Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database

Spinal Cord volume 61, pages 624–631 (2023)Cite this article

Subjects

Abstract

Study design

Secondary analysis of multicentre prospective observational data.

Objectives

To describe methods of bladder emptying at admission and discharge in patients with recently acquired spinal cord injury (SCI) and to describe predictors of bladder emptying methods at discharge.

Setting

First inpatient rehabilitation in specialised rehabilitation centres in the Netherlands.

Methods

Data from the Dutch Spinal Cord Injury Database collected between 2015 and 2019 were used. McNemar-Bowker test was used to evaluate if bladder emptying methods differed over time; One-Way ANOVA and Chi-Square tests to see if bladder emptying methods differed by demographic and injury-related characteristics. Binary logistic regression was used to predict the type of bladder emptying at discharge with demographic and injury-related characteristics measured at admission.

Results

Of 1403 patients, 44.1% had cervical, 38.4% thoracic and 17.5% lumbosacral lesions at admission. AIS classification was mostly D (63.8%). The method of bladder emptying changed significantly (p < 0.001) from admission to discharge: decrease of clean intermittent assisted catheterisation (17.1% to 4.1%) and indwelling catheter (33.4% to 16.3%) and increase in clean intermittent self-catheterisation (CISC, 7.8% to 22.2%) and normal voiding (40.2% to 56.1%). Age, sex, SCI level, AIS classification and level of independence predicted the method of bladder emptying at discharge (all p < 0.001).

Conclusions

During first inpatient rehabilitation, the method of bladder emptying changed resulting in more patients discharged with normal voiding and CISC. Age, sex, SCI level, AIS classification and level of independence in self-care were all confirmed as factors playing a role in this change.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Learn more

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3

Data availability

The data analysed for this study are available from the corresponding author, upon reasonable request.

References

  1. Kuris EO, Alsoof D, Osorio C, Daniels AH. Bowel and Bladder Care in Patients With Spinal Cord Injury. J Am Acad Orthop Surg. 2022;30:263–72.

    Article  PubMed  Google Scholar 

  2. Hamid R, Averbeck MA, Chiang H, Garcia A, Al Mousa RT, Oh SJ, et al. Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World J Urology. 2018;36:1517–27.

    Article  Google Scholar 

  3. Taweel WA, Seyam R. Neurogenic bladder in spinal cord injury patients. Res Rep Urol. 2015;7:85–99.

    PubMed  PubMed Central  Google Scholar 

  4. Bloemen-Vrencken JH, Post MW, Hendriks JM, De Reus EC, De, Witte LP. Health problems of persons with spinal cord injury living in the Netherlands. Disabil Rehabil. 2005;27:1381–9.

    Article  PubMed  Google Scholar 

  5. Piatt JA, Nagata S, Zahl M, Li J, Rosenbluth JP. Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life. J Spinal Cord Med. 2016;39:693–8.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. J Spinal Cord Medicine. 2006;29:527–73.

    Google Scholar 

  7. Adriaansen JJ, van Asbeck FW, Tepper M, Faber WX, Visser-Meily JM, de Kort LM, et al. Bladder-emptying methods, neurogenic lower urinary tract dysfunction and impact on quality of life in people with long-term spinal cord injury. J Spinal Cord Med. 2017;40:43–53.

    Article  PubMed  Google Scholar 

  8. Myers JB, Lenherr SM, Stoffel JT, Elliott SP, Presson AP, Zhang C, et al. Patient Reported Bladder Related Symptoms and Quality of Life after Spinal Cord Injury with Different Bladder Management Strategies. J Urology. 2019;202:574–84.

    Article  Google Scholar 

  9. Lapides J, Diokno AC, Silber SJ, Lowe BS. Clean, intermittent self-catheterization in the treatment of urinary tract disease. J Urology. 1972;107:458–61.

    Article  CAS  Google Scholar 

  10. Romo PGB, Smith CP, Cox A, Averbeck MA, Dowling C, Beckford C, et al. Non-surgical urologic management of neurogenic bladder after spinal cord injury. World J Urology. 2018;36:1555–68.

    Article  Google Scholar 

  11. Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urology. 2000;163:768–72.

    Article  CAS  Google Scholar 

  12. Linsenmeyer TA. Catheter-associated urinary tract infections in persons with neurogenic bladders. J Spinal Cord Medicine. 2018;41:132–41.

    Article  Google Scholar 

  13. Cameron AP, Wallner LP, Tate DG, Sarma AV, Rodriguez GM, Clemens JQ. Bladder management after spinal cord injury in the United States 1972 to 2005. J Urology. 2010;184:213–7.

    Article  Google Scholar 

  14. Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS. Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop. 2011;45:141–7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cameron AP, Wallner LP, Forchheimer MB, Clemens JQ, Dunn RL, Rodriguez G, et al. Medical and psychosocial complications associated with method of bladder management after traumatic spinal cord injury. Archives Physical Medicine Rehabilitation. 2011;92:449–56.

    Article  Google Scholar 

  16. Baradaran N, Peng J, Palettas M, Chen Y, DeVivo MJ, Schwab JM. Bladder Management With Chronic Indwelling Catheter is Associated with Elevated Mortality in Patients with Spinal Cord Injury. Urology. 2022;165:72–80.

    Article  PubMed  Google Scholar 

  17. Blok B, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. European Association of Urology Guidelines on Neuro-Urology.; Available from: https://uroweb.org/guideline/neuro-urology/#3. Accessed on: December 2021.

  18. Afsar SI, Yemisci OU, Cosar SN, Cetin N. Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study. Spinal Cord. 2013;51:645–9.

    Article  CAS  PubMed  Google Scholar 

  19. Oh SW, Jung JH, Cho IK, Lee HJ, Kwon SH, Lee BS. Changes in the Trend in Bladder Emptying Methods in Patients With Spinal Cord Injury: A 20-Year Single-Center Retrospective Study. Annals Rehabilitation Medicine. 2020;44:228–37.

    Article  Google Scholar 

  20. Post MWM, Nachtegaal J, van Langeveld SA, van de Graaf M, Faber WX, Roels EH, et al. Progress of the Dutch Spinal Cord Injury Database: Completeness of Database and Profile of Patients Admitted for Inpatient Rehabilitation in 2015. Top Spinal Cord Inj Rehabil. 2018;24:141–50.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Biering-Sørensen F, Craggs M, Kennelly M, Schick E, Wyndaele JJ. International lower urinary tract function basic spinal cord injury data set. Spinal Cord. 2008;46:325–30.

    Article  PubMed  Google Scholar 

  22. Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multi-center international study. Disabil Rehabil. 2007;29:1926–33.

    Article  CAS  PubMed  Google Scholar 

  23. Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Medicine. 2011;34:535–46.

    Article  Google Scholar 

  24. Krebs J, Wöllner J, Rademacher F, Pannek J. Bladder management in individuals with spinal cord injury or disease during and after primary rehabilitation: a retrospective cohort study. World J Urology. 2022;40:1737–42.

    Article  Google Scholar 

  25. Zlatev DV, Shem K, Elliott CS. Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most. Neurourology Uurodynamics. 2018;37:1106–12.

    Article  Google Scholar 

  26. Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: A Review. Top Spinal Cord Inj Rehabil. 2019;25:195–204.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gurcay E, Bal A, Eksioglu E, Cakci A. Quality of life in patients with spinal cord injury. Int J Rehabil Res. 2010;33:356–8.

    Article  PubMed  Google Scholar 

  28. Lane GI, Driscoll A, Tawfik K, Chrouser K. A cross-sectional study of the catheter management of neurogenic bladder after traumatic spinal cord injury. Neurourology Urodynamics. 2018;37:360–7.

    Article  PubMed  Google Scholar 

  29. Central Committee on Research Involving Human Subjects: File research; Available from: https://english.ccmo.nl/investigators/additional-requirements-for-certain-types-of-research/non-wmo-research/file-research. Accessed on: June 2023.

Download references

Acknowledgements

The Dutch Spinal Cord Injury Database (DSCID) is a collaboration of the Dutch-Flemish Spinal Cord Society (DuFSCOS), including Adelante: J. Hermans, C.C.M. van Laake-Geelen; Rehabilitation Centre De Hoogstraat: C.A. Dijkstra, J.M. Stolwijk-Swüste; Rehabilitation Centre Heliomare: W.X.M. Faber, D. Gobets; Rehabilitation Centre Het Roessingh: N. Jacobs, E.M. Maas, J. Snijders-Schuttevaar; Rehabilitation Centre Reade: J.J.E. Adriaansen, W.J. Achterberg-Warmer; Rehabilitation Centre Sint Maartenskliniek: H. Bongers-Janssen, I.J.W. van Nes, M. Vos-van der Hulst; Rijndam Rehabilitation: D.C.M. Spijkerman, R. Osterthun, T. Sluis; and UMCG Centre for Rehabilitation: G.E. van der Wal, E.H. Roels, M. Tepper. The DSCID project management group consists of C.A.M. van Bennekom, J. Nachtgaal, R. Osterthun, M.W.M. Post, E.H. Roels, E.W.M. Scholten and J.M. Stolwijk-Swüste.

Funding

Quality Funds Foundation of Dutch Medical Specialists (SKMS; grant no. Z69044861).

Author information

Authors and Affiliations

  1. Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands

    Claire G. Poublon, Eline W. M. Scholten, Marcel W. M. Post & Janneke M. Stolwijk-Swüste

  2. Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands

    Michel I. A. Wyndaele

  3. University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands

    Marcel W. M. Post

Authors
  1. Claire G. Poublon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eline W. M. Scholten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel I. A. Wyndaele
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcel W. M. Post
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Janneke M. Stolwijk-Swüste
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

CP writing the paper with input from all authors. CP, ES, MP conceiving and designing the analysis. CP, ES analysing data. CP, ES, MW, MP, JS interpreting results. ES, MW, MP, JS feedback on the report. JS supervised.

Corresponding author

Correspondence to Janneke M. Stolwijk-Swüste.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

The DSCID did not need formal ethical approval because this type of study does not fall within the scope of the Dutch law on Medical Research [29]. Nevertheless, the local ethical committees and boards of all participating centres approved the provision of anonymized data on their patients for the DSCID. This study was conducted according to the Helsinki II declaration.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Poublon, C.G., Scholten, E.W.M., Wyndaele, M.I.A. et al. Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database. Spinal Cord 61, 624–631 (2023). https://doi.org/10.1038/s41393-023-00925-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41393-023-00925-y

Search

Advanced search

Quick links