INTRODUCTION:Individuals with spinal cord injury (SCI) have varying bladder health trajectories after their injury. We explored whether a predictive machine learning model could identify which variables impact urinary symptoms. METHODS:We used 238 variables from the Neurogenic Bladder Research Group SCI registry for a Decision Tree analysis (eCHAID technique). The primary outcomes were the baseline Neurogenic Bladder Symptom Score (NBSS), and the change from the baseline NBSS at 1-year follow up (measured as better/worse than the median change). RESULTS:Among the 1479 participants, mean baseline NBSS was 24.16 ± 0.28 (standard error of the mean). Our decision tree that evaluated the NBSS at baseline predicted that individuals with a suprapubic tube/urostomy as their primary bladder management method and good bowel QOL at baseline had the lowest (best) mean baseline NBSS at 13.44 ± 0.83. In contrast, females with baseline spontaneous voiding had the highest (worst) mean baseline NBSS at 34.42 ± 1.05. Our second decision tree evaluated the change in the NBSS at 1-year follow-up. Of the 711 participants that performed better than the median change (i.e., improved), 45% were accounted for jointly by women who did not use bladder relaxing medications at baseline, and men without a history of prior urinary tract infections who used a single bladder management method at follow-up. The predictive capacity the decision tree was 57%. CONCLUSIONS:Decision tree models help identify combinations of patient characteristics which correlate with urinary symptoms after SCI. However, there was a limited predictive capacity of the decision tree to forecast future bladder symptoms.

ABSTRACT Purpose We investigated whether severity of autonomic dysreflexia (AD) was associated with more patient‐reported bladder and bowel symptoms and compared AD severity by bladder management strategy in people with spinal cord injury (SCI). Methods The Neurogenic Bladder Research Group SCI Registry is a prospective study which evaluated quality of life after SCI. Bladder and bowel symptoms were assessed through Neurogenic Bladder Symptom Score and Neurogenic Bowel Dysfunction score, respectively. AD severity was assessed with the Autonomic Dysreflexia Following Spinal Cord Injury (ADFSCI) instrument. Bladder management was classified as volitional voiding, clean intermittent catheterization (CIC), indwelling catheter (IDC), and surgery (augmentation and diversion). Results AD scores were identified for 1473 people. The mean age was 45. Bladder management was CIC in 754 (51%), IDC in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores occurred with complete injuries (3.1 vs 3.4, p = 0.03), cervical/thoracic injuries (3.8 vs 1.5, p < 0.0001), and chronic pain (3.9 vs 2.9, p = 0.0004). IDC (5.2) and surgery (4.5) had higher ADFSCI scores than CIC (3.0) and volitional voiding (2.8) ( p < 0.0001). Sub‐analysis showed bladder augmentation had significantly higher ADSCI scores than diversion (4.7 vs 3.7, p = 0.03). On multivariate analysis, level of injury, bladder management, and bowel and bladder symptoms remained associated with worse AD. Conclusion Level of injury, age, worse bowel and bladder symptoms and bladder management type were associated with higher AD scores. Bladder management with surgery, particularly bladder augment, and IDC had associated greater AD symptoms compared to CIC or voiding. Trial Registration clinicaltrials.gov NTC06216081 and HSRP20153564, U.S. National Library of Medicine, wwwcf.nlm.nih.gov .

PURPOSE:Patients with spinal cord injuries (SCIs) experience variable urinary symptoms and quality of life (QOL). Our objective was to use machine learning to identify bladder-relevant phenotypes after SCI and assess their association with urinary symptoms and QOL. MATERIALS AND METHODS:We used data from the Neurogenic Bladder Research Group SCI registry. Baseline variables that were previously shown to be associated with bladder symptoms/QOL were included in the machine learning environment. An unsupervised consensus clustering approach (k-prototypes) was used to identify 4 patient clusters. After qualitative review of the clusters, 2 outcomes of interest were assessed: the total Neurogenic Bladder Symptom Score (NBSS) and the NBSS-satisfaction question (QOL). The NBSS and NBSS-satisfaction question at baseline and after 1 year were compared between clusters using analysis of variance and linear regression. RESULTS:Among the 1263 included participants, the 4 identified clusters were termed "female predominant," "high function, low SCI complication," "quadriplegia with bowel/bladder morbidity," and "older, high SCI complication." Using outcome data from baseline, significant differences were observed in the NBSS score, with the female predominant group exhibiting worse bladder symptoms. After 1 year, the overall bladder symptoms (NBSS Total) did not change significantly by cluster; however, the QOL score for the high function, low SCI complication group had more improvement (β = -0.12, P = .005), while the female predominant group had more deterioration (β = 0.09, P = .047). CONCLUSIONS:This study demonstrates the utility of machine learning in uncovering bladder-relevant phenotypes among SCI patients. Future research should explore cluster-based targeted strategies to enhance bladder-related outcomes and QOL in SCI.

You have accessJournal of UrologyDiversity, Equity & Inclusion: Health Equity & Outcomes II (MP34)1 May 2024MP34-04 A FRAMEWORK FOR EVALUATING HEALTH DISPARITIES IN ADULT NEUROGENIC LOWER URINARY TRACT DYSFUNCTION—SYSTEMATIC REVIEW AND NEUROGENIC BLADDER RESEARCH GROUP WORKSHOP RECOMMENDATIONS Shanice N. Cox, Taiwo Dodo-Williams, Brandee Branch, Natalia Garcia-Peñaloza, Mayra Lucas, Sara Lenherr, Iryna Crescenze, Giulia Lane, Zhina Sadeghi, Christopher Elliott, Argyrios Stampas, Rose Khavari, Daniel Wood, John T. Stoffel, and Yahir Santiago-Lastra Shanice N. CoxShanice N. Cox , Taiwo Dodo-WilliamsTaiwo Dodo-Williams , Brandee BranchBrandee Branch , Natalia Garcia-PeñalozaNatalia Garcia-Peñaloza , Mayra LucasMayra Lucas , Sara LenherrSara Lenherr , Iryna CrescenzeIryna Crescenze , Giulia LaneGiulia Lane , Zhina SadeghiZhina Sadeghi , Christopher ElliottChristopher Elliott , Argyrios StampasArgyrios Stampas , Rose KhavariRose Khavari , Daniel WoodDaniel Wood , John T. StoffelJohn T. Stoffel , and Yahir Santiago-LastraYahir Santiago-Lastra View All Author Informationhttps://doi.org/10.1097/01.JU.0001008876.78012.90.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Social determinants (SDOH) contribute to inequity and healthcare delivery differences among patients with neurogenic lower urinary tract dysfunction (NLUTD). The understanding of equity in NLUTD is hindered by the complexity of diagnoses, diverse neurological triggers, and varying patient life stages. To address this, the Neurogenic Bladder Research Group (NBRG) formed a workgroup to develop a framework for evaluating disparities in adult NLUTD, aiming to enhance health equity in clinical care and research. METHODS: Phase 1: A systematic review with Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Embase (2013-2023) through Covidence Systematic Review Software. Inclusion criteria focused on specific NLUTD sub-populations in studies reporting disparities and NLUTD-specific outcomes including urologic symptoms, treatment, continence status, and surgical history. Phase 2: The workgroup, comprised of diverse stakeholders, employed a mixed methods approach in 4 focus groups, identifying discussion themes using grounded theory analysis. RESULTS: Phase 1: 4,390 references identified, 2209 references underwent screening, 59 studies assessed for eligibility. Fewer than 10 articles met inclusion criteria. Race and ethnicity are frequently utilized variables in the articles that investigate health equity within the NLUTD population. There is an association between race and ethnicity and variations in bowel and bladder management. These factors correlated with patients' likelihood of undergoing urinary tract reconstruction and urologic evaluation. There were no studies specific to NLUTD that examined social determinants of health beyond race and ethnicity. Phase 2: Workgroup discussions, summarized in Table 1, informed intervention points, forming a foundational framework for equitable care and research for NLUTD patients. CONCLUSIONS: The systematic review underscored a literature gap, with fewer than 10 studies addressing health inequity specific to NLUTD. Targeted research is crucial to bridge this gap and establish equitable healthcare. The workgroup's framework provides collaborative guidelines for improving health equity in the NLUTD population. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e572 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shanice N. Cox More articles by this author Taiwo Dodo-Williams More articles by this author Brandee Branch More articles by this author Natalia Garcia-Peñaloza More articles by this author Mayra Lucas More articles by this author Sara Lenherr More articles by this author Iryna Crescenze More articles by this author Giulia Lane More articles by this author Zhina Sadeghi More articles by this author Christopher Elliott More articles by this author Argyrios Stampas More articles by this author Rose Khavari More articles by this author Daniel Wood More articles by this author John T. Stoffel More articles by this author Yahir Santiago-Lastra More articles by this author Expand All Advertisement PDF downloadLoading ...

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD07)1 May 2024PD07-12 QUALITY OF LIFE OUTCOMES FOR PEOPLE WITH SUPRAPUBIC CATHETER VS. INDWELLING URETHRAL CATHETER Iryna M. Crescenze, Henry M. Gold, Blayne Welk, Sean Eilliott, Sara Lenherr, Jeremy Myers, John Stoffel, and Giulia Lane Iryna M. CrescenzeIryna M. Crescenze , Henry M. GoldHenry M. Gold , Blayne WelkBlayne Welk , Sean EilliottSean Eilliott , Sara LenherrSara Lenherr , Jeremy MyersJeremy Myers , John StoffelJohn Stoffel , and Giulia LaneGiulia Lane View All Author Informationhttps://doi.org/10.1097/01.JU.0001008552.16893.70.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clean intermittent catheterization (CIC) remains the standard of care for neurogenic bladder after spinal cord injury (SCI). However, for a variety of reasons, many people continue to manage their bladder with an indwelling urethral catheter (IUC). Suprapubic catheter (SPT) is associated with lower rates of urethral related complications as opposed to IUC but minimal difference in clinical outcomes has been demonstrated. The aim of this study is to compare quality of life (QOL) and complications between people with SCI using a SPT vs IUC. METHODS: We used data from the Neurogenic Bladder Research Group (NBRG) prospective study which included adults with acquired SCI. We focused our dataset on people with either IUC or SPT who were prospectively followed for 1 year. We performed bivariate analysis evaluating neurogenic bladder symptom score (NBSS) and quality of life, rates of urinary tract infections, and prospective hospitalization rates for urologic concerns between the two catheter groups. RESULTS: Of the 1479 eligible participants, 84 used IUC and 191 used SPT. There was no difference in level of injury, gender, age, BMI, or type of insurance (Table 1). People with IUC were further out from injury (19 ± 13 vs. 15 ± 12, p=0.008). Baseline UTI rates were similar between the two groups. Over 1 year, admission rates were similar for people IUC vs. SPT with 25% vs. 27% (p=0.6) reporting being admitted for any reason and 17% vs. 23% (p=0.3) for urologic related complications, respectively. NBSS scores were higher for individuals with IUC (21 (IQR 15, 30) vs. 16 (IQR 11, 23), p<0.001) indicating worse bladder related symptoms for people with IUC. Analysis of the NBSS QOL question showed that 43% of people with IUC were unhappy or dissatisfied with their bladder management vs. 29% with SPT (p=0.034). CONCLUSIONS: Individuals with long term SCI injuries who manage their bladder with SPT report less bladder symptoms and better bladder related QOL as compared to those managing with an IUC. There were no differences noted in overall hospitalizations or urologic related hospitalizations within one year of prospective follow up between the two catheter types. This data should be used in a clinical setting when guiding bladder management decisions for patients with neurogenic bladder. Source of Funding: Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e172 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Iryna M. Crescenze More articles by this author Henry M. Gold More articles by this author Blayne Welk More articles by this author Sean Eilliott More articles by this author Sara Lenherr More articles by this author Jeremy Myers More articles by this author John Stoffel More articles by this author Giulia Lane More articles by this author Expand All Advertisement PDF downloadLoading ...

OBJECTIVE:Young adults with spina bifida (and other congenital neurologic diseases) have their own aspirations that may include education, employment, relationships and having children. As they move from pediatric to adult care, they must eventually transition to an adult healthcare team. The objective of this paper is to review the challenges and controversies in the transitional and adult care of people with congenital neurourological diseases. METHODS:The Research Group convened a meeting of its members and invited guests to better understand the healthcare challenges faced by these patients as they become adults. The group examined potential research opportunities focused on people with these diagnoses and themes related to their healthcare. RESULTS:Trust and clear communication are essential for effective patient transition. Ideally parents are involved in the transition to help reinforce independent self-care and responsibility. Adolescents require education about sexual health and independence, which may not be part of the core skillset of a urologist. The healthcare team must promote self-management and autonomy as early as practical. One of the major limitations is that adult care lacks the coordination of pediatric care, and patients may not have a "medical home." Multidisciplinary clinics are ideal but face logistical barriers in adult medicine. Additional barriers include limited physicians with the required specialized training. In the adult system, financial constraints are a key challenge for patients and providers. CONCLUSION:Collaboration, supported by institutions and new research, is vital for improving the neurourological care of young adults with complex diseases. TRIAL REGISTRATION:This study reports on the proceedings of a meeting, and therefore clinical trial registration was not necessary.

INTRODUCTION AND OBJECTIVE:Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face.METHODS:Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue.RESULTS:Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3-64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00-1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03-1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12-1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7-170], p < 0.001).CONCLUSIONS:In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not.

Aims To determine if a history of urinary stone surgery in individuals with spinal cord injury (SCI) is associated with an increased incidence of SCI-related complications and lower quality of life (QOL). Methods The Neurogenic Bladder Research Group (NBRG) registry is a multicenter, prospective, observational study which measures QOL after acquired SCI. Over 1.5 years, 1479 participants were enrolled and grouped according to history of stone surgery. We evaluated SCI-related complications, QOL, and associations between patient factors and prior stone surgery using multivariable regression. Results Participants were a median of 11 years post-SCI and 189 (12.8%) reported prior bladder or kidney stone surgery; 95.8% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8-12.8). Hospitalizations were higher for those with prior stone surgery, with common reasons including UTIs, blood clots, pressure ulcers, and pneumonia (p < 0.001). During the year of observation, the incidence of stone surgery was 17% in those with a prior history of stone surgery and 2% per year in those without prior stone surgery (p < 0.001). Controlling for covariates, bladder management strategy, age, BMI, and years since SCI were associated with history of stone surgery. Conclusions People with SCI and a history of surgical stone disease are at high risk for episodes of recurrent stones and increased hospitalizations, particularly those with kidney stones and indwelling catheter use. Identification of high-risk patients may guide tailored surveillance for complications and stone prevention strategies.

PURPOSE:To measure the incidence and severity of urinary tract infections (UTI) in intermittent catheter (IC) users with neurogenic and non-neurogenic diagnoses. MATERIALS AND METHODS:Administrative health insurance claims data from the IBM MarketScan® Database between January 1, 2015 and  December 31, 2019, were analyzed. New IC-users with neurogenic lower urinary tract dysfunction (NLUTD); IC-users without NLUTD (non-NLUTD); and age-and-sex-matched general population without IC use (GEN) were compared. Individuals were followed for one year after initial IC utilization or random index date for GEN. The primary outcome was a patient seeing a physician or attending a hospital for a UTI (measured with a primary or secondary diagnosis code related to a UTI). UTI incidence, hospitalizations, and length of hospital stay were compared. RESULT:We identified 6944 NLUTD, 5102 non-NLUTD, and 120 426 GEN individuals. The annualized UTI incidence was higher in IC-users (54.9% NLUTD IC-users and 38.9% non-NLUTD IC-users) compared to GEN individuals (9.8%) (p < 0.001 between groups). Hospitalization for UTI was more common in NLUTD and non-LUTD (11.3% and 4.0%, respectively) compared with GEN individuals (1.0%) (p < 0.001 between groups). NLUTD individuals had a greater average length of hospital stay than non-NLUTD (2.2 ± 3.6 vs. 1.6 ± 2.1 days, p < 0.001). CONCLUSION:IC users had a significantly higher incidence of UTIs than the general population. NLUTD IC-users had a higher incidence of UTIs that required hospitalization compared to non-NLUTD individuals. Strategies to decrease the patient and healthcare burden of UTIs in those that catheterize should be prioritized.

e18614 Background: To examine the relationship between neoadjuvant chemotherapy (NAC) clinical risk factors, and patient reported quality of life in patients with MIBC undergoing cystectomy. Methods: cT2-T4, N0, M0 MIBC patients who underwent radical cystectomy were identified from a prospectively maintained institutional outcomes database. PROMIS-Ca surveys (physical function (PF), pain interference, fatigue, depression, and anxiety domains) were administered at consultation and follow-up as part of routine clinical care. Patients were stratified as receiving NAC vs. none and surveys were anchored to date of cystectomy. Non-parametric kernel regressions with variance-covariance matrix bootstrapping were used to estimate the mean effect of covariates on each domain T-score with 95% confidence intervals. Covariates were: body mass index, smoking history, age, Charlson comorbidity score, pT and pN stage, urinary diversion-type, and survey time relative to the cystectomy date. T-score changes over time were modeled by including univariable parameters with a P<=0.1 in a multivariable model (MVA) for each domain and predicting the marginal means at date of cystectomy, 6 and 12 months postop. Results: The median age was 68 (IQR 60-73) years. NAC was received by 69/134 patients (40 Gem/Cis, 24 MVAC, 5 unknown). On univariate analyses NAC significantly reduces PF (mean change in t-score, 95%CI; -2.4, -3.7 to -0.8, p=0.001), trends toward more pain (0.94, -0.20 to 1.78, p=0.074), but does not influence fatigue, depression or anxiety. Other covariates with p<0.05 reducing PF were BMI (-0.31, -0.53 to -0.03), pT4 vs pT1-2 (-0.31, -0.53 to -0.03), Charlson 1 vs 0 (-0.31, -0.53 to -0.03), age (-0.31, -0.53 to -0.03), and days from surgery (-0.31, -0.53 to -0.03). Table shows how t-scores predicted from the MVA change over time. Conclusions: MIBC patients have mild to moderate impairment in physical function, fatigue, and pain before and after cystectomy, suggesting a need for increased focus on rehabilitation and wellness programs. Although the univariable analysis implies there may be differences in PF and Pain for those receiving NAC vs none, future studies with increased power are needed to properly adjust for the interplay of other significant covariates.[Table: see text]

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-16 ASSOCIATION OF URINARY STONES WITH PATIENT-REPORTED COMPLICATIONS IN SPINAL CORD INJURY Khushabu Kasabwala, Michael Borofsky, John T. Stoffel, Blayne Welk, Jeremy B. Myers, Sara M. Lenherr, and Sean P. Elliott Khushabu KasabwalaKhushabu Kasabwala More articles by this author , Michael BorofskyMichael Borofsky More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: People with spinal cord injury (SCI) have an increased risk of urinary stone formation and morbidity from the surgeries to remove them. The highest risk of stones has been postulated to be in the first year after SCI, yet the natural history and health-related impact of stone disease among this patient population remains poorly defined. We hypothesized that a history of urinary stones would be associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS: 1479 participants with SCI in the Neurogenic Bladder Research Group registry were asked about urinary stone history (pre-dating or since SCI), SCI-related complications and neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI and followed for 12 months. Neurogenic Bladder Symptom Score (NBSS) was used for QOL assessment. Continuous variables were compared by the t-test and categorical variables were compared by the chi-square test (R version 3.5.2). Because the presence of stones was assessed by participant recall, we limited to those with a history of stone surgery to capture clinically significant urinary calcifications. RESULTS: At study entry, participants were a median of 11 years post-SCI and 189 (12.8%) reported a history of bladder or kidney stone surgery; 99.5% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8 - 12.8). During the year of observation, the incidence of stone surgery was 8%-9% in those with a history of stone surgery and 2% per year in those without prior stone surgery (p=0.001). The rate of patient-reported UTI did not differ between cohorts, but those with prior stone surgery had an increased rate of UTI-related hospitalizations (p=0.013). There was a higher rate of hospitalizations for those with prior stone surgery, commonly for blood clots, UTI, pressure ulcers, and pneumonia (p=0.001). There was no clinically significant difference in NBSS QOL scores across the three cohorts. CONCLUSIONS: Urinary stones in people with SCI are associated with patient-reported complications though they do not appear to affect QOL. Those with a history of urinary stones warrant careful surveillance both for additional stone episodes and for other negative health outcomes. Source of Funding: PCORI/CER-1409-21,348 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e955-e956 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khushabu Kasabwala More articles by this author Michael Borofsky More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE? John Stoffel, Rita Shehirian, Sara Lenherr, Sean Elliott, Diana O'Dell, Jeremy Myers, and Blayne Welk John StoffelJohn Stoffel More articles by this author , Rita ShehirianRita Shehirian More articles by this author , Sara LenherrSara Lenherr More articles by this author , Sean ElliottSean Elliott More articles by this author , Diana O'DellDiana O'Dell More articles by this author , Jeremy MyersJeremy Myers More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Autonomic dysreflexia (AD) can impact both the safety and quality of life of spinal cord injured people (SCI). We investigated whether bladder, bowel or pain symptoms were associated with worsening AD symptoms. METHODS: The Neurogenic Bladder Spinal Cord Injury registry prospectively enrolled SCI people in an observational study between 1/1/2016 – 6/30/2017. People self-reported demographic, clinical, and injury information. Quality of life was assessed with Neurogenic Bowel Dysfunction (NBD), Neurogenic Bladder Symptom Score (NBSS), and SCI SF-12 questionnaires. Chronic pain was reported as a dichotomous (y/n) variable. The severity of AD was assessed from a validated AD following SCI (ADFSCI) instrument and included domains of exercise, sexual activity, bladder function, bowel function, provoked and unprovoked activities. Total ADFSCI score ranged from 0 – 24. Bladder management was defined as surgical reconstruction (augment/diversion), indwelling catheter (suprapubic/urethral), any clean intermittent catheterization (CIC), or voiding. Univariate analysis and a logistic regression model were used to determine associations between variables and ADFSCI score. RESULTS: The registry enrolled 1470 people, of which 843 (57%) had paraplegia and 894 (60%) were men. The median age was 45 years and median time from injury was 11 years. Bladder management was reported as CIC in 754 (51%), indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores were reported among people with complete (3.91 vs 3.37, p = 0.02) and cervical/thoracic injures (3.83 CT vs 1.53 LS, p<0.0001), chronic pain (3.89 vs 2.86, p=0.0004), and multiple UTI’s (4.39 vs 2.66, p<0.0001). Rising ADFSCI score correlated with positively with increasing NBD score (r=0.243, p <0.0001) and negatively with age (r=-0.189, p <0.0001). Patients with indwelling catheters (5.25) or reconstructive surgery (4.48) had higher ADFSCI scores than CIC (3.00) and voiding (2.85) (p<0.0001). Multivariable analysis showed that level of injury, age, NBD score, and bladder management remained significantly associated with rising ADFSCI score. CONCLUSIONS: There were multiple variables associated with increased autonomic dysreflexia symptoms in this SCI cohort including level of injury, younger age, and worsening bowel symptoms. From a urologic standpoint, people with an augment/diversion or bladder managed with indwelling catheter had more AD symptoms compared to CIC or voiding. Source of Funding: PCORI © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e596-e596 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Stoffel More articles by this author Rita Shehirian More articles by this author Sara Lenherr More articles by this author Sean Elliott More articles by this author Diana O'Dell More articles by this author Jeremy Myers More articles by this author Blayne Welk More articles by this author Expand All Advertisement Loading ...

Prospective, multi-centered, observational. To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. Multi-institutional sites in the United States, cohort drawn from North America. We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p < 0.001; NBSS-satisfaction 0.6, p < 0.001; SCI-QoL Difficulties 2.4, p < 0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS −2.3, p = 0.03; NBSS-satisfaction −0.4, p < 0.001) and upper tertile SCI-QoL Positive Affect (NBSS −2.8, p < 0.001; NBSS-satisfaction −0.7, p < 0.001; SCI-QoL Difficulties −0.7, p < 0.001). In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.

Study design Cross sectional. Objectives To identify variables associated with severe bowel symptoms in spinal cord injured people. Setting National cohort. Methods Adult spinal cord injured (SCI) people were recruited for an online registry and 1373 were included for analysis. Univariate analysis and logistic regression was used to evaluate associations between severity of bowel symptoms and variables. Bowel symptoms were assessed by the Neurogenic Bowel Dysfunction (NBD) score and patients scoring ≥14 were categorized as having severe bowel symptoms. Autonomic dysreflexia (AD) severity was measured using a six item questionnaire and reported as total AD score (0–24). Bladder management was categorized as: voiding, clean intermittent catheterization (CIC), surgery (augmentation/diversion) or indwelling catheter. Results Severe bowel symptoms were reported in 570 (42%) On multivariable logistic regression, every point increase of AD total score was associated with 5% increased odds of having more severe bowel symptoms [OR 1.05 95% CI 1.03–1.10]. Type of bladder management was also associated with more severe symptoms ( p = 0.0001). SCI people with indwelling catheters (OR = 2.16, 95% CI 1.40–3.32) or reconstructive surgery (OR = 1.79, 95% CI 1.08–3.32) were almost twice as likely to report more severe bowel symptoms than those performing CIC.

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-06 GENDER IMPACT ON BLADDER-RELATED OUTCOMES AND QUALITY OF LIFE AFTER PARAPLEGIC SPINAL CORD INJURY Sara Lenherr*, Jennifer S. Herrick, Sean P Elliott, Angela P. Presson, Odinachi Moghalu, John T Stoffel, Blayne Welk, and Jeremy B Myers Sara Lenherr*Sara Lenherr* More articles by this author , Jennifer S. HerrickJennifer S. Herrick More articles by this author , Sean P Elliott Sean P Elliott More articles by this author , Angela P. PressonAngela P. Presson More articles by this author , Odinachi MoghaluOdinachi Moghalu More articles by this author , John T StoffelJohn T Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Jeremy B MyersJeremy B Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Females with spinal cord injury (SCI) have been collectively analyzed along with males with SCI, despite the fact that women have fundamentally different genitourinary anatomy. We hypothesized that women have different patient reported outcomes and quality of life (QoL) related to their neurogenic bladder dysfunction. METHODS: The Neurogenic Bladder Research Group (NBRG) SCI Registry is a multicenter prospective observational study designed to assess bladder−related symptoms and QoL after SCI. Outcomes included the Neurogenic Bladder Symptom Score (NBSS) total score and a global satisfaction with urinary function question (NBSS-QoL). Bladder management was categorized as: clean intermittent catheterization without prior bladder surgery (CIC), indwelling catheter (urethral or suprapubic), surgical (bladder augmentation, catheterizable channel, urinary diversion), or voiding (condom catheter, involuntary leaking, volitional). Multivariate linear regression analysis was conducted controlling for age, obesity, years since injury, chronic pain, UTI burden (>4 per year), severe bowel dysfunction, SCI-QoL bladder management difficulties and SCI-FI fine motor score. RESULTS: 1479 participants (894 male and 585 female) were identified. Mean age of 44 ± 13 years and mean 16 ± 12 years since SCI. SCI level was: 57% paraplegia & 43% tetraplegia. Among paraplegic participants (470 male, 373 female), females who had a bladder surgery (n=71) reported a better total NBSS score (adjusted difference (AD) -3.35, 95% CI -5.85 to -0.85, p=0.009) and better bladder-related QoL (AD -0.71, 95% CI -1.03 to -0.39, p<0.0001) compared to those using intermittent catheterization (n=198). In contrast, males who had surgery (n=30) did not have a statistically different total NBSS total score (AD 1.77, 95% CI -2.01 to 5.55, p=0.36) compared to those using intermittent catheterization (n=327) but bladder-related QoL was improved (AD -0.59, 95% CI -1.11 to -0.07, p=0.03). CONCLUSIONS: There are differences in neurogenic bladder symptoms based on gender after spinal cord injury. Women with paraplegia experience worse bladder-related symptoms and have more opportunity for improvement with surgery. Educational efforts to improve bladder-related outcomes should be tailored to address gender-specific concerns. Source of Funding: PCORI CER14092138 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e696-e696 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Lenherr* More articles by this author Jennifer S. Herrick More articles by this author Sean P Elliott More articles by this author Angela P. Presson More articles by this author Odinachi Moghalu More articles by this author John T Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B Myers More articles by this author Expand All Advertisement PDF downloadLoading ...

Study design Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. Objectives To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). Setting Multiple United States hospitals. Methods 1479 participants with SCI were asked about neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI. PRUTI frequency over the last year was classified as 0, 1–3, 4–6, or >6. Four UTI QOL domains were assessed: (1) UTIs limited daily activities, (2) UTIs caused increased muscle spasms, (3) UTIs would not go away, and (4) UTIs made me avoid going out. Multivariable regression identified variables associated with poor QOL. Results PRUTI frequency was 0 in 388 patients (26%), 1–3 in 677 (46%), 4–6 in 223 (15%), and more than 6 in 190 (13%). Increasing PRUTI rate was independently associated with worse QOL for all four questions. Compared with those with 0 PRUTIs, participants reporting >6 were more likely to limit daily activities (OR 9.0 [95% CI 8.1–21.2] p < 0.0001), experience increased muscle spasms (OR 12.4 [95% CI 7.5–20.6] p < 0.0001), perceive a UTI would not go away (OR 30.1 [95% CI 15.0–60.4] p < 0.0001), and avoid going out because of UTIs (OR 7.2 [95% CI 4.2–12.4] p < 0.0001). Conclusions An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.