Urological Management at Discharge from Acute Spinal Cord Injury Rehabilitation: A Descriptive Analysis from a Population-based Prospective Cohort

• Published in: European urology open science (Online) Vol. 38; pp. 1 - 9
• Main Authors: Anderson, Collene E., Birkhäuser, Veronika, Jordan, Xavier, Liechti, Martina D., Luca, Eugenia, Möhr, Sandra, Pannek, Jürgen, Kessler, Thomas M., Brinkhof, Martin W.G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.04.2022; Elsevier
• Subjects: Cohort studies; Neuro-Urology; Neurological rehabilitation; Spinal cord diseases; Spinal cord injuries; Urinary bladder, Neurogenic; Urinary catheters; Urinary incontinence; Urinary incontinence; Neurological rehabilitation; Urinary bladder, Neurogenic; Cohort studies; Spinal cord injuries; Urinary catheters; Spinal cord diseases
• ISSN: 2666-1683; 2666-1691; 2666-1683
• DOI: 10.1016/j.euros.2022.01.005

We describe the urological management of patients at discharge from specialized postacute spinal cord injury rehabilitation. Most patients have lower urinary tract impairment. Complete spinal cord injury is the main predictor of managed neurogenic lower urinary tract dysfunction. Women have a higher risk of urinary incontinence. There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI). To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation. The population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology. Data were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes. At discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0–7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79–85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18–3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52–8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35–42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18–25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26–33%). Urodynamic and renal function data were not collected. Our population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research. At discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence.