Brian M. Jordan, DO
Resident Physician, PM&R
MetroHealth Rehabilitation Institute/Case Western Reserve University
Lakewood, Ohio, United States
Christina V. Oleson, MD
Director, Neuro-Osteoporosis Program, and Professor of Physical Medicine and Rehabilitation
Case Western Reserve/MetroHealth Rehabilitation Institute
Cleveland, Ohio, United States
Complications of bladder function and related changes in bladder management are well established among persons with chronic spinal cord injury and disorders(SCI/D). Bladder complications have also been observed in persons meeting criteria for Post-Acute Sequelae of SARS-CoV-2(PASC). Although “COVID-19 cystitis,” characterized by prolonged cytokine elevation and detrusor hyperactivity has been reported, larger studies have refuted these findings in the general population. Our study objectives were to classify and quantify the types and severity of genitourinary complications in individuals with pre-existing neurogenic bladder. This currently involves analysis of persons with Spinal Cord Injury(SCI), Neuromyelitis Optica(NMO), and Transverse Myelitis(TM).
Design:
This retrospective chart review is part of a larger IRB-approved database of persons with PASC. We reviewed Long-COVID Rehabilitation clinic notes, available hospital records from initial COVID-19 diagnosis, relevant re-admissions, and medical specialty consultations. The date and patient age at first COVID diagnosis, pre-COVID bladder function, and post-COVID bladder changes in function or complications were reviewed.
Results:
Of 50 persons initially identified, 21 were excluded for insufficient data. In the 29 eligible for analysis, 16 had traumatic SCI, 10 non-traumatic SCI, 1 NMO, and 2 TM. Findings show 15/29 did not experience bladder changes(51.8%); while 7 described mild complications deemed “manageable” (24.1%). However 7 experienced severe complications affecting quality of life(24.1%). Some of these developments include severe or recurrent urinary tract infections(UTIs), sepsis, worsening urinary incontinence, and painful bladder spasms. Additionally, two patients previously having upper motor neuron bladder dysfunction subsequently developed a lower motor neuron pattern of injury.
Conclusions:
Findings suggest clinicians should have a heightened suspicion of bladder sequelae in SCI/D persons with PASC. In the near future, the researchers hope to gather more data further supporting the incidence and severity of PASC genitourinary sequelae as the Long-COVID database continues to grow.
