Bladder Managment for Adults with Spinal Cord Injury - 2

2

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

Indwelling Catheterization
1. Consider indwelling catheterization for individuals with: Poor hand skills. High fluid intake. Cognitive impairment or active substance abuse. Elevated detrusor pressures. Lack of success with other less invasive bladder management methods. Need for temporary management of vesicoureteral reflux. Limited assistance from a caregiver, making another type of bladder management not feasible. 2. Consider using suprapubic catheterization for individuals with: Urethral abnormalities, such as stricture, false passages, bladder neck obstruction, or urethral fistula. Urethral discomfort. Recurrent urethral catheter obstruction. Difficulty with urethral catheter insertion. Perineal skin breakdown as a result of urine leakage secondary to urethral incompetence. Psychological considerations such as body image or personal preference. A desire to improve sexual genital function. Prostatitis, urethritis, or epididymo-orchitis. 3. Consider avoiding urethral catheterization in individuals with SCI: Immediately following acute SCI if urethral injury is suspected, especially after pelvic trauma (blood at the urethral meatus and perineal and scrotal hematomas may be indicative of urethral trauma). If bladder capacity is small, with forceful uninhibited contractions despite treatment. 4. Consider indwelling catheterization for individuals who are at risk of genitourinary complications because of elevated detrusor pressures.

5. Advise individuals of the long-term complications associated with indwelling catheterization, which include: Bladder stones. Kidney stones. Urethral erosions. Epididymitis. Recurrent symptomatic urinary tract infections. Incontinence. Pyelonephritis. Hydronephrosis from bladder wall thickening or fibrosis. Bladder cancer. 6. Conduct more frequent cystoscopic evaluations for individuals with chronic indwelling catheters than for those with nonindwelling methods of bladder management. 7. Consider the use of anticholinergics in individuals with suprasacral lesions using chronic indwelling catheterization.

Reflex Voiding
1. Consider using reflex voiding for males who demonstrate post-spinal shock with adequate bladder contractions and have: Sufficient hand skills to put on a condom catheter and empty the leg bag, or a willing caregiver. Poor compliance with fluid restriction. Small bladder capacity. Small post-void residual volumes. Ability to maintain a condom catheter in place. 2. Conduct a thorough urodynamic evaluation to determine whether reflex voiding is a suitable method for a particular individual. 3. Consider not using reflex voiding as a method of bladder management in individuals who: Have insufficient hand skills or caregiver assistance.



Bladder Managment for Adults with Spinal Cord Injury

Table of Contents for the Digital Edition of Bladder Managment for Adults with Spinal Cord Injury

Bladder Management for Adults with Spinal Cord Injury
Contents
Foreword
Preface
Acknowledgments
Panel Members
Contributors
Summary of Recommendations
The Consortium for Spinal Cord Medicine
Introduction
Recommendations
Recommendations for Future Research
Appendix A: Economic Considerations for Bladder Management Methods
References
Index
Bladder Managment for Adults with Spinal Cord Injury - Bladder Management for Adults with Spinal Cord Injury
Bladder Managment for Adults with Spinal Cord Injury - i
Bladder Managment for Adults with Spinal Cord Injury - ii
Bladder Managment for Adults with Spinal Cord Injury - Contents
Bladder Managment for Adults with Spinal Cord Injury - Foreword
Bladder Managment for Adults with Spinal Cord Injury - Preface
Bladder Managment for Adults with Spinal Cord Injury - Acknowledgments
Bladder Managment for Adults with Spinal Cord Injury - Panel Members
Bladder Managment for Adults with Spinal Cord Injury - Contributors
Bladder Managment for Adults with Spinal Cord Injury - ix
Bladder Managment for Adults with Spinal Cord Injury - Summary of Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 2
Bladder Managment for Adults with Spinal Cord Injury - 3
Bladder Managment for Adults with Spinal Cord Injury - 4
Bladder Managment for Adults with Spinal Cord Injury - 5
Bladder Managment for Adults with Spinal Cord Injury - 6
Bladder Managment for Adults with Spinal Cord Injury - The Consortium for Spinal Cord Medicine
Bladder Managment for Adults with Spinal Cord Injury - 8
Bladder Managment for Adults with Spinal Cord Injury - 9
Bladder Managment for Adults with Spinal Cord Injury - 10
Bladder Managment for Adults with Spinal Cord Injury - 11
Bladder Managment for Adults with Spinal Cord Injury - 12
Bladder Managment for Adults with Spinal Cord Injury - Introduction
Bladder Managment for Adults with Spinal Cord Injury - 14
Bladder Managment for Adults with Spinal Cord Injury - 15
Bladder Managment for Adults with Spinal Cord Injury - 16
Bladder Managment for Adults with Spinal Cord Injury - Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 18
Bladder Managment for Adults with Spinal Cord Injury - 19
Bladder Managment for Adults with Spinal Cord Injury - 20
Bladder Managment for Adults with Spinal Cord Injury - 21
Bladder Managment for Adults with Spinal Cord Injury - 22
Bladder Managment for Adults with Spinal Cord Injury - 23
Bladder Managment for Adults with Spinal Cord Injury - 24
Bladder Managment for Adults with Spinal Cord Injury - 25
Bladder Managment for Adults with Spinal Cord Injury - 26
Bladder Managment for Adults with Spinal Cord Injury - 27
Bladder Managment for Adults with Spinal Cord Injury - 28
Bladder Managment for Adults with Spinal Cord Injury - 29
Bladder Managment for Adults with Spinal Cord Injury - 30
Bladder Managment for Adults with Spinal Cord Injury - 31
Bladder Managment for Adults with Spinal Cord Injury - 32
Bladder Managment for Adults with Spinal Cord Injury - 33
Bladder Managment for Adults with Spinal Cord Injury - 34
Bladder Managment for Adults with Spinal Cord Injury - 35
Bladder Managment for Adults with Spinal Cord Injury - 36
Bladder Managment for Adults with Spinal Cord Injury - 37
Bladder Managment for Adults with Spinal Cord Injury - 38
Bladder Managment for Adults with Spinal Cord Injury - 39
Bladder Managment for Adults with Spinal Cord Injury - 40
Bladder Managment for Adults with Spinal Cord Injury - 41
Bladder Managment for Adults with Spinal Cord Injury - Recommendations for Future Research
Bladder Managment for Adults with Spinal Cord Injury - Appendix A: Economic Considerations for Bladder Management Methods
Bladder Managment for Adults with Spinal Cord Injury - 44
Bladder Managment for Adults with Spinal Cord Injury - References
Bladder Managment for Adults with Spinal Cord Injury - 46
Bladder Managment for Adults with Spinal Cord Injury - 47
Bladder Managment for Adults with Spinal Cord Injury - 48
Bladder Managment for Adults with Spinal Cord Injury - 49
Bladder Managment for Adults with Spinal Cord Injury - Index
Bladder Managment for Adults with Spinal Cord Injury - Cover4
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