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Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study

Spinal Cord volume 61, pages 43–50 (2023)Cite this article

Subjects

Abstract

Study design

Prospective, multicenter, longitudinal cohort study.

Objectives

To describe female-male differences in first-line urological management during spinal cord injury (SCI) rehabilitation.

Setting

Inpatient specialized post-acute SCI rehabilitation in Switzerland.

Methods

Data on bladder storage medication (antimuscarinic and beta-3 agonist) use, suprapubic catheter placement, demographic and SCI characteristics was collected within 40 days of SCI and at rehabilitation discharge from May 2013–September 2021. Prevalence and indicators of bladder storage medication and suprapubic catheter use at discharge were investigated with sex-stratified descriptive and logistic regression analyses.

Results

In 748 patients (219 females, 29%), bladder storage medication use at discharge had a prevalence of 24% (95% CI: 18–29%) for females and 30% (95% CI: 26–34%) for males and was indicated by cervical AIS grade A, B, C and traumatic SCI in both sexes. Thoracic AIS grade A, B, C SCI (males), and lumbar/sacral AIS grade A, B, C SCI (females) predicted higher odds of bladder storage medication use (SCI characteristic*sex interaction, p < 0.01). Prevalence of suprapubic catheter use at discharge was 22% (95% CI: 17–28%) for females and 17% (95% CI: 14–20%) for males. Suprapubic catheter use was indicated by cervical AIS grade A, B, C SCI, and age >60 in both sexes. Females with thoracic grade A, B, C SCI tended to have higher odds of suprapubic catheter use (SCI characteristic*sex interaction, p = 0.013).

Conclusions

We identified sex differences in urological management especially in persons with AIS grade C or higher sub-cervical SCI. There is scope for well-powered, female-specific research in SCI in order to understand the underlying mechanisms and support patient-tailored management.

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Fig. 1: Bladder storage medication use and bladder emptying method at discharge stratified according to sex and SCI characteristics.
Fig. 2: Predicted probability of using bladder storage medication according to SCI characteristics and sex.
Fig. 3: Predicted probability of suprapubic catheter use according to SCI characteristics and sex.

Data availability

Owing to our commitment to SwiSCI study participants and their privacy, data sets generated during the current study are not made publicly available. The SwiSCI study center requires, on behalf of the SwiSCI Study Group, contact prior to any planned data usage (contact@swisci.ch).

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Acknowledgements

First of all, we thank all of the SwiSCI study participants for their invaluable contribution to this research. Additionally, we thank the SwiSCI Steering Committee with its members Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, NN (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (Balgrist University Hospital, Zürich); Margret Hund-Georgiadis, NN (REHAB Basel, Basel); Laurent Prince (Swiss Paraplegic Association, Nottwil); Heidi Hanselmann (Swiss Paraplegic Foundation, Nottwil); Daniel Joggi (Representative of persons with SCI); Mirjana Bosnjakovic (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Armin Gemperli (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).

Funding

This work was financially supported by the Swiss National Science Foundation (SNSF, 33IC30_179644). The funding body did not play a role in the design of the study, the analysis and interpretation of data or in writing the manuscript.

Author information

Author notes

  1. These authors contributed equally: Thomas M. Kessler, Martin W. G. Brinkhof.

Authors and Affiliations

  1. Swiss Paraplegic Research, Nottwil, Switzerland

    Collene E. Anderson & Martin W. G. Brinkhof

  2. Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Collene E. Anderson & Martin W. G. Brinkhof

  3. Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland

    Collene E. Anderson, Veronika Birkhäuser, Martina D. Liechti & Thomas M. Kessler

  4. Clinique Romande de Réadaptation, Sion, Switzerland

    Xavier Jordan & Eugenia Luca

  5. Neuro-Urology, REHAB Basel, Basel, Switzerland

    Sandra Möhr

  6. Department of Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland

    Jürgen Pannek

  7. Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Jürgen Pannek

Authors
  1. Collene E. Anderson
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Contributions

CEA, VB, TMK, and MWGB were responsible for the design and conceptualization of the study. Statistical analysis was performed by CEA and MWGB. CEA, VB, MDL, XJ, EL, SM, JP, TMK, and MWGB analyzed and interpreted the data. The manuscript was drafted by CEA, with the support of VB, TMK, and MWGB. All authors provided critical feedback on the manuscript regarding important intellectual content, and provided their approval on the final version.

Corresponding author

Correspondence to Martin W. G. Brinkhof.

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Competing interests

The authors declare no competing interests.

Ethical approval

Ethical approval was granted by all responsible ethics committees: Ethics Committee Northwest and Central Switzerland (EKNZ) 100/13, Ethics Committee Lucerne (LU) 12090; Ethics Committee Zurich (KEK Zurich) 2013-0249; Ethics Committee Valais (CE Valais) 032/13). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Anderson, C.E., Birkhäuser, V., Liechti, M.D. et al. Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study. Spinal Cord 61, 43–50 (2023). https://doi.org/10.1038/s41393-022-00860-4

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