DIAGNOSIS AND LOCALIZATION OF A COMPLICATED URINARY-TRACT INFECTION IN NEUROGENIC BLADDER DISEASE BY TUBULAR PROTEINURIA AND SERUM PROSTATE-SPECIFIC ANTIGEN

Introduction: Urinary tract infection is the most frequent complicatio n occurring in patients with spinal cord injuries and can cause renal failure and male infertility. We used the urinary alpha-1-microglobuli n (alpha 1Mg) as a marker for pyelonephritis and the serum prostate sp ecific antigen (PSA) as a marker for prostatitis with reference to the currently available methods. The aim of our study is (1) to different iate between upper (pyelonephritis) and lower urinary tract infection (cystitis, prostatitis) in neurogenic bladder disease, (2) to determin e if high (less than or equal to 38.5 degrees C) fever in a neurogenic bladder disease patient was due to urological (prostatitis, pyeloneph ritis) causes or not. Patients and methods: We evaluated 147 patients of whom 27 had acute pyelonephritis, 16 had prostatitis with fever, 13 had chronic pyelonephritis, 68 had cystitis; 23 were control patients of whom nine had fever (less than or equal to 38.5 degrees C) and 14 did not. The diagnoses and localizations were made on the basis of cli nical evidence, with a CT scan, urography, bladder wash-out tests, and five glass-specimen tests. The urinary alpha 1Mg was determined using latex enhanced immunonephelometry and the serum PSA was measured usin g RIA. Results: For the urinary alpha 1Mg, the sensitivity is 96% and the specificity 93% for the diagnosis of acute pyelonephritis. The ser um PSA has a sensitivity of 69% and specificity of 96% in the diagnosi s of prostatitis. The urinary alpha 1Mg has a sensitivity of 96% and a specificity of 56% and the serum PSA has a sensitivity of 68% and a s pecificity of 100% in the differential diagnosis of prostatitis and py elonephritis. The best discriminative parameter between pyelonephritis and prostatitis was the urinary alpha 1Mg/serum PSA ratio with a sens itivity of 92% and specificity of 88%. Conclusion: Upper-tract infecti on with fever can be diagnosed in neurogenic bladder disease by determ ining the urinary alpha 1Mg. In male patients, the serum PSA should be determined to distinguish upper-tract infection from prostatitis. Hig h fever does not significantly influence our parameters so that we can differentiate whether or not high fever is due to urological causes.