No cystometrogram among Veterans with spinal cord injury results in adverse urinary system outcomes

Abstract: BACKGROUND: A prior study of a large cohort of veterans with supra-sacral spinal cord injury or disorder (SCI/D) showed, as seen in other cohorts, substantial variation in application of bladder care processes and, specifically in the proportion of patients undergoing cystometrography (CMG). The next step in a systematic evaluation such as this is to assess the association CMG on outcomes related to the urinary system. OBJECTIVES: To assess the association of CMG being performed with changes in bladder management, urinary tract infections, urinary stones, renal deterioration, and dialysis care. METHODS: The cohort consisted of 49,326 veterans with supra-sacral spinal cord injury or disorder (SCI/D) within the Veterans Affairs (V.A.) healthcare system first seen from fiscal year 1999 to 2024. Multivariable regression models were used to assess factors, including CMG, that affected changes in bladder management (e.g., intermittent catheterization), annual probabilities of urinary tract infections, urinary stones and time to renal deterioration and to dialysis care. RESULTS: Having a CMG was associated with a significantly lowered annual probabilities of febrile urinary tract infections and urinary stones. CMG also was associated with delay in the time to renal deterioration (measured as more than 25% year-to-year drop in estimated glomerular filtration rate; hazard ratio 0.74; 95% CI: 0.70-0.78, p<0.001), and delay in time to initiation of dialysis for end-stage renal failure (hazard ratio 0.76 (95% CI: 0.60-0.96, p<0.05). CONCLUSIONS: After adjusting for observable confounding factors, a veteran not having a CMG was associated with significantly more adverse urinary system outcomes (urinary tract infection, stone, renal insufficiency). These findings indicate a need to reexamine systemwide policies to increase the use of CMG for this cohort, as recommended in many global guidelines.