Neurogenic lower urinary tract dysfunction (NLUTD) is commonly encountered in patients with chronic spinal cord injury (SCI). These patients may develop urinary incontinence due to neurogenic detrusor overactivity (NDO) with or without detrusor sphincter dyssynergia (DSD), dysuria or urinary retention due to detrusor underactivity or NDO and severe DSD. The bladder management methods used for patients with chronic SCI and NLUTD include spontaneous voiding by reflex, triggering, or abdominal pressure; clean intermittent catheterization (CIC); or indwelling suprapubic or transurethral catheter. Despite appropriate management of NLUTD in the initial stage, chronic SCI patients may develop changes in lower urinary tract morphology and function, leading to urological complications. This study investigated patients’ satisfaction with bladder management and surgical interventions in patients with chronic SCI who had been surveyed in community health examinations in Taiwan.

A total of 1275 patients with chronic SCI who participated in community health examinations were surveyed for bladder management, surgical interventions, and satisfaction with current bladder management. Patients were also questioned about the changes in bladder management after SCI and their satisfaction with the current bladder management. The advantages and disadvantages of their current bladder management were recorded.

A total of 1275 patients with chronic SCI were enrolled in this study, including 995 (78.0%) male and 280 (22.0%) female patients. The distribution of the level of SCI in this cohort was as follows: cervical (n = 567, 4.5%), thoracic above T6 (n = 171, 13.4%), thoracic below T6 (n = 345, 27.1%), lumbar (n = 181, 14.2%), and sacral (n = 11, 0.9%) segments. Among the patients, 715 (56.1%) had complete and 560 (43.9%) had incomplete SCI; 131 (10.3%) were tetraplegic, 894 (70.1%) had paraplegia, and 250 (19.6%) had incomplete paraparesis. The mean age of patients was 32.9 ± 14.9 years (range, 1–89) and the mean duration of SCI was 19.5 ± 12.4 years (range, 1–74). Among the patients, 884 (69.3%) were initially managed with cystostomy (3.5%), indwelling urethral catheter (46.4%), or CIC (19.5%). During the follow-up period, 503 (39.5%) patients retained their initial bladder management, whereas 772 (60.5%) patients had changes in their bladder management or received surgical intervention. After various surgical interventions, patients needed to change their bladder management to fit the requirements of the surgical procedure. Patients who received detrusor Botox injection (n = 419), bladder augmentation (n = 71), or suburethral sling (n = 20) must undergo CIC to periodically empty the bladder. Patients who received external sphincterotomy (n = 30), TUI-BN (n = 49), TUI-P or TUR-P (n = 46), urethral sphincter Botox injection (n = 114), or combined detrusor and urethral sphincter Botox injection (n = 35) may develop exacerbation of urinary incontinence. At final visit, 61.6% of patients still chose an indwelling catheter or CIC for bladder management, and only 10.2% of patients spontaneously voided without urinary incontinence. The other patients had mild urinary incontinence (9.3%) or severe incontinence (18.9%). Of the 516 patients who received surgical treatment and were expected to be dry, 169 (32.7%) were still incontinent and 29 (5.6%) finally opted for cystostomy or indwelling urethral catheter for bladder management. Among the 239 patients who received surgical to facilitate spontaneous voiding, 136 (56.9%) still experienced difficult bladder emptying and required CIC, cystostomy, or indwelling urethral catheter. Although the satisfaction rate with bladder management was not high, 921 patients (72.2%) claimed to have benefited from changing the initial bladder management or surgical intervention. In contrast, 354 (27.8%) patients reported drawbacks of changing bladder management or surgical intervention. The advantages and disadvantages of surgical treatment and bladder management in chronic SCI patients are listed in Table 1 and 2.

Patients with chronic SCI experienced different bladder storage and emptying problems. The initial bladder management showed some changes over a long duration of follow-up after surgical interventions or minimally invasive procedures. Despite a high rate of advantages of these procedures, the satisfaction with the current bladder management was still low. There remains a gap between urological treatments and expectations of a satisfactory bladder condition in patients with chronic SCI and NLUTD.

In this long-term follow-up study, more than 60% of patients with chronic SCI were still using catheter-dependent bladder management to empty their bladder, including CIC, cystostomy, and indwelling urethral catheter. The satisfaction rate with current bladder management or surgical intervention was only 40%, and 58.9% of patients were not satisfied but were able to accept (48.2%) or wished to change (10.7%) their current bladder management. The initial bladder management of patients with chronic SCI showed some changes over a 20-year follow-up after surgical interventions or minimally invasive procedures. Despite the reported high rate of advantages of these procedures, satisfaction with the current bladder management was still low.

Continence 12S (2024) 101545
DOI: 10.1016/j.cont.2024.101545