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Scoping review on managing the bladder and preventing urinary tract infections (UTIs) in athletes with spinal cord injuries

Bulletin of Faculty of Physical Therapy volume 29, Article number: 71 (2024) Cite this article

Abstract

Background

This research aimed to identify evidence-based protocols for the safe management of bladder infections and the prevention of UTIs in athletes who have spinal cord injuries (SCI), as they are constantly at high risk of developing UTIs again.

Study design

Scoping review

Methodology

Four databases were searched (PubMed, Scopus, Web of Science, and Science Direct) for pertinent literature. The non-randomized controlled studies (non-RCT) and randomized controlled trials (RCT) that described the application of any particular measure to properly manage bladder and avoid urinary tract infections (UTIs) in people with spinal cord injuries (SCIs) were chosen.

Results

Forty-nine articles were screened for the effectiveness of weekly oral cyclic antibiotics, bacterial interference, coated catheter types, and patient education in preventing UTIs in SCI were shown in 20 RCT and 29 non-RCT researches. Concerns were raised about cranberry supplements and low-dose antibiotic prophylaxis, which is unreliable and leads to the emergence of germs that are resistant to many drugs.

Conclusion

According to the scoping review, WOCA is the most effective antibiotic regimen. The proven methods for treating UTIs in SCI patients include coated catheters, bacterial interference, bladder irrigation, and patient education. Moreover, there is a great deal of variation in the research about the efficacy of cranberries. The best option for safe bladder management and preventing UTIs in SCIs is to use suprapubic and coated intermittent catheters (ICs). When a urine bag is full, it should be changed out for a fresh one, and patients should be told to employ spontaneous voiding if that's not an option.

Positioning

This research paper presents a comprehensive study on bladder care and UTI prevention in athletes with spinal cord injuries (SCI) [1]. UTIs are a common and long-lasting issue, affecting the quality of life and financial burden. Athletes with SCI are also susceptible to chronic UTIs due to their sports lifestyle, travel, and bladder control practices [2, 3]. The choice of catheters for bladder management depends on the degree of SCI. Some people support using cranberry tablets to reduce UTI symptoms, but there is a lack of evidence [4]. Probiotics and other dietary strategies can also help lower the risk of UTIs. Antibiotic resistance is linked to recurrent UTIs, and the treatment of persistent UTIs is threatened by this resistance [5, 6]. The scoping study aims to find online data to develop evidence-based recommendations for safe bladder management and UTI prevention in SCI athletes [7].

Introduction

The National Spinal Cord Injury Statistical Centre (NSCISC) reports that the USA experiences 17,700 instances of spinal cord injury (SCI) annually [2]. Urinary tract infections (UTIs) are more common in people with SCI, with clinically significant UTIs defined as having 105 bacteria/ml of recently passed urine [8]. Factors such as increased intravesical pressure, using catheters, and inadequate voiding exacerbate symptomatic UTIs. Frequent high-dose antibiotic use also contributes to the spread of infections [1].

UTIs are the primary source of morbidity for many SCI patients throughout their lifetimes [9]. Genitourinary sickness accounted for 7.6% of all illnesses and injuries sustained by athletes competing in the London 2012 Paralympic Games. UTIs are the most prevalent of all genitourinary issues [10, 11].

Safe bladder management is a top priority for those with spinal cord injuries. Disposable catheters, known as clean intermittent catheters (CICs), are the safest way to lower the risk of UTIs [12]. However, they can occasionally cause pain and discomfort and negatively affect patient satisfaction. Recurrent use of the same intermitter catheter (IC) by athletes from poor nations, like Brazil, Columbia, and South Africa, resulted in CA-UTI (Catheter-associated-UTI) [13, 14]. Athletes from wealthy countries, like the USA, Canada, and Sweden, did not reuse their catheters, but those who did experience three to four urinary tract infections annually [3].

Nutritional components to prevent UTIs, such as using cranberry juice or pills, have inconsistent research about their efficacy [15]. Methenamine salts, vitamin C, and D-mannose sugar are suggested as helpful in halting the growth of bacteria in the bladder. Additional evidence-based research is necessary to consider these components as effective dietary interventions [16, 17].

Travel to national and international championships is a common occurrence for professional SCI athletes, who purposefully dehydrate to reduce the need for catheterization while traveling [18]. A team physician's guidance should be followed when administering antibiotic prophylaxis, but the literature does not advise using antibiotic prophylaxis to treat UTIs in patients with SCI [5, 19].

The Australian Paralympic Position provides general guidelines for safe bladder management for athletes with SCI, but they do not address the use of probiotics, bacterial interference, or different types of catheters to reduce the risk of UTIs [20, 21]. This scoping review aims to locate research based on RCT and non-RCT trials to identify safe bladder control strategies for athletes with SCI to avoid UTI.

Methodology

A systematic framework for conducting scoping reviews was established by Arksey and O’Malley [22]. The author of this scoping study carefully examined Arksey and O’Malley’s recommendations, which outline a five-step procedure that begins with (1) identification of the research issue. (2) Locating pertinent research. (3) Study selection. (4) Data visualization; and 5) Outlining the findings. Additionally, Levac and colleagues’ clarification of scoping review criteria [23] was taken into consideration when making comments to improve the quality of this scoping review. To preserve methodological transparency, PRISMA-Scr [24] reporting guidelines—which are the thing that systematic reviews prefer to report and the extension of meta-analysis for scoping reviews—were also adhered to.

Identification of research questions

Bladder control involves athletes using external devices like CIC and indwelling catheters to assist urination. Prevention involves medical and dietary interventions for UTI treatment and prevention. The research question aims to identify bladder management and UTI prevention strategies based on evidence to reduce UTI episodes in athletes with spinal cord injuries.

Locating pertinent research

Using the following set of keywords, four databases (PubMed, Scopus, Web of Science, and Science Direct) were searched for relevant literature on bladder, management/synonyms, prevention/synonyms, UTI, and spinal cord injuries.

Study selection

Following a search using the terms listed above. The completed search results were downloaded and then subjected to additional screening using the inclusion/exclusion criteria listed below.

Criteria for inclusion

  • Studies, both controlled and uncontrolled, unequivocally state that individuals with neurogenic bladder syndrome (SCI) should utilize specific types of catheters, food supplements, or medications to regulate their bladders and avoid urinary tract infections.

Criteria for exclusion

  • Research on animals

  • Research that fails to provide a clear explanation of how a particular type of catheter, nutritional supplement, or medication is used to prevent or treat urinary tract infections in individuals with spinal cord injuries.

  • Research articles written in languages other than English.

  • Research that was done prior to 2000.

  • Protocols for studies and research on children.

  • Research on hospitalized patients’ bladder care and UTI prevention.

  • Research on UTI prevention in the fields of multiple sclerosis, stroke, geriatrics, and spina bifida.

After conducting the aforementioned keyword search and taking into account the basic search parameters, 535 research publications from all websites (PubMed, Scopus, Web of Science, and Science Direct) were found.

Data charting

Levac and colleagues recommend data charting for obtaining information from research. They suggest grouping retrieved studies into RCT and non-CT groups for precise answers [23]. Each group details specific dietary guidelines, catheter designs, or antibiotic regimens to control bladder and prevent UTI bouts, as outlined in the final investigations.

Below is a flowchart that details the amount of articles and the literature choices.

Results collection and summarizing findings

Levac and associates proposed dividing the fifth stage into three sections: data analysis, results reporting, and result interpretation. They highlighted the importance of summary tables for research and careful examination of data [23]. The descriptive summary tables were divided into cohorts to address specific topics. This method helps develop recommendations for safe bladder management and UTI prevention for people with spinal cord injury. It also informs athletes with SCI and their carers about these guidelines to manage their bladder and prevent recurrent UTI bouts.

Data analysis

Identification and selection of study

(1) Medication measurements; (2) nutritional guidelines; (3) safe catheter type; (4) bacterial interference; and (5) the education of patients are the criteria used to group the studies. The research findings from RCT-based and non-RCT-based studies were to be compared. We have split them into two distinct groups in order to better analyze and comprehend them. It would provide us with a clear understanding of evidence-based practice and help future researchers choose between an RCT and a non-RCT methodological approach when they conduct further research on evidence-based bladder management and UTI prevention techniques in individuals with spinal cord injury (Fig. 1).

Fig. 1
figure 1

Flow chart for selecting data

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Four hundred fifty-one studies did not meet the requirements for inclusion. The application of certain precautions to avoid UTIs or properly manage the bladder was not mentioned. Certain non-randomized controlled trials were eliminated due to their broad focus on UTIs and lack of participant recruitment or intervention implementation. Additional information regarding the excluded research is available in Table 1.

Table 1 The numbers and reasons for the exclusion of 451 studies
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The following summary tables provide further details about the listed studies. There are distinct summary tables for RCT and non-RCT research.

Results

Medicinal measures to manage UTI in SCI

Eleven non-RCT studies and five RCTs looked into the usage of various antibiotic kinds and regimens to treat UTI in people with SCI. Below is a more detailed explanation of those measures (Tables 2, 3, 4, 5, 6, 7, 8, 9, 10 and 11).

Table 2 Features of RCT research based on medical measures
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Table 3 Features of RCT research based on bacterial interference
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Table 4 Features of RCT research based on an educational program for people with SCI
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Table 5 Features of RCT research based on catheter type or bladder management technique
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Table 6 Features of RCT research based on nutritional guidelines
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Table 7 Features of non-RCT research based on medical guidelines
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Table 8 Features of non-RCT qualitative research based on educational programs for persons with SCI
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Table 9 Features of non-RCT research based on bacterial interference
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Table 10 Features of non-RCT research based on nutritional guidelines
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Table 11 Features of non-RCT research based on catheter type or bladder control technique
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Weekly oral cyclic antibiotics: (WOCA)

Two antibiotics are alternately administered once a week as part of WOCA [10]. Four WOCA studies—3 non-randomized and 1 randomized—out of a total of 16 investigations demonstrated extremely encouraging outcomes of the WOCA regimen in the treatment of UTI in SCI without a discernible increase in the growth of multidrug-resistant bacteria. According to a 6-month RCT trial [10], WOCA was successful in treating UTI in patients with SCI Three other non-RCT investigations, two of which were cross-sectional studies [45] and the other one was a prospective observational research [46, 47], yielded comparable results.

Bladder irrigation

To prevent the growth of bacterial colonies, bladder irrigation entails putting an antibiotic solution inside the bladder [44]. Three non-RCT studies were conducted, and the results of all three indicated that bladder irrigation is a safe and efficient way to reduce symptomatic UTI episodes in patients with SCI and that it effectively stopped the growth of bacterial colonies. Of these three investigations, one was a systematic review [41] and the other two were prospective clinical trials [44, 50]. These trials supported bladder irrigation with gentamicin [41], povidone-iodine [44], and chlorhexidine [50].

Antibiotics prophylaxis (ABP)

Continuous low-dose ABP was the basis of five studies to prevent UTI in people with SCI. Out of five studies, three recommended using trimethoprim, cephalexin, and nitrofurantoin as an ABP against UTIs in SCI [27, 42, 48]. However, these three investigations similarly came to the conclusion that multi-drug resistance bacteria were developed as a result of the prolonged ABP [27, 42, 48]. A non-RCT prospective observational investigation [40], the fourth trial in this group, found that ongoing low-dose ABP did not aid in the treatment of UTIs in SCI patients, but rather contributed to the development of antibiotic resistance. The systematic review [49] based on ABP was the fifth study. Additionally, this study came to the conclusion that the data do not support treating UTI in SCI with ABP. Another RCT [28] came to the conclusion that SCI patients’ UTI symptoms might be effectively alleviated by using methenamine and methylene blue.

Long vs short course of antibiotic regimen

Three trials [25, 26, 43] looked at the effectiveness of a long course of antibiotics versus a short course of antibiotics in treating UTI symptoms in people with spinal cord injuries. Regarding regimen selection, the results of these investigations were not entirely uniform. For the treatment of UTIs, one RCT research [26] found that a 14-day regimen including 250 mg of ciprofloxacin was more successful than a 3-day regimen, while another RCT research [25] found that both short course and long courses were equally beneficial. According to the results of a third non-RCT trial [43], treating a UTI with a brief course of antibiotics was successful. It is hard to draw firm conclusions regarding the effectiveness of a long-course versus short-course antibiotic regimen to prevent UTI in SCI due to the heterogeneity of the outcomes.

Bacterial interference

In order to accomplish colonization, avirulent strains of bacteria are introduced into the bladder through bacterial interference, which is safe for human health [29]. Six investigations in all, including one RCT [29], four non-RCT clinical researches [52, 53, 55, 56], and one retrospective cohort research [54], were based on bacterial interference. Every study that used bacterial interference to treat UTIs in SCI patients had excellent outcomes. Five trials out of six found that E. coli strains (HU2117 and 83972) were very effective at colonizing the bladder and preventing UTIs from coming back [29, 52, 54,55,56]. Based on the application of Lactobacillus rhamnosus GG (LGG), the sixth trial [53] found that introducing LGG was both safe and effective in avoiding symptomatologic UTIs in people with SCI.

Program of education for people with SCI

One unique RCT investigation focused on the education of patients and SCI patients’ knowledge of UTIs [30]. This unique study found that following the instructional program, the experimental group had a significant decrease in UTI episodes. Written information regarding self-hygiene, general UTI introduction, and other crucial guidelines to prevent bacterial introduction in perineal areas were distributed to the experimental group. For half a year, this group was also contacted via phone. This study found that educational initiatives contributed to a decrease in UTI episodes. According to the findings of another non-RCT qualitative study [51], most catheter users were unsure of the symptoms and indicators of UTIs and were unsure of when to get medical attention. They also suggested creating a self-help book or booklet with basic UTI prevention advice for individuals with SCIs that is simple to read and comprehend [51].

Nutritional measures

There is a lack of consensus among dietary interventions to treat UTIs in spinal cord injury (SCI) patients. Two non-RCT studies and six RCTs have found inconsistent results [37]. One review disapproved of cranberry supplements, while another found them helpful [38]. There is also disagreement among RCT studies about the efficacy of cranberry therapy. One 6-month RCT found 400 mg of cranberry pills taken twice daily for six months to be highly effective in reducing UTI incidence in SCI patients [39]. Another 2-year RCT found that neither cranberry nor methenamine hippurate helped SCI patients’ UTI symptoms [36]. A 4-week RCT refuted the efficacy of cranberry supplementation. Probiotics were also found to be incongruous in two RCTs [8]. One study found probiotics useful in treating UTIs in two SCI patients, while another found no benefit in 207 participants [9].

Catheter type/bladder management technique

Based on the kind of catheter and the method used to manage the bladder, there were seven RCTs and ten non-RCT studies. More information is provided below.

Coated vs non-coated intermittent catheters

Seventeen studies have examined bladder management in patients with spinal cord injuries using coated and non-coated catheters [31]. Results show that hydrophilic-coated intermittent catheters are more effective in preventing urinary tract infections (UTIs) and reducing UTI bouts [32]. However, hydrophilic-coated and non-coated PVC catheters are significantly inferior to gel-lubricated, non-hydrophilic catheters [33]. Silver hydrogel- and silver alloy-coated catheters are more effective than ordinary non-coated PVC catheters. Noble metal alloy-coated foley catheters are more successful than standard foley catheters without coating [35].

New vs old urine bag

It was shown in a quasi-experimental study that it is crucial to replace the pee bag whenever it becomes full [64]. Because used pee bags encourage the growth of bacterial colonies, which in turn lead to UTI symptoms [64]. Their investigation also found that in comparison to the conventional practice of emptying the urine bag, replacing the bags considerably decreased the prevalence of UTIs and bacteriuria [64].

Different types of catheters and UTI incidence

The type of catheter used significantly impacts the frequency of urinary tract infections (UTIs) [48]. Those with SCI who practice spontaneous voiding are less likely to have UTIs compared to indwelling catheter users [50]. Intermittent catheterization (IC) users have a lower incidence of UTIs compared to indwelling catheter users. Supra-pubic catheters are linked to a reduced incidence of UTIs. Intermittent catheterization also reduces bladder emptying, as leftover pee encourages bacterial colon growth, worsening UTIs [27].

Discussion

The scoping review on bladder control and UTI prevention in spinal cord injury patients found agreement on prescription medication and antibiotic regimens. The WOCA regimen and bladder irrigation showed promise, supported by RCT and non-RCT trials. [10]. It is not advised to administer the same antibiotic to these populations for an extended period of time due to the risk of multidrug-resistant bacteria [49, 69]. Antibiotic resistance is a major global issue that threatens the prevention of highly contagious diseases [11, 70]. Our scoping analysis revealed a similar pattern, with multiple studies concluding that low-dose antibiotic prophylaxis contributed to the development of significant antibiotic resistance while not helping to control UTIs in SCI [27, 40, 42, 48].

Recurrent UTIs in SCI are caused by bacterial colonies adhering to the bladder wall as a result of UTIs [71, 72]. These bacterial colonies develop resistance to a variety of available antibiotics as a result of sustained antibiotic administration [34]. Bladder irrigation has been a popular method to lower bacteriuria in patients with SCI since the 1960s, and it is a safe substitute for conventional antibiotics for this reason [73, 74]. Using antiseptics such as povidone-iodine, chlorhexidine, and neomycin to wash the bladder is known as bladder irrigation [75]. Research indicates that when it comes to managing UTIs in SCI patients, bladder irrigation is more effective than conventional antibiotic prophylaxis (ABP) [74, 76]. This scoping review on bladder irrigation came to similar conclusions [41, 44, 50]. A systematic review [41], two prospective clinical trials [44, 50], and other researches supported the effectiveness of gentamicin [41], povidone-iodine [44], and chlorhexidine [50] in irrigation of bladder for the treatment of UTIs in the SCI patients.

The current body of research indicates that there is disagreement on whether short-term (< 10 days) or long-term (> 10 days) antibiotic regimens are more effective in treating symptomatic UTIs in people with spinal cord injuries [26, 77,78,79]. Our scoping assessment yielded comparable results for the length of vs. short course of several antibiotic kinds [25, 26, 43]. We are unable to identify the major antibiotic regimen for treating symptomatic UTIs in individuals with SCI due to uncertainties over the effectiveness of a particular regimen. E. Coli HU2117 and 83972 are bacterial strains that are commonly used for this purpose, particularly to treat symptomatic UTIs in SCI [52]. The effectiveness of bacterial interference in treating symptomatic UTIs in SCI has been well-proven in earlier research [80,81,82]. In patients with SCI, the avirulent strain of E. coli 83,972 has proven to be highly successful in colonizing the bladder and preventing UTIs [83]. Promising outcomes for bacterial interference without major negative effects were also observed in our scoping assessment.

A crucial component of any healthcare rehabilitation program is patient education. Simple-to-understand instructions on how to prevent different chronic diseases are the main focus of patient education [84]. Additionally, the significance of this strategy lies in its ability to enhance patients’ quality of life in addition to managing the disease [85]. Numerous studies in the literature have come to the conclusion that patient education can enhance patients’ quality of life and aid in the prevention of numerous chronic conditions, including arthritis, fibromyalgia, and high blood pressure [86,87,88,89]. Similar results were observed in our review, wherein 1 RCT-based trial [30] found that following a 6-month educational program, patients in the experimental group demonstrated symptoms of reduced UTI. The foundation of this training program was a broad introduction to UTIs, self-hygiene standards, and optimal management of perineal areas in terms of hygiene [30]. A non-RCT qualitative study [51] that examined IC users’ awareness of UTI signs and symptoms came to the conclusion that IC users were unclear about these symptoms and indications and were unsure of when to seek medical attention. This study also proposed the creation of a self-help book with simple instructions for maintaining personal hygiene and a broad understanding of urinary tract infections for people with spinal cord injuries [51].

There has been discussion in the literature regarding the role that cranberries play in preventing UTIs in patients with SCI [20]. A similar discrepancy was discovered in our scoping review, wherein data on the usage of cranberry and other food supplements for the treatment of UTIs were reported by 6-RCTs and 2-non-RCTs in very diverse and inconsistent ways. Cranberry was reported to be beneficial for preventing UTIs in patients with spinal cord injury (SCI) in one comprehensive study [57], but it was found to be useless in another [58]. Probiotic use was the subject of similar inconsistent results in 2-RCTs; one study [9] showed that probiotics are useful in preventing UTIs in SCI patients, whereas another study [8] came to the opposite conclusion. Regarding the utilization of cranberry supplementation, other non-RCT studies are likewise inconclusive; one research [38] found it beneficial, while another [36] found it useless. According to one study [39], co-supplementing proanthocyanidins and cranberries can improve the management of UTIs in patients with SCI. Nutritional research faces a significant deal of challenge when multiple authors provide contradicting and inconsistent conclusions on the same subject. This is mostly because of many uncontrollable confounding factors [90].

With over 150 million cases annually, catheter-associated UTIs (CA-UTIs) are the most prevalent healthcare-associated illness. Urinary catheters are thought to be the most extensively used medical equipment worldwide [91]. However, the quality of life for SCI patients has been significantly impacted by recent advancements in catheter quality and material [92]. According to our scoping assessment, there is encouraging evidence that, in comparison to conventional non-coated PVC catheters, hydrophilic coated [4, 32, 33] and gel-lubricated non-hydrophilic coated catheters [5] offer superior protection against the occurrence of UTIs in SCI. Catheters that are hydrophilic-coated are coated with a particular hydrophilic material that, when combined with water, creates a slick surface that allows the catheter to slide into the urethral canal without creating any damage [93].

Hydrophilic-coated catheters were also linked to less urethral damage and fewer UTI bouts in SCI, according to three systematic reviews [61,62,63]. In addition to the advantages of hydrophilic coatings, research also shows that silver hydrogel and alloy coatings are more effective than conventional PVC catheters without coatings [35, 60]. Compared to an indwelling catheter (IC) or suprapubic catheter users, the incidence of urinary tract infections (UTIs) is much greater in suprapublican IDC users [31]. However, compared to conventional non-coated foley catheters, foley catheters that are coated with noble metal alloys are significantly more effective in preventing UTIs, according to an RCT trial involving 1000 patients [34]. Urine bags that are used for longer periods of time when an indwelling catheter is in place create bacterial colonies, which then multiply and cause recurrent urinary tract infections [94]. Most of the time, regular antibiotic treatment does not work against these bacterial colonies [10]. According to the results of a quasi-experimental investigation, replacing a full urine bag with an empty one drastically decreased the prevalence of symptomatic UTIs and bacteriuria [64]. Due to the development of bacterial colonies, a lot of people simply empty the pee bag and continue using it, which this study considered malpractice [64].

The literature indicates that the type of catheter used and the frequency of UTIs are strongly correlated [16]. Due to the fact that compared to suprapubic and IC users, indwelling urinary catheter users had the highest risks of urinary tract infections [65, 68]. Additionally, there was little to no remaining pee in the bladder after using IC [66]. Urinary stasis in the bladder causes bacterial colonies to grow, which exacerbates UTIs in SCI. For this reason, it is crucial that the bladder be completely emptied.

Limitations

The development of UTI prevention measures for athletes with SCI is the goal of this review. The author concurs that the public with UTIs is the main target of this study rather than athletes. The author was unable to locate any publication that was exclusively based on evidence-based recommendations for SCI athletes. In order to determine whether athletes with SCI could benefit from these recommendations, the author had to locate evidence-based guidelines for the general public’s prevention of UTIs.

Conclusion

According to the scoping review, WOCA is the most effective antibiotic regimen. The proven methods for treating UTIs in SCI patients include coated catheters, bacterial interference, bladder irrigation, and patient education. Moreover, there is a great deal of variation in the research about the efficacy of cranberries. The best option for safe bladder management and preventing UTIs in SCI patients is to use a suprapubic catheter and coated IC. If spontaneous voiding is not possible, a new full urine bag should be provided, and patients should be urged to utilize it.

Availability of data and materials

By using the reference listed at the conclusion of this review, you can access information online.

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Acknowledgements

Author would like to extend his gratitude to his promoter Mr. Yang Long for their great help and huge support throughout this review.

Funding

The authors did not receive any kind of financial help from anyone at any stage of this project.

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Authors and Affiliations

  1. Taiyuan University of Technology, Taiyuan, China

    Qasim Ali & Yang Long

  2. University of Rome ‘Tor Vergata’, Rome, Italy

    Muhammad Ali

  3. Riphah International University, Islamabad, Pakistan

    Hamna

  4. Master of Science in Physical Therapy, The University of Lahore, Lahore, Pakistan

    Maria Naeemi Malhi

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  1. Qasim Ali
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  3. Muhammad Ali
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  4. Hamna
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Contributions

Qasim Ali, Yang Long, and Maria Naeemi Malhi wrote the introduction and methodology. Qasim Ali, Hamna, and Maria Naeemi Malhi wrote the manuscript with support from Yang Long. Qasim Ali and Muhammad Ali carried out the data collection and analysis. Yang Long helped supervise the project. Qasim Ali, Yang Long, and Muhammad Ali conceived the original idea. Yang Long supervised the project. All authors read and approved the final manuscript.

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Correspondence to Qasim Ali.

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I, Qasim Ali, hereby state that my research paper titled, “Scoping review on managing the bladder and preventing urinary tract infections (UTIs) in athletes with spinal cord injuries “is my own work and has not been submitted previously in any journal by me or anywhere else in the country/world. I worked with my Associate professor Mr. Yang Long (Taiyuan University of Technology, CHINA). At any time, if my statement is found to be incorrect, even after my paper publication, you have the right to withdraw and reject my paper.

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Ali, Q., Long, Y., Ali, M. et al. Scoping review on managing the bladder and preventing urinary tract infections (UTIs) in athletes with spinal cord injuries. Bull Fac Phys Ther 29, 71 (2024). https://doi.org/10.1186/s43161-024-00231-5

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