Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study

Spinal Cord. 2023 Jan;61(1):43-50. doi: 10.1038/s41393-022-00860-4. Epub 2022 Oct 12.


Study design: Prospective, multicenter, longitudinal cohort study.

Objectives: To describe female-male differences in first-line urological management during spinal cord injury (SCI) rehabilitation.

Setting: Inpatient specialized post-acute SCI rehabilitation in Switzerland.

Methods: Data on bladder storage medication (antimuscarinic and beta-3 agonist) use, suprapubic catheter placement, demographic and SCI characteristics was collected within 40 days of SCI and at rehabilitation discharge from May 2013-September 2021. Prevalence and indicators of bladder storage medication and suprapubic catheter use at discharge were investigated with sex-stratified descriptive and logistic regression analyses.

Results: In 748 patients (219 females, 29%), bladder storage medication use at discharge had a prevalence of 24% (95% CI: 18-29%) for females and 30% (95% CI: 26-34%) for males and was indicated by cervical AIS grade A, B, C and traumatic SCI in both sexes. Thoracic AIS grade A, B, C SCI (males), and lumbar/sacral AIS grade A, B, C SCI (females) predicted higher odds of bladder storage medication use (SCI characteristic*sex interaction, p < 0.01). Prevalence of suprapubic catheter use at discharge was 22% (95% CI: 17-28%) for females and 17% (95% CI: 14-20%) for males. Suprapubic catheter use was indicated by cervical AIS grade A, B, C SCI, and age >60 in both sexes. Females with thoracic grade A, B, C SCI tended to have higher odds of suprapubic catheter use (SCI characteristic*sex interaction, p = 0.013).

Conclusions: We identified sex differences in urological management especially in persons with AIS grade C or higher sub-cervical SCI. There is scope for well-powered, female-specific research in SCI in order to understand the underlying mechanisms and support patient-tailored management.

Publication types

  • Multicenter Study

MeSH terms

  • Cohort Studies
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Prospective Studies
  • Sex Characteristics
  • Spinal Cord Injuries* / epidemiology
  • Spinal Cord Injuries* / rehabilitation