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The effects of augmentation cystoplasty and botulinum toxin injection on patient‐reported bladder function and quality of life among individuals with spinal cord injury performing clean intermittent catheterization
Author(s) -
Myers Jeremy B.,
Lenherr Sara M.,
Stoffel John T.,
Elliott Sean P.,
Presson Angela P.,
Zhang Chong,
Rosenbluth Jeffery,
Jha Amitabh,
Patel DarshanP,
Welk Blayne
Publication year - 2019
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23849
Subject(s) - medicine , spinal cord injury , clean intermittent catheterization , quality of life (healthcare) , botulinum toxin , rehabilitation , urinary system , urology , surgery , physical therapy , spinal cord , nursing , psychiatry
Aims Clean intermittent catheterization (CIC) is recommended after spinal cord injury (SCI) because it has the least complications, however, CIC has a high discontinuation rate. We hypothesized that bladder botulinum toxin injection or augmentation cystoplasty may improve satisfaction with CIC. Methods The NBRG registry is a multicenter, prospective, observational study asking SCI participants about neurogenic bladder (NGB) related quality of life (QoL). In this study, participants performing CIC as primary bladder management were categorized into 3 groups: (1) CIC alone (CIC); (2) CIC with botulinum toxin (CIC‐BTX); and (3) CIC with augmentation cystoplasty (CIC‐AUG). Outcomes included primary : Neurogenic Bladder Symptom Score (NBSS) and SCI‐QoL Bladder Management Difficulties, and secondary : NBSS subdomains (Incontinence, Storage & Voiding, Consequences) and the NBSS final question (satisfaction with urinary function). Multivariable regression, controlling for multiple factors was used to establish differences between the three groups. Results Eight hundred seventy‐nine participants performed CIC as primary bladder management and had the following characteristics: mean age 43.4 (±12.9) and years from injury 13.7 (±10.7), tetraplegia in 284 (32%), and 543 (62%) were men. Bladder management was CIC in 593 (67%), CIC‐BTX in 161 (19%), and CIC‐AUG in 125(15%). Primary outcomes: CIC‐AUG had associated improved total NBSS versus CIC(−3.2(−5.2 to −1.2), P = 0.001 and CIC‐BTX(−3.9(−6.3 to −1.6), P = 0.001), CIC‐AUG also had better SCI‐QoL Difficulties scores versus CIC(−4(−5.48 to −2.53, P < 0.001) and CIC‐BTX(−4.4(−6.15 to −2.65, P < 0.001). Secondary outcomes: CIC‐AUG had associated improved Incontinence and Satisfaction scores versus CIC and CIC‐BTX. Conclusions Compared to patients performing CIC with or without botulinum toxin treatment, those with augmentation cystoplasty had associated better urinary function and satisfaction with their urinary symptoms.