Background: European and AUA Guidelines recommend initial cystometrogram for patients with suprasacral spinal cord injuries. The extent of adherence to neurogenic bladder surveillance by urodynamics and its association with survival is limited.

Objective: To assess the proportion of patients with spinal cord injury who underwent cystometrogram and the extent to which cystometrograms are associated with survival.

Methods: We emulated a target trial of subjects with spinal cord injuries who had no prior urological conditions or procedures. Measures included whether the veteran had a cystometrogram and the association between cystometrogram and mortality risk, controlling for measured confounding factors.

The data was extracted from a nationwide hospital system database based on ICD9 &10 coding to compile a dataset of subject with spinal cord injury excluding Amyotrophic lateral Sclerosis, multiple sclerosis and other neurological diseases not affecting the spinal cord. Cauda Equina injuries were also excluded.  Also excluded were those with a cancer diagnosis as cause for SCI and those who had no follow up after one year of meeting criteria for entry (high mortality risk).

The study period was from october 1st 1999 to December 8th 2023.  Data was extracted retrospectively by ICD9/10 coding for spinal injury or diease above the sacral region, comorbidities including cardiovascular disease, diabetes, pulmonary diease, infections, renal disease, infections, obesity, cereborvascular diesease. Data was assessed in 5 year intervals prior to 2005, 2005-2009, 2010-14, 2015-2020 and 2020- close. Urodynamic studies were determined based primarily on the use of cystometry coding (51725-9).

Results: The cohort consisted of 43 326 SCI patients with a mean follow-up of 122 ± 78 months (mean ± SD) Overall, 31% had a cystometrogram. The decreased mortality risk (odds ratio 0.74 or 26%) associated with a subject haveing a cystometrogram was significant. This included controlling for confounding variables  (odds ratio 0.74; 95% CI 0.71-0.77; p < 0.001). This association was observed throughout all years of follow-up, with a difference of more than 7% in cumulative survival by 20 years of longest follow-up. The association was observed in subjects who had other preventative health measures, such screening colonoscopy.

1) Adherence to guideline-recommended cystometrograms for patients with suprasacral spinal cord injury was low in previous observational investigations and in this study at 31% overall.
2)  The patients who had cystometrogram experienced 26% lower mortality risk throughout the 20 years of longest follow-up.

Conclusion: . The patients who had cystometrogram experienced lower mortality risk throughout the 20 years of longest follow-up. This study, combined with evidence in other investigations on associations of cystometrograms on urinary system outcomes, compel re-examining approaches to increase adherence to surveillance protocols for neurogenic bladder in patients with supra-sacral spinal cord injury.