12. Monitoring of Neurogenic Bladder

Actionable Nuggets for SCI (2nd ed., 2013)

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

The Problem:

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.

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.

Key reference:

    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.

Additional references:

    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).
    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 Urology13(5): 3239-43.
    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.
    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. Urology74(2): 263-266.
    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.
    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 Cord42(8): 438-42.
    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.
    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.