Prevalence of testosterone deficiency after spinal cord injury.

OBJECTIVE: To define the prevalence of testosterone deficiency in persons with chronic spinal cord injury (SCI) and to identify factors associated with this deficiency. DESIGN: Cross-sectional study. SETTING: A U.S. Department of Veterans Affairs SCI unit. PARTICIPANTS: Participants (n = 60) included male veterans completing annual evaluations from July 2006 to April 2007. METHODS: In addition to routine annual evaluation laboratory examination, which included measurements of serum albumin levels, participants underwent measurements of serum total testosterone, luteinizing hormone, follicle stimulating hormone, and prolactin levels. Outcome measures included the prevalence of testosterone deficiency (defined as total serum testosterone <325 ng/dL) and the relationship of testosterone level with participant's age, serum albumin level, narcotic medication use, time since injury, American Spinal Injury Association Impairment Scale (AIS) grade, and neurologic level of injury. RESULTS: A low serum testosterone level (<325 ng/dL) was detected in 43.3% of participants. The testosterone level was significantly associated with severity of injury as defined by AIS grade (t = -2.59, P = .012). The prevalence of testosterone deficiency was significantly greater in participants with motor complete (AIS A and B) injuries compared with those with motor incomplete (AIS C, D, and E) injuries. Testosterone levels were significantly lower in participants who were taking narcotic medications for pain management (t = -0.25, P < .05). There was no relationship between the use of narcotic medications and severity of injury. Given the small number of participants, the SCI levels, age, duration of injuries, serum albumin levels, and serum levels of luteinizing hormone, follicle stimulating hormone, and prolactin did not reach statistical significance in predicting testosterone level. CONCLUSIONS: These findings confirm both a substantial population of men with SCI and with testosterone deficiency, and a significant association between testosterone level and severity of SCI. Measuring serum total testosterone levels should be included in standard screenings for patients with SCI, particularly those with motor complete injuries.

Prevalence of prostate cancer in patients with chronic spinal cord injury.

OBJECTIVE: To determine the prevalence of prostate cancer in patients with chronic spinal cord injury (SCI), with regard to the duration, level, and severity of injury. DESIGN: Retrospective chart review study. SETTING: Inpatient and outpatient Veterans Affairs spinal cord unit. PARTICIPANTS: The electronic medical records of 350 veterans with chronic SCI and 344 veterans without SCI as a control group were reviewed. MAIN OUTCOME MEASURE: Prevalence of prostate cancer in patients with chronic SCI with regard to the duration, level, and severity of injury. RESULTS: Of 350 veterans with chronic SCI, 7 individuals (2%) had prostate cancer. In comparison, of 344 age-matched veterans without SCI, 18 (5.2%) had prostate cancer. In SCI group with prostate cancer, 2 patients had motor complete injury (American Spinal Cord Injury Association Impairment Scale [AIS] A and B), and 5 patients had motor incomplete injury (AIS C, D, and E). Patients with SCI and with prostate cancer were slightly older (mean [SD] age, 72.14 ± 8.25 years) than the control group (mean [SD] age, 69.83 ± 8.79 years) with cancer. CONCLUSION: Findings from this study indicate a lower prevalence of prostate cancer among veterans with chronic SCI in comparison with age-matched veterans without SCI. Given the small number of patients with SCI and with prostate cancer in this study, we did not find any statistically significant correlation between the prevalence of prostate cancer and the level, duration, and severity of injury.

Role of creatinine clearance as a screening test in persons with spinal cord injury.

OBJECTIVES: To determine (1) the variability of annual creatinine clearance (C(Cr)) testing for subjects with chronic spinal cord injury (SCI) and (2) whether decisions to change neurogenic bladder management are made based on C(Cr) measurements. DESIGN: Retrospective chart review. SETTING: Inpatient Veterans Affairs SCI unit. PARTICIPANTS: The medical records of 70 men were consecutively selected for review from among 664 veterans enrolled in the SCI clinic. All patient charts had to have at least 5 C(Cr) tests performed within 10 years preceding the review. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Development of renal insufficiency and change in medical or bladder management of the patient, based on the results of the C(Cr) test. RESULTS: For individual patients, the results of 24-hour C(Cr) were highly variable from 1 evaluation to the next; the within-subject standard deviation (SD) for C(Cr) was 25.9mL/min. The within-subject SD for serum creatinine was 0.12mg/dL. For all comparisons of repeatability, variability, and reliability, serum creatinine was superior to C(Cr). No medical management decisions were made based on the result of the 24-hour creatinine clearance. Renal ultrasound results and postvoid bladder residuals were the major factors in changing medical management with regard to renal function preservation. CONCLUSIONS: The C(Cr) test has little value as a screening measure for renal disease in SCI patients because of its variability in serial testing.