12. Monitoring of Neurogenic Bladder

Actionable Nuggets for SCI (3rd ed., 2016)

The Problem:Man hand on wheelchair

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).

Actionable Nugget

Bladder function should be reviewed annually by the family physician, and periodically by a urologist.

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.

Key Reference:

    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):

    Averbeck, M. A., & Madersbacher, H. (2015). Follow-up of the neuro-urological patient: A systematic review. BJU International, 115(S6), 39–46. http://doi.org/10.1111/bju.13084
    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 International115(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 cord53, 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 Sciences36(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
    Danforth, T. L., & Ginsberg, D. A. (2014). Neurogenic lower urinary tract dysfunction: how, when, and with which patients do we use urodynamics?. Urologic Clinics of North America, 41(3), 445-452. http://doi.org/10.1016/j.ucl.2014.04.003
    Goldmark, E., Niver, B., & Ginsberg, D. A. (2014). Neurogenic bladder: from diagnosis to management. Current Urology Reports, 15(10), 448. http://doi.org/10.1007/s11934-014-0448-8
    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 cord52(7), 551-555. http://doi.org/10.1038/sc.2014.9
    Welk, B., Morrow, S., Madarasz, W., Baverstock, R., Macnab, J., & Sequeira, K. (2014). The validity and reliability of the neurogenic bladder symptom score. The Journal of urology192(2), 452-457. http://doi.org/10.1016/j.juro.2014.01.027
    Welk, B., Tran, K. C., Liu, K., & Shariff, S. (2014). The pattern of urologic care among traumatic spinal cord injured patients. Canadian Urological Association Journal8(11-12), E805.
    Akkoc, Y., Ersöz, M., Yıldız, N., Erhan, B., Alaca, R., Gök, H., … & Alemdaroğlu, E. (2013). Effects of different bladder management methods on the quality of life in patients with traumatic spinal cord injury. Spinal cord, 51(3), 226-231.
    Linsenmeyer, T. A., & Linsenmeyer, M. A. (2013). Impact of annual urodynamic evaluations on guiding bladder management in individuals with spinal cord injuries. The Journal of Spinal Cord Medicine, 36(5), 420-6.
    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 Urology31(3), 659-664.
    Vírseda, M., Salinas, J., Esteban, M., & Méndez, S. (2013). Reliability of ambulatory urodynamics in patients with spinal cord injuries. Neurourology and Urodynamics32(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 Cord50(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 Biomedicine106(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 Endourology25(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 America95(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 Urology184(186), 2423-2428.
    Apostolidis, A., Dasgupta, P., Denys, P., Elneil, S., Fowler, C. J., Giannantoni, A., et al. (2009). Recommendations on the Use of Botulinum Toxin in the Treatment of Lower Urinary Tract Disorders and Pelvic Floor Dysfunctions: A European Consensus Report. European Urology55 (51), 100-120.
    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.
    Woodbury, M.G., Hayes, K.C., & Askes, H.K. (2008). Intermittent catheterization practices following spinal cord injury: A national survey. Canadian Journal of Urology15(3), 4065-71.
    Blok, B.F., Karsenty, G., & Corcos, J. (2006). Urological surveillance and management of patients with neurogenic bladder: Results of a survey among practicing urologists in Canada. Canadian Journal of Urology, 13(5), 3239-43.
http://www.canjurol.com/abstract.php?ArticleID=1407&version=1.0
    Consortium for Spinal Cord Medicine (2006). Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. Journal of Spinal Cord Medicine29(5), 527-73.
http://www.pva.org/site/News2?news_iv_ctrl=-1&page=NewsArticle&id=7121
    Vaidyanathan, S., Singh, G., Soni, B.M., Hughes, P.L., Mansour, P. Oo, T., Bingley, J., et al. (2004). Do spinal cord injury patients always get the best treatment for neuropathic bladder after discharge from regional spinal injuries centre? Spinal Cord, 42(8), 438-42.