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

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.

Acute ampakines increase voiding function and coordination in a rat model of SCI

“…Future studies will need to be completed in both male and female rats to compare potential sex differences in ampakine effects. While we have not observed any sex effects of ampakines in our respiratory studies ( Rana et al, 2021 ), there are known differences in recovery and injury manifestation between male and females that need to be further studied ( Anderson et al, 2023 ; Myers et al, 2023 ).…”

Identifying Bladder Phenotypes After Spinal Cord Injury With Unsupervised Machine Learning: A New Way to Examine Urinary Symptoms and Quality of Life

“…In the NBRG registry, we have shown that women are less likely to use intermittent catheters, and more likely to undergo NLUTD-related surgery; in multivariable regression female sex was associated with worse symptoms and lower QOL. 5,20 A cross-sectional study of 135 women with SCI found they had worse NLUTD symptoms than men, and their QOL was dependent on bladder management. 21 The female predominant cluster in the current study serves to both confirm these previous findings using a different analytic technique, and also to demonstrate that while female sex is likely a significant risk factor for urinary symptoms and poor QOL after SCI, it has complex interactions with other variables as women were also present (making up 33%) in the high functioning, low complications cluster.…”

Editorial Comment

“…In the accompanying article, Myers and colleagues describe important gender-specific experiences of patients with spinal cord injury (SCI) managed at tertiary urology centers. 1 The Neurogenic Bladder Symptom Score (NBSS) was administered to all patients upon entry and served as the primary outcome measure for the multicenter study. Interestingly, at entry, women had significantly higher NBSS scores, more self-reported urinary tract infections, and were much more likely to have undergone surgical intervention (catheterizable channel AE augmentation).…”