Barriers to urologic care following spinal cord injury.

Abstract

Background: Individuals with spinal cord injury (SCI) are at high risk for developing neurogenic bladder or neurogenic lower urinary tract dysfunction (NLUTD), which can lead to severe complications and negatively impact quality of life. Despite the critical need for timely urologic care, barriers to access remain poorly understood, particularly in resource-limited settings. This study aims to identify systemic and perceived barriers to urologic follow-up for individuals with SCI treated at an academic medical center.

Methods: A single-center, observational study was conducted on individuals presenting with a diagnosis code indicative of complete SCI at an academic hospital between October 2015 and October 2023. Data were extracted from electronic medical records using ICD-10 codes for SCI, and phone interviews were conducted to assess symptoms, quality of life, and perceived barriers to care. Descriptive statistics summarized the findings. Univariate and multivariate Firth logistic regression analyses were performed to analyze for possible covariates impacting the odds of follow-up or having obtained a urodynamics study.

Results: Of 213 records, 136 met the inclusion criteria. Among them, only 17 (13%) received a urology consultation during their hospital stay, and 28 (21%) had been seen in a urology clinic post-injury. Phone interviews with 42 patients revealed that 93% reported NLUTD symptoms, with a mean quality of life impact score of 7.3. Barriers identified included availability (71%), accessibility (45%), accommodation (69%), affordability (43%), and acceptability (31%) barriers. Firth logistic regression demonstrated that male sex was associated with lower odds (OR = 0.205, 95% CI: 0.048, 0.772, p = 0.02) of having obtained a urodynamics study.

Conclusion: Significant gaps in urologic care for individuals with SCI exist. Statistically significant variation in management via Firth logistic regression analyses also demonstrates potential disparities in follow-up and management. Addressing these challenges requires improved discharge planning, increased healthcare accessibility, and innovative care models such as telemedicine. Future research should explore broader geographic regions and interventions to improve outcomes.