OBJECTIVE

To evaluate the efficacy and safety of a comprehensive medical rehabilitation program using non-invasive spinal cord stimulation and intradetrusor injections of Dysport to restore urinary tract function in patients with sequelae of spinal cord injury (SCI).

MATERIAL AND METHODS

The study analyzed data from 43 patients with neurogenic urination disorders due to spinal cord injury who underwent medical rehabilitation. All patients had a confirmed diagnosis of neurogenic lower urinary tract dysfunction (NLUTD). All patients underwent a comprehensive urodynamic study (CUDS) to determine the type of NLUTD and to establish the indications for intradetrusor botulinum therapy. As part of the 17-day rehabilitation course, the following interventions were performed: intradetrusor injection of Dysport at 600—800 U; transcutaneous electrical stimulation of the spinal cord (TESCS); robotic mechanotherapy; locomotor training; kinesiotherapy and occupational therapy; training in self-catheterization techniques. The effectiveness of rehabilitation was assessed using the following scales and classifications: FIM, ASIA, GRASP, and ICF.

RESULTS

Of the 43 patients, 38 (93%) had overactive bladder/detrusor overactivity confirmed by the CUDS data. Urge urinary incontinence was controlled in 26 (68.4%) patients with overactive bladder after the first course of therapy. The median interval between repeat Dysport injections was 6 months. Twenty-eight patients (65%) were successfully transitioned to independent or assisted intermittent self-catheterization, and 18 (61%) patients with cervical lesions mastered the self-catheterization technique, despite tetraparesis. Adverse events (AEs) were reported in four patients (9.3%). Thirty-five (81%) patients demonstrated an increase in functional independence of ≥22 points on the FIM scale (median increase of 28 points). Quality of life significantly improved in 36 patients (84%).

CONCLUSION

The introduction of new compulsory health insurance tariffs (ST037.31 and ST037.33) and their implementation in routine practice at institutions providing rehabilitation care is a milestone, as it ensures synchronization of urological and motor rehabilitation from the early post-SCI period. The integration of timely diagnosis of urological disorders and intradetrusor botulinum therapy into the rehabilitation path for patients with SCI has improved not only urinary control but also limb motor function, sensitivity, motivation, functional independence, social adaptation, and quality of life.