Timing of urological management during post-acute spinal cord injury rehabilitation

Objectives: To provide a population-based description of the timing and indicators of bladder storage medication and method of bladder emptying during post-acute specialised spinal cord injury (SCI) rehabilitation. Patients and methods: Data from patients undergoing inpatient specialised post-acute SCI rehabilitation were collected from 2013 to 2024 by the prospective, multicentre, longitudinal, Swiss Spinal Cord Injury Cohort Study (SwiSCI). Information on bladder storage medication use (antimuscarinics, β adrenergic agonists, intradetrusor onabotulinumtoxinA injections), bladder emptying method (spontaneous voiding, intermittent self-catheterisation [ISC], intermittent assisted catheterisation, suprapubic and transurethral catheterisation), demographic and SCI characteristics was collected at up to four time points (28, 84, and 168 days after SCI; 0-15 days before discharge). Multivariable time-to-event regression analyses were employed to describe time-to-first-reported medication or bladder emptying method use. Results: Bladder storage medication was used by 31% of the 1084 patients during rehabilitation (2% onabotulinumtoxinA injections), starting a median of 97 days after SCI and was associated with American Spinal Injury Association Impairment Scale (AIS) Grade A, B, C SCI. Spontaneous voiding, ISC, and suprapubic catheter were the main bladder emptying methods at discharge, starting a median of 42, 90, and 75 days after SCI. Age and SCI severity were associated with all bladder emptying methods, while sex was associated with suprapubic catheter and ISC use, but not with spontaneous voiding. Rehabilitation centre was associated with all outcomes. Conclusions: This descriptive study revealed considerable between-centre variation in the individualised patient management regarding timing of bladder storage medication and bladder emptying method during inpatient SCI rehabilitation in a high-resource setting. These findings warrant future targeted prospective research to evaluate the impact of centre-specific patient management processes on long-term upper and lower urinary tract outcomes. Between-centre differences in timing of medication and bladder emptying method initiation also need consideration in the design of multicentre randomised controlled trials during post-acute SCI rehabilitation.