Urinary, Faecal and Sexual Disorders After Traumatic Spinal Cord Injury: Frequency, Management and Recovery in 366 Patients at Bouaké University Hospital (Côte d'Ivoire)

Abstract

Background: After a traumatic spinal cord injury (SCI), bladder, bowel and sexual disorders weigh heavily on autonomy, and African
data are scarce.

Objective: We described their frequency, management and recovery in an Ivorian referral centre.

Methods: Single-centre cohort of 366 patients with confirmed SCI, with a retrospective phase (2017–2021) and a prospective phase (1 January 2025–30 June 2026), reported according to STROBE. The primary outcome was the presence of a vesicosphincteric disorder (urinary or faecal). Secondary outcomes were sexual dysfunction, functional recovery and in-hospital mortality. We compared patients by ASIA grade and lesion level, then used logistic regression to look for factors associated with recovery.

Results: Vesico-sphincteric disorders affected 227 patients (62.0%): urinary incontinence 41.0%, faecal incontinence 25.7%, acute urinary retention 18.6%. Sexual dysfunction was reported by 15.8% of patients. Frequency fell from ASIA grade A to grade E (84.4% to 23.1%), after 17 ASIA E patients were reclassified on record audit; it reached 84.4% in complete injuries versus 47.0% in incomplete injuries (p < 0.001) and did not vary with lesion level (p = 0.40). In-hospital mortality was 25.1% with disorders versus 5.0% without (p < 0.001). The difference persisted after stratification by severity (ASIA A vs B–E; Mantel-Haenszel OR 3.16; 95% CI 1.34–7.47) and after adjustment for ordinal ASIA grade and age (adjusted OR 2.99; 95% CI 1.25–7.15); these analyses are exploratory. Among the 227 affected patients, urinary management combined bladder rehabilitation (27.3%), spinal surgery (22.5%), intermittent catheterisation (22.0%) and simple monitoring (17.6%); bowel management relied mainly on a bowel programme (57.3%). For sexuality, 73.1% had received counselling only and 23 patients (10.1%) a specialised treatment. Among the 170 survivors with initial disorders (median follow-up 45 days [14– 180]), recovery was partial in 38.8%, absent in 32.9% and replaced by persistent bladder dysfunction in 28.2%. No clinical variable tested was associated with recovery (inconclusive result).

Conclusion: These disorders are frequent and follow lesion completeness. They are associated with in-hospital mortality, including after stratification by severity (exploratory analysis). Sexual function is under-assessed. Recovery is modest and no usual clinical variable predicts it (inconclusive result). Early multidisciplinary care, integrated into the neurosurgical pathway, is needed.