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Updated: Mar 10, 2026
Paradigms of Lower Extremity Electrical Stimulation Training After Spinal Cord Injury
Published on: February 1, 2018
In-Depth Real-World Evidence: Assembling a Comprehensive Spinal Cord Injury or Disease Veteran Cohort to Advance
John Hornberger1,2, John Lavelle1,2
1Department of Veterans Affairs Palo Alto Health Care System, Urology Section, Palo Alto, California, USA.
Background:
Guidelines recommend initial cystometrography in patients with supra-sacral spinal cord injuries. Contemporary data on cohort composition and related adherence to neurogenic bladder guidelines is limited.
Objectives:
To assess treads in cohort composition and the proportion of persons with spinal cord injury who were seen by a urologist and who underwent cystometrography.
Methods:
We identified the cohort of veterans with supra-sacral spinal cord injury in whom neurogenic bladder guidelines may apply. Measures included whether the veteran was seen by a urologist and had a cystometrography procedure performed within 2 years of the first SCI/D clinic or hospital encounter. We also examined trends over 20+ year cohort composition and overall survival.
Results:
The cohort consisted of 49 347 veterans with a mean follow-up of 10.2 (SD 6.5) years. The number of new patients was more than 3000 in 2000 and has been approximately 1200 from 2020 to 2023. Prevalent patients peaked in 2019 at 25 812, followed by a decline. Eighty percent of veterans had at least one record of lower urinary tract symptoms within 1 year of their first SCI/D encounter, and more than 55% received medication for urinary conditions or urinary supplies. An urologist visit was reported for 14 408 (29%) veterans, and cystometrography (CMG) was performed in 15 512 (31%) veterans. Over 20+ years, from 2000 to 2023, the mean age of new patients increased by almost 9 years, as did the proportion of veterans with baseline comorbidities; for example, the proportion of veterans with diabetes increased from 17% in 2000 to more than 45% in 2022. Median survival was 13.3 (IQR: 6.4-22.4).
Conclusion:
The characteristics of veterans with supra-sacral SCI/D have changed to older age and more comorbidities, and most veterans have recorded lower urinary tract symptoms early after the initial SCI/D encounter. Given the study's insights into changing patient demographics, the crucial role of CMG, and the low rates of specialized urological care, there is a pressing need for enhanced awareness, surveillance, and updated treatment strategies tailored for this unique patient population. This paper calls for a concerted effort to improve healthcare delivery for veterans with supra-sacral SCI/D, aiming for early diagnosis and treatment to optimize outcomes and quality of life.
Clinical Trial Registration Statement:
The study does not require clinicaltrials. gov trial registration. The reason is that is we did not "prospectively assign people or a group of people to an intervention" (ICMJE, Section I.1). Supplemental materials for the fourth paper in this series includes a STROBE statement (STrengthening the Reporting of OBservational studies in Epidemiology; https://www.strobe-statement.org).
