Longitudinal urodynamic changes and UTI risk factors in neurogenic bladder patients using clean intermittent catheterization: a retrospective cohort study.

PURPOSE: To assess how urodynamic parameters change over time and identify urinary tract infection (UTI) risk factors in neurogenic bladder patients undergoing clean intermittent catheterization (CIC).

METHODS

This retrospective cohort study analyzed 105 neurogenic bladder patients who underwent two urodynamic studies (UDS) over 24 months while performing CIC. Researchers collected data on demographics, comorbidities, CIC use, and medications (alpha-adrenergic receptor antagonists [α-blockers], anticholinergics, beta-3 adrenergic receptor agonists). Key UDS parameters—maximum cystometric capacity, bladder compliance, detrusor overactivity (DO), maximum urinary flow rate, and postvoid residual—were compared between baseline and follow-up. Multivariate logistic regression identified independent predictors of UTI.

RESULTS

Over 24 months, most urodynamic parameters remained stable, with no significant changes in maximum cystometric capacity or maximum urinary flow rate. Poor bladder compliance (< 20 ml/cmH2O) significantly decreased from 38.1% to 24.8% (p = 0.003), while DO increased from 33.3% to 44.8% (p = 0.035). However, the maximal detrusor pressure during DO remained unchanged (median 0 cmH2O at both time points; p = 0.652). Postvoid residual showed no significant reduction (430.0 ± 139.2 ml to 408.1 ± 145.5 ml; p = 0.145). Thirteen patients (12.4%) experienced at least one symptomatic UTI. Multivariate analysis identified baseline DO as an independent risk factor for UTI (odds ratio 5.36; 95% confidence interval 1.37–20.98; p = 0.016). The use of α-blockers showed a borderline, not statistically significant association with UTI risk (odds ratio 3.86; 95% confidence interval 0.96–15.50; p = 0.057). Bladder compliance was not a statistically significant predictor of UTI.

CONCLUSION

Bladder function remained stable over 24 months in CIC patients; however, baseline DO significantly increased the risk of UTI, and the use of α-blockers showed a potentially relevant association. These findings support a risk-adapted follow-up strategy beyond the policy-mandated second UDS at 24 months, rather than a fixed time-based schedule.