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Context/objective: This study aimed to assess the clinical practice for long-term follow-up (FU) of neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) in Italy and compare this practice with the clinical practice in other countries and with the international guidelines., Design: Data concerning the long-term urological FU of individuals with SCI were collected using a questionnaire and analyzed by means of descriptive and inferential statistics., Setting: Twenty-one Italian centers following SCI patients., Participants: One physician at each center (either a permanent staff member or chief)., Outcome Measures: Questions addressed the treatment of urinary tract infections (UTI), frequency of visits, urinary tract imaging examinations and urodynamic tests (UD), distinguishing between suprasacral and sacral SCI., Results: Nineteen out of 21 centers completed the survey. In most centers, patients were recommended to undergo a visit and an ultrasound examination of urinary tract (UT) at least once a year. While the median interval between FU visits was identical (12 months) for individuals with suprasacral and sacral SCI, the two interval distributions were significantly different (suprasacral SCI: min-max 4-18, IQR = 6; sacral SCI: min-max 6-24; IQR = 8.5; P = 0.02), showing people with suprasacral SCI are followed up more often. Approximately 80% of the surveyed centers performed scheduled UD, with a yearly median frequency of 12 months (range 6-36) for patients with suprasacral SCI, as compared to a median frequency of 18 months for sacral SCI (range 0-36, P = 0.04). VideoUD and antibiotic prophylaxis for recurrent UTIs are carried out only by urologists in 63% and 47.4% of the centers, respectively. Overall, Italian centers share common strategies that compare to standards, including yearly visits, yearly UT examinations and stricter follow-up of people with suprasacral SCI, but may not have standard protocols for antibiotic prophylaxis of UTI, and in few cases control visits and UD are carried out too often., Conclusions: Even though most Italian centers follow up patients with NLUTD secondary to SCI according to international guidelines, heterogeneity in frequency of FU examinations still exists. A tailored approach to the SCI patient that minimizes unnecessary examinations and groups different tests in a single access could improve patients' compliance with FU and reduce costs for the Health system.

After spinal cord injury (SCI), patients face many physical and psychological issues including intestinal dysfunction and comorbidities, strongly affecting quality of life. The gut microbiota has recently been suggested to influence the course of the disease in these patients. However, to date only two studies have profiled the gut microbiota in SCI patients, months after a traumatic injury. Here we characterized the gut microbiota in a large Italian SCI population, within a short time from a not only traumatic injury. Feces were collected within the first week at the rehabilitation center (no later than 60 days after SCI), and profiled by 16S rRNA gene-based next-generation sequencing. Microbial profiles were compared to those publicly available of healthy age- and gender-matched Italians, and correlated to patient metadata, including type of SCI, spinal unit location, nutrition and concomitant antibiotic therapies. The gut microbiota of SCI patients shows distinct dysbiotic signatures, i.e. increase in potentially pathogenic, pro-inflammatory and mucus-degrading bacteria, and depletion of short-chain fatty acid producers. While robust to most host variables, such dysbiosis varies by lesion level and completeness, with the most neurologically impaired patients showing an even more unbalanced microbial profile. The SCI-related gut microbiome dysbiosis is very likely secondary to injury and closely related to the degree of completeness and severity of the lesion, regardless of etiology and time interval. This microbial layout could variously contribute to increased gut permeability and inflammation, potentially predisposing patients to the onset of severe comorbidities.

Background: Traumatic spinal cord injury (SCI) is a neurological disorder that causes a traumatic anatomical discontinuity of the spinal cord. SCI can lead to paraplegia, spastic, or motor impairments. Go-karting for people with SCI is an adapted sport that is becoming increasingly popular. The purpose of this case report is to shed light on the effects of driving a go-kart on a patient with SCI-related spasticity and to deepen understanding of the possible related role of whole-body vibration (WBV) and neuroendocrine reaction. Methods: The patient was a 50-year-old male with a spastic paraplegia due to traumatic SCI. He regularly practiced go-kart racing, reporting a transient reduction in spasticity. He was evaluated before (T0), immediately after (T1), 2 weeks after (T2), and 4 weeks after (T3) a go-kart driving session. On both sides, long adductor, femoral bicep, and medial and lateral gastrocnemius spasticity was assessed using the Modified Ashworth Scale (MAS), and tone and stiffness were assessed using MyotonPro. Results: It was observed that a go-kart driving session could reduce muscle spasticity, tone, and stiffness. Conclusions: Go-kart driving can be a valid tool to obtain results similar to those of WBV and hormone production in the reduction of spasticity. [ABSTRACT FROM AUTHOR]

Intermittent catheterisation (IC) is considered the gold standard for bladder dysfunction‐related voiding problems following spinal cord injury (SCI). Despite this, up to 50% of individuals were no longer using IC 5 years after discharge from the rehabilitation centre. Hence, we initiated the IC Education Programme to offer standardized IC training and improve adherence. The programme was a European initiative undertaken by eight rehabilitation centres in Norway, France and Italy. The aim of this study is to evaluate the effectiveness of the IC Education Programme. The control group comprised individuals with SCI discharged from one of the participating rehabilitation centres using IC up to 1 year before the Education Programme was initiated. A questionnaire was sent by post to this group before the IC Education Programme started. The second group comprised individuals who had participated in and been discharged using the IC Education Programme; they received the questionnaire up to 1 year after programme initiation. Anonymous responses from the two groups were compared to assess outcomes such as ongoing use of IC, satisfaction with training and attitude towards bladder issues. Three hundred sixteen responses (from 500 questionnaires sent) were received from the control group (63%) and 84 (of 142) from the IC Education Programme group (59%). The IC Education Programme significantly increased the percentage of individuals still using IC during the first year at home (99 vs. 83% for the Education Programme and control groups, respectively; p < 0·05) and improved satisfaction with training in IC. Individuals who had participated in the IC Education Programme were also significantly less bothered by bladder issues than the control group (overall SF‐Qualiveen index 1·58 vs. 1·76, respectively; p = 0·032). The IC Education Programme improved the standard of care following SCI as it enabled more individuals to continue with IC up to 1 year after discharge, and improved training satisfaction. [ABSTRACT FROM AUTHOR]