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

• Published in: Neurourology and urodynamics 2019-01, Vol.38 (1), p.285-294
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Adult; Bladder; Botulinum toxin; Botulinum Toxins, Type A - therapeutic use; Catheterization; Female; Humans; incontinence; Injection; Intermittent Urethral Catheterization; Intubation; Male; Management; Middle Aged; neurogenic bladder; Patient Reported Outcome Measures; patient reported outcomes; Patients; Prospective Studies; Quality of Life; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - physiopathology; surgery; Urinary Bladder, Neurogenic - etiology; Urinary Bladder, Neurogenic - physiopathology; Urinary Bladder, Neurogenic - therapy; Urination - physiology
• ISSN: 0733-2467; 1520-6777
• DOI: 10.1002/nau.23849

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