Adhering to Clinical Advice: The Level of Alignment of Care Processes With Global Bladder Guidelines in Veterans With Spinal Cord Injuries or Diseases

Background Guidelines contain recommendations for monitoring and care of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury/disorder. Evidence on the level of adherence to these recommendations is limited. Objectives To assess treads in proportion of patients with spinal cord injury/disorder receiving commonly recommended processes of care for NLUTD. Methods The cohort consisted of 49 326 veterans with supra‐sacral spinal cord injury or disorder (SCI/D) within the Veterans Affairs (V.A.) healthcare system first seen from fiscal year 1999–2024. Measures included laboratories, imaging, bladder‐care procedures, and whether the veteran was seen by a urologist and had cystometrography (CMG). Results The analysis reveals the use of recommended NLUTD monitoring processes, with 41% undergoing renal imaging, 48% having a urology encounter, and 31% receiving cystometrography. A longitudinal view shows a decline in these rates over time. However, CMG rates exhibited some increase in veterans entering the system between 2005 and 2014, indicating a slight improvement in adherence over time. Conclusions The study highlights gaps between current practices and recommended processes for NLUTD, which may compromise outcomes for veterans with supra‐sacral SCI/D. Further research is necessary to explore the barriers to executing suggested processes and implications for outcomes of this vulnerable population.