title: The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective.
abstract: METHODS
  Despite significant progress in bladder management, urinary tract infections (UTIs) are still common among individuals with spinal cord injury (SCI), and could negatively impact their health and quality of life. However, there are no data available on bladder management and frequency of UTIs among elite athletes with SCI.
  
  
  METHODS
  Athletes were assessed during the London 2012 Paralympic Games and 2013 Paracycling World Championships. Athletes completed the standard form of the International Standards to Document remaining Autonomic Functions after SCI, along with the standardized Autonomic Function Questionnaire.
  
  
  RESULTS
  A total of 61 (age=35.5±7.7 years (mean±s.d.); time since injury=16.0±7.6 years) elite athletes from 15 countries with traumatic SCI and who used clean intermittent catheterization were included in this study. The majority (75%) were from developed nations. Athletes catheterized on average 6±2 times per day. We found that individuals who reused catheters experienced more frequent UTIs (P<0.001). We also demonstrated that 83% of individuals from developed nations never reused a single-use catheter, whereas only 27% of individuals from developing nations used a new catheter each time (P<0.001). We also noted a twofold increase in the frequency of UTIs in individuals from developing nations (P=0.027).
  
  
  CONCLUSIONS
  This study demonstrates that catheter reuse is intimately linked to UTI frequency and provides novel insight on bladder function and management in elite athletes with SCI. Reasons for catheter reuse may be due to a lack of health education and/or a lack of bladder-management resources. (Support: Craig Neilsen Foundation, ICORD, IPC).
authors.affiliation: 1] International Collaboration on Repair Discoveries, Vancouver, BC, Canada [2] Division of Physical Medicine and Rehabilitation, Department of Medicine, Vancouver, BC, Canada [3] GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Krassioukov
authors.affiliation: 1] International Collaboration on Repair Discoveries, Vancouver, BC, Canada [2] School of Population and Public Health, Vancouver, BC, Canada.
authors.forename: J J
authors.initials: JJ
authors.lastname: Cragg
authors.affiliation: International Collaboration on Repair Discoveries, Vancouver, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: West
authors.affiliation: Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Voss
authors.affiliation: Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Krassioukov-Enns
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D056352:Athletes; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications*; D013997:Time Factors; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000628:therapy*; D014546:Urinary Catheterization / Q000379:methods*; D014552:Urinary Tract Infections / Q000209:etiology*; D055815:Young Adult