Long-term Trends in Bladder Management Strategies in Females Following Spinal Cord Injury.

Objective: To describe trends in bladder management strategies (BMS) for female patients following spinal cord injury (SCI).

Methods: Data were collected from the National Spinal Cord Injury Model Systems Database on 29,202 patients from 1972 to 2016. BMS included the following categories: Noninvasive (N), Urinary Diversion (UD), Urethral Catheter (UC), Intermittent Catheterization (CIC), and suprapubic catheter. Descriptive statistics were summarized, and chi-squared analysis with Bonferroni correction was used to compare BMS among males and females.

Results: The most common BMS for females at 40 years follow up was UC (33%), followed by CIC (30%) and N (22%). The proportion of UD increased from approximately 0% initially to 7% at 40 years. At any timepoint, females were significantly more likely to have UD (2.2% vs 1.2%) and UC (24.3% vs 12.4%) compared to males but less likely to perform CIC (38.3% vs 32.8%) or use an Suprapubic Catheter (18.5% vs 9.1%) (all P <.05). Patient-reported wheelchair use was prevalent among females with UD (94%), with 67% of them reporting new wheelchair use at the time of conversion to UD.

Conclusion: The use of UC in females after SCI is commonplace despite the known risks of this BMS. UD increase over time, which may be due to complications from previous BMS or functional decline, such as transition to wheelchair use. Further studies are needed to better understand the factors that govern the choice of each BMS and the associated effect on quality of life.