Anderson Collene E, Birkhäuser Veronika, Jordan Xavier, Liechti Martina D, Luca Eugenia, Möhr Sandra, Pannek Jürgen, Kessler Thomas M, Brinkhof Martin W G
Swiss Paraplegic Research, Nottwil, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Eur Urol Open Sci. 2022 Feb 15;38:1-9. doi: 10.1016/j.euros.2022.01.005. eCollection 2022 Apr.
There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI).
To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation.
The population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology.
Data were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes.
At discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0-7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79-85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18-3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52-8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35-42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18-25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26-33%). Urodynamic and renal function data were not collected.
Our population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research.
At discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence.
描述急性脊髓损伤（SCI）患者当代神经泌尿管理的流行病学证据有限。
描述SCI康复出院时神经源性下尿路功能障碍（NLUTD）的管理情况。
设计、地点和参与者：基于人群的瑞士脊髓损伤（SwiSCI）队列研究前瞻性收集了2013年至2020年602名接受专门急性SCI后康复的成年人的数据。管理策略基于欧洲泌尿外科学会（EAU）神经泌尿学指南。
出院时使用国际SCI下尿路功能基本数据集收集数据。采用多变量逻辑回归，对人口统计学、SCI特征和中心进行调整，并采用逆概率加权法来校正抽样偏差，以得出患病率估计值，并确定下尿路症状（LUTS）和NLUTD管理结果的预测因素。
出院时（SCI后中位时间：5.0个月[第一四分位数 - 第三四分位数：3.0 - 7.2]），LUTS或接受管理的NLUTD患病率为82%（95%置信区间[CI]：79 - 85%）。SCI的完整性是LUTS和接受管理的NLUTD的主要预测因素。女性尿失禁风险升高（优势比1.98[95%CI：1.18 - 3.32]），且损伤完全时风险更高（优势比4.71[95%CI：2.52 - 8.81]）。排尿功能障碍最常采用间歇性导尿管理（患病率39%[95%CI：35 - 42%]），其次是留置导尿（患病率22%[95%CI：18 - 25%]）。抗毒蕈碱或米拉贝隆的使用患病率为29%（95%CI：26 - 33%）。未收集尿动力学和肾功能数据。
我们基于人群对瑞士SCI中心采用EAU神经泌尿学指南进行泌尿管理的描述，可作为其他环境下评估的参考。数据进一步表明需要开展针对性别的神经泌尿管理研究。
脊髓损伤（SCI）康复出院时，大多数患者存在下尿路问题，尤其是那些SCI完全损伤的患者。女性尿失禁风险更高。
