Study design, materials and methods
This was a single‑center retrospective cohort study enrolling patients with NB managed at the First Affiliated Hospital of Zhengzhou University between November 2023 and June 2025, who underwent either CIC or suprapubic cystostomy with a follow‑up of at least 3 years. Eligibility criteria included confirmed neurogenic bladder based on documented neurological disease and abnormal urodynamic findings, urinary retention requiring bladder drainage, complete annual urodynamic and renal ultrasonography data, and signed informed consent. Patients with incomplete urodynamic records or severe cognitive impairment were excluded. The study protocol was approved by the institutional ethics committee (2020‑NY‑191).
Propensity score matching was performed using logistic regression conditioned on age, sex, etiology of neurogenic bladder, hand function, functional independence, baseline hydronephrosis, detrusor pressure, history of recurrent urinary tract infection (UTI), urethral abnormalities, and Charlson Comorbidity Index. One‑to‑one nearest‑neighbor matching was applied with a caliper width of 0.2 standard deviations of the logit.
Primary outcomes comprised recurrent UTIs, newly developed or aggravated hydronephrosis, renal functional deterioration, key urodynamic variables (maximum cystometric capacity, maximum detrusor pressure, and bladder compliance), procedure‑related complications, and validated patient‑reported measures including the SF‑Qualiveen and Neurogenic Bladder Symptom Score (NBSS). Within the CIC group, participants were subdivided into partial CIC (≤4 times daily with residual spontaneous voiding) and full CIC (>4 times daily).
Results
Ninety-six patients were screened (62 CIC, 34 cystostomy); 82 were included after matching (54 CIC, 28 cystostomy). Baseline characteristics were balanced (SMD <0.10). Mean age was 51.4±11.1 years（CIC group：51.1+11.3；cystostomy group:52.0+10.9, P=0.75）; mean follow-up was 3.2±1.3 years. Recurrent UTI rates were similar (33.3% vs. 39.3%, P=0.59), but annual UTI frequency was lower in the CIC group (1.6±0.9 vs. 2.1±1.1, P=0.045). New or worsened hydronephrosis was less common with CIC (9.3% vs. 25.0%, P=0.045). CIC showed greater bladder capacity (392±85 vs. 335±92 mL, P=0.012), lower detrusor pressure (34.6±9.8 vs. 41.2±10.5 cmH₂O, P=0.006), and better compliance (P=0.004). Re-intervention was more frequent after cystostomy (25.0% vs. 7.4%, P=0.029).
CIC patients had better quality of life (SF-Qualiveen 1.52±0.48 vs. 2.11±0.55, P<0.001) and lower NBSS scores (P<0.001). Partial CIC was associated with fewer UTIs and better symptom scores than complete CIC, without differences in urodynamic study parameters.
Interpretation of results
The present study demonstrated that, following rigorous propensity score matching, CIC yielded superior overall clinical outcomes relative to suprapubic cystostomy among patients with NB. Although the cumulative incidence of recurrent urinary tract infection was comparable between groups, CIC substantially reduced annual infection episodes and facilitated better preservation of upper urinary tract function, as reflected by slower progression of hydronephrosis and a favorable trend toward alleviating high‑pressure bladder physiology. Urodynamic assessments further corroborated the intrinsic physiological benefits of CIC, including augmented bladder capacity, diminished detrusor pressure, and optimized bladder compliance—key determinants sustaining long‑term renal integrity.
In addition, CIC was associated with fewer re-interventions and better quality-of-life outcomes, reflected by significantly lower SF-Qualiveen and NBSS scores. Importantly, subgroup analysis suggests that patients with preserved spontaneous voiding may benefit most from partial CIC, achieving lower infection burden and better symptom control without compromising urodynamic safety. Overall, these research results further confirm that for the appropriate population, CIC is a better strategy for bladder management, and emphasize the importance of personalized catheterization plans in optimizing the long-term treatment outcome.