Table 7.

Genitourinary and gastrointestinal systems

Article	Methods	Results
Scott et al.86 USA D & B = 11 N = 22 530 Cross-sectional with AB controls	636 men with SCI; ages 50 +. Comparison of incidence and characteristics of prostate cancer with AB controls (n = 20 949) and men with prostate cancer (n = 945) Outcome measure: SCI, cancer registry, and outpatient databases.	1.7% of SCI group had been diagnosed with prostate cancer compared to 4.4% of AB controls. Average serum prostate specific antigen (PSA) level at diagnosis was significantly ↑ (P = 0.043) in group with SCI compared to AB controls. 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%).
Pramjudi et al.89 USA D & B = 13 N = 737 Cross-sectional with AB controls	366 men with SCI; age range 40–79 (40–49 years, 50–59 years, 60–69 years, and 70–79 years). Comparison of serum PSA with age and gender matched AB controls (n = 371) Outcome measure: Abbott AxSym assay.	No differences in PSA levels between group with SCI and AB controls.
Konety et al.85 USA D & B = 12 N = 79 Cross-sectional with AB controls	All men with SCI; age range 40–89 years (40–49 years, 50 – 59 years, 60–69 years, 70–79 years, and 80–89 years). Comparison of serum PSA with AB controls (n = 501), age and gender matched. Outcome measure: Abbot MEIA assay.	No differences in PSA levels between group with SCI and AB controls.
Shim et al.90 Korea D & B = 12 N = 62 Cross-sectional with AB controls	31 men with SCI, median age 58 (45–81 years); median YPI 32 (5–55 years). Comparison of serum PSA with AB controls (n = 31), age and gender matched. Outcome measure: immunoradiometric assay; digital rectal examination; transrectal ultrasonography.	No differences in PSA levels and prostate volume parameters between group with SCI and AB controls.
Pannek et al.87 Germany D & B = 10 N = 675 Cross-sectional with AB controls	100 men with SCI, mean age 53.7 ± 11.3 (35 –≥71 years). Comparison of prostate size and serum PSA with AB controls (n = 575), age and gender matched. Outcome measure: immunoenzymatic assay; transrectal ultrasonography.	No differences in prostate size or PSA levels between group with SCI and AB controls. 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.
Alexandrino et al.88 Brazil D & B = 13 N = 88 Cross-sectional with AB controls	44 men with SCI, mean age 33.98 ± 9.12 (18–58 years). Comparison of total serum prostate specific antigen (PSA) and seminal PSA with AB controls (n = 44), age and gender matched. Outcome measure: Abbot AxSYM assay.	No differences in total PSA levels between group with SCI and AB controls. Total seminal PSA was ↓ (P = 0.0012) in group with SCI compared to AB controls.
Lamid et al.83 USA D & B = 13 N = 32 Longitudinal	All men with SCI; mean age 29.72 (19 – 66 years) at injury. Medical chart review of annual visits from SCI patients with vesicoureteral reflux until 12 YPI. Outcome measures: medical records with information on bladder function, including radiological and laboratory examinations.	The majority of refluxes developed 1–2 YPI, and some disappeared spontaneously without causing damage to the urinary tract. After 4 YPI, the number of refluxes ↑ and progressed to grade II and IV, causing kidney damage with caliectasis.
Dewire et al.80 USA D & B = 16 N = 57 Longitudinal	57 men with cervical SCI. 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 measure: patients’ medical records excretory urogram.	No significant difference found between patients with and without chronic indwelling urinary catheters.
Sekar et al.81 USA D & B = 16 N = 1 114 Longitudinal	915 men and 199 women with SCI; mean age 31.25 ± 13.79 (1–87 years) at injury. Evaluated the effects of different bladder management methods on long-term renal function for at least 10 YPI. Outcome measure: total and individual kidney ERPF.	A decreasing trend in mean ERPF was detected over time after injury, except for a slight reversal at 10 YPI.
Viera et al.82 USA D & B = 15 N = 99 Longitudinal	77 men and 22 women; age range 14–65 years at injury. Investigated the effect of current bladder management techniques on renal function at 6–60 months post-injury. Outcome measure: serum creatinine, eExcretory urogram. Determination of short renal clearance ofiothalamate.	In the indwelling catheter group (n = 9), bladder calculi occurred in 3 patients at 7, 28, and 44 months post-injury, and were the only group to develop bladder stones. Excretory urogram abnormalities tended to occur earlier in the intermittent self-catheterization group (first 18 months) than in the bladder retraining group (third year).
Kuhlemeier et al.84 USA D & B = 9 N = 687 Cross-sectional with AB controls	160 acute and 240 chronic; age range 16–60 years, YPI range for chronic 6–6 months. Comparison of renal function with AB controls, age and gender matched (n = 287). Outcome measure: computer-assisted renal scintigraphy.	Both individual and global kidney effective plasma flows were ↓ in the acute SCI group for persons who were 21–50 years old, but no difference existed for persons younger than 20 or older than 50.
Lynch et al.95 New Zealand D & B = 16 N = 934 Cross-sectional with AB controls	384 men and 83 women with SCI; mean age 43.5 (15–89 years); mean YPI 14 (0.7–42.1 years). Comparison of bowel functioning with age and gender matched AB controls (n = 467). Outcome measure: mean fecal incontinence score, bowel motion frequency, haemorrhoidectomy, time at toilet, assistance at toilet.	SCI had ↑ fecal incontinence, less frequent bowel motion, spent longer times on the toilet, and required more assistance.
Krogh et al.92 Denmark D & B = 16 N = 60 Cross-sectional with AB controls	11 men and 15 women; age range 17–69 years; YPI range 11–24 days. Comparison of total GITTs and segmental CTTs with age and gender matched AB controls (n = 24). Outcome measure: GITT and CTT.	GITT and CTT are significantly prolonged in SCI patients than in AB controls.
Menardo et al.94 Italy D & B = 10 N = 48 Cross-sectional with AB controls	8 men and 3 women with SCI; age range 17–63 years YPI range 2 months 15 years. Comparison of transit of contents through the large bowel with AB controls (n = 37), age matched. Outcome measure: GITTs.	Compared with AB controls, GITT was ↓ in all patients with paraplegia. Flow contents through the left colon was 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.
Faaborg et al.91 United Kingdom D & B = 12 N = 159 Longitudinal	114 men and 45 women with SCI; mean age at time 2: 37 (15–70 years); mean YPI at time 2: 10 (0–48 years). Assessed colorectal function over a 10-year period (1996 and 2006). Outcome measure: NBD score.	Constipation-related symptoms ↑ in the 10-year period (P < 0.001). The time needed for each defecation was > 30 min in 24 at time 1, and the corresponding number was 37 at time 2 (P < 0.00001). As well, the need for digital stimulation or evacuation of the anorectum every day or at least once per week ↑ from 34 and 69 to 48 (P < 0.00005) and 80 (P < 0.00001), respectively. Use of oral laxatives, suppositories and enema, and need for assistance did not ↑ between time periods. Persons reporting fecal incontinence at least once every month ↓ (P < 0.001) between time periods.
Emmanuel et al.93 United Kingdom D & B = 9 N = 81 Cross-sectional with AB controls	45 men and 10 women with complete SCI; mean age 36 (19 – 68 years); mean YPI 34 months (13–134 months). Comparison of rectal muscosal blood flow with age matched AB controls (n = 26). Outcome measure: Doppler probe.	Compared with AB controls, resting blood flow was ↑ in persons with lesions above T5 (P = 0.056) and similar in persons with lesions below T5. Compared with AB controls, 6 patients with lesions below T5 had a tendency towards a ↓in mucosal blood flow, although this was not significant.

Abbreviations: AB, able-bodied; CTT, colorectal transit time; D and B, Downs and Black score; ERPF, effective renal plasma flow; GITT, gastrointestinal transit times; NBD, neurogenic bowel dysfunction; PSA, prostate-specific antigen; SCI, spinal cord injury; YPI, years post-injury.