Neurogenic Bladder Symptom Score Research Articles

Quality of Life and Bladder Symptoms in Adolescents and Young Adults With Spina Bifida Who Catheterize via Urethra vs Catheterizable Channel.

We sought to assess associations between health-related quality of life (QOL), bladder-related QOL, bladder symptoms, and bladder catheterization route among adolescents and young adults with spina bifida. Clinical questionnaires administered to individuals ≥ 12 years old requiring catheterization between June 2019 to March 2020 in a spina bifida center were retrospectively analyzed. Questionnaires were completed in English or Spanish independently or with caregiver assistance. Medical records were reviewed for demographic and clinical characteristics. Primary exposure was catheterization route (urethra or channel). Primary outcome was health-related QOL, measured by Patient-Reported Outcomes Measurement Information System Pediatric Global Health 7 (PGH-7). Secondary outcomes were bladder-related QOL and bladder symptoms, measured by Neurogenic Bladder Symptom Score (NBSS). Nested, multivariable linear regression models assessed associations between catheterization route and questionnaire scores. Of 162 patients requiring catheterization, 146 completed both the PGH-7 and NBSS and were included. Seventy-three percent were catheterized via urethra and 27% via channel. Median age was 17.5 years (range 12-31), 58% of patients were female, and 80% had myelomeningocele. Urinary incontinence was more common among those who catheterized via urethra (60%) compared to channel (33%). On adjusted analyses, catheterization route was not significantly associated with PGH-7 or NBSS bladder-related QOL scores. More bladder symptoms were associated with worse bladder-related QOL. Patients who catheterized via channel had fewer bladder symptoms than those who catheterized via urethra. Catheterization route was not significantly associated with QOL. Though catheterization via channel was associated with fewer bladder symptoms, only degree of current bladder symptoms was significantly associated with bladder-related QOL.

Identifying Bladder Phenotypes After Spinal Cord Injury With Unsupervised Machine Learning: A New Way to Examine Urinary Symptoms and Quality of Life.

Patients with spinal cord injuries (SCIs) experience variable urinary symptoms and quality of life (QOL). Our objective was to use machine learning to identify bladder-relevant phenotypes after SCI and assess their association with urinary symptoms and QOL. We used data from the Neurogenic Bladder Research Group SCI registry. Baseline variables that were previously shown to be associated with bladder symptoms/QOL were included in the machine learning environment. An unsupervised consensus clustering approach (k-prototypes) was used to identify 4 patient clusters. After qualitative review of the clusters, 2 outcomes of interest were assessed: the total Neurogenic Bladder Symptom Score (NBSS) and the NBSS-satisfaction question (QOL). The NBSS and NBSS-satisfaction question at baseline and after 1 year were compared between clusters using analysis of variance and linear regression. Among the 1263 included participants, the 4 identified clusters were termed "female predominant," "high function, low SCI complication," "quadriplegia with bowel/bladder morbidity," and "older, high SCI complication." Using outcome data from baseline, significant differences were observed in the NBSS score, with the female predominant group exhibiting worse bladder symptoms. After 1 year, the overall bladder symptoms (NBSS Total) did not change significantly by cluster; however, the QOL score for the high function, low SCI complication group had more improvement (β = -0.12, P = .005), while the female predominant group had more deterioration (β = 0.09, P = .047). This study demonstrates the utility of machine learning in uncovering bladder-relevant phenotypes among SCI patients. Future research should explore cluster-based targeted strategies to enhance bladder-related outcomes and QOL in SCI.

157 Minimally Invasive Treatment of Idiopathic Normal Pressure Hydrocephalus Using the Endovascular eShunt Implant

INTRODUCTION: Idiopathic Normal Pressure Hydrocephalus (NPH) is a reversible form of dementia typically treated with ventriculo-peritoneal shunt surgery. Recently we have described the first percutaneous transfemoral transvenous deployment of an endovascular CSF shunt (eShunt® System; CereVasc, Inc., Auburndale, MA, USA) to treat communicating hydrocephalus. METHODS: Patients were included after demonstrating >20% gait improvement in lumbar drainage trial. Gait was assessed using Timed Up & Go (TUG) test, cognition using Montreal cognitive assessment (MoCA), and urinary incontinence using Neurogenic Bladder Symptom Score (NBSS). Results were normalized per-patient to pre-treatment scores. A composite outcome score (COS) incorporating TUG/MOCA/NBSS was computed. RESULTS: Eleven patients (4 female; mean age 74.8 ± 4.2 years) underwent successful eShunt placement. Follow-up data showed significant improvement in gait by 35.4% at 30-days (n = 6, P < 0.003), 24.8% at 90-days (n = 6, p < 0.03) and by 32.8% at 180-days (n = 4, p < 0.01) compared to baseline. MOCA and NBSS showed significant improvements at 30-days and the COS was significantly improved at all time points (p < 0.005 at 30-, 90- and 180-days). No procedural/delayed hemorrhage or unexpected readmissions were encountered during this early follow-up phase. CONCLUSIONS: In elderly patients affected by NPH and its insidious effect on mobility, cognition and urinary continence, these results show that the endovascular eShunt implant can be safely deployed with a favorable risk profile and with rapid and sustained improvements in functional outcome scores.

Arabic version of the SF-Qualiveen: cross-cultural adaptation, translation, and validation of urinary disorder‐specific instruments in patients with multiple sclerosis

BackgroundThe Short Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients’ quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic-speaking patients with multiple sclerosis (MS).MethodsThe English version of the SF-Qualiveen was translated into Arabic using an algorithm for linguistic and cultural adaptation. MS patients completed the SF-Qualiveen, and the Neurogenic Bladder Symptom Score(NBSS) questionnaire. Psychometric features such as content and construct validity, test–retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the NBSS questionnaire. Internal consistency was measured using Cronbach’s alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test-retest reliability.ResultsOne hundred and two patients with MS were included in this study. The internal consistency of the total SF-Qualiveen, and the domains “Bother with limitations,” “Fear,” “Feeling,” and “Frequency of limitations” showed good internal consistency (Cronbach’s alpha of > 0.7). ICC was 0.91 for the total score 0.85 for the Bother with limitations, 0.81 for Fears, 0.86 for Feeling, and 0.81 for Frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.473, p = 0.027), fears (r = 0.611, p = 0.031), feelings (r = 0.572, p = 0.04), and frequency of limitations (r = 0.514, p = 0.013).ConclusionsThe findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with MS in both research and clinical practice.

Bowel and Bladder Dysfunction after SCI: A Comparison between India and Canada

Background: The inclusion of people living with spinal cord injury (SCI) in research has allowed for an informed understanding of priorities of recovery of which bowel dysfunction and bladder dysfunction have been continuously identified. Research has also demonstrated the global disparities in SCI outcomes particularly when comparing high- and low-income countries. Currently, there is a lack of direct comparison between countries when assessing SCI outcomes. Objectives: This is an exploratory study to better understand bowel and bladder dysfunction amongst individuals with SCI in India and Canada. Methods: Data from 33 participants were analyzed. Participants completed an online questionnaire assessing demographic information and the Neurogenic Bowel Dysfunction (NBD) score, Wexner score, Neurogenic Bladder Symptom Score (NBSS), and the Incontinence Quality of Life Instrument (I-QOL). Continuous data were compared using t tests. For not normally distributed data, the independent Mann-Whitney U test was used. Categorical variables were evaluated for association using Fisher's exact or chi-square test, depending on the sample size. Results: Independent Mann-Whitney U test demonstrated that the Canadian participants had poorer bowel function with higher total NBD scores (p = .007) and less frequent bowel movements (p = .036), and they were more likely to experience uneasiness, headaches, and perspiration during bowel movements (p < .001). NBSS results indicated a small but significantly higher proportion of the Indian participants were unsatisfied or unhappy with their bladder function (p = .049). The distribution of Wexner and I-QOL scores were the same across countries. Conclusion: Potential explanations for differences include lifestyle, management, financial resources, patient and caregiver education, and societal pressures, which are all heavily influenced by cultural, geographical, and economic circumstances.

Arabic version of the SF‐Qualiveen: cross-cultural adaptation, translation, and validation of urinary disorder‐specific instruments in patients with spinal cord injury

BackgroundThe Short-Form Qualiveen (SF-Qualiveen) questionnaire assesses the effect of bladder and urinary symptoms on patients' quality of life (QoL) with urological impairment caused by neurological diseases. There is no validated SF-Qualiveen questionnaire in Arabic, so this study aims to provide a translated and validated version of the SF-Qualiveen questionnaire among Arabic patients experiencing spinal cord injury (SCI).MethodsPsychometric features such as content and construct validity, test–retest reliability, and internal consistency were analyzed. Construct validity was evaluated by contrasting the SF-Qualiveen with the Neurogenic Bladder Symptom Score Short-Form (NBSS-SF) questionnaire. Internal consistency was measured using Cronbach's alpha, whereas the intraclass correlation coefficient (ICC) was employed to assess the test–retest reliability. Factorial validity was established by principal component analysis (PCA).ResultsThe internal consistency of the total SF-Qualiveen and the domains “Bother with limitations,” “Fear,” “Feeling,” and “Frequency of limitations” showed good internal consistency (Cronbach's alpha of > 0.7). ICC was 0.90 for the total score, 0.83 for the bother with limitations, 0.80 for fears, 0.84 for feeling, and 0.81 for frequency of limitations. The correlation analysis revealed a positive association between the total scores on the NBSS-SF and the domains of the SF-Qualiveen, comprising bother with limitations (r = 0.53, p = 0.02), fears (r = 0.44, p = 0.03), feelings (r = 0.49, p = 0.04), and frequency of limitations (r = 0.46, p = 0.02). The best-fit four-factor model for confirming overall item communalities ranged from 0.552 to 0.814, which indicates moderate to high communalities, and confirms the homogeneity of the SF-Qualiveen using PCA.ConclusionsThe findings of this validation study revealed that the SF-Qualiveen is a reliable and valid instrument appropriate for Arabic-speaking patients with SCI in both research and clinical practices.

Clinical tools for evaluating the severity of overactive bladder: A systematic review of psychometric properties

Objectives To systematically evaluate the evidence describing the psychometric properties of clinical measures for assessing overactive bladder symptoms (urinary urgency with or without urge urinary incontinence, urinary frequency and nocturia). To evaluate the quality of this evidence-base using the COnsensus-based Standards for selecting health status Measurement INstruments (COSMIN) checklist and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) tools. Data sources Five electronic databases (CINAHL, EMBASE, MEDLINE, Scopus and Web of Science) were searched from dataset inception to August 2023. Review methods Study screening, data extraction and quality appraisal were performed by two independent authors. Inclusion criteria were studies testing one or more psychometric properties of clinical tools for the assessment of overactive bladder symptoms among adults aged 18 years and older for both sexes. The methodological quality and quality of the evidence were evaluated using the COSMIN checklist and GRADE tools, respectively. Results The search identified 40 studies totalling 10,634 participants evaluating the psychometric properties of 15 clinical tools. The COSMIN methodological quality was rated good for most measures, and the GRADE quality of evidence ranged from low (13%) to high (33%). The Overactive Bladder Symptom Score, Overactive Bladder Questionnaire and Neurogenic Bladder Symptom Score were of good methodological and high-GRADE evidence qualities. Conclusion Overactive Bladder Symptom Score, the Overactive Bladder Questionnaire and the Neurogenic Bladder Symptoms Score are promising psychometrically sound measures. The Overactive Bladder Symptom Score has been applied to the most culturally diverse populations supported by studies of good methodological and high-GRADE evidence quality.

Gait Training Based-Motor Imagery and EEG Neurofeedback in Lokomat: A Clinical Intervention with Complete Spinal Cord Injury Individuals.

Robotic systems, such as Lokomat® have shown promising results in people with severe motor impairments, who suffered a stroke or other neurological damage. Robotic devices have also been used by people with more challenging damages, such as Spinal Cord Injury (SCI), using feedback strategies that provide information about the brain activity in real-time. This study proposes a novel Motor Imagery (MI)-based Electroencephalogram (EEG) Visual Neurofeedback (VNFB) system for Lokomat® to teach individuals how to modulate their own μ (8-12 Hz) and β (15-20 Hz) rhythms during passive walking. Two individuals with complete SCI tested our VNFB system completing a total of 12 sessions, each on different days. For evaluation, clinical outcomes before and after the intervention and brain connectivity were analyzed. As findings, the sensitivity related to light touch and painful discrimination increased for both individuals. Furthermore, an improvement in neurogenic bladder and bowel functions was observed according to the American Spinal Injury Association Impairment Scale, Neurogenic Bladder Symptom Score, and Gastrointestinal Symptom Rating Scale. Moreover, brain connectivity between different EEG locations significantly (p <0.05) increased, mainly in the motor cortex. As other highlight, both SCI individuals enhanced their μ rhythm, suggesting motor learning. These results indicate that our gait training approach may have substantial clinical benefits in complete SCI individuals.

Bladder management is the top health concern among adults with a spinal cord injury.

Individuals with spinal cord injury (SCI) commonly experience secondary complications though it is not known how they prioritize these different health domains. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to identify the top health concerns of individuals with SCI and identify factors that may be associated with these choices with particular focus on urologic issues that participants face. Participants in the NBRG registry were asked: "What are the top 3 problems that affect you on a daily basis?" Urinary symptoms and QoL were assessed with the Neurogenic Bladder Symptom Score (NBSS). Multivariate regression was used to identify factors related to selecting a top ranked health issue. Among our 1461 participants, 882 (60.4%) were men and the median age was 45.1 years (IQR 25.3-64.9). Bladder management was the most commonly top ranked primary issue (39%) followed by pain (16.4%) and bowel management (11.6%). Factors associated with ranking bladder management as the primary concern included years since injury (OR 1.01 [1.00-1.02], p = 0.042), higher (worse) total NBSS (OR 1.05 [1.03-1.06], p < 0.001), and higher (worse) NBSS QoL (OR 1.25 [1.12-1.41], p < 0.001). Reporting chronic pain on a daily basis was associated with ranking pain as the primary health concern (OR 41.7 [15.7-170], p < 0.001). In this cohort, bladder management was ranked as the top health issue and increasing time from injury was associated with increased concern over bladder management. More bladder symptoms were also associated with ranking bladder management as a primary concern while bladder management method and urinary tract infections rate were not.

MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY

You have accessJournal of UrologyCME1 Apr 2023MP52-05 BLADDER MANAGEMENT IS THE TOP HEALTH CONCERN AMONG ADULTS WITH A SPINAL CORD INJURY John P. Ratanawong, Christopher J. Loftus, Jeremy B. Myers, Sara M. Lenherr, John T. Stoffel, Blayne Welk, and Sean P. Elliott John P. RatanawongJohn P. Ratanawong More articles by this author , Christopher J. LoftusChristopher J. Loftus More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder management has been shown to be the most important health concern for people with spinal cord injury (SCI), outranking even ambulation. Incontinence, urinary tract infections (UTI) and clean intermittent catheterization (CIC) compared to other bladder management methods, have been shown to predict poor urinary quality of life (QoL) in people with SCI. But, it is unclear if these factors impact ranking bladder management as a top health concern. Using the Neurogenic Bladder Research Group (NBRG) SCI registry, our objective was to confirm whether bladder management is the top health concern and whether this is associated with urinary incontinence, UTI, or CIC utilization. METHODS: Participants in the NBRG registry were asked: “What are the top 3 problems that affect you on a daily basis? (Rank top 3): bladder management/issues, bowel management/issues, pressure ulcer, mobility issues, autonomic dysreflexia, spasticity/stiffness, pain, depression/anxiety, heart problems, lung problems, sexual function, fertility, or other.” Incontinence and urinary QoL were assessed using the Neurogenic Bladder Symptom Score (NBSS). We performed a multivariate regression to identify factors related to their primary choice. RESULTS: Among our 1460 participants, 882 (60%) were men, mean age was 44.9 years, and mean time since injury was 14.4 years. 574 (39%) ranked bladder management as their primary issue, followed by pain and bowel management (Figure 1). Factors associated with choosing bladder as the top concern included more years since injury (OR 1.02 [1.00,1.03], p<0.02), worse NBSS incontinence domain score (OR 1.06 [1.02, 1.09], p<0.01), and worse NBSS QoL (OR 1.20 [1.04, 1.37], p=0.01); UTI≥1/year (OR 1.03 [0.70, 1.50], p=0.89) and CIC (OR 1.40 [0.92, 2.14], p=0.12) were not significant. CONCLUSIONS: In this group, bladder management was ranked as the top health issue, over other sequelae of SCI. The farther out from injury people are, the more important bladder management becomes. Bladder QoL and, in particular, incontinence also drive people to view bladder issues as their top health concern. By managing incontinence in people with SCI, urologists can impact the top health concern of people with SCI. Source of Funding: PCORI-1409-21348 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information John P. Ratanawong More articles by this author Christopher J. Loftus More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Cross-cultural adaptation and validation of the Neurogenic Bladder Symptom Score for Spanish speakers

Cross-cultural adaptation and validation of the Neurogenic Bladder Symptom Score for Spanish speakers

DEVELOPMENT OF JAPANESE TRANSLATION OF THE NEUROGENIC BLADDER SYMPTOM SCORE

(Objectives) To develop Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Subjects and methods) The questionnaires were forward translated by a Japanese healthcare professional and non-medical professional and backward translated by two native English-speaking translators. Then, the products were harmonized by the participants involved in the translational processes. Finally, 15 persons with spinal cord lesions were interviewed to improve the provisional Japanese translations based on their suggestions. (Results) Throughout the forward and backward translations and their harmonization, no major translational problems were encountered, other than those attributable to differences in syntax between English and Japanese. The persons could complete the provisional Japanese translations of the standard and short forms in median 7.0 and 3.0 minutes, respectively. Although none of them reported difficulty in answering the questions, 6, 3, and 5 persons pointed out that the tenth question (the seventh question in the short form) and the answers to the nineteenth and twenty-second questions, respectively, were not easy to understand. Taking their suggestions into consideration, we finalized the Japanese translations with the help of a developer of the questionnaire as well as the back-translators. (Conclusions) After a multi-step review process, linguistically valid Japanese translations of the standard and short forms of the Neurogenic Bladder Symptom Score (Neurogenic Bladder Symptom Score Japanese version 1.0) were completed. We hope that these Japanese translations will facilitate future research on patient-reported outcomes in persons with neurogenic lower urinary tract dysfunction.

Psychometric properties of the Persian version of neurogenic bladder symptom score questionnaire: A methodological study on patients with multiple sclerosis and stroke.

Concerning the impact of neurogenic lower urinary tract dysfunction (NLUTD) on quality of life, besides the lack of standard psychometrically-analyzed Persian tools, the present study investigated the validity and reliability of the Persian version of the neurogenic bladder symptom score (NBSS) questionnaire. A total of 279 multiple sclerosis (MS) or stroke/cerebrovascular accident(CVA) patients over 18 years of age with NLUTD referred to the neurology clinics entered the study in 2021-2022. After translation, back-translation, and developing a Persian version, its validity and reliability were determined. The content validity index (CVI) and content validity ratio (CVR) were calculated quantitatively. To determine the internal consistency and scale reliability, a test-retest was used. The Cronbach's α coefficient was 0.83 and the intraclass correlation coefficient (95% confidence interval) was 0.85 (0.82, 0.88). Cronbach's α in all domains (incontinence, storage and voiding, and consequence) was greater than 0.70. The criterion validity also showed a positive correlation of NBSS with the International Consultation on IncontinenceQuestionnaire-overactive bladder (p &lt; 0.001 and r = 0.55). The face validity was acceptable according to the opinion of 10 participants. To determine the CVI and the CVR, 10 experts' panels reviewed all items related to the questionnaire in terms of necessity, clarity, transparency, and relevancy. Based on the expert panel all NBSS criteria got a high score, and all criteria were essential to assess NLUTD (CVI: 0.78-1). Regarding validity and reliability, the Persian version NBSS questionnaire can properly evaluate NLUTD in MS or stroke/CVA patients.

French version of the short form of the Neurogenic Bladder Symptom Score: Cross-cultural adaptation and validation.

This study aimed to empirically validate a French version of the Neurogenic Bladder Symptoms Score-Short From (NBSS-SF), a psychometric multidimensional tool to assess lower urinary tract symptoms (LUTS) for patients with a neurological condition. One hundred and five participants with multiple sclerosis or spinal cord injury prospectively completed the questionnaire at baseline and 7-14 days later. The α coefficient of Cronbach (internal consistency) and the intraclass correlation coefficient (ICC) (test-retest reliability) were calculated. The internal consistency for the overall questionnaire was high (Cronbach's α coefficients from 0.79), while coefficients for each subscale were variable (urinary incontinence 0.91; storage and voiding 0.69; consequences 0.25). For test-retest reliability, 88/105 (84%) patients filled and sent back their questionnaire 10 days (±3.6 days) after baseline version. ICC was 0.90 for the total score and was 0.73 for the urinary incontinence subdomain, 0.79 for storage and voiding, and 0.75 for consequences. The psychometric qualities of the French version of the NBSS-SF are well-supported, thus providing a valid tool to measure bladder symptoms across three different domains in patients with neurogenic bladder.

A Randomized Study of b3 Agonists versus Anticholinergics Administration in Patients with Multiple Sclerosis and Lower Urinary Tract Dysfunction

Abstract Introduction and Objective: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system usually affecting lower urinary tract function. In the present study, we compare the efficacy and safety of either a b3 agonist (mirabegron) or anticholinergics in treating MS patients with lower urinary tract dysfunction (LUTD) and assess the LUTD symptom improvement. Evidence Acquisition: A multi-center, single-blinded, comparative study was designed, including MS patients with LUTD. Patients were administered either mirabegron or anticholinergics in combination with standard MS treatment. All cases underwent clinical examination and completed urination diaries and validated questionnaires (Neurogenic Bladder Symptom Score and MS International Quality of Life). Furthermore, urine test analysis, as well as abdominal ultrasound imaging examination, was performed. Data on several clinical and imaging parameters were collected between the two groups at the first visit and after 3 months of treatment. Evidence Synthesis: A total of 61 patients with LUTD participated in the survey. An improvement regarding LUTD was noted in all patients. However, no statistical difference was recorded between the mirabegron and the anticholinergic group. Medical treatment was well tolerated, and no patient discontinued medication due to side effects. Conclusions: Both mirabegron and anticholinergic therapy can be administered for LUTD in MS patients. In terms of drug efficacy, no statistical difference was noted between the two cohorts at 3 months.

Prospective Evaluation of Intradetrusor Injections of OnabotulinumtoxinA in Adults With Spinal Dysraphism

ObjectiveTo prospectively evaluate the effectiveness of OnabotulinumtoxinA (BTX-A) on neurogenic overactive bladder (nOAB) in adults with congenital spinal dysraphism (CSD). MethodsWe conducted a prospective, nonrandomized pilot study of 24 adults with CSD and neurogenic overactive bladder. Patients were evaluated with baseline video-urodynamics (UDS) and validated questionnaires, underwent injection 200U BTX-A, and then underwent repeat evaluation with questionnaires and UDS 1-3 months postinjection. A high-risk subgroup was separately analyzed based on adverse clinical characteristics (ie, decrease bladder compliance, vesicoureteral reflux, hydronephrosis, chronic kidney disease). ResultsBTX-A injection improved patient recorded outcome measures seen in both I-QOL Score total (67.9 vs 75.5, P = .007) and Neurogenic Bladder Symptom Score total (38.0 vs 29.0, P = .001). On UDS, BTX-A injection significantly improved end filling pressure (16.0 vs 8.8, P = .036) and also improved bladder compliance (mL/cm H2O) (89.38 vs 135.81, P = .445). High-risk patients were found to have similar improvements in most subjective questionnaire scoring, a significant decrease in end filling pressures, and improved bladder compliance on UDS. ConclusionBTX-A can be used as an effective treatment in adults with CSD. We found that BTX-A significantly improved quality of life from patient reported outcome measurements as well as improving end filling pressures and bladder compliance. These improvements were seen even within our high-risk subgroup. Further studies are needed to evaluate long-term efficacy and appropriate follow-up of this at-risk population.

Time-Related Changes in Patient Reported Bladder Symptoms and Satisfaction after Spinal Cord Injury.

Increased time after spinal cord injury (SCI) is associated with a migration to bladder managements with higher morbidity such as indwelling catheter (IDC). Still, it is unclear how this affects bladder-related quality of life (QoL). We hypothesized that time from injury (TFI) would be associated with changes in bladder management, symptoms and satisfaction. Cross-sectional analysis of time-related changes in patient-reported bladder management, symptoms and satisfaction using the Neurogenic Bladder Research Group SCI Registry. Outcomes included Neurogenic Bladder Symptom Score (NBSS) and bladder-related satisfaction (NBSS-satisfaction). Multivariable regression was performed to assess associations between TFI and outcomes, adjusting for participant characteristics, injury specifics, and psychosocial aspects of health-related QoL. Participants with TFI <1 year were excluded and TFI was categorized 1-5 (reference), 6-10, 11-15, 16-20 and >20 years. Of 1,420 participants mean age at injury was 29.7 years (SD 13.4) and mean TFI was 15.2 years (SD 11.6). Participants grouped by TFI included 298 (21%) 1-5, 340 (24%) 6-10, 198 (14%) 11-15, 149 (10%) 16-20 and 435 (31%) >20 years. As TFI increased, clean intermittent catheterization (CIC) declined (55% 1-5 vs 45% >20 years, p <0.001) and IDC increased (16% 1-5 vs 21% >20 years, p <0.001). On multivariable analysis, increased TFI was associated with fewer bladder symptoms at >20 years from injury (-3.21 [CI -1.29, -5.14, p <0.001]) and better satisfaction (6-10 years -0.20 [CI -0.41, 0.01, p=0.070], 11-15 years -0.36 [CI -0.60, -0.11, p=0.002], 16-20 years -0.59 [CI -0.86, -0.32, p <0.001], >20 years -0.85 [CI -1.07, -0.63, <0.001]). After SCI, CIC decreases and IDC increases over time; however, increasing TFI is associated with reduced urinary symptoms and improved bladder-related satisfaction.

PD46-04 TIME-RELATED CHANGES IN PATIENT-REPORTED BLADDER SYMPTOMS AND SATISFACTION AFTER SPINAL CORD INJURY

You have accessJournal of UrologyHealth Services Research: Practice Patterns, Quality of Life and Shared Decision Making IV (PD46)1 Sep 2021PD46-04 TIME-RELATED CHANGES IN PATIENT-REPORTED BLADDER SYMPTOMS AND SATISFACTION AFTER SPINAL CORD INJURY Odinachi Moghalu, John Stoffel, Sean Elliott, Blayne Welk, Sara Lenherr, Chong Zhang, Angela Presson, and Jeremy Myers Odinachi MoghaluOdinachi Moghalu More articles by this author , John StoffelJohn Stoffel More articles by this author , Sean ElliottSean Elliott More articles by this author , Blayne WelkBlayne Welk More articles by this author , Sara LenherrSara Lenherr More articles by this author , Chong ZhangChong Zhang More articles by this author , Angela PressonAngela Presson More articles by this author , and Jeremy MyersJeremy Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002060.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Neurogenic lower urinary tract dysfunction is a significant source of concern and morbidity to individuals with spinal cord injury (SCI). Increased time from initial SCI is associated with improvements in bladder symptoms and satisfaction, despite a migration to bladder management strategies with higher morbidity such as indwelling catheters (IDC). We sought to better characterize the relationship between time from injury, bladder symptoms and satisfaction. METHODS: This is a cross-sectional analysis of time-related changes in patient reported bladder symptoms and satisfaction using data from the Neurogenic Bladder Research Group Spinal Cord Injury Registry. Study outcomes included: Neurogenic Bladder Symptom Score (NBSS-total) and its overall quality of life (QoL) question (NBSS-Satisfaction). Multivariable regression was performed to assess associations between time from injury and outcomes, adjusting for: demographics, injury characteristics, bladder management, and psychosocial aspects of health related QoL. Time from injury was categorized as 1-5 (ref.), 6-10, 11-15, 16-20, and >20 yrs. RESULTS: Of 1420 participants, median age at injury was 25.9 yrs. (IQR 19.7–38.8) and median time from injury was 11.6 yrs. (IQR 5.7–22.9). Primary bladder management changed with time from injury. There was a decline in use of clean intermittent catheterization (CIC) (55% 1-5 yrs. vs. 45% >20 yrs., p<0.001), and voiding (21% 1-5 yrs. vs. 17% >20 yrs., p<0.001) with increasing time from injury. Meanwhile, management with IDC (16% 1-5 yrs. vs. 21% >20 yrs.) and surgery (8% 1-5 yrs. vs 18% >20 yrs.) increased as time from injury increased (Figure 1). On multivariable analysis, increased time from injury was associated with less bladder symptoms (lower scores) at >20 yrs. from injury (NBSS-total -3.33, p<0.001) and better satisfaction in participants >10 yrs. from injury (NBSS-satisfaction 11-15 yrs. -0.36, 16-20 yrs. -0.59, >20 yrs. -0.86, p<0.001). CONCLUSIONS: Even in a contemporary population of SCI patients, there is a migration away from CIC, and an increase in IDC usage with time from injury. Despite this, there is a significant decrease in urinary symptoms, and improved QoL, even after adjusting for demographics, injury characteristics, bladder management, and psychosocial aspects of health related QoL. Source of Funding: This work was partially supported through a Patient-Centered Outcomes Research Institute (PCORI) Award (CER14092138). This investigation was supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant 5UL1TR001067-05 (formerly 8UL1TR000105 and UL1RR025764) © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e749-e750 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Odinachi Moghalu More articles by this author John Stoffel More articles by this author Sean Elliott More articles by this author Blayne Welk More articles by this author Sara Lenherr More articles by this author Chong Zhang More articles by this author Angela Presson More articles by this author Jeremy Myers More articles by this author Expand All Advertisement Loading ...

MP54-16 ASSOCIATION OF URINARY STONES WITH PATIENT-REPORTED COMPLICATIONS IN SPINAL CORD INJURY

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-16 ASSOCIATION OF URINARY STONES WITH PATIENT-REPORTED COMPLICATIONS IN SPINAL CORD INJURY Khushabu Kasabwala, Michael Borofsky, John T. Stoffel, Blayne Welk, Jeremy B. Myers, Sara M. Lenherr, and Sean P. Elliott Khushabu KasabwalaKhushabu Kasabwala More articles by this author , Michael BorofskyMichael Borofsky More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: People with spinal cord injury (SCI) have an increased risk of urinary stone formation and morbidity from the surgeries to remove them. The highest risk of stones has been postulated to be in the first year after SCI, yet the natural history and health-related impact of stone disease among this patient population remains poorly defined. We hypothesized that a history of urinary stones would be associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS: 1479 participants with SCI in the Neurogenic Bladder Research Group registry were asked about urinary stone history (pre-dating or since SCI), SCI-related complications and neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI and followed for 12 months. Neurogenic Bladder Symptom Score (NBSS) was used for QOL assessment. Continuous variables were compared by the t-test and categorical variables were compared by the chi-square test (R version 3.5.2). Because the presence of stones was assessed by participant recall, we limited to those with a history of stone surgery to capture clinically significant urinary calcifications. RESULTS: At study entry, participants were a median of 11 years post-SCI and 189 (12.8%) reported a history of bladder or kidney stone surgery; 99.5% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8 - 12.8). During the year of observation, the incidence of stone surgery was 8%-9% in those with a history of stone surgery and 2% per year in those without prior stone surgery (p=0.001). The rate of patient-reported UTI did not differ between cohorts, but those with prior stone surgery had an increased rate of UTI-related hospitalizations (p=0.013). There was a higher rate of hospitalizations for those with prior stone surgery, commonly for blood clots, UTI, pressure ulcers, and pneumonia (p=0.001). There was no clinically significant difference in NBSS QOL scores across the three cohorts. CONCLUSIONS: Urinary stones in people with SCI are associated with patient-reported complications though they do not appear to affect QOL. Those with a history of urinary stones warrant careful surveillance both for additional stone episodes and for other negative health outcomes. Source of Funding: PCORI/CER-1409-21,348 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e955-e956 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khushabu Kasabwala More articles by this author Michael Borofsky More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement Loading ...

PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE?

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (PD36)1 Sep 2021PD36-04 AUTONOMIC DYSREFLEXIA: WHAT VARIABLES ARE ASSOCIATED WITH WORSENING SYMPTOMS IN SPINAL CORD INJURED PEOPLE? John Stoffel, Rita Shehirian, Sara Lenherr, Sean Elliott, Diana O'Dell, Jeremy Myers, and Blayne Welk John StoffelJohn Stoffel More articles by this author , Rita ShehirianRita Shehirian More articles by this author , Sara LenherrSara Lenherr More articles by this author , Sean ElliottSean Elliott More articles by this author , Diana O'DellDiana O'Dell More articles by this author , Jeremy MyersJeremy Myers More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002040.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Autonomic dysreflexia (AD) can impact both the safety and quality of life of spinal cord injured people (SCI). We investigated whether bladder, bowel or pain symptoms were associated with worsening AD symptoms. METHODS: The Neurogenic Bladder Spinal Cord Injury registry prospectively enrolled SCI people in an observational study between 1/1/2016 – 6/30/2017. People self-reported demographic, clinical, and injury information. Quality of life was assessed with Neurogenic Bowel Dysfunction (NBD), Neurogenic Bladder Symptom Score (NBSS), and SCI SF-12 questionnaires. Chronic pain was reported as a dichotomous (y/n) variable. The severity of AD was assessed from a validated AD following SCI (ADFSCI) instrument and included domains of exercise, sexual activity, bladder function, bowel function, provoked and unprovoked activities. Total ADFSCI score ranged from 0 – 24. Bladder management was defined as surgical reconstruction (augment/diversion), indwelling catheter (suprapubic/urethral), any clean intermittent catheterization (CIC), or voiding. Univariate analysis and a logistic regression model were used to determine associations between variables and ADFSCI score. RESULTS: The registry enrolled 1470 people, of which 843 (57%) had paraplegia and 894 (60%) were men. The median age was 45 years and median time from injury was 11 years. Bladder management was reported as CIC in 754 (51%), indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). On univariate analysis, higher ADFSCI scores were reported among people with complete (3.91 vs 3.37, p = 0.02) and cervical/thoracic injures (3.83 CT vs 1.53 LS, p<0.0001), chronic pain (3.89 vs 2.86, p=0.0004), and multiple UTI’s (4.39 vs 2.66, p<0.0001). Rising ADFSCI score correlated with positively with increasing NBD score (r=0.243, p <0.0001) and negatively with age (r=-0.189, p <0.0001). Patients with indwelling catheters (5.25) or reconstructive surgery (4.48) had higher ADFSCI scores than CIC (3.00) and voiding (2.85) (p<0.0001). Multivariable analysis showed that level of injury, age, NBD score, and bladder management remained significantly associated with rising ADFSCI score. CONCLUSIONS: There were multiple variables associated with increased autonomic dysreflexia symptoms in this SCI cohort including level of injury, younger age, and worsening bowel symptoms. From a urologic standpoint, people with an augment/diversion or bladder managed with indwelling catheter had more AD symptoms compared to CIC or voiding. Source of Funding: PCORI © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e596-e596 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information John Stoffel More articles by this author Rita Shehirian More articles by this author Sara Lenherr More articles by this author Sean Elliott More articles by this author Diana O'Dell More articles by this author Jeremy Myers More articles by this author Blayne Welk More articles by this author Expand All Advertisement Loading ...