 cervical, 41 thoracic, and 14 lumbar, with 48 complete and 65 incomplete cases. Patients underwent routine assessments, including laboratory biochemical tests and kidney ultrasounds every 3 months, and videourodynamic studies (VUDS) and effective renal plasma flow (ERPF) evaluations every 6-12 months. UTI events were tracked via medical records and patient interviews. Major UTIs were defined as episodes requiring hospitalization or marked by fever (>38°C), while minor UTIs included turbid or dark urine, new voiding difficulties, kidney/bladder discomfort, or autonomic dysreflexia without other causes

The average annual incidence rates were 0.32 ± 0.38 for major UTIs, 0.45 ± 0.46 for minor UTIs, and 0.77 ± 0.65 for all UTIs combined. No significant associations were found between UTI frequency and gender, injury level, duration, or completeness. However, a statistically significant variation in UTI rates was observed across bladder management methods (p < 0.001), with the highest incidence in patients using indwelling urethral catheters, followed by suprapubic cystostomy, intermittent catheterization, and reflex voiding. Hydronephrosis and bladder wall trabeculation were also significantly linked to both major and minor UTIs, whereas bladder wall compliance showed no association with UTI occurrence.

Although UTI rates in SCI patients have decreased in recent years, specific risk factors persist. Bladder management with indwelling urethral catheters, along with hydronephrosis and bladder trabeculation, significantly elevates UTI risk. These findings highlight the need for individualized bladder management strategies to reduce infection rates in chronic SCI patients. Regular monitoring with ultrasound and urodynamic studies is essential for identifying at-risk individuals. Future efforts should focus on optimizing catheter use and addressing structural abnormalities to further lower UTI incidence, ultimately enhancing patient outcomes and quality of life in this population.