Time Burden of Bladder Management in Individuals With Spinal Cord Injury

Velaer, Kyla N.; Welk, Blayne; Ginsberg, David A.; Myers, Jeremy B.; Shem, Kazuko; Elliott, Christopher S.

doi:10.46292/sci20-00007

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…Time burden for self-catheterization has been previously studied, and, although women and men had similar average times for self-catheterization, women in this study had high rates (38%) of catheterizable channel creation. 25 Our study results highlight that creation of catheterizable channels in women is an important treatment option in those that want to continue CIC.…”

Section: Discussionmentioning

confidence: 68%

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

et al. 2023

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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.

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Section: Discussionmentioning

confidence: 68%

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

et al. 2023

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“…21 ISC and bowel management are timeconsuming and require a longer duration of management, resulting in a relatively high therapeutic burden, and are associated with a lower QOL for people with an SCI. 22,23 The potential burden of each treatment should be taken into account when considering the continuity T A B L E 3 Association between catheter maintenance and symptomatic urinary tract infection. of multiple treatments because adding an additional workload may lead to diminished self-care, lower adherence to treatments, and worse treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…A survey of 1334 people with SCI in the United Kingdom showed that bowel or urinary management had a greater effect on daily life than wheelchair use or pain 21 . ISC and bowel management are time‐consuming and require a longer duration of management, resulting in a relatively high therapeutic burden, and are associated with a lower QOL for people with an SCI 22,23 . The potential burden of each treatment should be taken into account when considering the continuity of multiple treatments because adding an additional workload may lead to diminished self‐care, lower adherence to treatments, and worse treatment outcomes 24 .…”

Section: Discussionmentioning

confidence: 99%

Hygiene management of intermittent self‐catheterization using reusable silicone catheters in people with spinal cord lesions: A cross‐sectional Internet survey in Japan

Takahashi

Sekido

Matsuoka

et al. 2023

LUTS

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ObjectivesTo investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self‐catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI).MethodsWe conducted a cross‐sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI.ResultsOf 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI.ConclusionsThere are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.

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“…Previously proposed explanations for the higher rates of suprapubic catheter insertion in women include less straightforward access to the urethra, transferring difficulties [ 14 , 15 ], which along with other factors, could lead to a suprapubic catheter allowing women to have more independence [ 8 ]. In a community setting, the time required for catheterization through the urethra tended to be substantially longer for a small sample of women who were overweight or who required caregiver support [ 26 ], indicating that the suprapubic catheter might be the more convenient option for some [ 8 ]. A final factor identified in the community setting, "lack of sitting balance" was more commonly cited by females than males as an explanation of inability to perform intermittent catheterization independently [ 27 ], and this might also provide a suggestion as to why thoracic AIS grade A,B,C SCI is tentatively a female-specific predictor of suprapubic catheter use in the present study.…”

Section: Discussionmentioning

confidence: 99%

Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study

et al. 2022

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Study Design Prospective, multicenter, longitudinal cohort study. Objectives To describe female-male differences in first-line urological management during spinal cord injury (SCI) rehabilitation. Setting Inpatient specialized post-acute SCI rehabilitation in Switzerland. Methods Data on bladder storage medication (antimuscarinic and beta-3 agonist) use, suprapubic catheter placement, demographic and SCI characteristics was collected within 40 days of SCI and at rehabilitation discharge from May 2013-September 2021. Prevalence and indicators of bladder storage medication and suprapubic catheter use at discharge were investigated with sex-stratified descriptive and logistic regression analyses. Results In 748 patients (219 females, 29%), bladder storage medication use at discharge had a prevalence of 24% (95% CI: 18-29%) for females and 30% (95% CI: 26-34%) for males and was indicated by cervical AIS grade A,B,C and traumatic SCI in both sexes. Thoracic AIS grade A,B,C SCI (males), and lumbar/sacral AIS grade A,B,C SCI (females) predicted higher odds of bladder storage medication use (SCI characteristic*sex interaction, p <0.01). Prevalence of suprapubic catheter use at discharge was 22% (95% CI: 17-28%) for females and 17% (95% CI: 14-20%) for males. Suprapubic catheter use was indicated by cervical AIS grade A,B,C SCI, and age >60 in both sexes. Females with thoracic grade A,B,C SCI tended to have higher odds of suprapubic catheter use (SCI characteristic*sex interaction, p =0.013). Conclusions We identified sex differences in urological management especially in persons with AIS grade C or higher sub-cervical SCI. There is scope for well-powered, female-specific research in SCI in order to understand the underlying mechanisms and support patient-tailored management.

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Time Burden of Bladder Management in Individuals With Spinal Cord Injury

Cited by 12 publications

References 16 publications

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

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

Hygiene management of intermittent self‐catheterization using reusable silicone catheters in people with spinal cord lesions: A cross‐sectional Internet survey in Japan

Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study

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