[How does the new spinal-cord-injured patient profile influence bladder management?] / ¿Cómo afecta el nuevo perfil del lesionado medular al manejo vesical?

OBJECTIVES: To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment. METHODS: We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit. RESULTS: The sample included 250 patients. Patients' mean age was observed to increase from 38 to 47 years during the study (p<0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) ( p<0.05 ). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p<0.05). CONCLUSIONS: CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications.

OBJETIVOS: Describir el manejo vesical en pacientes con una lesión medular y comprobar si el aumento de la edad media del paciente que está sufriendo una lesión medular en los últimos años está condicionando un cambio en su tratamiento.MATERIALES Y MÉTODOS: Hemos realizado un estudio retrospectivo de todos los pacientes que han sufrido una lesión medular traumática aguda en Canarias entre el 2001-2015. Los datos se han recogido del registro hospitalario de una unidad de referencia regional para la lesión medular. RESULTADOS: La muestra ha sido de 250 pacientes. La media de edad del paciente aumentó de 38 a 47 años a lo largo del estudio (p< 0,05). El cateterismo intermitente (CI) fue el método de vaciado vesical más usado (42,4%) seguido de la micción voluntaria (MV) (26,4%) y la derivación permanente (DP) (23,6%). Durante este tiempo hubo un descenso en el uso del CI (48,1% a 35,4%) y un aumento de la DP (13,5% a 32,5%) (p< 0,05). Las lesiones cervicales se relacionaron con la MV (35,8%) mientras que las lesiones dorsales y lumbares lo hicieron con el CI (67% y 41,7% respectivamente). El destino al alta a una residencia se asoció con la DP (81,8%) (p<0,05). CONCLUSIONES: El CI es actualmente el método de vaciado vesical más usado en el lesionado medular en nuestro medio. El aumento de la edad media del paciente que sufre una lesión medular está favoreciendo un progresivo incremento de la derivación permanente con el riesgo de complicaciones urológicas que puede ocasionar.

¿Cómo afecta el nuevo perfil del lesionado medular al manejo vesical? / How does the new spinal-cord-injured patient profile influence bladder management?

Objetivos: Describir el manejo vesical en pacientes con una lesión medular y comprobar si el aumento de la edad media del paciente que está sufriendo una lesión medular en los últimos años está condicionando un cambio en su tratamiento. Materiales y métodos: Hemos realizado un estudio retrospectivo de todos los pacientes que han sufrido una lesión medular traumática aguda en Canarias entre el 2001-2015. Los datos se han recogido del registro hospitalario de una unidad de referencia regional para la lesión medular. Resultados: La muestra ha sido de 250 pacientes. La media de edad del paciente aumentó de 38 a 47 años a lo largo del estudio (p< 0,05). El cateterismo intermitente (CI) fue el método de vaciado vesical más usado (42,4%) seguido de la micción voluntaria (MV) (26,4%) y la derivación permanente (DP) (23,6%). Durante este tiempo hubo un descenso en el uso del CI (48,1% a 35,4%) y un aumento de la DP (13,5% a 32,5%) (p< 0,05). Las lesiones cervicales se relacionaron con la MV (35,8%) mientras que las lesiones dorsales y lumbares lo hicieron con el CI (67% y 41,7% respectivamente). El destino al alta a una residencia se asoció con la DP (81,8%) (p<0,05). Conclusiones: El CI es actualmente el método de vaciado vesical más usado en el lesionado medular en nuestro medio. El aumento de la edad media del paciente que sufre una lesión medular está favoreciendo un progresivo incremento de la derivación permanente con el riesgo de complicaciones urológicas que puede ocasionar

Objectives: To describe the bladder management in spinal cord injury and to verify if the increase in the age of the patient who is suffering a spinal cord injury in recent years is conditioning a change in its treatment. Methods: We performed a retrospective review of all acute traumatic spinal cord injured patients in Canary Islands between 2001-2015. Data were collected from the hospital records of a regional referral Spinal Cord Unit. Results: The sample included 250 patients. Patients' mean age was observed to increase from 38 to 47 years during the study (p < 0.05). Clean Intermittent Catheterization (CIC) was the most used bladder emptying method (42.4%), followed by normal voiding (NV) (26.4%) and permanent derivation (PD) (23.6%). There was a decrease in CIC use (48.1% to 40.3%) and an increase in PD use (13.5% to 32.5%) (p < 0.05). Cervical injuries were associated with NV (35.8%), while thoracic and lumbar injuries were associated with IC (67% and 41.7% respectively). Patients discharged to a health care residence were associated with IC (81.8%) (p < 0.05). Conclusions: CIC is currently the most frequently used bladder emptying method in spinal cord injured patients in our population. The mean age of new spinal cord injury patients is progressively increasing and it promotes the use of indwelling catheter with an increased risk of urologic complications

[Spanish consensus document for the diagnosis, treatment and management of neurogenic bladder.] / Documento de consenso español para el diagnóstico, el tratamiento y el manejo de la vejiga neurógena.

OBJECTIVES: The purpose of this document is to establish practical recommendations on neurogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consensual approach in Spain. METHODS: This paper reports results from the first modified Delphi consensus building exercise on this procedure. A committee of recognised opinion-leaders in rehabilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neurorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document. RESULTS: This review provided an overview of the main aspects described by the different clinical guidelines already available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable impact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment techniques to obtain satisfactory results and promote their autonomy. CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evidence- based care and also an overview of the current drug and surgical treatments of NB.

OBJETIVO: El objetivo de este documento es establecer recomendaciones prácticas sobre el manejo de la vejiga neurógena (VN) en función de la evidencia científica y las perspectivas médicas y de enfermería en Unidades de Lesionados Medulares (ULM) como un primer enfoque de consenso multidisciplinar en España.MÉTODOS: En este artículo se presentan los resultados del primer ejercicio de consenso basado en metodología Delphi modificada sobre este procedimiento. Se constituyó un comité del que formaron parte reconocidos expertos en rehabilitación y urología, especializados en el manejo de VN. Este documento ha sido elaborado por un grupo de trabajo formado por médicos especialistas en rehabilitación, urólogos y personal de enfermería de ULM y unidades de Neurorrehabilitación de varios hospitales y centros especializados españoles asociados con el panel de expertos sobre VN. RESULTADOS: Esta revisión ofrece un resumen de los principales aspectos descritos en diversas guías clínicas ya disponibles y destaca la necesidad de centrarse en recomendaciones sobre situaciones especialmente prioritarias sobre las que actualmente no existe consenso. En vista del considerable impacto de esta enfermedad sobre la calidad de vida, los pacientes deben recibir ayuda para que comprendan mejor su enfermedad y también deben recibir formación sobre el uso de técnicas de tratamiento para conseguir resultados satisfactorios y fomentar su autonomía. CONCLUSIONES: En este artículo se presenta una versión de la guía para el manejo de pacientes con VN. Las guías definen el perfil clínico de los pacientes para ofrecer la mejor asistencia basada en la evidencia y también un resumen de los tratamientos farmacológicos y quirúrgicos actuales para la VN.

Documento de consenso español para el diagnóstico, el tratamiento y el manejo de la vejiga neurógena / Spanish consensus document for the diagnosis, treatment and management of neurogenic bladder

Objetivo: El objetivo de este documento es establecer recomendaciones prácticas sobre el manejo de la vejiga neurógena (VN) en función de la evidencia científica y las perspectivas médicas y de enfermería en Unidades de Lesionados Medulares (ULM) como un primer enfoque de consenso multidisciplinar en España. Métodos: En este artículo se presentan los resultados del primer ejercicio de consenso basado en metodología Delphi modificada sobre este procedimiento. Se constituyó un comité del que formaron parte reconocidos expertos en rehabilitación y urología, especializados en el manejo de VN. Este documento ha sido elaborado por un grupo de trabajo formado por médicos especialistas en rehabilitación, urólogos y personal de enfermería de ULM y unidades de Neurorrehabilitación de varios hospitales y centros especializados españoles asociados con el panel de expertos sobre VN Resultados: Esta revisión ofrece un resumen de los principales aspectos descritos en diversas guías clínicas ya disponibles y destaca la necesidad de centrarse en recomendaciones sobre situaciones especialmente prioritarias sobre las que actualmente no existe consenso. En vista del considerable impacto de esta enfermedad sobre la calidad de vida, los pacientes deben recibir ayuda para que comprendan mejor su enfermedad y también deben recibir formación sobre el uso de técnicas de tratamiento para conseguir resultados satisfactorios y fomentar su autonomía. Conclusiones: En este artículo se presenta una versión de la guía para el manejo de pacientes con VN. Las guías definen el perfil clínico de los pacientes para ofrecer la mejor asistencia basada en la evidencia y también un resumen de los tratamientos farmacológicos y quirúrgicos actuales para la VN

Objectives: The purpose of this document is to establish practical recommendations on neurogenic bladder (NB) management based on scientific evidence and medical and nursing perspective in Spinal Cord Injury (SCI) Units as a first multidisciplinary consensual approach in Spain. METHODS: This paper reports results from the first modified Delphi consensus building exercise on this procedure. A committee of recognised opinion-leaders in rehabilitation and urology with special interest in NB was constituted. A working group formed by rehabilitation doctors, urologists and nursing staff of SCI and Neurorehabilitation Units of a number of Spanish hospitals and specialised centres associated with the panel of NB experts have prepared this document. Results: This review provided an overview of the main aspects described by the different clinical guidelines already available and highlighted the need to focus on recommendations in special priority situations in which there was no consensus. In view of the considerable impact this condition has on quality of life, patients should be offered help to better understand the disorder and they should be taught how to use the treatment techniques to obtain satisfactory results and promote their autonomy. CONCLUSIONS: This article presents a version of guidelines for patients with NB. The guidelines define the clinical profile of patients to provide the best evidence based care and also an overview of the current drug and surgical treatments of NB

Seudohernia abdominal tras lesión medular. A propósito de 3 casos / Abdominal pseudohernia after spinal cord injury: Report of three cases

No disponible

Change in the profile of traumatic spinal cord injury over 15 years in Spain.

BACKGROUND: Traumatic spinal cord injury remains a serious public health and social problem. Although incidence rates are decreasing in our environment, it is a high cost condition that is associated with great disability. The objective of this study was to describe the epidemiological and demographic characteristics of traumatic spinal cord injury and to analyse its epidemiological changes. METHODS: This study was an observational study with prospective monitoring of all traumatic spinal cord injury patients in the Canary Islands, Spain (2.1 million inhabitants) between 2001 and 2015. RESULTS: Over the specified period of the study, 282 patients suffered a traumatic spinal cord injury. The crude incidence rate was 9.3 cases per million people/year. The patients' mean age increased from 38 years (2001-2005) to 48 years (2011-2015) (p < 0.05). Overall, 80.1% of patients were males. The trauma mechanisms of spinal cord injury were falls in 44%, traffic accidents in 36.5%, diving accidents in 8.9% and others in 10.7%. While traffic accidents decreased, falls increased, particularly in the elderly (p < 0.05). The most frequently affected level was the cervical spine (50.9%), and incomplete tetraplegia was the most prevalent group (29.8%). A total of 76.6% of all patients suffered a vertebral fracture, and 91.6% of these required surgery. Among 282 patients, 12.5% were transferred to residences. The patients transferred increased from 8.5% in the first period to 20.0% (p < 0.05) in the last period. Such cases were related to age, cervical level injuries and injuries associated with poor functionality (p < 0.05). CONCLUSIONS: The rise in the number of falls among the older population, as well as the reduction in traffic accidents, decreased the incidence of traumatic spinal cord injury in our environment. This change in the profile of new traumatic spinal cord injuries led us to reformulate the functional objectives planned for these patients upon admission to specialized units, to plan destination-upon-discharge in advance and to promote campaigns to prevent spinal cord injury in older adults.

Lesión medular secundaria a zambullida en Canarias / Spinal cord injuries resulting from diving accidents in the Canary Islands

Objetivo: La zambullida es una de las principales causas de lesión medular, tras las caídas y los accidentes de tráfico. El objetivo de este estudio es conocer las características epidemiológicas y clínicas de estos pacientes en nuestro medio para realizar una mejor prevención. Material y métodos: Se ha realizado un estudio descriptivo retrospectivo de los pacientes que han sufrido una lesión medular de origen traumático tras una zambullida en la comunidad autónoma canaria desde el 2000 hasta el 2014 y que ingresaron en la Unidad de Lesionados Medulares del Hospital Universitario Insular de Gran Canaria. Resultados: De los 264 pacientes que ingresaron en nuestra unidad por una lesión medular traumática aguda, 23 (8,7%) fueron por una zambullida. Si se agrupan los pacientes por quinquenios, entre el 2000 y el 2005 se produjeron el 56% de las lesiones, entre el 2006 y el 2010 el 17% y entre el 2011 y el 2014 el 26%. Todos los pacientes eran varones, con una media de edad de 29años. El 65% eran menores de 30años. Veintidós de 23 pacientes sufrieron una fractura vertebral C5 —el nivel vertebral más afectado— y la fractura aplastamiento fue la más prevalente. El 86% fueron intervenidos quirúrgicamente. Todas las lesiones medulares fueron cervicales, siendo C6 el nivel neurológico afectado con más frecuencia. El 65% presentaban una lesión medular completa. Conclusiones: Las lesiones medulares tras una zambullida son la tercera causa de lesión medular traumática en nuestro medio. Afecta a varones jóvenes, y la presentación clínica más frecuente es una lesión medular cervical completa. Dado el carácter irreversible de la lesión, es de gran importancia la prevención, dirigida principalmente a la población juvenil

Objective: Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries. Material and methods: We performed a retrospective, descriptive study of patients who have suffered from a traumatic spinal cord injury after a diving accident in the Canary Islands, Spain from 2000 to 2014. These patients were admitted to the Spinal Cord Unit of Hospital Universitario Insular de Gran Canaria. Results: Of the 264 patients admitted to our unit for acute traumatic spinal cord injury, 23 (8.7%) cases were due to diving. Grouping the patients into 5years periods, 56% of the injuries occurred in 2000-2005, 17% in 2006-2010 and 26% in 2011-2014. All patients were male, with a mean age of 29years. Approximately 65% were under 30years. A total of 22/23 patients had a fracture and injury most commonly occurred to the C5 vertebra. Burst fractures were the most common. A total of 86% of cases underwent surgery. All the spinal cord injuries were cervical, with C6 being the neurological level most often affected. A total of 65% of spinal cord injuries were complete injuries. Conclusions: Spinal cord injury secondary to diving accidents is the third leading cause of traumatic spinal cord injury in our setting. It affects young males and the most common clinical presentation is a complete cervical spinal cord injury. Given the irreversible nature of the injury, prevention, aimed mainly at young people, is of great importance

Efficacy and safety of urinary catheters with silver alloy coating in patients with spinal cord injury: a multicentric pragmatic randomized controlled trial. The ESCALE trial.

BACKGROUND: Patients with spinal cord injury (SCI) who carry indwelling urinary catheters have an increased risk of urinary tract infection (UTI). Antiseptic silver alloy-coated (SAC) silicone urinary catheters prove to be a promising intervention to reduce UTIs; however, current evidence cannot be extrapolated to patients with SCI. PURPOSE: This study aimed to assess the efficacy of SAC urinary catheters for preventing catheter-associated urinary tract infections. DESIGN/SETTING: This is an open-label, multicenter (developed in Spain, Portugal, Chile, Turkey, and Italy), randomized clinical trial conducted in 14 hospitals from November 2012 to December 2015. PATIENT SAMPLE: Eligible patients were men or women with traumatic or medical SCI, aged ≥18 years, requiring an indwelling urinary catheter for at least 7 days. OUTCOME MEASURES: The primary outcome was the incidence of symptomatic UTIs. The secondary outcome included bacteremia in the urinary tract and adverse events. MATERIALS AND METHODS: Patients were randomized to receive a SAC urinary catheter (experimental group) or a standard catheter (control group) for at least 7 days. Data were compared using chi-squared test and also calculating the absolute risk difference with a 95% confidence interval. An adjusted analysis including different risk factors of UTI was performed. This study was mainly funded by La Marató de TV3 Foundation (grant number # 112210) and the European Clinical Research Infrastructures Network organization. The funders had no role in the interpretation or reporting of results. RESULTS: A total of 489 patients were included in the study, aged 55 years in the experimental group and aged 57 in the control group (p=.870); 72% were men; 43% were hospitalized patients, and 57% were outpatients (p=1.0). The most frequent cause of SCI was traumatic (73.75%), and the localization was mainly the cervical spine (42.74%). Most of the patients had an A score (complete spinal injury and no motor and sensory is preserved) on the ASIA scale (62.37%). The median time of urethral catheterization was 27 days in the experimental group and 28 days in the control group (p=.202). Eighteen patients (7.41%) in the experimental group and 19 in the control (7.72%) group had a symptomatic UTI (odds ratio [OR] 0.96 [0.49-1.87]). The adjusted analysis revealed no change in the results. Only three patients in the experimental group had bacteremia within the urinary tract. The experimental group presented more adverse events related to the use of a catheter than the control group (OR 0.03 [0.00-0.06]). CONCLUSIONS: The results of this study do not support the routine use of indwelling antiseptic SAC silicone urinary catheters in patients with SCI. However, UTIs associated to long-term urinary catheter use remain a challenge and further investigations are still needed.

[Spinal cord injuries resulting from diving accidents in the Canary Islands]. / Lesión medular secundaria a zambullida en Canarias.

OBJECTIVE: Diving accidents is one of the leading causes of spinal cord injury after falls and car accidents. The objective of this study was to determine the epidemiological and clinical characteristics of these patients in our setting to better prevent these injuries. MATERIAL AND METHODS: We performed a retrospective, descriptive study of patients who have suffered from a traumatic spinal cord injury after a diving accident in the Canary Islands, Spain from 2000 to 2014. These patients were admitted to the Spinal Cord Unit of Hospital Universitario Insular de Gran Canaria. RESULTS: Of the 264 patients admitted to our unit for acute traumatic spinal cord injury, 23 (8.7%) cases were due to diving. Grouping the patients into 5years periods, 56% of the injuries occurred in 2000-2005, 17% in 2006-2010 and 26% in 2011-2014. All patients were male, with a mean age of 29years. Approximately 65% were under 30years. A total of 22/23 patients had a fracture and injury most commonly occurred to the C5 vertebra. Burst fractures were the most common. A total of 86% of cases underwent surgery. All the spinal cord injuries were cervical, with C6 being the neurological level most often affected. A total of 65% of spinal cord injuries were complete injuries. CONCLUSIONS: Spinal cord injury secondary to diving accidents is the third leading cause of traumatic spinal cord injury in our setting. It affects young males and the most common clinical presentation is a complete cervical spinal cord injury. Given the irreversible nature of the injury, prevention, aimed mainly at young people, is of great importance.

Epidemiología de la lesión medular de origen traumático en Gran Canaria / Epidemiology of traumatic spinal cord injury in Gran Canaria

Objetivo: Determinar la tendencia de la incidencia del paciente con una lesión medular de origen traumático y describir las características epidemiológicas y clínicas de esta población. Material y métodos: Se ha realizado un estudio descriptivo retrospectivo de los pacientes que han sufrido una lesión medular de origen traumático en la isla de Gran Canaria (islas Canarias, España) desde el año 2000 al 2014. Para estudiar la tendencia se han dividido los pacientes en 3 periodos según el año de la lesión: 2000-2005, 2006-2010 y 2011-2014. Resultados: El número de casos ha sido de 141 pacientes. La incidencia media para todo el periodo ha sido de 12 casos/millón/año con una disminución de los casos en el segundo y tercer periodo. Mientras la relación hombre/mujer de 3,8/1 se ha mantenido, la edad media del paciente ha aumentado de 38,8 años entre el año 2000-5 a 54,5 años en el 2011-14 (p < 0,05). La caída, que ha sido la principal causa de lesión medular (48,2%) seguida de los accidentes de tráfico (37,6%), ha aumentado especialmente en la población de mayor edad. La lesión incompleta ha predominado sobre la completa, siendo la tetraplejía incompleta el grupo más prevalente (30,5%). El 70,3% de los lesionados medulares tenían una fractura vertebral y de ellos han sido intervenidos quirúrgicamente el 93,2%. Conclusiones: En los últimos años ha habido una disminución de la incidencia de la lesión medular de origen traumático con un cambio en la población diana, afectando principalmente a la población de mayor edad. Estos hallazgos muestran la necesidad de replantear las campañas de prevención local de la lesión medular en el anciano

Objective: To evaluate the epidemiological and clinical trends in acute traumatic spinal cord injuries. Material and methods: A retrospective study was conducted of traumatic spinal cord injury patients in Gran Canaria (Canary Islands, Spain) from 2000 to 2014. Demographic and spinal injury severity trends were analysed by year of injury grouped into 3 periods: 2000-2005, 2006-2010, and 2011-2014. Results: The sample included 141 patients. The mean incidence for the entire period was 12 cases/million/year. There was a decrease in cases in the second and third period. While the male/female ratio was 3.8/1 and was maintained in all periods, the mean patient age increased from 38.8 in 2000-5 to 54.5 years in 2011-4 (P < .05). Falls have been the leading cause of spinal cord injury (48.2%), followed by traffic accidents (37.6%). Falls have increased, especially in the older population. Incomplete tetraplegia has been the most prevalent group (30.5%). A vertebral fracture was suffered by 70.3% of all patients, with 93.2% of them requiring surgery. Conclusions: There has been a decrease in the incidence of traumatic spinal cord injury in recent years. The target population has changed, and the older population is currently the most affected. This reality suggests the need to change the local prevention campaigns for spinal cord injury in the elderly

[Epidemiology of traumatic spinal cord injury in Gran Canaria]. / Epidemiología de la lesión medular de origen traumático en Gran Canaria.

OBJECTIVE: To evaluate the epidemiological and clinical trends in acute traumatic spinal cord injuries. MATERIAL AND METHODS: A retrospective study was conducted of traumatic spinal cord injury patients in Gran Canaria (Canary Islands, Spain) from 2000 to 2014. Demographic and spinal injury severity trends were analysed by year of injury grouped into 3 periods: 2000-2005, 2006-2010, and 2011-2014. RESULTS: The sample included 141 patients. The mean incidence for the entire period was 12 cases/million/year. There was a decrease in cases in the second and third period. While the male/female ratio was 3.8/1 and was maintained in all periods, the mean patient age increased from 38.8 in 2000-5 to 54.5 years in 2011-4 (P<.05). Falls have been the leading cause of spinal cord injury (48.2%), followed by traffic accidents (37.6%). Falls have increased, especially in the older population. Incomplete tetraplegia has been the most prevalent group (30.5%). A vertebral fracture was suffered by 70.3% of all patients, with 93.2% of them requiring surgery. CONCLUSIONS: There has been a decrease in the incidence of traumatic spinal cord injury in recent years. The target population has changed, and the older population is currently the most affected. This reality suggests the need to change the local prevention campaigns for spinal cord injury in the elderly.

A randomized controlled trial to assess the efficacy and cost-effectiveness of urinary catheters with silver alloy coating in spinal cord injured patients: trial protocol.

BACKGROUND: Patients with non-acute spinal cord injury that carry indwelling urinary catheters have an increased risk of urinary tract infection (UTIs). Antiseptic Silver Alloy-Coated Silicone Urinary Catheters seems to be a promising intervention to reduce UTIs; however, actual evidence cannot be extrapolated to spinal cord injured patients. The aim of this trial is to make a comparison between the use of antiseptic silver alloy-coated silicone urinary catheters and the use of standard urinary catheters in spinal cord injured patients to prevent UTIs. METHODS/DESIGN: The study will consist in an open, randomized, multicentre, and parallel clinical trial with blinded assessment. The study will include 742 spinal cord injured patients who require at least seven days of urethral catheterization as a method of bladder voiding. Participants will be online centrally randomized and allocated to one of the two study arms (silver alloy-coated or standard catheters). Catheters will be used for a maximum period of 30 days or removed earlier if the clinician considers it necessary. The main outcome will be the incidence of UTIs by the time of catheter removal or at day 30 after catheterization, the event that occurs first. Intention-to-treat analysis will be performed, as well as a primary analysis of all patients. DISCUSSION: The aim of this study is to assess whether silver alloy-coated silicone urinary catheters improve ITUs in spinal cord injured patients. ESCALE is intended to be the first study to evaluate the efficacy of the silver alloy-coated catheters in spinal cord injured patients. TRIAL REGISTRATION: NCT01803919.