Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

Abstract

Objective Clean intermittent catheterization (CIC) is a preferred method of bladder management for many patients with spinal cord injury (SCI), but long‐term adherence is low. The aim of this study is to identify factors associated with low urinary quality of life (QoL) in SCI adults performing CIC. Methods Over 1.5 years, 1479 adults with SCI were prospectively enrolled through the Neurogenic Bladder Research Group registry, and 753 on CIC with no prior surgeries were included. Injury characteristics, complications, hand function, and Neurogenic Bladder Symptom Score (NBSS) were analyzed. The NBSS QoL question (overall satisfaction with urinary function) was dichotomized to generate comparative groups (dissatisfied vs neutral/satisfied). Results The cohort was 32.9% female with a median age of 43.2 (18‐86) years, time since the injury of 9.8 (0‐48.2) years, and 69.0% had an injury at T1 or below. Overall 36.1% were dissatisfied with urinary QoL. On multivariable analysis, female gender (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.15‐2.31; P = 0.016), earlier injury (OR, 0.95 per year; 95% CI, 0.93‐0.97; P < 0.001), ≥4 urinary tract infections (UTIs) per year (OR, 2.36; 95% CI, 1.47‐3.81; P = 0.001), and severe bowel dysfunction (OR, 1.42; 95% CI, 1.02‐1.98; P = 0.035) predicted dissatisfaction. Level of injury, fine motor hand function, and caregiver dependence for CIC were not associated with dissatisfaction. Conclusions In a mature SCI cohort, physical disability does not predict dissatisfaction with urinary QoL but severe bowel dysfunction and recurrent UTIs have a significant negative impact. With time the rates of dissatisfaction decline but women continue to be highly dissatisfied on CIC and may benefit from early intervention to minimize the burden of CIC on urinary QoL.

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

“…In a study of SCI participants performing CIC alone, CIC with botulinum toxin, and CIC with augmentation cystoplasty, tetraplegia had lower (improved) NBSS total and SCI‐QoL difficulties . Conversely, there was no association between the level of injury and fine motor hand function on dissatisfaction among participants reporting CIC as a bladder management strategy, when patients who underwent any procedure to improve urinary‐related QoL were excluded …”

TASCI—transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial

“…[2][3][4] The consequences of NLUTD, including urinary incontinence, dependence on catheters and recurrent urinary tract infections, negatively impact quality of life (QoL). [5][6][7] On a neurological level, intact pathways between the brain and the LUT are required for the complex multilevel neural network governing the LUT to function properly. 8 SCI is thought to trigger neuroplastic changes in C-fibre-mediated spinal reflex pathways in the spinal cord, which lead to the emergence of aberrant micturition reflexes.…”

Impact of clean intermittent catheterization on quality of life of patients with neurogenic lower urinary tract dysfunction due to radical hysterectomy: A cross‐sectional study

“…Clean intermittent catheterization (CIC) is a standard procedure for patients with neurogenic lower urinary tract dysfunction (NLUTD) who are unable to void spontaneously 1,2 . While the efficacy and safety of CIC have been frequently reported, 3,4 there have been few reports regarding differences in quality of life (QOL) between CIC and spontaneous voiding (SV) in patients with NLUTD, except patients with spinal cord injury (SCI) 5‐11 . Patients' QOL after SCI is profoundly affected not only by urinary management but also by disability due to the injury itself 7‐10 .…”

“…While the efficacy and safety of CIC have been frequently reported, 3,4 there have been few reports regarding differences in quality of life (QOL) between CIC and spontaneous voiding (SV) in patients with NLUTD, except patients with spinal cord injury (SCI) 5‐11 . Patients' QOL after SCI is profoundly affected not only by urinary management but also by disability due to the injury itself 7‐10 . Therefore, in order to understand whether the QOL is reduced by underlying disease or is a result of urinary management, it is essential to exclude those participants with significant disabilities to attain a homogenous study population 8 .…”

“…Third, we did not investigate the association between urinary complications, for example, frequency or severity of urinary incontinence, or recurrent UTI and QOL. Since those complications are associated with reduced QOL in patients with SCI,6,9 further studies are needed to determine the presence or absence of the association in patients after RH. Fourth, we did not use a uterine cervical cancer-specific QOL questionnaire, which renders assessment of the impact of sexual or bowel dysfunctions on SF-36 and KHQ impossible.…”