Urinary Symptoms and Sexual Dysfunction in National Level Wheelchair Rugby Male Athletes With Spinal Cord Injury

In 69 paralyzed rugby players, years of sport participation predicted bladder control better than injury classification did

Journal: Neurourology and Urodynamics | Published: 2026-03-18 | Type: Cross-sectional survey | PMID: 41847992 Authors: Gavel-Pinos EH et al. (University of Alberta; University of Michigan Department of Urology) Funding/COI: University of Michigan NIDDK K12 program; COI not disclosed

Summary

Sixty-nine male national-level wheelchair rugby (WCR) athletes with spinal cord injury (SCI) completed validated questionnaires on bladder and sexual function during competition. The headline finding: athletes with more than 10 years of WCR experience had significantly better neurogenic bladder scores than those with under 10 years (p = 0.036), while injury classification and injury completeness showed no such difference. Sexual function scores clustered in the mild-to-moderate erectile dysfunction range across the group, with newer athletes (<2 years) scoring worse in several IIEF domains.

Claims

• Mean NBSS-SF (Neurogenic Bladder Symptom Score Short Form) overall: 9.8 ± 4.2; incontinence subdomain 3.2 ± 2.4; storage/voiding 4.1 ± 2.0; consequence 2.5 ± 1.2
• Athletes with >10 years WCR experience had significantly better bladder function vs. those with <10 years (p = 0.036)
• Mean IIEF erectile function domain: 19.3 ± 7.0 (out of 30; the standard cutoff for mild-to-moderate ED is 17–21)
• Orgasmic function mean: 4.6 ± 2.4 (out of 10) — substantially reduced
• Sexual desire: 8.0 ± 1.8 (out of 10) — relatively preserved
• Intercourse satisfaction: 11.8 ± 3.6 (out of 15); overall satisfaction: 7.7 ± 2.1 (out of 10)
• Athletes with <2 years experience had notably lower IIEF domain scores
• Injury classification (motor/sensory completeness) was not associated with functional score differences

Study Quality

This is a cross-sectional, self-report survey with no control group and a sample of 69 — adequate for prevalence description, insufficient for causal inference. The instruments used (NBSS-SF and IIEF) are validated and widely used in urological research, which is a genuine strength. However, the study cannot determine whether sport participation improves bladder function or whether athletes with better baseline function simply stay in the sport longer — a classic survival/selection bias problem. The "rehabilitative benefit" framing in the conclusions leans further than the design can support.

The recruitment setting (national competition) ensures a highly selected, high-functioning sample of SCI patients. These results do not generalize to the broader SCI population and likely represent a ceiling of what sustained sport engagement looks like among people with SCI who are physically capable of competing at the national level.

Red Flags

• No control group: no non-athlete SCI comparison, no non-SCI athlete comparison — makes it impossible to assess how much sport actually changes outcomes vs. baseline selection
• Cross-sectional design: the observed association between sport tenure and bladder function could entirely reflect survivors staying in sport, not sport improving function
• n = 69: subgroup comparisons (e.g., <2 years vs. >10 years) are underpowered; p = 0.036 for the bladder finding should be interpreted cautiously at this sample size
• COI not disclosed: listed as "not listed," not confirmed absent — a gap in transparency
• Self-report only: no urodynamic testing, no objective erectile function measurement
• Causal language in conclusions: "rehabilitative benefit of sustained sport engagement" is not supported by a cross-sectional design

Strengths

• Validated instruments (NBSS-SF, IIEF) applied to an understudied population
• National competition recruitment captures a defined, high-participation stratum — useful for benchmark data
• Provides concrete prevalence numbers for bladder and sexual dysfunction in competitive SCI athletes, a demographic rarely studied
• Includes orgasmic function and sexual desire subdomains, not just erectile function, giving a more complete picture of sexual health

Verdict

A useful descriptive snapshot of an understudied population, nothing more. The finding that injury classification doesn't predict bladder or sexual function scores is genuinely interesting and worth noting — it challenges the assumption that lesion level alone drives outcomes. But the headline association (more sport experience = better bladder function) cannot be disentangled from selection bias in this design, and the authors' framing of it as a "rehabilitative benefit" is a stretch the data don't support. Read it for the prevalence numbers and validated-instrument baselines, not for the causal story the conclusions try to tell.