Suzanne Groah, MD MSPH, Director of the Spinal Cord Injury Research Center at MedStar National Rehabilitation Hospital was awarded a grant from the Patient-Centered Outcomes Research Institute (PCORI) to study the use of a probiotic to mitigate urinary symptoms in person with neuropathic bladder.
Neuropathic bladder is associated with a disproportionately high risk of genitourinary complications, including bladder and kidney infections, calculi, and bladder cancer, among others. While neuropathic bladder can result from any trauma or disease of the brain or spinal cord, people with spinal cord injury (SCI) and spina bifida (SB) are nearly universally affected. Urinary tract infections (UTIs) were historically the most common cause of death for people with SCI/SB9 , and while early mortality due to UTI and subsequent kidney failure has declined with improved prevention and management, UTIs remain the most common cause of emergency department visits 10and rehospitalization11 among people with neuropathic bladder.
While UTI is a major chronic and recurrent health condition for people with neuropathic bladder, it is also a major worldwide public health problem with staggering economic impact and potential for human suffering. Recent estimates from the Department of Health & Human Services demonstrate that UTIs cost in excess of $1 billion annually. Further, it is estimated that there are 561,677 catheter-associated UTIs occurring in the hospital setting annually, costing $1,006 per infection, totaling more than $500 million in 2009, and being responsible for 8,205 deaths. This does not include the personal suffering or time lost from gainful employment. In sum, UTI is associated with significant burden to the US population, it is responsible for even greater burden to people with neuropathic bladder, and this proposal emphasizes a gap for people with neuropathic bladder due to SCI and SB who often have multiple chronic health conditions.
The PCORI Project will develop, validate, and assess a Urinary Symptom Questionnaire for use in people with neuropathic bladder (USQ-NB) and (2) develop and pilot a Self-Management Protocol using Probiotics (SMP-UTI) for UTI symptoms utilizing a readily available Lactobacillus supplement that the patient self-administers (or administers with caregiver assistance). We ultimately aim to (3) determine whether a 6-month intravesicular Lactobacillus intervention can reduce the frequency, severity and impact of urinary symptoms and UTI in people with neuropathic bladder due to SCI and SB, also characterizing the effects of Lactobacillus on the urinary microbiome as preliminary evidence supporting a second phase comparative effectiveness study in the future.