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JU INSIGHT Sex Differences in Bladder Management, Symptoms, and Satisfaction After Spinal Cord Injury

By: Jeremy B. Myers, MD, University of Utah, Salt Lake City; John T. Stoffel, MD, University of Michigan, Ann Arbor; Sean P. Elliott, MD, MS, University of Minnesota, Minneapolis; Blayne Welk, MD, MSc, Western University, London, Ontario, Canada; Jennifer S. Herrick, MS, University of Utah, Salt Lake City; Sara M. Lenherr, MD, MS, University of Utah, Salt Lake City | Posted on: 25 Oct 2023

For the Neurogenic Bladder Research Group

Myers JB, Stoffel JT, Elliott SP, Welk B, Herrick JS, Lenherr SM. Sex differences in bladder management, symptoms, and satisfaction after spinal cord injury. J Urol. 2023;210(4):659-669.

Study Need and Importance

Bladder-related quality of life (QoL) after spinal cord injury (SCI) is complex and sits at the intersection of demographics, injury characteristics, complications from SCI, and psychosocial aspects of health-related QoL. One of the most potentially important demographic factors affecting QoL is sex. Bladder-related QoL is very important to individuals with SCI as bladder and bowel function are some of the leading health-related concerns for these individuals, sometimes even over mobility.

What We Found

In the Neurogenic Bladder Research Group SCI Registry (see Figure), we analyzed bladder-related QoL in women and men to establish which factors for each group were associated with worse bladder symptoms and satisfaction. We found that women utilized bladder surgery at a much higher rate than men, especially bladder augmentation with or without a catheterizable channel (19.3% vs 4.4%; P < .001). In an adjusted analysis, overall bladder symptoms were less in both women and men who utilized either indwelling catheters (IDCs) or had surgery in comparison to clean intermittent catheterization. An interaction analysis showed that women had fewer bladder symptoms with IDCs and surgery compared to the decrease in men associated with these bladder managements. In women, surgery, greater independence, and better positive affect and well-being were all associated with better bladder satisfaction.

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Figure. Investigators and patient stakeholders for the Neurogenic Bladder Research Group Spinal Cord Injury Registry Study, a prospective study of bladder-related quality of life after spinal cord injury.

Limitations

We only tested for the interaction of sex in our primary outcome (overall bladder symptoms); for secondary outcomes we can only comment on which variables have important associations with bladder symptoms and satisfactions within each sex, and not on differences between sexes.

Interpretation for Patient Care

In women, the higher use of surgery, along with the observation that surgery was associated with fewer bladder symptoms and higher satisfaction compared to clean intermittent catheterization, demonstrates the important role of surgery in bladder-related QoL. Participants of both sexes using IDCs had fewer associated bladder symptoms.

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