How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management

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Study examined the upper-extremity (UE) motor function in patient with spinal cord injury (SCI) to provide insight into why clean intermittent catheterization (CIC) 'dropout' occurs and determine a more appropriate target percentage for CIC in this patient population. Discharge data were extracted from the National Spinal Cord Injury Database (NSCID) for the years 2006 to 2012. Neurologic motor scores for C5 to C8 (involved in UE movement) were transformed into a binary variable consisting of the ability (strong) or the inability (weak) to achieve active motion against resistance. An algorithm based on expert opinion and published literature was generated to categorize a person’s ability to perform CIC by the UE function alone. Of the 4,481 patients evaluated, 77.3 percent were unable to volitionally void. Of this subset, 58.8 percent were categorized as able to catheterize, 12.9 percent as possibly able, 4.3 percent as only able with surgical assistance, and 23.3 percent as unable. Among patients discharged with an indwelling catheter, 33.4 percent had adequate UE function for CIC. Among patients performing CIC at discharge, 14.1 percent had inadequate UE function for self-catheterization. The findings suggest that CIC dropout may occur, in part, because of inadequate UE motor function. In a best-case scenario, approximately 76 percent of patients with SCI who cannot volitionally void could potentially perform CIC given appropriate assistance.

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