To evaluate the association between neurogenic lower urinary tract dysfunction, particularly urinary symptom severity, and functional, psychological and socioeconomic outcomes in individuals with spinal cord injury (SCI).

This cross-sectional observational study included 398 adults aged ≥18 years with SCI, proportionally recruited from all geographic regions of Brazil. Participants were recruited through institutional contact with organizations supporting individuals with SCI and through social media dissemination. Data were collected through a dedicated telephone call center using structured interviews. Urinary variables assessed included urinary incontinence, recurrent urinary tract infection, bladder emptying method, and severity of urinary symptoms. Urinary symptom severity was assessed using the ICIQ-SF score. Outcomes analyzed included caregiver dependence, employment status, presence of moderate to severe depressive symptoms (PHQ-9 ≥10), and urinary-related quality of life assessed using Qualiveen-SF and I-QoL. Multivariable logistic regression and generalized linear models were applied, adjusted for age, sex, time since injury, and geographic region. The study protocol was approved by the local Ethics Committee.

Among the participants, 292 (73.4%) were men, with a mean age of 43.7 years. Mean time since SCI was 14.3 years, and 216 (54.3%) had complete spinal cord injury. Bladder catheter use was reported by 367 (92%) participants, of whom 357 (89.7%) performed intermittent catheterization. PVC catheters were used by 215 (56.7%) participants, whereas hydrophilic catheters were used by 111 (29.4%). Urinary incontinence was self-reported by 268 (67.3%) participants. Recurrent urinary tract infections were reported by 206 (51.8%) and antibiotic prophylaxis was reported by 95 (23.9%) participants. Only 161 (40.5%) individuals were employed, and moderate-to-severe depressive symptoms were identified in 120 (30.1%). Greater urinary symptom severity was significantly associated with lower likelihood of employment (OR 0.946; 95% CI 0.906–0.989) and higher odds of moderate to severe depressive symptoms (OR 1.084; 95% CI 1.036–1.134). A significant association with worse quality of life was also observed, consistently across both instruments used (β = 0.045 for Qualiveen-SF; β = −2.539 for I-QoL; p < 0.001). In contrast, greater caregiver dependence was present in 39.2% and it was associated with shorter time since injury, with no significant association observed with urinary variables.

These findings indicate that urinary dysfunction in individuals with spinal cord injury extends beyond lower urinary tract morbidity and is closely linked to broader dimensions of social participation and psychological well-being. The consistent association between greater urinary symptom severity and reduced employment, depressive symptoms, and poorer urinary-specific quality of life suggests that urinary burden may represent an important marker of long-term disability after SCI. The absence of association between urinary variables and caregiver dependence, in contrast to the influence of time since injury, suggests that functional dependency may be more strongly determined by neurological adaptation and chronicity than by urinary status itself. Overall, these results reinforce the relevance of lower urinary tract symptoms  control as a component of comprehensive rehabilitation strategies aimed at improving long-term psychosocial outcomes.

Lower urinary tract symptoms, particularly symptoms severity, were consistently associated with functional and psychosocial burden after spinal cord injury, supporting the inclusion of urinary outcomes as core components of long-term care strategies aimed at improving autonomy, mental health, and social participation in individuals with SCI.