Urinary tract infections (UTIs) and renal damage were historically the most common cause of death for people with spinal cord injury (SCI), multiple sclerosis (MS), and spina bifida (SB). While mortality has declined with improvements in genitourinary management, UTIs remain the most common cause of emergency room visits and rehospitalization among people with neurogenic bladder (NB). However, there are no evidence-based guidelines for diagnosis of UTI in people with NB; existing guidelines rely on expert consensus. As such, disparities exist in the treatment of urinary symptoms and it is suspected that overtreatment with antimicrobials is commonplace, leading to an increased prevalence of multi-drug resistant organisms.

To address these disparities, and strengthen the understanding of urinary symptom and UTI evidence in people with NB, we have developed a series of instruments to assess urinary symptoms in people with NB; these instruments are patient-centered and patient-reported, and vary depending on bladder management strategy. First, we will discuss the variability in urinary symptom experiences for persons with NB according to bladder management method. Next, we will present our evidence for characterizing these symptoms as “infectious” and “pre-infectious”. Lastly, we will discuss how these instruments may be used by physiatrists and by patients to lead to reductions in unnecessary prescriptions of antimicrobials, as well as to increase patient self-management.