Comparison of Bladder Management Complication Outcomes in Female Spinal Cord Injury Patients

Abstract

A total of 70 female spinal cord injury patients was retrospectively analyzed for outcomes of long-term bladder management. Three groups were defined: 1) 23 patients on intermittent catheterization, 2) 25 treated by reflex voiding and incontinence padding, and 3) 22 with an indwelling catheter. Mean years of using the specific bladder management technique were 8.5 plus/minus 4.7, 15.8 plus/minus 7.3 and 16.7 plus/minus 9.0 for the 3 groups, respectively. All patients were evaluated for long-term complications. There were 4 major complications (17 percent) in the intermittent catheterization group, 10 (40 percent) in the padding group and 58 (greater than 200 percent) in the indwelling catheter group. The aggregate difference in complication rates among the 3 group was highly significant (p less than 0.00001). Of comparable long-term patients (11 to 23 years) there were no major complications among 6 on intermittent catheterization, 8 among 14 who use padding and 21 among 9 with an indwelling catheter. The differences among the groups remained significant (p less than 0.00001). Additional analyses showed highly significant differences between the catheter group and the other 2 groups (intermittent catheterization p = 0.0009 and padding p = 0.0005), and a difference that approached significance between the intermittent catheterization and padding groups (p = 0.085). The results strongly support intermittent catheterization as the optimal management of female patients following spinal cord injury given that other factors, in particular independent hand function or the need for appropriate assistance, are considered.