Introduction

Little is known about the relative quality of life (QoL) benefits of different bladder management strategies after spinal cord injury (SCI). We sought to describe bladder-related symptoms and QoL using a national sample of SCI patients.

Methods

Data from a national prospective observational survey was used. Demographic and clinical information were obtained by interview. The Neurogenic Bladder Symptom Score (NBSS), a validated tool to measure urinary symptoms, was administered electronically. Patient demographics, NBSS total score and the NBSS QoL question (&[Prime]If you had to live the rest of your life with the way your bladder (or urinary reservoir) currently works, how would you feel?&[Prime]) were compared with bladder management method using chi-squared, Fisher&[prime]s exact, ANOVA and Kruskal-Wallis tests as appropriate.

Results

Since January 2016, 780 participants completed the baseline interview. Median age was 46 (interquartile range, IQR: 35-56) with median 27 (IQR: 20-41) years since injury. 39% of participants were recruited in clinic and 55% online/remote. SCI level was: 49% paraplegia, 43% tetraplegia, and 8% unknown/other. Current bladder management was: 63% clean-intermittent catheterization (CIC), 23% indwelling suprapubic/urethral catheter or stoma, 9% spontaneous voiding, and 5% condom catheter. Those using CIC were significantly younger than those using other bladder management methods (p<0.001) and those using spontaneous voiding had the longest median time since injury (p<0.001). The total NBSS score was lowest for indwelling catheter/stoma (18.3 ± 10.5) as compared to condom catheter (22.9 ± 9.3), CIC (24.5 ± 9.9) and spontaneous voiding (28.1 ± 11.9) (p <0.001). Similarly, bladder QoL was &[Prime]pleased&[Prime] or &[Prime]mostly satisfied&[Prime] in 43% of people with an indwelling catheter/stoma, 35% for CIC, 27% for condom catheter, and 26% for spontaneously voiding (chi-square test with permutation, p=0.012; Figure 1).

Conclusions

In a large cohort of SCI patients, indwelling catheters or stoma drainage was associated with reduced bladder-related symptoms and consequences and best QoL among bladder management methods. This patient-centered outcome differs from the urologists preference for CIC based on medical benefits. Further exploration is needed to understand the patient-reported QoL and clinical outcomes.

Funding

PCORI CER14092138