Sex Differences in Bladder Management, Symptoms, and Satisfaction after Spinal Cord Injury.

PURPOSE: To characterize sex-stratified differences in bladder management and bladder symptoms and satisfaction after spinal cord injury (SCI).

MATERIALS AND METHODS: This study was a prospective, cross-sectional, observational study; eligibility included: age ≥18 years and acquired SCI. Bladder management was grouped as: (1) clean intermittent catheterization (CIC), (2) indwelling catheter (IDC), (3) surgery, and (4) voiding. Primary outcomes : Neurogenic Bladder Symptom Score (NBSS). Secondary outcomes : sub-domains of the NBSS and bladder-related satisfaction. Multivariable regression was used in sex-stratified models to establish associations between participant characteristics and outcomes.

RESULTS: 1479 participants enrolled in the study. 843 (57%) were paraplegic, 585 (40%) were women, median age and time from injury were 44.9 (IQR-34.3,54.1) and 11 (IQR-5.1, 22.4) years. Women utilized CIC at a lower rate (42.6% vs 56 . 5%) and surgery at a higher rate (22.6% vs 7.0%), especially catheterizable channel creation with or without augmentation cystoplasty (11.0% vs 1.9%). Women had worse measures of bladder symptoms and satisfaction across all outcomes. In adjusted analyses, women and men utilizing IDCs had less associated overall symptoms (NBSS), Incontinence, and Storage and Voiding. Surgery was associated with less bladder symptoms (NBSS) and Incontinence in women and was also associated with better Satisfaction in both sexes.

CONCLUSIONS: There are significant sex-stratified differences in bladder management after SCI, which included a much higher use of surgery. Bladder symptoms and satisfaction are worse across all measurements in women. Women have a substantial associated benefit with surgery while both sexes have fewer bladder symptoms with IDCs, compared to CIC.