Patterns of neurogenic lower urinary tract dysfunction management and associated

In the present study, we leveraged LCA to identify the distinct patterns of NLUTD management among individuals with SCI living in the community, and explored the association of latent classes with socio-demographic and disease-related factors. Our findings indicate that almost 82.8% (2582/3120) of community-dwelling individuals with SCI could not fully control their urination and required supplemental methods to manage NLUTD. This prevalence is consistent with previous research on NLUTD in SCI patients³. Given the high prevalence of NLUTD in this population, it is crucial for rehabilitation and urology professionals to provide more attention and interventions.

The LCA results identified a 4-class model. 40.3% of our participants (Class 1) tended to use the urinal collecting apparatus (condom catheter or incontinence pad) for NLUTD management. The multinomial logistic regression showed that urinary incontinence was significantly associated with Class 1. The finding was similar to the study in Denmark, which found the most common combination of the bladder-emptying method was IC and the use of urinal collecting apparatus due to the incontinence not being easy to overcome¹⁰. However, the urinal collecting apparatus dominated pattern is too passive which means that patients rely primarily on incontinence to urinate and may bring high risk of UTI and high intravesical pressure⁴. Persons suffered from urinary incontinence should adjust their medication to control DO, or change the IC protocol to accommodate the increased urine leaks under medical guidance. The urinal collecting apparatus should be utilized as an auxiliary method to combat incontinence rather than being the main approach for NLUTD management.

Class 2 represented 30.7% of the sample consisted of individuals who relied on bladder compression such as Credé or Valsalva maneuver to void. This approach may lead to increased intravesical pressure and bladder outlet resistance due to reflex sphincter contraction^4,17, which might cause urological complications such as structural bladder damage, vesicoureteral reflux (VUR), hydronephrosis, and renal insufficiency^4,18. Another manually assisted voiding method, triggered reflex voiding, which is not always achievable and the maneuvers are unique to each person and too difficult to master¹⁹, showed a low usage rate among participants (13.1%) and was highest in Class 2. This indicates that when individuals are unable to successfully urinate using the triggered reflex, they resort to bladder compression techniques. It is important to note that these manually assisted voiding methods should only be attempted in patients with confirmed safe urodynamic parameters. Due to the associated complications with UUT, these methods are no longer routinely recommended.

Only 19.3% of our participants belonged to Class 3 (IC dominated pattern), who tended to use IC for NLUTD management. As the mainstream NLUTD management method worldwide, IC has a low complication rate and improves continence, leading to greater community participation and decreasing home confinement¹⁹. However, our results suggest that the penetration rate of IC remains low in China. Class 4 (IUC dominated pattern) represented 9.6% of our participants. IUC is generally reserved for patients who are unable or unwilling to perform IC and have contraindications to other options like SPIC¹⁹. However, in general, IUC should only be used as a last resort due to its high complication rate, including urethral erosion, fistula, epididymitis, and periurethral abscess¹⁹.

It is well known that IC is the safest NLUTD management method for patients with SCI in terms of urological complications⁴. The results of LCA indicated that the majority of community-dwelling individuals with NLUTD after SCI were still using non-recommended NLUTD management methods. Understanding the differences between Class 3 and the other classes will aid in promoting the adoption of IC and reducing the risk of urinary complications among community-dwelling individuals with SCI.

Multinomial logistic regression analysis revealed that impaired hand function and longer duration of SCI were associated with Classes 1, 2, and 4. Apparently, impaired hand function will make it more difficult for persons to self-catheter. For these people, SPIC may be more recommended than IUC, bladder compression, and urinal collecting apparatus in the absence of contraindications because its long-term outcomes are comparable with IC²⁰. Regarding the duration of SCI, due to the late promotion of IC in China, people with a long course of SCI have less access to the IC. Therefore, the standardization process for IC should not be limited to hospitals but extended to community settings.

Unemployment was associated with Classes 1…