Actionable Nuggets for SCI (3rd ed., 2016)
Bladder function should be reviewed annually by the family physician, and periodically by a urologist.
Neurogenic bladder (dysfunction of the ability to store and void urine) is a common complication of spinal cord injury (SCI), affecting 80-85% of individuals. Spinal cord injury often causes decreased bladder compliance, detrusor-sphincter dysynergia, or increased detrusor pressure (>40 cm H2O). These conditions can result in significant renal damage if not properly managed. Neurogenic bladder may be accompanied by complications such as bladder or kidney stones, recurrent infections, or autonomic dysreflexia (see Nugget #4).
Evidence-based Best Practice:
The goals of managing neurogenic bladder are continence, regular emptying, avoiding increased bladder pressure, and preventing complications. Success of bladder management is measured in terms of social continence, bladder capacity >360 ml, detrusor pressure <40 cm H2O, and absence of autonomic dysreflexia (AD).
Methods of managing a neurogenic bladder include clean intermittent catheterization, specific voiding techniques, and indwelling or condom collection devices. The method(s) used by individual patients depend on the patient’s anatomy, functional abilities, medical co-morbidities, and social life. An optimal bladder management routine is typically determined by a physiatrist or urologist during rehabilitation or follow-up, but bladder function may change as patients age and acquire secondary conditions, or their circumstances change.
Annual review of bladder function in primary care should include bloodwork and ultrasound of the upper and lower urinary tract. Periodic cystoscopy and urodynamic assessment should be completed as dictated by symptoms.
Waleed, A. T., & Seyam, R. (2015). Neurogenic bladder in spinal cord injury patients. Research and Reports in Neurology, 7(February), 85–99.
Additional References (chronological order):
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Schöps, T. F., Schneider, M. P., Steffen, F., Ineichen, B. V., Mehnert, U., & Kessler, T. M. (2015). Neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury: long‐term urodynamic findings. BJU International, 115(S6), 33-38. http://doi.org/10.1111/bju.13085
Wöllner, J., & Pannek, J. (2015). Urodynamic or video-urodynamic assessment in patients with spinal cord injury: this is not a question!. Spinal cord, 53, S22-S24. http://doi.org/10.1038/sc.2014.224
Yalçın, S., & Ersöz, M. (2015). Urodynamic findings, bladder emptying methods and therapeutic approaches in patients with upper lumbar and lower lumbar–sacral spinal cord injury. Neurological Sciences, 36(11), 2061-2065. http://doi.org/10.1007/s10072-015-2311-1
Burden, H., Warren, K., & Abrams, P. (2014). Urodynamics for Spinal Cord Injury – How, When, Why. Current Bladder Dysfunction Reports, 9(2), 71–77. http://doi.org/10.1007/s11884-014-0225-z
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Yıldız, N., Akkoç, Y., Erhan, B., Gündüz, B., Yılmaz, B., Alaca, R., … Tunç, H. (2014). Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up. Spinal Cord, 52(6), 462–7. http://doi.org/10.1038/sc.2014.41
Rahimkhani, M., Mordadi, A., Varmazyar, S., & Tavakoli, A. (2014). Evaluation of Urinary Interleukin-8 Levels in Patients with Spinal Cord Injury. Recent patents on anti-infective drug discovery, 9(2), 144-149. http://doi.org/10.2174/1574891X10666150310152532
Vírseda-Chamorro, M., Salinas-Casado, J., de la Marta-García, M., Esteban-Fuertes, M., & Méndez, S. (2014). Comparison of ambulatory versus video urodynamics in patients with spinal cord injury. Spinal cord, 52(7), 551-555. http://doi.org/10.1038/sc.2014.9
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Pannek, J., Bartel, P., Göcking, K., & Frotzler, A. (2013). Clinical usefulness of ultrasound assessment of detrusor wall thickness in patients with neurogenic lower urinary tract dysfunction due to spinal cord injury: urodynamics made easy?. World Journal of Urology, 31(3), 659-664.
Vírseda, M., Salinas, J., Esteban, M., & Méndez, S. (2013). Reliability of ambulatory urodynamics in patients with spinal cord injuries. Neurourology and Urodynamics, 32(4), 387-392.
Cameron, A. P., Rodriguez, G. M., & Schomer, K. G. (2012). Systematic review of urological followup after spinal cord injury. The Journal of Urology, 187(2), 391-397.
Del Popolo, G., Mencarini, M., Nelli, F., & Lazzeri, M. (2012). Controversy over the pharmacological treatments of storage symptoms in spinal cord injury patients: a literature overview. Spinal Cord, 50(1), 8-13.
Kim, K. S., & Song, C. G. (2012). Availability of a newly devised ambulatory urodynamics monitoring system based on personal device assistance in patients with spinal cord injury. Computer Methods and Programs in Biomedicine, 106(3), 260-273.
Wolfe, D.L., Legassic, M., McIntyre, A., Cheung, K., Goettl, T., Walia, S., Loh, E., et al. (2012). Bladder health and function following spinal cord injury. Spinal Cord Injury Rehabilitation Evidence, Version 4.0, 1-143.
Pannek, J., Gocking, K., & Bersch, U. (2011). Clinical usefulness of the Memokath Stent as a second-line procedure after Sphincterotomy failure. Journal of Endourology, 25(2), 335-9.
Klausner, A., & Steers, W. (2011). The neurogenic bladder: An update with management strategies for primary care physicians. The Medical Clinics of North America, 95(2011), 111-20.
Abdel-Meguid, T. A. (2010). Botulinum toxin-A injections into neurogenic overactive bladder-To include or exclude the trigone? A prospective, randomized, controlled trial. Journal of Urology, 184(186), 2423-2428.
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Pannek, J., & Kullik, B. (2009). Does optimizing bladder management equal optimizing quality of life? Correlation between health-related quality of life and urodynamic parameters in patients with spinal cord lesions. Urology, 74(2), 263-266.
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