Cystometry Is Associated With Reduced Overall Mortality in Veterans With Suprasacral Spinal Cord Injury or Disease

Guidelines recommend initial cystometrogram for patients with suprasacral spinal cord injuries. The extent of adherence to neurogenic bladder surveillance by urodynamics and its association with survival is limited.

To assess the proportion of patients with spinal cord injury who underwent cystometrogram and the extent to which cystometrograms are associated with survival.

We emulated a target trial of veterans with spinal cord injuries who had no prior urological conditions or procedures. Measures included whether the veteran had a cystometrogram and the association between cystometrogram and mortality risk, controlling for measured confounding factors.

The cohort consisted of 43 326 veterans with a mean follow-up of 122 ± 78 months; 31% had a cystometrogram. After controlling for confounding variables, having a cystometrogram was significantly associated with reduced mortality risk (odds ratio 0.74; 95% CI 0.71-0.77; p < 0.001). This association was observed throughout all years of follow-up, with a difference of more than 7% in cumulative survival by 20 years of longest follow-up. The association was observed in veterans who had other preventative health measures, such screening colonoscopy.

Adherence to guideline-recommended cystometrograms for veterans with suprasacral spinal cord injury was low in previous observational investigations and in this study. The veterans who had cystometrogram experienced lower mortality risk throughout the 20 years of longest follow-up. This study, combined with evidence in prior investigations from our team on associations of cystometrograms on urinary system outcomes, compel re-examining approaches to increase adherence to surveillance protocols for neurogenic bladder in patients with supra-sacral spinal cord injury.