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Response to Letter to the Editor on No Cystometrogram Among Veterans With Spinal Cord Injury Results in Adverse Urinary System Outcomes by N. Yıldız and S. Ötken.

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Updated: Jan 31, 2026

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No Cystometrogram Among Veterans With Spinal Cord Injury Results in Adverse Urinary System Outcomes.

John Lavelle1,2, John Hornberger1,2

  • 1Department of Veterans Affairs Palo Alto Health Care System, Urology Section, Palo Alto, California, USA.

Neurourology and Urodynamics
|January 29, 2026
PubMed
Summary

Cystometrography (CMG) in veterans with spinal cord injury or disorder (SCI/D) is linked to fewer urinary tract infections, stones, and delayed kidney issues. Increased CMG use may improve bladder care outcomes for this population.

Keywords:
adherenceguidelinesspinal cord injuryurodynamics

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Area of Science:

  • Urology
  • Nephrology
  • Spinal Cord Injury Medicine

Background:

  • A previous study revealed significant variability in bladder care processes among veterans with spinal cord injury or disorder (SCI/D).
  • Specifically, the proportion of patients undergoing cystometrography (CMG) varied considerably.
  • This study aimed to evaluate the impact of CMG on urinary system outcomes.

Purpose of the Study:

  • To determine the association between performing CMG and subsequent changes in bladder management.
  • To assess the relationship between CMG and the incidence of urinary tract infections (UTIs), urinary stones, and renal deterioration.
  • To evaluate the effect of CMG on the need for dialysis care.

Main Methods:

  • The study analyzed a cohort of 49,326 veterans with SCI/D within the Veterans Affairs healthcare system from 1999 to 2024.
  • Multivariable regression models were employed to assess factors influencing bladder management changes.
  • The models also examined the annual probabilities of UTIs, urinary stones, and time to renal deterioration or dialysis initiation.

Main Results:

  • Undergoing CMG was associated with a significantly lower annual probability of febrile UTIs and urinary stones.
  • CMG use was linked to a delayed onset of renal deterioration, defined as a >25% year-to-year drop in estimated glomerular filtration rate (HR 0.74).
  • CMG was also associated with a delayed initiation of dialysis for end-stage renal failure (HR 0.76).

Conclusions:

  • Veterans with SCI/D who did not undergo CMG experienced significantly more adverse urinary system outcomes.
  • These outcomes included increased rates of urinary tract infections, stones, and renal insufficiency.
  • Findings suggest a need to review and potentially revise system-wide policies to promote increased CMG utilization in this patient group, aligning with global recommendations.