Autonomous bladder training for neurogenic bladder: a randomized controlled trial.
Yue Yang, Lianchi Li, Jing Ye and 5 others
PMID 42488971WHAT IT FOUND
Four weeks of a five-part bladder training programme, added to usual rehabilitation, cut post-void leftover urine by 55.8 mL more than usual care in adults with neurogenic bladder.
Fewer needed antibiotics for urinary infections, but that was judged clinically, not by culture.
Key findings
01Leftover urine after voiding fell much more with the training programme than with usual care over 4 weeks: on average from 151.1 mL to 65.3 mL in the treatment group against 153.0 mL to 121.5 mL in controls, an adjusted difference in change of 55.8 mL (95% CI 46.9 to 64.7 mL).
02Urinary infections judged clinically and treated with antibiotics were less common in the treatment group: 8 of 84 (9.5%) versus 23 of 84 (27.4%), risk ratio 0.35. Cultures were only taken for some episodes, so the authors treat this as exploratory rather than confirmed infection.
03At the exploratory 12-week follow-up the treatment group still had lower average leftover urine than controls (74.8 mL versus 128.6 mL), but higher than it had been at 4 weeks, so whether the benefit lasts is not settled.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Everything comes from one rehabilitation department in one country, so these results may not carry over to a different setting or a less selected caseload. Just over three-quarters of participants had a spinal cord injury. Multiple sclerosis, stroke and other causes were each represented by only a handful of people, so the trial cannot say whether the programme works the same way in those groups. The main result is at 4 weeks. The 12-week follow-up was exploratory, fewer people had bladder function testing then, and leftover urine was already higher than it had been at 4 weeks. Nothing here shows the improvement lasts. All five components were given together, so the trial cannot show which of them produced the improvement, how much of each is needed, or whether any could be dropped. Urinary infection was counted on clinical grounds and on whether antibiotics were started. Cultures were available for only some episodes (5 of 8 and 14 of 23), and the instilled saline may itself have washed bacteria and white cells out of the bladder, so the infection result is not firm. The suggestion that people who did more of the programme improved more comes from the treated group only and the study was not designed to test a dose-response relationship. No long-term outcomes are reported for kidney function, damage to the upper urinary tract, or whether anyone became independent of catheters.
Declared interests
The authors declare no conflicts of interest. The study was funded by the National Natural Science Foundation of China (grant 82102657) and the Chengdu Science and Technology Bureau Technology Innovation R&D Project (grant 2024-YF05-00632-SN). The paper does not state any role for the funders in designing, running or writing up the study.
The easy way to misread this
Do not read this as proof that all five components are needed, or that the programme is ready for routine use. They were delivered together, so the trial cannot say which parts produced the improvement or whether a simpler programme would work as well, and the benefit was measured over 4 weeks in a single centre.
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