Which factors predict regret after urinary reconstruction in spinal cord injury patients?

Lower urinary tract reconstruction remains a well-accepted approach for managing refractory neurogenic bladder in patients with spinal cord injury, but decision regret persists for some.

Fifty-two patients (mean age 54.9 years, 41 [78.8 percent] men) were included in this study, with a mean follow-up of 30 years postinjury and 21.9 years postsurgery. Most patients were Hispanic (n=41, 78.8 percent), with complete spinal cord injuries (n=39, 76 percent). 

Reconstruction procedures included bladder augmentation (n=38, 73.1 percent) and augmentation with continent catheterizable stoma (n=9, 17.3 percent).

Most participants had low regret, as indicated by the median decision regret score of 7.5. Bladder irrigation frequency (p=0.002) predicted decision regret, while other patient and surgical factors such as demographics, urinary tract infection (UTI) frequency, and surgery type did not.

Surgical regret showed a moderate association with diminished bowel-related quality of life (ρ=0.333; p=0.016) and increased Neurogenic Bladder Symptom Score (ρ=0.328; p=0.018). In addition, the incontinence (ρ=0.286; p=0.040) and consequences (ρ=0.299; p=0.031) domains showed weak associations, while the storage and voiding domain did not reach significance (ρ=0.245; p=0.080).

“Factors associated with decision regret, such as need for irrigation, should be incorporated in patient-centred decision-making,” the researchers said. 

In this study, patients with spinal cord injuries who underwent bladder reconstruction surgery at least 10 years ago were interviewed. The administered surveys involved queries on bowel quality of life and dysfunction, UTIs, and decisional regret.

The researchers assessed daily bladder management and symptoms using the Neurogenic Bladder Symptom Score and obtained data on demographics, injury characteristics, and surgical modality using chart review. They then compared decisional regret among subgroups and explored its association with patient-reported outcomes.