Study tracks shifts in bladder management for female SCI patients

In this interview, Bridget Lang Findlay, MD, a reconstructive urologist with Mayo Clinic in Phoenix, Arizona discusses her recent study examining long-term trends in bladder management strategies (BMS) among women with spinal cord injury (SCI).¹ The research highlights shifts over several decades, with clean intermittent catheterization (CIC) emerging as the most common initial strategy at hospital discharge—used in 42% of cases—followed by indwelling urethral catheterization (27%) and non-invasive methods (26%). Over time, the use of non-invasive strategies declined, whereas CIC increased, likely reflecting evolving clinical standards and improved understanding of bladder function during the post-injury recovery phase, particularly spinal shock.

Findlay notes that urinary diversion (UD)—both continent and incontinent—has increased over time, potentially due to functional decline and growing burdens on patients and caregivers. Although the dataset lacked detailed information on patient decision-making and functional changes, she hypothesizes that declines in mobility, such as new wheelchair use, likely influenced transitions to UD. Transferring between a wheelchair and toilet can become physically demanding, and UD options, like ileal conduits or catheterizable stomas, offer easier management and greater independence.

The study also suggests a possible link between progressive motor decline and changes in bladder function, reinforcing the need for adaptable long-term management strategies. Although the initial BMS choice is often influenced by urinary retention during spinal shock, long-term strategies evolve based on patient function, complications, and quality of life considerations.

Findlay emphasizes the importance of continued research to better understand how physical function and patient preferences drive changes in bladder management, ultimately aiming to improve individualized care for women living with SCI.

REFERENCE

1. Findlay BL, Fadel A, Dash M, Kemble J, Viers BR, Anderson KT. Long-term trends in bladder management strategies in females following spinal cord injury. Urology. 2025 Jun 15:S0090-4295(25)00597-7. doi:10.1016/j.urology.2025.06.026