Urodynamic assessment of urinary bladder and bowel function in incomplete spinal cord injury patients

To evaluate storage safety parameters and patient-reported bladder/bowel outcomes in adults with incomplete SCI using urodynamics and validated PROMs.

Consecutive adults with incomplete SCI (AIS B-E) underwent NBSS, SF-Qualiveen, NBD, SCIM-III, and urodynamics (capacity, compliance in mL/cmH₂O, Qmax, pdet@Qmax, PVR; DSD when available). Poor compliance was prespecified as <20 mL/cmH₂O. Analyses were stratified by level and management; safety proportions used measured denominators. Categorical outcomes were compared with χ²; continuous outcomes across ⩾3 groups with Kruskal-Wallis; secondary pairwise tests used Mann-Whitney with Benjamini-Hochberg FDR correction.

N = 84; median age 35.5 years. PVR ⩾ 100 mL occurred in 71.4% and differed by neurological level (χ²(3) = 20.77, p = 0.00012). Poor compliance < 20 mL/cmH₂O occurred in 26.2% overall and clustered in sacral injuries (72.7%) versus cervical 7.1%, thoracic 10.7%, lumbar 10.0% (χ²(3) = 33.46, p = 2.6 × 10⁻⁷). Severe NBD (⩾14) differed by management (χ²(3) = 14.92, p = 0.0019). NBSS totals differed by management (H = 52.86, p = 1.96 × 10⁻¹¹), while SF-Qualiveen showed a borderline trend (H = 7.45, p ≈ 0.059). In a complete-case logistic model (outcome low compliance; predictors level, age, sex; reference thoracic), sacral level remained independently associated with poor compliance.

Elevated residual urine and impaired bladder compliance remained common despite neurological sparing. Patient-reported burden varied across bladder-management categories, while sacral lesions demonstrated a disproportionate burden of poor compliance. Combined urodynamic assessment and validated PROMs may help identify patients at risk for unsafe storage and significant symptom burden.