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Patient reported bladder-related symptoms and quality of life after spinal cord injury with different bladder management strategies.

Research paper by Jeremy B JB Myers, Sara M SM Lenherr, John T JT Stoffel, Sean P SP Elliott, Angela P AP Presson, Chong C Zhang, Jeffery J Rosenbluth, Amitabh A Jha, Darshan P DP Patel, Blayne B Welk,

Indexed on: 01 Jul '19Published on: 09 Apr '19Published in: The Journal of Urology®



Abstract

Neurogenic bladder (NGB) significantly impacts individuals after spinal cord injury (SCI). We hypothesized there were differences in bladder-related symptoms and quality of life (QoL) with four common bladder managements. This was a prospective, observational study, which measured NGB-related QoL after SCI. Eligibility included: age ≥18 years and acquired SCI. Bladder management was grouped as: (1) clean intermittent catheterization (CIC), (2) indwelling catheter (IDC), (3) Surgery (bladder augmentation, catheterizable channel, urinary diversion), and (4) Voiding (condom catheter, involuntary leaking, volitional voiding). Primary outcomes: Neurogenic Bladder Symptom Score (NBSS) and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). sub-domains of the NBSS and satisfaction with urinary function. Multivariable regression was used to establish differences between the groups, separated by level. 1479 participants enrolled in the study. 843(57%) had paraplegia, 894(60%) were men, median age and time from injury were 44.9(IQR34.4,54.1) and 11(IQR5.1, 22.4) years. Bladder management was CIC in 754(51%), IDC in 271(18%), Surgery in 195(13%), and Voiding in 259(18%). Primary outcomes: In both paraplegia and tetraplegia, IDC and Surgery had less urinary symptoms (NBSS) compared to CIC, while Voiding had more symptoms. In both paraplegia and tetraplegia, Surgery was associated with less bladder management difficulties (SCI-QoL Difficulties). Satisfaction was improved in Surgery in individuals with either paraplegia or tetraplegia. In individuals with SCI, there were less bladder symptoms associated with IDCs and surgery and worse bladder symptoms in voiding individuals compared to CIC. Satisfaction with the urinary system was improved after surgery compared to CIC.

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