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

Collene E Anderson; Veronika Birkhäuser; Xavier Jordan; Martina D Liechti; Eugenia Luca; Sandra Möhr; Jürgen Pannek; Thomas M Kessler; Martin W G Brinkhof

doi:10.1016/j.euros.2022.01.005

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

Eur Urol Open Sci. 2022 Feb 15:38:1-9. doi: 10.1016/j.euros.2022.01.005. eCollection 2022 Apr.

Authors

Collene E Anderson^{1

2

3}, Veronika Birkhäuser³, Xavier Jordan⁴, Martina D Liechti³, Eugenia Luca⁴, Sandra Möhr⁵, Jürgen Pannek^{6

7}, Thomas M Kessler³, Martin W G Brinkhof^{1

2}

Affiliations

¹ Swiss Paraplegic Research, Nottwil, Switzerland.
² Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
³ Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.
⁴ Clinique Romande de Réadaptation, Sion, Switzerland.
⁵ Neuro-Urology, REHAB Basel, Basel, Switzerland.
⁶ Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland.
⁷ Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

Background: There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI).

Objective: To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation.

Design setting and participants: 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.

Outcome measurements and statistical analysis: 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.

Results and limitations: 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.

Conclusions: 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.

Patient summary: 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.

Keywords: Cohort studies; Neurological rehabilitation; Spinal cord diseases; Spinal cord injuries; Urinary bladder, Neurogenic; Urinary catheters; Urinary incontinence.