PALO ALTO, CA — The VA should reexamine systemwide policies to increase the use of cystometrography (CMG ) for veterans with supra-sacral spinal cord injury or disorder (SCI/D) , as recommended in many global guidelines.
That is according to a new study led by the VA Palo Alto, CA, Healthcare System and Stanford University. The authors noted that a “prior study of a large cohort of veterans with supra-sacral spinal cord injury or disorder showed, as seen in other cohorts, substantial variation in application of bladder care processes and, specifically in the proportion of patients undergoing cystometrography (CMG). The next step in a systematic evaluation such as this is to assess the association CMG on outcomes related to the urinary system.”
The more-recent study sought to assess the association of CMG being performed with changes in bladder management, urinary tract infections, urinary stones, renal deterioration and dialysis care.
The cohort consisted of 49 326 veterans with SCI/D in the VHA first seen from fiscal year 1999 to 2024. The study team used multivariable regression models to assess factors, including CMG, that affected changes in bladder management (e.g., intermittent catheterization), annual probabilities of urinary tract infections, urinary stones and time to renal deterioration and to dialysis care.
Results reported in Neurourology Urodynamics indicated that having a CMG was associated with a significantly lowered annual probabilities of febrile urinary tract infections and urinary stones. “CMG also was associated with delay in the time to renal deterioration (measured as more than 25% year-to-year drop in estimated glomerular filtration rate; hazard ratio 0.74; 95% CI: 0.70–0.78, p < 0.001), and delay in time to initiation of dialysis for end-stage renal failure (hazard ratio 0.76 (95% CI: 0.60–0.96, p < 0.05),” the authors wrote.1
SCI/D , which affects more than 6 million patients, has substantial morbidity and mortality risks, according to background information in the article. It advised that “guidelines have been developed based on the best available evidence for the management of neurogenic urinary tract dysfunction (NLUTD). Surveillance cystometrography, along with upper tract imaging and renal functional assessment, is recommended for some types of SCI/D with unknown risk —primarily supra-sacral lesions—citing decades-old small, longitudinal studies of children with SCI/D, and guidelines. The consequent grading of the evidence is Level C (‘Low certainty—Our confidence in the effect estimate is limited’), which is below that of randomized controlled trials or of large, longitudinal studies that attempt to control for potential confounding factors of poor outcomes. It thus is unsurprising that studies in Medicare populations and our own studies of veterans have shown many patients living with SCI/D never have a CMG.”
They added that the consequent effect of low adherence to the CMG guideline on urinary system outcomes, i.e., using comprehensive, large databases that include extensive clinically relevant historical details of patient characteristics and applying the most contemporary adjustment models for causal inference, has yet to be performed. In this study, the researchers extended their efforts to use the extensive data resources of the VA to examine the association of CMG with urinary-system outcomes.
- Lavelle J, Hornberger J. No Cystometrogram Among Veterans With Spinal Cord Injury Results in Adverse Urinary System Outcomes. Neurourol Urodyn. 2026 Jan 29. doi: 10.1002/nau.70214. Epub ahead of print. PMID: 41609098.