Persistent urinary retention is a common problem in patients with neurogenic bladder and often requires long-term bladder management. The aim of this study was to evaluate the frequency of persistent urinary retention, the methods of bladder management, associated complications, and their impact on quality of life in patients with neurogenic bladder.

This was a retrospective observational study including 112 patients with neurogenic bladder and persistent urinary retention. Demographic data, underlying neurological disease, type of catheterization, duration and frequency of catheterization, urinary tract infections, renal function, incontinence, medication use, and quality of life were recorded. Quality of life was assessed using a visual analogue scale from 0 to 10. Statistical analysis included descriptive statistics and correlation analysis between clinical variables and quality of life.

A total of 112 patients were included, with equal gender distribution and a mean age of 43.49 years. The most common underlying conditions were multiple sclerosis (39.29%) and spinal cord injury (35.71%), followed by retention syndrome (10.71%) and other causes (14.29%).
Regarding bladder management, most patients performed intermittent self-catheterization (83.93%), while fewer patients used caregiver catheterization (8.93%), permanent urethral catheter (4.46%), or suprapubic catheter (2.68%). The mean duration of intermittent catheterization was 5.51 years and the mean number of catheterizations per day was 5.17.
The mean number of urinary tract infections was 1.14 episodes per year. Renal function was normal in 85.71% of patients and reduced in 14.29%. Urinary incontinence was reported in 80.36% of patients. The mean number of pads used per day was 3.32 and the mean quality of life score was 4.41.
Quality of life differed according to catheterization method, with better quality of life reported in patients with suprapubic catheters and worse quality of life in patients performing intermittent self-catheterization. Correlation analysis showed a weak positive correlation between age and worse quality of life, negligible correlation between number of catheterizations per day and quality of life, and a moderate positive correlation between urinary tract infections and worse quality of life.

The results show that intermittent self-catheterization is the most commonly used method for managing persistent urinary retention in patients with neurogenic bladder, confirming its role as the standard management approach. Renal function remained preserved in the majority of patients, suggesting that current bladder management strategies are generally safe for the upper urinary tract.
However, urinary incontinence and urinary tract infections remain common and significantly affect patients' quality of life. The moderate correlation between urinary tract infections and worse quality of life indicates that prevention and proper management of infections may be one of the most important factors in improving patient outcomes. The weak correlation between catheterization frequency and quality of life suggests that the burden of catheterization itself may be less important than complications such as infections and incontinence.
Interestingly, patients with permanent catheterization, especially suprapubic catheters, reported better quality of life, possibly due to easier bladder management and fewer catheterization procedures per day. This finding suggests that bladder management should be individualized according to patient needs, abilities, and complications.

Persistent urinary retention in patients with neurogenic bladder is mainly managed with intermittent self-catheterization, which preserves renal function but could be associated with incontinence and urinary tract infections that negatively affect quality of life. Prevention of urinary tract infections and individualized selection of bladder management method are key factors for improving long-term outcomes and quality of life in these patients.

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