Actionable Nuggets for SCI (2nd ed., 2013)
Neurogenic bladder dysfunction (dysfunction of the ability to store and void urine) is common complication of spinal cord injury (SCI). Spinal cord injury may cause decreased bladder compliance, detrusor-sphincter dysynergia, or increased detrusor pressure (>40 cm H2O). These conditions can only be accurately detected using urodynamics, and can result in significant renal damage if not properly managed.
Bladder management 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 pressure, and preventing complications. Methods of bladder management include voiding techniques, collection devices, pharmacological agents, and surgery. 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.
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. Annual urological review should include ultrasound of the upper and lower urinary tract.
Effectiveness of bladder management strategies may change as patients age, acquire secondary conditions, or their circumstances change. Referral to a urologist for urodynamic studies is warranted in patients with persisting incontinence or AD despite adherence to bladder management routine.
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