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Original article

Vol. 155 No. 4 (2025)

Urinary tract infections are common and have an impact on performance in elite wheelchair athletes: a cross-sectional study of self-reported data

Cite this as:
Swiss Med Wkly. 2025;155:4113
Published
02.04.2025

Summary

STUDY AIMS: Wheelchair athletes may be at risk of urinary tract infections, especially those with spinal cord injury. A urinary tract infection can lead to a loss of training hours and reduced performance in athletes. We assessed the self-reported occurrence of urinary tract infections and the impact of urinary tract infections on training and performance in elite wheelchair athletes. We also evaluated the prophylactic measures used, as reported by the athletes.

METHODS: Data were collected from September 2022 to August 2023 at an institute specialised in examining wheelchair athletes. All wheelchair athletes active in international and/or national competitions who attended one of the routine checkups at the institute during the study period were included. The number of self-reported urinary tract infections during the previous 12 months was collected, including symptoms associated with urinary tract infections, prophylaxis, and impact on training and performance. The method of bladder voiding was assessed by catheter use, either “Yes” (intermittent and indwelling) or “No” (no catheter use at all).

RESULTS: Eighty-one athletes were included (mean ± standard deviation age 35±11 years; 24 females; 67 with spinal cord injury; 56 using a catheter). Prophylaxis was used by 38 (47%) athletes; the most common was natural supplements, including cranberry juice and D-mannose. Thirty-six (44%) athletes had had at least one urinary tract infection during the previous 12 months. Athletes were more likely to have had at least one urinary tract infection if they had spinal cord injury (34 [94%] vs 2 [6%] athletes, p = 0.013) or were using a catheter (32 [89%] vs 4 [11%] athletes, p = 0.001). A urinary tract infection resulted in 4±6 lost training days and impaired performance.

CONCLUSION: Urinary tract infections are common in elite wheelchair athletes and have a negative impact on training volume and performance. About half of the athletes use prophylaxis. Athletes with spinal cord injury or who use a catheter are especially at risk of urinary tract infections.

References

  1. Jaworski CA, Rygiel V. Acute Illness in the Athlete. Clin Sports Med. 2019 Oct;38(4):577–95. doi: https://doi.org/10.1016/j.csm.2019.05.001
  2. Janse Van Rensburg DC, Schwellnus M, Derman W, Webborn N. Illness Among Paralympic Athletes: Epidemiology, Risk Markers, and Preventative Strategies. Phys Med Rehabil Clin N Am. 2018 May;29(2):185–203. doi: https://doi.org/10.1016/j.pmr.2018.01.003
  3. Derman W, Runciman P, Eken M, Boer PH, Blauwet C, Bogdos M, et al. Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days. Br J Sports Med. 2022 Dec;bjsports-2022-106312.
  4. Derman W, Runciman P, Eken M, Boer PH, Blauwet C, Bogdos E, et al. Incidence of injury and illness at the Beijing 2022 Paralympic Winter Games held in a closed-loop environment: a prospective cohort study of 7332 athlete days. Br J Sports Med. 2024 Jul;58(15):836–43. doi: https://doi.org/10.1136/bjsports-2023-107525
  5. Compton S, Trease L, Cunningham C, Hughes D. Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes. Br J Sports Med. 2015 Oct;49(19):1236–40. doi: https://doi.org/10.1136/bjsports-2014-094527
  6. McKibben MJ, Seed P, Ross SS, Borawski KM. Urinary Tract Infection and Neurogenic Bladder. Urol Clin North Am. 2015 Nov;42(4):527–36. doi: https://doi.org/10.1016/j.ucl.2015.05.006
  7. Dutton RA. Medical and Musculoskeletal Concerns for the Wheelchair Athlete: A Review of Preventative Strategies. Curr Sports Med Rep. 2019 Jan;18(1):9–16. doi: https://doi.org/10.1249/JSR.0000000000000560
  8. Krebs J, Wöllner J, Pannek J. Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord. 2016 Sep;54(9):682–6. doi: https://doi.org/10.1038/sc.2015.214
  9. Linsenmeyer TA. Catheter-associated urinary tract infections in persons with neurogenic bladders. J Spinal Cord Med. 2018 Mar;41(2):132–41. doi: https://doi.org/10.1080/10790268.2017.1415419
  10. Walter M, Ruiz I, Squair JW, Rios LA, Averbeck MA, Krassioukov AV. Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury. Spinal Cord. 2021 Sep;59(9):1018–25. doi: https://doi.org/10.1038/s41393-020-00565-6
  11. Krassioukov A, Cragg JJ, West C, Voss C, Krassioukov-Enns D. The good, the bad and the ugly of catheterization practices among elite athletes with spinal cord injury: a global perspective. Spinal Cord. 2015 Jan;53(1):78–82. doi: https://doi.org/10.1038/sc.2014.208
  12. Pannek J, Pannek-Rademacher S, Jus MS, Wöllner J, Krebs J. Usefulness of classical homeopathy for the prophylaxis of recurrent urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. J Spinal Cord Med. 2019 Jul;42(4):453–9. doi: https://doi.org/10.1080/10790268.2018.1440692
  13. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007 Oct;335(7624):806–8. doi: https://doi.org/10.1136/bmj.39335.541782.AD
  14. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011 Nov;34(6):535–46. doi: https://doi.org/10.1179/204577211X13207446293695
  15. Davis M, Jethani L, Robbins E, Kaner M. Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. Top Spinal Cord Inj Rehabil. 2023;29(1):94–107. doi: https://doi.org/10.46292/sci22-00009
  16. Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS; American College of Sports Medicine. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007 Feb;39(2):377–90.
  17. Garcia-Arguello LY, O’Horo JC, Farrell A, Blakney R, Sohail MR, Evans CT, et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord. 2017 Jun;55(6):526–34. doi: https://doi.org/10.1038/sc.2016.173
  18. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002 Jul;113(1 Suppl 1A):5S–13S. doi: https://doi.org/10.1016/S0002-9343(02)01054-9
  19. Deltourbe L, Lacerda Mariano L, Hreha TN, Hunstad DA, Ingersoll MA. The impact of biological sex on diseases of the urinary tract. Mucosal Immunol. 2022 May;15(5):857–66. doi: https://doi.org/10.1038/s41385-022-00549-0
  20. Togan T, Azap OK, Durukan E, Arslan H. The prevalence, etiologic agents and risk factors for urinary tract infection among spinal cord injury patients. Jundishapur J Microbiol. 2014 Jan;7(1):e8905. doi: https://doi.org/10.5812/jjm.8905
  21. Sartori AM, Padilla-Fernández B, ’t Hoen L, Blok BF, Castro-Díaz DM, Del Popolo G, et al. Definitions of Urinary Tract Infection Used in Interventional Studies Involving Neurourological Patients-A Systematic Review. Eur Urol Focus. 2022 Sep;8(5):1386–98. doi: https://doi.org/10.1016/j.euf.2021.07.012
  22. Sellami M, Puce L, Bragazzi NL. Immunological Response to Exercise in Athletes with Disabilities: A Narrative Review of the Literature. Healthcare (Basel). 2023 Jun;11(12):1692. doi: https://doi.org/10.3390/healthcare11121692
  23. Pannek J, Wöllner J. Management of urinary tract infections in patients with neurogenic bladder: challenges and solutions. Res Rep Urol. 2017 Jul;9:121–7. doi: https://doi.org/10.2147/RRU.S113610
  24. Hertig-Godeschalk A, Perret C. How Elite Athletes with a Spinal Cord Injury Sweat during Exercise-An Exploratory Study. Sports (Basel). 2024 Mar;12(3):81. doi: https://doi.org/10.3390/sports12030081
  25. Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2023 Nov;11(11):CD001321.
  26. Hill TC, Baverstock R, Carlson KV, Estey EP, Gray GJ, Hill DC, et al. Best practices for the treatment and prevention of urinary tract infection in the spinal cord injured population: the Alberta context. Can Urol Assoc J. 2013;7(3-4):122–30. doi: https://doi.org/10.5489/cuaj.337
  27. Everaert K, Lumen N, Kerckhaert W, Willaert P, van Driel M. Urinary tract infections in spinal cord injury: prevention and treatment guidelines. Acta Clin Belg. 2009;64(4):335–40. doi: https://doi.org/10.1179/acb.2009.052
  28. Lee BS, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012 Oct;10(10):CD003265. doi: https://doi.org/10.1002/14651858.CD003265.pub3
  29. Toh SL, Lee BB, Ryan S, Simpson JM, Clezy K, Bossa L, et al. Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial. Spinal Cord. 2019 Jul;57(7):550–61. doi: https://doi.org/10.1038/s41393-019-0251-y
  30. Sihra N, Goodman A, Zakri R, Sahai A, Malde S. Nonantibiotic prevention and management of recurrent urinary tract infection. Nat Rev Urol. 2018 Dec;15(12):750–76. doi: https://doi.org/10.1038/s41585-018-0106-x
  31. Schwellnus M, Soligard T, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, et al. How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness. Br J Sports Med. 2016 Sep;50(17):1043–52. doi: https://doi.org/10.1136/bjsports-2016-096572
  32. Perret C. Elite-adapted wheelchair sports performance: a systematic review. Disabil Rehabil. 2017 Jan;39(2):164–72. doi: https://doi.org/10.3109/09638288.2015.1095951
  33. Barbieri A, Fuk A, Gallo G, Gotti D, Meloni A, La Torre A, et al. Cardiorespiratory and metabolic consequences of detraining in endurance athletes. Front Physiol. 2024 Jan;14:1334766. doi: https://doi.org/10.3389/fphys.2023.1334766
  34. Raysmith BP, Drew MK. Performance success or failure is influenced by weeks lost to injury and illness in elite Australian track and field athletes: A 5-year prospective study. J Sci Med Sport. 2016 Oct;19(10):778–83. doi: https://doi.org/10.1016/j.jsams.2015.12.515
  35. Massa LM, Hoffman JM, Cardenas DD. Validity, accuracy, and predictive value of urinary tract infection signs and symptoms in individuals with spinal cord injury on intermittent catheterization. J Spinal Cord Med. 2009;32(5):568–73. doi: https://doi.org/10.1080/10790268.2009.11754562
  36. Saw AE, Main LC, Gastin PB. Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures: a systematic review. Br J Sports Med. 2016 Mar;50(5):281–91. doi: https://doi.org/10.1136/bjsports-2015-094758