Bladder Managment for Adults with Spinal Cord Injury - 22

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

Recurrent urethral catheter obstruction. Difficulty with urethral catheter insertion. Perineal skin breakdown due to 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 epididymoorchitis.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Suprapubic catheterization has several proven or theoretic benefits over urethral catheterization after SCI. In cases of urethral injury or abnormality, suprapubic catheterization is clinically indicated to prevent further urethral trauma. Complications, such as epididymitis, tend to be higher with urethral catheterization versus suprapubic catheterization, intermittent catheterization, and spontaneous voiding (Weld and Dmochowski, 2000). Additionally, for some people, sexual function and self-image may be enhanced with a suprapubic as opposed to an indwelling urethral catheter. Some individuals prefer a suprapubic catheter to a urethral catheter for comfort and convenience. Suprapubic catheters may be especially beneficial for females who are considering an indwelling catheter because females are more likely than males to have leakage around a urethral catheter as a result of incompetence (Bennett et al., 1995). 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.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

traumatic events, such as blunt trauma after a motor vehicle crash, a penetrating injury due to a gun shot or stab wound, a sporting accident, fall, or an iatrogenic injury from a traumatic catheter placement. It is imperative that urethral trauma be diagnosed quickly and efficiently so that effective treatment measures can be implemented to prevent serious long-term complications. Often, urethral injuries accompany major trauma and immediate repair is unlikely because other lifethreatening injuries preclude treatment (Koraitim, 1999; Sandler and McCallum, 2000). Urethral injury should be suspected after pelvic fracture, traumatic catheterization, or penetrating injury near the urethra. Symptoms after SCI include hematuria, blood at the meatus, or a high-riding prostate gland. Diagnosis may require a high index of suspicion and is made by retrograde urethrogram. Placement of a urethral catheter should be avoided as this could result in further injury. In these cases, placement of a suprapubic catheter is preferred (Addison and Mould, 2000; Koraitim, 1996). 4. Consider indwelling catheterization for individuals who are at risk of genitourinary complications due to elevated detrusor pressures.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: Upper tract abnormalities can result from increased detrusor pressure. Leak point pressure above 40 cm H2O is associated with upper urinary tract deterioration. In a comparison of urodynamic changes over time in individuals with SCI, maximum detrusor pressure was lower and there was less bladder trabeculation in individuals using indwelling catheters than in those using clean intermittent catheterization, external collection, and spontaneous voiding (Cardenas, Mayo, and Turner, 1995; Weld, Graney, and Dmochowski, 2000). Bladder compliance is typically lower for individuals using indwelling catheters (Cardenas, Mayo, and Turner, 1995; Weld, Graney, and Dmochowski, 2000). The possible mechanism for this is the constant decompression of the bladder caused by the catheter and inflammation and infections related to the catheter leading to vesical wall fibrosis. 5. Advise individuals of the long-term complications associated with indwelling catheterization, which include: Bladder stones. Kidney stones.

Rationale: Instrumentation can further exacerbate urethral injury, which can lead to long-term complications such as stricture or difficulty voiding. Most urethral injuries are associated with clear

Bladder Managment for Adults with Spinal Cord Injury

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