Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry

Darshan P Patel; Jennifer S Herrick; John T Stoffel; Sean P Elliott; Sara M Lenherr; Angela P Presson; Blayne Welk; Amitabh Jha; Jeremy B Myers; Neurogenic Bladder Research Group (NBRG.org)

doi:10.1002/nau.24172

Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry

Neurourol Urodyn. 2020 Jan;39(1):211-219. doi: 10.1002/nau.24172. Epub 2019 Oct 2.

Authors

Darshan P Patel¹, Jennifer S Herrick², John T Stoffel³, Sean P Elliott⁴, Sara M Lenherr¹, Angela P Presson², Blayne Welk⁵, Amitabh Jha⁶, Jeremy B Myers¹; Neurogenic Bladder Research Group (NBRG.org)

Affiliations

¹ Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah.
² Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah.
³ Department of Urology, University of Michigan, Ann Arbor, Michigan.
⁴ Department of Urology, University of Minnesota, Minneapolis, Minnesota.
⁵ Department of Surgery, University of Western Ontario, London, Ontario, Canada.
⁶ Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah.

PMID: 31578784
DOI: 10.1002/nau.24172

Abstract

Introduction: Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation.

Methods: The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL.

Results: There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties).

Conclusions: Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.

Keywords: catheters; indwelling; intermittent urethral catheterization; patient-reported outcome measures; quality of life; spinal cord injuries; urinary bladder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Female
Health Behavior
Humans
Intermittent Urethral Catheterization / adverse effects*
Male
Middle Aged
Patient Compliance
Patient Satisfaction
Quality of Life*
Registries
Spinal Cord Injuries / complications*
Urinary Bladder, Neurogenic / etiology*
Urinary Tract Infections / etiology*