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Recovery of Preoperative Neurogenic Bladder Dysfunction and Identification of Risk Factors for Persistent Bladder
Toshiki Okubo1,2, Narihito Nagoshi1,2, Junichi Yamane2,3
1Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Study Design:
Prospective multicenter cohort study.
Objectives:
To investigate the postoperative recovery trajectory of preoperative neurogenic bladder dysfunction (NBD) in patients with degenerative cervical myelopathy (DCM) and identify factors linked to persistent NBD after surgery.
Summary Of Background Data:
Although surgical intervention typically enhances neurological function, post-surgery bladder function recovery varies and may not align with improvements in other neurological areas. Longitudinal data on the postoperative progression of bladder functional recovery remain limited.
Methods:
This prospective study included 352 DCM patients with preoperative NBD who underwent surgery. Patients were categorized into a full recovery group (Japanese Orthopaedic Association [JOA] bladder function score = 3 at 2-year) or a persistent dysfunction group (≤2). Patient-reported bladder outcomes were evaluated using the JOA Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). General health-related quality of life was assessed using the Short Form36 Health Survey (SF-36). Binary logistic regression analysis was conducted to identify factors associated with persistent NBD.
Results:
NBD showed progressive improvement over time, and 2-year post-surgery, 71.3% of patients achieved complete recovery of bladder function. Older age at the time of surgery (odds ratio [OR], 1.029; 95% confidence interval [CI], 1.002-1.055) and lower preoperative JOA bladder function scores (OR, 0.631; 95% CI, 0.406-0.982) were independently associated with postoperative persistent NBD. The overall effective rate based on the JOACMEQ bladder function domain was 26.5%, with higher postoperative scores and effective rates observed in the full recovery group. The SF-36 Physical and Mental Component Summary scores showed no significant intergroup differences.
Conclusions:
Approximately 70% of patients with DCM and preoperative NBD achieved complete bladder functional recovery within 2-year post-surgery. Postoperative bladder functional recovery was mainly influenced by patient age and baseline NBD severity, following a recovery pattern that was distinct from other neurological domains. Bladder-specific evaluation remains crucial for postoperative assessment and patient counseling in DCM.
Level Of Evidence:
II.