Department of Urology, Stanford University Medical Center, Palo Alto, California.
Division of Urology, Santa Clara Valley Medical Center, San Jose, California.
Neurourol Urodyn. 2019 Mar;38(3):975-980. doi: 10.1002/nau.23943. Epub 2019 Feb 22.
Bladder dysfunction after spinal cord injury (SCI) often requires clean intermittent catheterization (CIC) or other management strategies. A common dilemma in those desiring to perform CIC independently but lacking the appropriate upper extremity (UE) motor function is the timing of reconstructive surgery.
We assessed the National Spinal Cord Injury Data Set for the years 2000-2016. Our cohort consisted of persons with cervical SCI, who underwent complete motor examination upon discharge from rehabilitation and at 1-year follow-up. Using a previously published algorithm, UE motor scores were transformed to predict a patient's ability to independently perform CIC. Improvements in the predicted ability to self-catheterize were evaluated.
Of the 1428 individuals meeting the inclusion criteria, improvements in the predicted UE motor function necessary to independently self-catheterize were observed in 39%, 42%, and 38% of those deemed possibly able, only able with surgical assistance, or unable to self-catheterize at rehabilitation discharge, respectively. On multivariate analysis, only increasing Association Impairment Scale (AIS) classification and AIS classification improvement over the first year were associated with an increased odds of improving predicted CIC ability (odds ratio [OR] = 1.44 for AIS C and 1.97 for AIS D compared with AIS A, and OR = 1.90 for AIS classification improvement versus stable AIS classification, P < 0.05 for each).
Improvements in UE motor function to independently perform CIC occur in approximately 40% of persons with cervical SCI in the first year after rehabilitation discharge. Those with incomplete injuries are more likely to improve. These findings should enhance patient bladder management counseling and guide surgeons in determining an appropriate timeline for offering reconstruction.
脊髓损伤（SCI）后的膀胱功能障碍通常需要清洁间歇性导尿（CIC）或其他管理策略。对于那些希望独立进行 CIC 但上肢（UE）运动功能不足的人来说，一个常见的难题是重建手术的时机。
我们评估了 2000 年至 2016 年的国家脊髓损伤数据。我们的队列包括颈髓 SCI 患者，他们在康复出院时和 1 年随访时接受了完整的运动检查。使用先前发表的算法，UE 运动评分被转换为预测患者独立进行 CIC 的能力。评估了自我导尿能力的预测改善情况。
在符合纳入标准的 1428 人中，分别有 39%、42%和 38%的患者在康复出院时被认为可能能够、仅在手术协助下能够或无法独立自我导尿的患者中，观察到独立自我导尿所需的 UE 运动功能预测改善。多变量分析显示，只有不断增加的损伤协会（AIS）分类和 AIS 分类在第一年的改善与预测 CIC 能力改善的几率增加相关（与 AIS A 相比，AIS C 和 AIS D 的比值比 [OR] 分别为 1.44 和 1.97，与稳定的 AIS 分类相比，AIS 分类改善的 OR 为 1.90，P<0.05）。
在康复出院后的第一年，约有 40%的颈髓 SCI 患者 UE 运动功能能够独立进行 CIC。不完全损伤的患者更有可能改善。这些发现应增强患者膀胱管理咨询，并指导外科医生确定提供重建的适当时间线。
