Department of Surgery (Urology), University of Utah, Salt Lake City, Utah.
Departments of Urology, University of Michigan, Ann Arbor, Michigan.
J Urol. 2019 Sep;202(3):574-584. doi: 10.1097/JU.0000000000000270. Epub 2019 Aug 8.
Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods.
In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level.
Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia.
In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.
神经原性膀胱会对脊髓损伤患者造成严重影响。我们假设，4 种常见的膀胱管理方法在膀胱相关症状和生活质量方面会存在差异。
在这项前瞻性观察研究中，我们测量了脊髓损伤后与神经原性膀胱相关的生活质量。研究入选标准包括年龄≥ 18 岁和获得性脊髓损伤。膀胱管理方法分为 1）清洁间歇性导尿，2）留置导尿管，3）手术（膀胱扩大术、可插管通道或尿流改道术）和 4）排尿（避孕套导尿管、不自主漏尿或自主排尿）。主要结局指标是 NBSS（神经原性膀胱症状评分）和 SCI-QoL 困难（脊髓损伤生活质量测量系统膀胱管理困难）。次要结局指标是 NBSS 亚域和对排尿功能的满意度。多变量回归用于确定不同组之间的差异，按水平分组。
在这项研究中，共纳入 1479 名参与者，其中 843 名（57%）为截瘫患者，894 名（60%）为男性。中位年龄为 44.9 岁（IQR 34.4-54.1），从损伤到入组的中位时间为 11 年（IQR 5.1-22.4）。膀胱管理方法为清洁间歇性导尿 754 例（51%），留置导尿管 271 例（18%），手术 195 例（13%），排尿 259 例（18%）。在截瘫和四肢瘫痪患者中，与清洁间歇性导尿相比，留置导尿管和手术与较少的 NBSS 尿症状相关，而排尿与更多的症状相关。在截瘫和四肢瘫痪患者中，与清洁间歇性导尿相比，手术与 SCI-QoL 困难中较少的膀胱管理困难相关。在次要结局方面，手术与截瘫或四肢瘫痪患者的满意度提高有关。
在脊髓损伤患者中，与留置导尿管和手术相关的膀胱症状较少，与清洁间歇性导尿相比，排尿患者的膀胱症状更严重。与清洁间歇性导尿相比，手术后对泌尿系统的满意度提高。
