Jeremy B Myers1, Sara M Lenherr1, John T Stoffel2, Sean P Elliott3, Angela P Presson4, Chong Zhang4, Jeffery Rosenbluth5, Amitabh Jha6, Darshan P Patel1, Blayne Welk7. 1. Department of Surgery (Urology), University of Utah, Salt Lake City, Utah. 2. Departments of Urology, University of Michigan, Ann Arbor, Michigan. 3. University of Minnesota, Minneapolis, Minnesota. 4. Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah. 5. Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah. 6. Department of Physical Medicine and Rehabilitation, Salt Lake City Veterans Medical Center, Salt Lake City, Utah. 7. Western University, London, Ontario, Canada.
Abstract
PURPOSE: Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. MATERIALS AND METHODS: In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. RESULTS: Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. CONCLUSIONS: In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.
PURPOSE: Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. MATERIALS AND METHODS: In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. RESULTS: Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. CONCLUSIONS: In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.
Authors: Denise G Tate; Tracey Wheeler; Giulia I Lane; Martin Forchheimer; Kim D Anderson; Fin Biering-Sorensen; Anne P Cameron; Bruno Gallo Santacruz; Lyn B Jakeman; Michael J Kennelly; Steve Kirshblum; Andrei Krassioukov; Klaus Krogh; M J Mulcahey; Vanessa K Noonan; Gianna M Rodriguez; Ann M Spungen; David Tulsky; Marcel W Post Journal: J Spinal Cord Med Date: 2020-03 Impact factor: 1.985
Authors: Odinachi Moghalu; John T Stoffel; Sean P Elliott; Blayne Welk; Chong Zhang; Angela Presson; Jeremy Myers Journal: J Urol Date: 2021-09-22 Impact factor: 7.450
Authors: Kyla Nichole Velaer; Blayne Welk; David Ginsberg; Jeremy Myers; Kazuko Shem; Christopher Elliott Journal: Top Spinal Cord Inj Rehabil Date: 2021-08-13
Authors: Veronika Birkhäuser; Martina D Liechti; Collene E Anderson; Lucas M Bachmann; Sarah Baumann; Michael Baumberger; Lori A Birder; Sander M Botter; Silvan Büeler; Célia D Cruz; Gergely David; Patrick Freund; Susanne Friedl; Oliver Gross; Margret Hund-Georgiadis; Knut Husmann; Xavier Jordan; Miriam Koschorke; Lorenz Leitner; Eugenia Luca; Ulrich Mehnert; Sandra Möhr; Freschta Mohammadzada; Katia Monastyrskaya; Nikolai Pfender; Daniel Pohl; Helen Sadri; Andrea M Sartori; Martin Schubert; Kai Sprengel; Stephanie A Stalder; Jivko Stoyanov; Cornelia Stress; Aurora Tatu; Cécile Tawadros; Stéphanie van der Lely; Jens Wöllner; Veronika Zubler; Armin Curt; Jürgen Pannek; Martin W G Brinkhof; Thomas M Kessler Journal: BMJ Open Date: 2020-08-13 Impact factor: 2.692
Authors: Andrew J Cohen; Philip J Cheng; Sikai Song; German Patino; Jeremy B Myers; Samit S Roy; Sean P Elliott; Joseph Pariser; Justin Drobish; Brad A Erickson; Thomas W Fuller; Jill C Buckley; Alex J Vanni; Nima Baradaran; Benjamin N Breyer Journal: Transl Androl Urol Date: 2021-05