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Satisfaction with Bladder Management in Community-Dwelling Patients with Chronic Spinal Cord Injury

T. Huang¹, S. Chen¹, H. Kuo¹

¹Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien, Taiwan, Department of Urology, Hualien, Taiwan

Introduction:

Neurogenic lower urinary tract dysfunction (NLUTD) is commonly encountered in patients with chronic spinal cord injury (SCI). These patients may develop urinary incontinence due to neurogenic detrusor overactivity (NDO) with or without detrusor sphincter dyssynergia (DSD), dysuria or urinary retention due to detrusor underactivity or NDO and severe DSD. The bladder management methods used for patients with chronic SCI and NLUTD include spontaneous voiding by reflex, triggering, or abdominal pressure; clean intermittent catheterization (CIC) or clean intermittent self-catheterization (CISC); or indwelling suprapubic cystostomy or urethral catheter. This study investigated satisfaction of community-dwelling patients with SCI regarding bladder management and urological treatments.

Material and methods:

Chronic SCI patients in community health examinations were surveyed in Taiwan. A total of 1275 chronic SCI patients were surveyed for initial bladder management, urological treatments, changes in bladder management, and satisfaction with current bladder management. The advantages and disadvantages of their current bladder management were retrospectively recorded and analyzed.

Results:

The study population included 995 (78.0%) male and 280 (22.0%) female patients with SCI. The mean age was 32.9±14.9 years (range, 1–89) and the mean duration of SCI was 19.5±12.4 years (range, 1–74). The initial bladder management included suprapubic cystostomy, indwelling urethral catheter, or clean intermittent catheterization (CIC) in 884 (69.3%) patients. During follow-up, 414 (32.5%) patients did not change their initial bladder management, the remaining 861 (67.5%) received urological treatment or changing bladder management. Totally, 921 patients (72.2%) reported that they benefited from changing the initial bladder management or intervention. However, the satisfaction rate was only 40% with current bladder management and after urological treatments, 48.2% of patients were not satisfied but found it acceptable, and 10.7% of patients wished to change their current bladder management.