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In this study, we aimed at evaluating the long-term adjustable peri-urethral balloons (PUB) durability in both male and female with neurogenic or non-neurogenic stress urinary incontinence.Each consecutive patient who underwent surgery for PUB placement before 2008 was included in this study. A PUB was proposed for patients with refractory to perineal reeducation stress urinary incontinence (SUI) caused by intrinsic sphincter deficiency. There were no exclusion criteria. Demographic, clinical and perioperative data were collected retrospectively from our clinical follow-up notes.A total of 177 patients were included in the study. Median [IQR] follow-up was 5 years [1.8-11.2]. The 3 main causes of SUI were radical prostatectomy (n=82, 46.3%), idiopathic intrinsic sphincter deficiency (n=55, 31.1%) and neurogenic sphincter deficiency (n=32, 18.1%). Complete continence (no pad necessary) was achieved for 109 patients (61.6%). At the end of the follow-up, the PUB global survival rate was 47.5% (Fig. 1). Median [IQR] PUB survival without removal was 57.8 months [42.3-81.7]. PUB survival without failure rate was 68.4% accounting for a median [IQR] survival duration of 116.9 months [86.2-176.9] CONCLUSION: In this study, we evidenced acceptable long-term efficiency and survival of PUB in the management of SUI in both neurogenic and non-neurogenic population. Given those results it could be a good alternative to AUS on unfit or unwilling population.

To perform a narrative review of the contemporary literature on the diagnosis, prognosis and adjuvant management of muscle-invasive bladder cancer (MIBC) patients with pathological pelvic lymph node involvement (pN+) at radical cystectomy.A narrative review of the contemporary literature available on Medline was conducted to report studies evaluating the diagnosis, prognosis and/or adjuvant treatments for MIBC patients with pN+ disease at radical cystectomy.Open or robotic extended pelvic lymph node dissection up to the crossing of the ureter with common iliac vessels can enhance the diagnosis of pN+ MIBC, especially using separate packages for the submission of a maximum number of lymph nodes. The main prognosis factors for pN+ patients are the number of positive and retrieved lymph nodes, lymph node density, extranodal extension as well as lymph node metastasis diameter. Adjuvant chemotherapy is likely to prolong overall survival in pN+ patients treated with radical cystectomy alone while adjuvant immunotherapy using nivolumab has been shown to decrease the risk of recurrence in all pN+ patients, especially those with ypN+ disease after neoadjuvant chemotherapy followed by radical cystectomy. However, few data are currently available on the role of adjuvant radiation therapy, which remains currently experimental for these patients.Multiple parameters have been reported to impact the diagnosis and prognosis of patients with pN+ MIBC at radical cystectomy. Adjuvant management is currently based on chemotherapy and immunotherapy with preliminary data on radiation therapy.

Urinary prostheses for the treatment of male stress urinary incontinence ranged from simple to adjustable bulbourethral compressing devices to complex artificial urinary sphincter. Those devices have remarkably evolved since the 1950s. In this article, we review the story of a patient who experienced this device evolution. His history provides us with the opportunity to retrieve the historical transformation of the incontinence prostheses around time. Moreover, this patient story challenges us on those devices past and present limitations.

Sacral neuromodulation (SNM) is a minimally invasive technique that provides effective treatment for the management of refractory overactive bladder (OAB), non-obstructive urinary retention (NOUR), and fecal incontinence (FI). This study assessed patient preferences between the currently available non-rechargeable SNM device and a new, full-body magnetic resonance imaging (MRI)-safe, smaller, rechargeable device.An online cross-sectional survey was conducted among French OAB, NOUR, FI patients, recruited via a market research vendor. To assess their preferences, patients were asked to indicate their level of agreement with 10 statements regarding the size of the device, its rechargeability, and the role of MRI using a 6-item Likert scale. A descriptive statistical analysis was performed.In all, 95 patients (68% women), mean age 50 years, were included in the study: 51% were treated for OAB; 44% received an oral treatment and 28% had SNM. Overall, 71% of the 95 patients indicated a preference for the new device; 75% considered that recharging the device would not impact their lifestyle; 74% believed that the smaller size of the rechargeable device would facilitate their choice to be treated with SNM; 80% found full-body MRI compatibility important.Most patients may prefer the new rechargeable SNM device over the current "standard". Compatibility with full-body MRI and the smaller device size seemed the key features of the newer device that would influence their choice of being treated with SNM. Future national and international recommendations should consider a shared decision-making process between the physician and the patient.

Management of pregnancy and delivery in women with lower urinary tract reconstruction is challenging and the currently available literature is insufficient to guide clinical practice. We report pregnancy and delivery outcomes in this specific population.We conducted a national multicenter retrospective study (16 centers) including 68 women with 96 deliveries between 1998 and 2019. These women had at least 1 successful pregnancy and delivery after augmentation enterocystoplasty, catheterizable channel creation and/or artificial urinary sphincter implantation. Maternal and fetal complications during pregnancy and delivery were reported, as well as postpartum functional outcomes, according to the delivery mode. The chi-square test and Student's t-test were used to compare categorical and continuous variables, respectively.Overall 32% of reported pregnancies were complicated by febrile urinary tract infections, 13.5% by renal colic and 14.6% required upper urinary tract diversion. In addition, 10% of patients reported transient self-catheterization difficulties and 13.5% reported de novo or increased urinary incontinence. The preterm delivery rate was 35.3%. Elective C-section was performed in 61% of pregnancies. Twenty complications occurred during delivery (20%), including 19 during elective C-section. Urinary continence at 1 year was unchanged for 93.5% of deliveries. Delivery mode (p=0.293) and multiparity (p=0.572) had no impact on urinary continence.In this population C-section appeared to be associated with a high risk of complications. In the absence of any obstetric or neurological contraindications, vaginal delivery should be proposed as the first line option to the majority of these women.

The aim of this work was to issue clinical practice guidelines on antibiotic prophylaxis in urodynamics (urodynamic studies, UDS).Clinical practice guidelines were provided using a formal consensus method. Guidelines proposals were drew up by a multidisciplinary experts group (pilot group = steering group), then rated by a panel of 12 experts (rating group) using a formal consensus method, and then peer reviewed by a reviewing/reading group of experts (different from the rating group).Urine (bacterial) culture with antimicrobial susceptibility testing is recommended for all patients before UDS (strong agreement). In patients with no neurologic disease, the risk factors for tract urinary infection (UTI) after UDS are age70 years, recurrent UTI, and post-void residual volume100ml. In patients with neurologic disease, the risk factors for UTI after UDS are recurrent UTI, vesicoureteral reflux, and intermicturition pressure40cmHThese new guidelines should help to harmonize clinical practice and limit exposure to antibiotics.4.

Intradetrusor injection of botulinum toxin A and sacral neuromodulation are the two recommended third line treatments for patients with neurogenic detrusor overactivity, before undergoing with surgery. However, only Botox® injection is supported by a high level of evidence allowing its recommendation by all institutional guidelines. Despite few positive results, sacral neuromodulation should be proposed in carefully selected patients. Indeed, other studies remain mandatory to increase its level of evidence necessary for allowing its use in neurogenic detrusor overactivity.

The aim of the study was to report the very long-term functional outcomes of artificial urinary sphincter (AUS) in male neurological patients.Male neurological patients diagnosed with stress urinary incontinence due to sphincter deficiency and undergoing AUS (AMS 800Fourteen patients with a median age of 27.3 years (IQR: 27.3-40.8) were included: four had a spinal cord injury and ten a spina bifida. Prior continence surgery was reported by 6 patients (42.9 %). Artificial urinary sphincter was implanted in a peribulbar (n=4) or periprostatic position (n=10). Median follow-up was 18.3 years (IQR: 10.1-20.3). At last follow-up, all patients were alive. Three native devices were still in place, eight were revised (four of them were secondarily explanted) and three were explanted due to erosion or infection. The 5-, 10-, 15-, 20-year explantation-free survival rates were respectively 85.7, 62.3, 52.0, 39.0 %. The 5-, 10-, 15-, 20-year revision-free survival rates were respectively 78.6, 42.9, 28.6, 7.1 %. At last follow-up, 50 % patients were continent.In the very long run, AUS provided a 50 % continence rate in male neurological patients but the revision rates were important.4.

Objectifs Malgre le developpement des unites de chirurgie ambulatoire (UCA) dans la plupart des hopitaux en France, la prostatectomie totale laparoscopique robot-assistee (PTLRA) reste une intervention le plus souvent realisee en hospitalisation conventionnelle. L’objectif de cette etude etait d’evaluer la faisabilite de la PTLRA sur une plateforme dediee en UCA pour la prise en charge du cancer de la prostate (CaP). Methodes Les caracteristiques et resultats des patients selectionnes pour etre operes d’une PTLRA en UCA dans notre centre ont ete collectes prospectivement entre fevrier 2018 et juin 2019. L’intervention chirurgicale robotique transperitoneale etait realisee en 1re position le matin par 3 operateurs experimentes a l’aide du robot Da Vinci Si ou Xi sans laisser de drain. Le protocole d’anesthesie permettait une recuperation rapide et la sortie etait autorisee si : – EVA – lever et prise de boisson sans difficulte entre H4 et H6. Un appel telephonique a j1 permettait de verifier l’absence de complication precoce. Des analyses descriptives ont ete realisees. Resultats Au total, 12 patients operes d’une PTLRA en UCA pour un CaP de risque faible (n = 2), intermediaire (n = 7) ou eleve (n = 3) ont ete inclus dans cette etude. Un curage ganglionnaire ilio-obturateur bilateral a ete realise chez 3 patients. La duree operatoire mediane etait de 95 min (80–120). Aucune complication peroperatoire n’est survenue alors qu’une complication postoperatoire immediate Clavien 2 (bronchospasme) a necessite l’hospitalisation conventionnelle d’un patient pour une duree de 24 h. Les autres patients ont pu quitter l’UCA avec la sonde vesicale apres une duree mediane de surveillance de 310 min (250–390). Aucun d’entre eux n’a ete rehospitalise et aucune autre complication postoperatoire a 1 mois n’a ete observee. L’examen anatomopathologique definitif a mis en evidence une lesion ≥ pT3 et score de Gleason ≥ 8 chez 2 et 1 patient, respectivement. Aucune marge chirurgicale positive ou adenopathie pelvienne n’a ete identifiee. Conclusion La PTLRA est une intervention chirurgicale faisable en UCA pour la prise en charge du CaP. Les Resultats preliminaires semblent similaires a ceux obtenus apres PTLRA en hospitalisation conventionnelle mais cela necessite une selection des patients a faible risque chirurgical et aptes a comprendre les implications d’un retour rapide a domicile.

Objectifs Malgre le developpement des unites de chirurgie ambulatoire (UCA), la nephrectomie partielle laparoscopique robot-assistee (NPLRA) reste une intervention le plus souvent realisee en hospitalisation conventionnelle compte tenu du risque hemorragique. L’objectif de cette etude etait d’evaluer la faisabilite de la NPLRA sur une plateforme dediee en UCA pour la prise en charge du cancer du rein (CaR). Methodes Les caracteristiques et resultats des patients selectionnes pour etre operes d’une NPLRA en UCA dans notre centre ont ete collectes prospectivement entre fevrier 2017 et juin 2019. L’intervention chirurgicale robotique transperitoneale etait realisee en 1re position le matin par 3 operateurs experimentes a l’aide du robot Da Vinci Si ou Xi sans laisser de drain. Le protocole d’anesthesie permettait une recuperation rapide et la sortie etait autorisee si : – EVA – lever et prise de boisson sans difficulte entre H4 et H6. Un appel telephonique a j1 permettait de verifier l’absence de complication (NFS j1). Des analyses descriptives ont ete realisees. Resultats Au total, 22 patients operes d’une NPLRA en UCA pour un CaR avec un score RENAL median de 4 (4–5) ont ete inclus dans cette etude. L’âge median etait de 60 ans (52–76). La duree operatoire mediane etait de 60 min (45–80) avec une duree de clampage mediane de 5 min (0–10). Un agent hemostatique a ete utilise chez 17 patients (80 %). Aucune complication peroperatoire ou postoperatoire immediate n’a ete rapportee. Tous les patients ont pu quitter l’UCA apres une duree mediane de surveillance de 350 min (270–420). Aucune deglobulisation n’a ete observee sur la NFS a j1. Deux patients ont ete readmis dans le mois postoperatoire dont un a j3 pour une complication Clavien grade 3a (hematome necessitant une embolisation) pour une hospitalisation de 5 jours. Aucune marge chirurgicale positive n’a ete observee. Conclusion La NPLRA est une intervention chirurgicale faisable en UCA pour la prise en charge du CaR. Les resultats preliminaires semblent similaires a ceux obtenus en hospitalisation conventionnelle mais cela necessite une selection des patients a faible risque chirurgical et aptes a comprendre les implications d’un retour rapide a domicile.

To describe, using cluster analysis methods, the existence of a clinical typology specific to men, who are responding or not to anticholinergic treatment, and identify predictive factors associated with treatment success.An observational study was conducted in consecutive male patients who were prescribed anticholinergics for the first time. Sociodemographic data, patient characteristics, urinary symptom profile (USP) questionnaire, Ditrovie scale and symptom severity were assessed at inclusion and after 3 months of treatment. A cluster analysis according the hierarchical classification of Ward was used to discriminate two clusters (low and strong persistence of urinary disorders, respectively). Logistic regression was used to identify factors associated with evolution of treatment satisfaction and symptoms.Out of 1018 patients evaluated, 410 had available follow-up data. A treatment with anticholinergic was prescribed to all of patient among which solifenacin represented 92.4% and 27.6% of patients received also an alpha-blocker. Cluster analysis identified two populations of responders. Recent symptoms, young age, absence of obesity or associated treatment, and urgency without incontinence were associated with a better clinical outcome under treatment. The USP questionnaire showed voiding difficulties in 12.4% of patients, and the only associated factor was symptom duration before consultation.Anticholinergics are efficacious for management of storage lower urinary tract symptom management in men. Clinical factors (age, obesity, treatments, urge urinary incontinence) could influence treatment outcome and allow a better patient selection for clinical decision-making.4.

Data are scarce regarding pregnancy and delivery among women with a neurogenic bladder due to congenital spinal cord defects.To report the obstetrical and urological outcomes of women with congenital spinal cord defects and vesico-sphincteric disorders.A retrospective multicentric study included all consecutive women with a neurogenic bladder due to congenital spinal defects, who delivered between January 2005 and December 2014. The following data were collected: demographics, neuro-urological disease characteristics, urological and obstetrical history, complications during pregnancy, neonatal outcomes, and changes in urological symptoms.Overall, sixteen women, median age 29,4 years old (IQR 22-36), had a total of 20 pregnancies and 21 births (15 caesareans, 5 vaginal deliveries). Prior to the beginning of their first pregnancy, 12 patients were under intermittent self-catheterization. Symptomatic urinary tract infections during pregnancy occurred in 11 pregnancies, including 4 pyelonephritis. In 4 women, stress urinary incontinence had worsened but recovered post-partum. In 3 women, de novo clean intermittent catheterization became necessary and had to be continued post-partum. During 3 pregnancies, anticholinergic treatment had been started or increased because of urge urinary incontinence worsened. These changes were maintained after delivery. The median gestational age at birth was 39.0 weeks (IQR 37.8-39.5). There were 15 caesarean sections, of which 9 were indicated to prevent a potential aggravation of vesico-sphincteric disorders. Among the 5 pregnancies with vaginal delivery, there was no post-partum alteration of the sphincter function.Successful pregnancy outcome is possible in women with congenital spinal cord defects and vesico-sphincteric disorders but it requires managing an increased risk of urinary tract infections, caesarean section, and occasionally worsened urinary incontinence.5.

To evaluate the long-term functional outcomes after retropubic tension-free vaginal tape (TVT) placement to treat female stress urinary incontinence (SUI).From September 1998 to September 2000, we prospectively enrolled all consecutive women in our center suffering SUI caused by urethral hypermobility. All women had a retropubic TVT inserted by the same surgeon. Patients were evaluated at 1, 3, 6 and 12 months postoperatively, and annually thereafter. Postoperative assessment included a measurement of post-voiding residual volume, urinalysis, a 1-hour pad test, a urinary symptom questionnaire, and an assessment of quality-of-life. Objective continence (defined as no urine leakage at clinical examination) and subjective continence (defined as no urine leakage, whatever the mechanism, reported by the patient) were reported.Overall, 58 consecutive women (median age 59; IQR 49-67; min 21-max 78) were evaluated. Median follow-up was 10.2years (IQR 1.4-16.0; min 1-max 13.2). At the last follow-up, objective and subjective continence rates were 93% and 78%, respectively and remained stable in the long run. Pad tests, urinary symptom questionnaire scores and quality-of-life were significantly improved. Self-intermittent catheterisation was required by three women. A section of one TVT and removal of another tape was undertaken in two women with chronic pelvic pain. One patient had a chronic urinary infection. Rate of de novo urgency was 10%.TVT implantation offered good and stable functional long-term outcomes. This procedure enhanced quality-of-life and had low morbidity.3.

Among available urinary diversion, continent cutaneous urinary diversion (CCUD) is not frequently used after cystectomy for malignancy. The aim of our work was to assess mid-term oncological and functional outcomes of CCUD in case of malignancies.We retrospectively included all patients who underwent CCUD after radical cystectomy for cancer (according Mitrofanoff or Monti's principle) between July 2001 and November 2015 in our department. Perioperative data, oncological and functional outcomes were reported. To measure disease specific quality of life, we used the French version of Bladder Cancer Index.Overall 12 patients were involved in the study. With a median follow-up of 32 months, we noticed one death due to cancer recurrence. Early postoperative complications occurred in 8 patients, with one requiring reoperation. The late postoperative complication rate was 66%, whose 4 patients (33%) presented cutaneous stenosis. Overall satisfaction rate was scored 8.9/10 and body image was preserved for 75% of patients. At last follow-up, continence (no urinary leakage) was achieved for 62.5% of patient. Sexual impairment was significant for 5 patients.The CCUD is a valid alternative to other urinary diversions with similar oncological results and with a similar rate of complications. The high satisfaction rate was related to the preservation of body image and the high rate of continence.5.

Self-catheterising males aged ⩾18 years with spinal cord lesion and normal/impaired urethral sensation were enrolled in this comparative, randomised, crossover and open-labelled multicentre trial. When possible, intermittent catheterisation is the preferred method of bladder emptying for neurogenic bladder dysfunction. Hydrophilic-coated catheters have improved safety and ease of use, and a new compact catheter for men has been developed to improve discretion. Participants self-catheterised at least four times daily for 14 days with a standard or compact catheter. The primary outcome measure was discomfort, using a visual analogue scale. Non-inferiority was defined as a difference in mean discomfort score of

Objectifs Quatorze centres de reference tertiaires ont participe a un essai prospectif de trois ans (clinicaltrials.gov NCT01608789 ) sur le traitement de l’incontinence urinaire apres prostatectomie radicale avec la bandelette 4 bras virtue© (coloplast a/s, humlebaek, danemark). Ce travail evalue les donnees d’efficacite et d’innocuite a 12 mois. Cent dix-huit patients ont ete inclus d’aout 2012 a fevrier 2015 (66,5 ± 6,7 ans). Methodes Les patients ayant une vessie hyperactive predominante, une chirurgie d’incontinence anterieure, une stenose uretrale ou des antecedents de radiotherapie ont ete exclus. Le succes objectif a ete defini comme une diminution de plus de 50 % du pad test de 24 heures et le succes subjectif comme l’amelioration globale du patient rapportee par l’indice pgi-i. La version abregee du questionnaire iciq-ui-sf a egalement ete completee. L’evaluation a ete realisee a 1, 3, 6, 12, 24 et 36 mois. Une debitmetrie (qmax) avec rpm ont ete systematiquement mesures. Les evenements indesirables lies a la bandelette ou a la procedure (ae) ont ete rapportes. Resultats Les incontinences legere, moderee et severe preoperatoires etaient respectivement de 53 (46 %), 47 (41 %) et 15 (13 %) [3 donnees manquantes (DM)]. Il n’y a pas eu de degradation significative des parametres evalues et enregistres entre 3 et 12 mois de suivi. (cf Tableau 1 ). Aucune difference selon la gravite de l’incontinence de base et l’imc n’a ete retrouvee. Aucun changement significatif du qmax (de 20,6 a 23,9 mL/s) ni du rpm (de 5 a 13,7 mL) n’ont ete rapportes. Les principaux ae etaient une douleur perineale (13 ; 11 %), une douleur scrotale (10 ; 8,5 %), une douleur a l’aine (10 ; 8,5 %), dont 8,5 % ont necessite un traitement medical, des paresthesies genitales (7 ; 5,9 %), une retention urinaire transitoire (8 ; 6,8 %), des urgences de novo (12 ; 10,2 %) ou un hematome (4 ; 3,4 %). Conclusion La bandelette 4 bras virtue© apparait comme une alternative de traitement sur et efficace de l’incontinence urinaire legere a moderee apres prostatectomie radicale. Ces donnees devront etre confirmees dans le suivi a 3 ans.

Context: Most patients with neurogenic lower urinary tract dysfunction (NLUTD) require life-long care to maintain their quality of life (QoL) and to maximise life expectancy. Objective: To provide a summary of the 2008 version of the European Association of Urology (EAU) guidelines on NLUTD and to assess the effectiveness of currently available diagnostic tools, particularly ultrasound imaging and urodynamics. Evidence acquisition: The recommendations provided in the 2008 EAU guidelines on NLUTD are based on a review of the literature, using online searches of Medline and other source documents published between 2004 and 2007. A level of evidence and/or a grade of recommendation have been assigned to the guidelines where possible. Evidence synthesis: NLUTD encompasses a wide spectrum of pathologies, and patients often require life-long, intensive medical care to maximise their life-expectancy and to maintain their QoL. Treatment must be tailored to the needs of the individual patient and, in many cases, involves a multidisciplinary team of experts. Timely diagnosis and treatment are essential if irreversible deterioration of both the upper and lower Urinary tracts are to be avoided. Therapeutic decisions are made on the basis of a comprehensive medical assessment, including urodynamics to identify the type of dysfunction. Advances in investigative technologies have facilitated the noninvasive and conservative management of patients who have NLUTD. Conclusions: The diagnosis and treatment of NLUTD, which is a highly specialised and complex field involving both urology and medicine, requires up-to-date expert advice to be readily available. The current guidelines are designed to fulfil this need. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

To determine the prevalence of overactive bladder (OAB) syndrome in France and gather data about initial patient trajectories in the healthcare system.A dedicated questionnaire (41 questions) has been sent to a 12,000 sample of people representative of the global population. The following data were investigated: social and demographic features, medical history, Urinary Symptom Profile questionnaire, bother, history of symptoms, care seeking and treatments received. Patient were considered having OAB in case if presenting at least two episodes of urgency per week, or being under treatment of OAB. OAB prevalence was the main outcome, and associated factors were characterized by univariate and multivariate analysis.Based on 8842 available questionnaires, the global prevalence of OAB was estimated to be 14.4%. Prevalence was significantly higher in women, older age groups, as well as obesity, irritable bowel syndrome, urinary tract infections, enuresia, constipation, anxiety/depression, neurological diseases, sleep apnea syndrome, asthma, chronic obstructive pulmonary disease, diabetes and hypertension. Only 34.6% of patients with OAB had visited a health practitioner for this problem. General practitioners were most frequently implicated in patient primary care and evaluation. Seventy-two percent of patients with OAB had had additional investigations (mostly a urine culture) and only 6% of patients had to complete a bladder diary. The most frequent treatment option was oral antimuscarinics. Physical therapy and rehabilitation have been prescribed in 26% of cases, as well as dietary advice.OAB is a frequent syndrome. Its prevalence increases with age, and OAB frequently concern elderly frail people with many other associated diseases.3.

To provide an overview of the urological management of spinal cord injured patients based on an economic analysis.A literature search from January 1994 to December 2014 was performed using Medline and Embase database using the following keywords: cost-effectiveness; cost-benefit; cost-utility; spinal cord injury; neurogenic bladder; intermittent catheterization; antimuscarinics; botulinum toxin; sacral neuromodulation; tibial nerve; Brindley; sphincterotomy. The tool used for comparison was the QALY ("quality adjusted life years"); an indicator between 0 and 1 allowing the comparison between two medical treatments using cost per QALY.Solifenacin (5 to 10mg) is the most cost-effective treatment with an incremental cost-effectiveness ratio (ICER) of 19,893 €/QALY compared to trospium 40mg, of 16,657 €/QALY compared to trospium 60mg, of 12,309 £/QALY compared to oxybutinin. Botulinum toxin A is also cost-effective with an ICER of 24,720 $/QALY compared to best supportive cares for anticholinergic-refractory neurogenic detrusor overactivity.Solifenacin and botulinum toxin A appears to be the most cost-effective treatments for spinal injured urological cares. There is a pressing need to both increase and improve data collection and research on spinal cord injury.