Lower urinary changes over time in suprasacral spinal cord injury

This paper reviews 179 patients (23 females and 156 males) with suprasacral spinal cord injury (SCI) who underwent videourodynamic evaluation to compare maximum detrusor pressure, compliance, and trabeculation with methods of bladder management, years post-injury, and age. The patients were divided into four groups based on mode of bladder management: clean intermittent catheterization (CIC), indwelling catheter (IND), external collector (EC), and voiding (V). Maximum pressure decreased significantly with increasing age for those using EC (P < 0.01) and CIC (P < 0.05). Maximum pressure also decreased significantly with years post-injury for patients on EC (P < 0.01) and was highest the first decade after injury and progressively decreased through the fifth decade. Post-hoc tests indicated more severe trabeculation in patients in the EC group than in either the CIC or IND groups. Age and trabeculation did not correlate in those on EC. We conclude that patients with long-standing suprasacral SCI using EC are more likely to have lower detrusor pressures than are those with less chronic SCI. This finding may reflect the effects of age as well as reduced survival in those using EC with chronically elevated detrusor pressure.