Incidence and predictive factors for developing vesicoureteric reflux in individuals with suprasarcral spinal cord injury: a historical cohort study.

STUDY DESIGN

A historical cohort study OBJECTIVES: The aim of the study was to examine the incidence of and predictive factors for VUR in individuals with suprasacral spinal cord injury (SCI).

SETTING

Srinagarind Hospital, Khon Kaen University, Thailand METHODS: Medical records were reviewed for all individuals with SCI and neurogenic bladder admitted for urological check-up between 1996 and 2016. The primary outcome was the cumulative incidence of VUR. The statistical tests used included the Nelson-Aalen Estimator and Cox Proportional Hazard Ratio. Harrell's C concordance statistic was used to evaluate the discrimination ability of the predictive model.

RESULTS

293 participants with SCI (102 tetraplegic and 191 paraplegic) were included. Most participants were male (67%), and the median age was 52 years. The overall incidence of VUR was 7.5 cases per 100 person-years (95% CI, 6.15-9.4). In the multivariate analysis, the predictive factors for VUR were: (1) maximum detrusor pressure at first visit ≥ 75 cm of water (HR: 2.4 [95% CI: 1.4-4.1]); (2) indwelling urethral catheterization (IUC) (HR: 11.1 [95% CI: 3.9-31.7]) and clean intermittent catheterization (CIC) (HR: 6.5 [95% CI: 2.2-18.7]); (3) age ≥ 60 years at onset of SCI (HR: 1.7 [95% CI: 1.1-2.8]); and, (4) absence of antimuscarinic medication (HR: 3.8 [95% CI: 2.4-6.1]). The predictive model had an overall C-index of 0.78.

CONCLUSIONS

The incidence of VUR was high up to 12 years after SCI. High maximum detrusor pressure, IUC, age ≥ 60 years and absence of antimuscarinic medication were predictive factors for VUR.