Sex Differences in Bladder Management, Symptoms, and Satisfaction After Spinal Cord Injury

No AccessJournal of UrologyAdult Urology1 Oct 2023Sex Differences in Bladder Management, Symptoms, and Satisfaction After Spinal Cord InjuryThis article is commented on by the following:Editorial Comment Jeremy B. Myers, John T. Stoffel, Sean P. Elliott, Blayne Welk, Jennifer S. Herrick, and Sara M. Lenherr Jeremy B. MyersJeremy B. Myers *Correspondence: Department of Surgery (Urology), University of Utah, 30 N 1900 E, Rm 3B420, Salt Lake City, UT 84132 telephone: 801-213-2700; E-mail Address: [email protected] Department of Surgery (Urology), University of Utah, Salt Lake City, Utah , John T. StoffelJohn T. Stoffel Department of Urology, University of Michigan, Ann Arbor, Michigan , Sean P. ElliottSean P. Elliott Department of Urology, University of Minnesota, Minneapolis, Minnesota , Blayne WelkBlayne Welk Western University, London, Ontario, Canada , Jennifer S. HerrickJennifer S. Herrick Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah , and Sara M. LenherrSara M. Lenherr Department of Surgery (Urology), University of Utah, Salt Lake City, Utah for the Neurogenic Bladder Research Group View All Author Informationhttps://doi.org/10.1097/JU.0000000000003611AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We sought to characterize sex-stratified differences in bladder management and bladder symptoms and satisfaction after spinal cord injury. Materials and Methods: This study was a prospective, cross-sectional, observational study; eligibility included: age ≥18 years and acquired spinal cord injury. Bladder management was grouped as (1) clean intermittent catheterization, (2) indwelling catheter, (3) surgery, and (4) voiding. Primary outcome was Neurogenic Bladder Symptom Score. Secondary outcomes were subdomains of the Neurogenic Bladder Symptom Score and bladder-related satisfaction. Multivariable regression was used in sex-stratified models to establish associations between participant characteristics and outcomes. Results: A total of 1,479 participants enrolled in the study. Of the patients 843 (57%) were paraplegic and 585 (40%) were women. Median age and time from injury were 44.9 (IQR 34.3, 54.1) and 11 (IQR 5.1, 22.4) years. Women utilized clean intermittent catheterization at a lower rate (42.6% vs 56.5%) and surgery at a higher rate (22.6% vs 7.0%), especially catheterizable channel creation with or without augmentation cystoplasty (11.0% vs 1.9%). Women had worse measures of bladder symptoms and satisfaction across all outcomes. In adjusted analyses, women and men utilizing indwelling catheters had fewer associated overall symptoms (Neurogenic Bladder Symptom Score), less incontinence, and fewer storage and voiding symptoms. Surgery was associated with fewer bladder symptoms (Neurogenic Bladder Symptom Score) and less incontinence in women, and was also associated with better satisfaction in both sexes. Conclusions: There are significant sex-stratified differences in bladder management after spinal cord injury, which included a much higher use of surgery. Bladder symptoms and satisfaction are worse across all measurements in women. Women have a substantial associated benefit with surgery, while both sexes have fewer bladder symptoms with indwelling catheters compared to clean intermittent catheterization. REFERENCES 1. . Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn. 2011; 30(3):395-401. Crossref, Medline, Google Scholar 2. ; Spinal Cord Injury Rehabilitation Evidence Scire Research Team. The health and life priorities of individuals with spinal cord injury: a systematic review. J Neurotrauma. 2012; 29(8):1548-1555. 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All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI. Conflict of Interest: The Authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Author Contributions: JM, SL, BW, JS, and JH contributed to the design and statistical analysis of the research. JM, BW, JH, SE, and JS contributed to writing the manuscript. Data were collected and quality was overseen by JM, SE, and JS. JM and SL conceived and supervised the project. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byLemack G (2023) Editorial CommentJournal of Urology, VOL. 210, NO. 4, (669-669), Online publication date: 1-Oct-2023.Related articlesJournal of Urology25 Jul 2023Editorial Comment Volume 210Issue 4October 2023Page: 659-669Supplementary Materials Peer Review Report Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.Keywordsurinary bladderneurogenicspinal cord injuriessexurinary incontinencepatient reported outcome measuresMetrics Author Information Jeremy B. Myers Department of Surgery (Urology), University of Utah, Salt Lake City, Utah *Correspondence: Department of Surgery (Urology), University of Utah, 30 N 1900 E, Rm 3B420, Salt Lake City, UT 84132 telephone: 801-213-2700; E-mail Address: [email protected] More articles by this author John T. Stoffel Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Sean P. Elliott Department of Urology, University of Minnesota, Minneapolis, Minnesota More articles by this author Blayne Welk Western University, London, Ontario, Canada More articles by this author Jennifer S. Herrick Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah More articles by this author Sara M. Lenherr Department of Surgery (Urology), University of Utah, Salt Lake City, Utah More articles by this author Expand All Support: This work was supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138). All statements in this report, including its findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI. Conflict of Interest: The Authors declare that they have no affiliations with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript. Ethics Statement: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Author Contributions: JM, SL, BW, JS, and JH contributed to the design and statistical analysis of the research. JM, BW, JH, SE, and JS contributed to writing the manuscript. Data were collected and quality was overseen by JM, SE, and JS. JM and SL conceived and supervised the project. Data Availability: The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Advertisement PDF downloadLoading ...