Hypothesis / aims of study
Management of Neurogenic lower urinary tract dysfunction (NLUTD) following spinal cord injury (SCI) represents an incredible economic burden on health care system and quality of life. Considering that proper management strategy for NLUTD is a crucial component of rehabilitation program for SCI population. Therefore, we aimed to identify the impact of NLUTD, and related management strategy on quality of life in SCI population from Canadian societal perspective.
Study design, materials and methods
This is a retrospective multicenter study analyzing the database registry of 198 adult patients with traumatic SCI who received urologic care at Rick Hansen participating facilities in Montreal, Canada from April 2010 to July 2017. Participants underwent clinical evaluation including demographic and injury profile based on the American Spinal Injury Association Impairment Scale (ASIA). Patients provided urine analysis and completed validated questionnaires of General Self-Efficacy Scale (GSE), and pain inventory. Functional state of patients was evaluated by using the Spinal Cord Independence Measure (SCIM). Patients also described their bladder management method over the long term.
A total of 155 men and 43 women with a mean age of 53 (±18.5) years were included in the study. The etiology of lesion was traumatic falls in 98 (50%) patients and transport related injury in 43 (22%) patients. Mean time since injury was 3 (±8.3) years. Most of these SCls were incomplete motor by the ASIA classification. 64 (40%) fit the classification for AIS D, 43 (27%) for AIS A, 29 (18%) for AIS C, 25 (15%) for AIS B, and 1 (0.6%) for AIS E. The prevalence of urinary tract infection (UTI) was 42%. The method of bladder management at follow-up was normal voiding in 73 (49%) cases, intermittent self-catheterization (ISC) in 52 (35%), catheterization by attendant in 4 (3%), Indwelling urethral catheterization in 12 (8%), and suprapubic catheterization in 7 (5%) cases. Patients with UTI had significantly less total SCIM score and subscales scores (P<0.001). Analysis of bladder management method in relation to quality of life parameters revealed ISC and normal voiding groups had significant higher SCIM and GSE scores compared to other groups (Table 1).
Interpretation of results
In the present study, overall rate of UTI in patients with NLUTD is 42%. Analysis of UTI prevalence in this population revealed significantly higher risk for UTI in patients using indwelling urethral catheterization. Furthermore, UTIs are associated with decreased health-related QoL and minimize the independence of patients as demonstrated in SCIM questionnaire. In this population, 35% of patients were treated with ISC, while only 13% used indwelling (transurethral or suprapubic) catheterization. Selection of an optimal bladder management method should be individualized to the patient’s motor functions, anatomic limitations, bladder characteristics, wishes and quality of life. While UTI risk between SPC and CIC appears comparable, there is a significantly increased risk with indwelling urethral catherization.