Functional Recovery of Neurogenic Bladder After Spinal Cord Injury: A Propensity-Matched Analysis of Indwelling vs. Intermittent Catheterization

Introduction: Neurogenic bladder dysfunction is a common consequence of spinal cord injury (SCI), commonly requiring either indwelling catheterization (IndC) or intermittent catheterization (IntC). Clinical guidelines recommend IntC over IndC to mitigate urinary tract infection (UTI) risk; however, the impact of catheterization method on the recovery of bladder function remains underexplored. This study aims to evaluate the impact of bladder management method (IntC vs. IndC) on the likelihood of regaining volitional bladder control within one year of discharge.

Methods: We conducted a multicenter retrospective cohort study using the National Spinal Cord Injury Model Systems (SCIMS) database. Adults (n = 2,827) discharged from SCIMS centers from 2011-2021 with either IndC or IntC as their primary bladder management method were included. Propensity score matching balanced demographic and injury characteristics, resulting in 1,032 matched individuals (516 per group). The primary outcome was recovery of volitional bladder control within one year. Secondary outcomes included sacral motor and sensory improvements to determine whether bladder recovery is specific to bladder management or attributable to broader neurological improvement. Multivariable logistic regressions assessed associations between catheterization method and outcomes.

Results: The median age of the matched cohort was 42 years (IQR: 27-58) and 79% male; there were no differences in the matched characteristics between cohorts (all standardized differences <.1 and P-values >.05). Individuals managed with IntC were significantly more likely to regain bladder control within one year compared to those managed with IndC (17.1% vs. 11.6%, adjusted odds ratio [aOR] for IndC = 2.13, 95% confidence interval [CI]: 1.37-3.33, P < .0001). No significant differences were observed in sacral motor or sensory improvements (motor: P = .85; sensory: P = .38).

Conclusion : Intermittent catheterization is associated with significantly greater likelihood of regaining volitional bladder control within one year of discharge compared to indwelling catheterization, independent of general neurological improvement. These findings support the use of IntC for promoting bladder control recovery in addition to prevention of UTI to optimize functional recovery and improve quality of life for individuals with SCI.