title: Prospective evaluation of urological effects of aging in chronic spinal cord injury by method of bladder management.
abstract: OBJECTIVE
  Risk of treatment-related problems in spinal cord injury (SCI) mandates assessment of complication rates of different bladder management methods (BMMs). The current study evaluated aging-related complications of various BMMs over a 6-year period in a population with spinal cord injury for at least 20 years.
  
  
  METHODS
  Clinical parameters were compared using a linear mixed effects model, controlling for various confounding variables, to establish complication trends with aging and their association with BMM. Results for people whose BMM was changed during the study were evaluated separately as well as in combination with the whole population.
  
  
  RESULTS
  One hundred and ninety six people (mean age 57.4 and years post injury (YPI) 33) were evaluated on three occasions. Both age and YPI were significantly associated with rising complication rates regardless of BMM. The BMMs assessed differed in terms of complication rates. In comparison with balanced reflex voiding, straining was significantly better for renal structural abnormality. Intermittent catheterization was associated with significantly worse renal function, possibly for demographic reasons. Overall, 28.8% changed BMM during the study period, particularly, those using straining or balanced reflex voiding. The probability of change increased with age and YPI. Reasons for change of BMM were varied and there was no specific association between reason for change and BMM.
  
  
  CONCLUSIONS
  Aging and duration of injury substantially influence urological complication rates, and BMM options differ in respect of prevalence and incidence of complications. At a late stage post injury there remains a high probability of change in BMM. The findings indicate the importance of long-term planning from the time of injury to minimize late complications.
authors.affiliation: School of Surgical Sciences, University of Newcastle, United Kingdom. m.j.drake@ncl.ac.uk
authors.forename: M J
authors.initials: MJ
authors.lastname: Drake
authors.forename: M
authors.initials: M
authors.lastname: Cortina-Borja
authors.forename: G
authors.initials: G
authors.lastname: Savic
authors.forename: S W
authors.initials: SW
authors.lastname: Charlifue
authors.forename: B P
authors.initials: BP
authors.lastname: Gardner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D014546:Urinary Catheterization; D014552:Urinary Tract Infections / Q000209:etiology / Q000473:pathology / Q000628:therapy; D014555:Urination Disorders / Q000209:etiology* / Q000473:pathology / Q000628:therapy*