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Sources of Funding: None

Introduction

Impaired bladder function after spinal cord injury (SCI) is common, with over 75% of patients unable to volitionally void at the time of discharge from rehabilitation. A significant number of patients with SCI have dissatisfaction related to their bladder care and for many improving their bladder condition is more important than improving their motor function. The ability to predict a return to volitional voiding would be useful.

Methods

Data for the years 2000 to 2013 within the National Spinal Cord Injury Database was assessed. Each patient’s bladder management method was determined at discharge from inpatient rehabilitation and at 1-year followup. Patient variables most likely to affect return of volitional voiding were evaluated: patient age, gender, American Spinal Injury Association Impairment Scale (AIS) classification, presence of deep rectal sphincter sensation/contraction, lowest sensory level, and a composite bilateral lower extremity motor score for L2-S1 (range 0-50). Given the large variance between AIS A-D for voiding return, the models were run separately for each AIS classification.

Results

Of the 3307 persons evaluated, 681 (20.7%) were volitionally voiding at discharge from inpatient rehabilitation. This increased to 29.9% at 1-year followup. AIS classification and composite lower extremity motor score were the largest predictors of volitional voiding (p<.001) (Figure 1). Persons in the AIS A and B categories rarely had return of voiding at 1-year follow-up (1.4% and 4.5% respectively) as compared to AIS C and D (27.7% and 74.4% respectively). Several predictors of volitional voiding based on AIS Class were identified. For those with AIS C, younger age and higher composite lower extremity motor score were significant predictors of volitional voiding. These were also significant in the AIS D population, in addition to female gender and the combination of deep rectal sensory and motor function (as compared to sensory alone).

Conclusions

Volitional voiding after SCI is predicted well by AIS Class and lower motor extremity function composite score. In neurologically less impaired patients, female gender and the combination of deep rectal sensory and motor function also help to predict future voiding.

Funding

None