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Reply to Letter re: “Optimal Bladder Management Following Spinal Cord Injury: Evidence, Practice and a Cooperative Approach Driving Future Directions in Australia”

      We thank the author for raising the important issue of spinal cord injury (SCI) immune deficiency syndrome. Although outside the scope of our study, we agree that SCI immune deficiency syndrome is increasingly being recognized as a risk factor for urinary tract infection (UTI) and is critical for developing effective therapies for SCI.
      • Sun X.
      • Jones Z.B.
      • Chen X.M.
      • Zhou L.
      • So K.F.
      • Ren Y.
      Multiple organ dysfunction and systemic inflammation after spinal cord injury: a complex relationship.
      We are also cognizant of the paradox that the immune response after SCI, and in neurologic disease, has long been recognized as both detrimental and beneficial
      • Yong H.Y.
      • Rawji K.S.
      • Ghorbani S.
      • Xue M.
      • Yong V.W.
      The benefits of neuroinflammation for the repair of the injured central nervous system.
      with identification of mechanisms, and therefore, development of treatments, requiring inclusion of both aspects. Indeed, immunotherapy is emerging as a promising approach with, for example, current clinical trials using intravenous immunoglobulin for transverse myelitis
      • Absoud M.
      • Brex P.
      • Ciccarelli O.
      • et al.
      A multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin compared with standard therapy for the treatment of transverse myelitis in adults and children (STRIVE).
      and acute traumatic cervical or thoracic SCI with infusion ≤12 hours of injury.
      • Ruitenberg M.
      Assessing feasibility, safety and efficacy of IVIg therapy in patients with acute traumatic spinal cord injury.
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      References

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        • Jones Z.B.
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        • So K.F.
        • Ren Y.
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        Cell Mol Immunol. 2019; 16: 540-546
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        Health Technol Assess. 2017; 21: 1-50
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        Assessing feasibility, safety and efficacy of IVIg therapy in patients with acute traumatic spinal cord injury.
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      Linked Article

      • Does Intermittent Catheterization Result in Fewer Infections Than Indwelling?
        Archives of Physical Medicine and RehabilitationVol. 100Issue 9
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          I admire the commitment of researchers and clinicians at the Victorian Spinal Cord Service in their strong effort to improve bladder health among patients with spinal cord injuries (SCI).1 During training, most of us learned that SCI patients suffer more urinary tract infections (UTIs) with indwelling urethral catheters (IUCs) than with intermittent catheterization (IC). Nonetheless, a review of the literature will show many studies that fail to demonstrate a difference in UTI risk between the 2 methods.
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