Study Design: Prospective, multi-centered, observational Objectives: To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. Setting: Multi-institutional sites in the United States, cohort drawn from North America Methods: We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score ( NBSS ), Neurogenic Bladder Symptom Score Satisfaction ( NBSS-Satisfaction ), and SCI-QoL Bladder Management Difficulties ( SCI-QoL Difficulties ). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence , and SCI-QoL Positive Affect and Well-being (Positive Affect) . Psychosocial variables were sub-divided by tertiles for the analysis. Results: There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain ( NBSS 3.8, p <0.001; NBSS-satisfaction 0.6, p <0.001; SCI-QoL Difficulties 2.4, p<0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence ( NBSS −2.3, p=0.03; NBSS-satisfaction −0.4, p<0.001) and upper tertile SCI-QoL Positive Affect ( NBSS −2.8, p<0.001; NBSS-satisfaction −0.7, p<0.001; SCI-QoL Difficulties −0.7, p<0.001). Conclusion: In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.
Purpose:Increased time after spinal cord injury (SCI) is associated with a migration to bladder managements with higher morbidity such as indwelling catheter (IDC). Still, it is unclear how this affects bladder-related quality of life (QoL). We hypothesized that time from injury (TFI) would be associated with changes in bladder management, symptoms and satisfaction.Materials and Methods:Cross-sectional analysis of time-related changes in patient-reported bladder management, symptoms and satisfaction using the Neurogenic Bladder Research Group SCI Registry. Outcomes included Neurogenic Bladder Symptom Score (NBSS) and bladder-related satisfaction (NBSS-satisfaction). Multivariable regression was performed to assess associations between TFI and outcomes, adjusting for participant characteristics, injury specifics, and psychosocial aspects of health-related QoL. Participants with TFI <1 year were excluded and TFI was categorized 1–5 (reference), 6–10, 11–15, 16–20 and >20 years.Results:Of 1,420 participants mean age at injury was 29.7 years (SD 13.4) and mean TFI was 15.2 years (SD 11.6). Participants grouped by TFI included 298 (21%) 1–5, 340 (24%) 6–10, 198 (14%) 11–15, 149 (10%) 16–20 and 435 (31%) >20 years. As TFI increased, clean intermittent catheterization (CIC) declined (55% 1–5 vs 45% >20 years, p <0.001) and IDC increased (16% 1–5 vs 21% >20 years, p <0.001). On multivariable analysis, increased TFI was associated with fewer bladder symptoms at >20 years from injury (−3.21 [CI −1.29, −5.14, p <0.001]) and better satisfaction (6–10 years −0.20 [CI −0.41, 0.01, p=0.070], 11–15 years −0.36 [CI −0.60, −0.11, p=0.002], 16–20 years −0.59 [CI −0.86, −0.32, p <0.001], >20 years −0.85 [CI −1.07, −0.63, <0.001]).Conclusions:After SCI, CIC decreases and IDC increases over time; however, increasing TFI is associated with reduced urinary symptoms and improved bladder-related satisfaction.
Treatments for Peyronie’s Disease (PD) include oral medications, intralesional injections and surgery. Collagenase Clostridium histolyticum (CCh) is the only FDA approved treatment for PD. We sought to examine current trends in treatment of PD across the United States. Using data in the MarketScan Database, we conducted a retrospective study of men with PD in the United States. Cases were identified by ICD-9 and 10 codes, and treatments were identified using NDC and CPT codes. Treatment rates were analyzed using linear regression model, and a cox proportional hazard function test was performed for time-to-treatment analysis. About 27.8% of men with PD were treated within a year of diagnosis. Annual treatment rate increased from 23.2% to 35.4% and intralesional injection was the most used treatment. Over the study period, percentage of men receiving treatment with oral medication increased from 0.66% to 20.5%, while use of intralesional injection and surgery decreased. Increased odds of treatment were observed in men 45–54 years (odds ratio [OR] 1.35; 95% confidence interval [CI], 1.21–1.50; p=0) and in the southern region (OR 1.48; 95% CI, 1.39–1.56; p=0). Trends in treatment of PD have changed over time. Intralesional injection remains the most used treatment option for men with PD.
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