Study: Women with SCI are more likely to use indwelling catheters

In this video, Bridget Lang Findlay, MD, a reconstructive urologist with Mayo Clinic in Phoenix, Arizona, focuses on her study examining long-term bladder management strategies among women with spinal cord injuries (SCI), using data from the national Spinal Cord Injury Model Systems database spanning over 30 years.¹ The study specifically investigates how bladder management approaches have evolved in females, how they compare with male patients, and what factors contribute to transitioning to more invasive interventions like urinary diversion.

Key findings highlight that clean intermittent catheterization (CIC) emerged as the second most commonly used bladder management method over time in both sexes, aligning with recent American Urological Association guidelines for neurogenic lower urinary tract dysfunction. Notably, women with SCI were more likely to continue using CIC than men throughout the follow-up period. Despite this, females were nearly twice as likely to use indwelling urethral catheters at each time point compared with their male counterparts. Although urinary diversion was the least utilized approach overall, women showed a higher likelihood of adopting this method at 5, 10, and 15 years post-injury—typically coinciding with significant functional changes, such as transitioning to wheelchair use.

Findlay also addresses the complications associated with long-term indwelling catheter use, particularly in females. The study notes a high risk of urethral erosion with chronic urethral catheterization, leading to the guideline-recommended preference for suprapubic catheters over urethral ones. Alhtough CIC remains the preferred method, its suitability is often influenced by factors like physical ability, anatomical considerations, and availability of caregiver support. Findlay emphasizes the importance of individualized patient care, encouraging health care professionals to consider both clinical guidelines and patient-specific circumstances when making bladder management decisions. Counseling patients on the risks of urethral damage and the benefits of suprapubic catheters is essential for optimizing long-term outcomes.

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