The effects of augmentation cystoplasty and botulinum toxin injection on patient‐reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization

Abstract

Aims Clean intermittent catheterization (CIC) is recommended after spinal cord injury (SCI) because it has the least complications, however, CIC has a high discontinuation rate. We hypothesized that bladder botulinum toxin injection or augmentation cystoplasty may improve satisfaction with CIC. Methods The NBRG registry is a multicenter, prospective, observational study asking SCI participants about neurogenic bladder (NGB) related quality of life (QoL). In this study, participants performing CIC as primary bladder management were categorized into 3 groups: (1) CIC alone (CIC); (2) CIC with botulinum toxin (CIC‐BTX); and (3) CIC with augmentation cystoplasty (CIC‐AUG). Outcomes included primary: Neurogenic Bladder Symptom Score (NBSS) and SCI‐QoL Bladder Management Difficulties, and secondary: NBSS subdomains (Incontinence, Storage & Voiding, Consequences) and the NBSS final question (satisfaction with urinary function). Multivariable regression, controlling for multiple factors was used to establish differences between the three groups. Results Eight hundred seventy‐nine participants performed CIC as primary bladder management and had the following characteristics: mean age 43.4 (±12.9) and years from injury 13.7 (±10.7), tetraplegia in 284 (32%), and 543 (62%) were men. Bladder management was CIC in 593 (67%), CIC‐BTX in 161 (19%), and CIC‐AUG in 125(15%). Primary outcomes: CIC‐AUG had associated improved total NBSS versus CIC(−3.2(−5.2 to −1.2), P = 0.001 and CIC‐BTX(−3.9(−6.3 to −1.6), P = 0.001), CIC‐AUG also had better SCI‐QoL Difficulties scores versus CIC(−4(−5.48 to −2.53, P < 0.001) and CIC‐BTX(−4.4(−6.15 to −2.65, P < 0.001). Secondary outcomes: CIC‐AUG had associated improved Incontinence and Satisfaction scores versus CIC and CIC‐BTX. Conclusions Compared to patients performing CIC with or without botulinum toxin treatment, those with augmentation cystoplasty had associated better urinary function and satisfaction with their urinary symptoms.

Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury

“…In our previous work, we have established relationships between demographic factors, bladder management method, injury characteristics, SCI complications and bladder-related symptoms and satisfaction [ 10 – 13 ]; however, very little is known about how psychosocial aspects of HRQoL influence bladder-related QoL. Studies have established relationships between psychosocial aspects of HRQoL factors and general QoL outcomes following SCI and how psychosocial factors such as depression, chronic pain, and independence all can influence the way people perceive biologic function [ 5 , 7 , 9 ].…”

Recommendations for evaluation of neurogenic bladder and bowel dysfunction after spinal cord injury and/or disease

“…Furthermore, studies that fall in any of the other 17 domains are currently not specifically recommended to collect data on NBB. This is important because recent 20,133 2 validation studies, 1 of which used the SCI-QOL as reference measure for the NBBS. 20,133,134 Measures bladder incontinence, leakage, accidents and management and impact on self.…”

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

“…Overall QoL among tetraplegic participants using CIC as the primary bladder management strategy is likely related to improvement in urinary concerns . 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 …”