Catheterization Method and Functional Recovery of Neurogenic Bladder in Spinal Cord Injury

Abstract

Importance: Neurogenic bladder dysfunction affects up to 80% of individuals with spinal cord injury (SCI), greatly impacting quality of life and health outcomes. Although current guidelines recommend intermittent catheterization primarily for infection prevention, its potential influence on recovery of volitional bladder control remains poorly understood.

Objective: To determine whether intermittent catheterization, compared with indwelling catheterization, is associated with a higher likelihood of regaining volitional bladder control within 1 year after discharge in individuals with SCI, and to assess whether observed benefits are specific to bladder function or attributable to general neurological improvement.

Design, setting, and participants: This retrospective cohort study used prospectively collected data from rehabilitation centers affiliated with the National Spinal Cord Injury Model Systems, representing diverse clinical settings across the US (2011-2021). Participants were adults (≥18 years) with traumatic SCI discharged with either indwelling or intermittent catheterization as primary bladder management. Data analysis was performed in October 2024.

Exposure: Bladder management method at discharge (intermittent vs indwelling catheterization).

Main outcomes and measures: The primary outcome was recovery of volitional bladder control at 1 year. Secondary outcomes included improvements in sacral motor and sensory function to assess the specificity of any observed benefits to bladder function. Propensity score matching was used to minimize selection bias. Multivariable logistic regression models were used to estimate adjusted odds ratios (aORs) for outcomes.

Results: Among 1032 matched participants (median [IQR] age, 42 [27-58] years; 815 male [79.0%]), intermittent catheterization was associated with a higher rate of bladder control recovery than indwelling catheterization (88 patients [17.1%] vs 60 patients [11.6%]). After adjusting for matched covariates, intermittent catheterization was associated with significantly higher odds of bladder recovery (aOR, 2.11; 95% CI, 1.39-3.22; P < .001). No significant differences were observed for improvements in sacral motor function (120 patients [23.3%] vs 116 patients [22.4%]; aOR, 1.05; 95% CI, 0.59-1.90; P = .85) or sacral sensory function (127 patients [24.6%] vs 144 patients [27.9%]; aOR, 0.77; 95% CI, 0.43-1.37; P = .38), suggesting that the observed difference was specific to bladder function rather than general neurological recovery.

Conclusions and relevance: In this cohort study of patients with traumatic SCI, intermittent catheterization was independently associated with significantly higher odds of regaining volitional bladder control after SCI compared with indwelling catheterization, providing further evidence to support the prioritization of intermittent catheterization in this patient population.