Bladder Managment for Adults with Spinal Cord Injury - 27

CLINICAL PRACTICE GUIDELINE

poor bladder emptying, high intravesical voiding pressures, and autonomic dysreflexia—are frequently a result of detrusor sphincter dyssynergia. 5. First consider use of the following nonsurgical methods to help decrease detrusor sphincter dyssynergia in individuals who use reflex voiding as their method of bladder management: Alpha-blockers. Botulinum toxin injection into the urinary sphincter mechanism.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Proper use and care of external condom catheter. The condom catheter is applied securely to avoid leakage and constriction for 24 hours. To avoid skin maceration and breakdown, the glans is washed daily when the condom is changed, the skin is aired for 20–30 minutes, and the condom is reapplied. To prevent pressure ulcers, alternate legs are used to anchor the tubing. Care of equipment. Daytime and nighttime urinary collection devices are cleaned daily. A 1:10 solution of bleach to water has been shown to provide effective cleansing (Dille and Kirchhoff, 1993). Assistance required. The individual or a caregiver can apply the condom catheter, empty the urine receptacle, clean the equipment, provide daily hygienic care, and perform daily skin assessment. An electronic emptying device that affixes to the wheelchair can assist with emptying the urine receptacle. Cosmesis. A leg bag is worn during the day and a nighttime drainage bag is used at night. Loose clothing should be worn to accommodate the leg bag. Interference with social/sexual function. Urine leakage may occur during sexual activity. Use of a regular condom may be an option for management. Other. Individual anatomy and allergies to latex or adhesive are considerations when choosing a condom catheter. The appropriate size selfadhesive condom (small to extra large) and the appropriate length (short, extra wide with adhesive) must be determined. Individuals with allergies to the adhesive can use nonadhesive condoms, which are available from most of the pharmaceutical companies that make condoms.
Adapted from Joseph, A.C., A. Hixon, J. Giroux, D. Briggs, M. Gardenhire, D. Diaz, and J. Wells. Nursing clinical practice guideline: neurogenic bladder management. Spinal Cord Injury Nursing 15 (2) (1998): 21–56.

Rationale: Because individuals with spinal cord injury usually have detrusor sphincter dyssynergia, problems may result, such as high voiding pressures (which can cause upper tract damage), autonomic dysreflexia, and high post-void residuals. A trial of nonsurgical treatments is recommended prior to surgery because they are easy to reverse if a person chooses to try a different method of bladder management instead. (See Alpha-Blockers and Botulinum Toxin Injection for a description of and rationale for each method.) 6. To ensure low-pressure voiding during reflex voiding, consider the use of two surgical methods: Transurethral sphincterotomy. Endourethral stents.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Nursing Consideratio ns for Reflex Vo i d i n g
Individuals who choose reflex voiding for bladder management should determine the type of collecting device to be used prior to the treatment intervention. Individuals will need to understand in advance how the treatment intervention will alter care of the bladder. There are a number of variations on reflex voiding technique and care. The following is one example.

Alpha-Blockers
Alpha-blockers are a nonsurgical method to treat detrusor sphincter dyssynergia and low bladder pressure during voiding. Alpha adrenergic receptors have been identified in the proximal urethra, prostate, and bladder neck. Alpha adrenergic blockers have been found to lower urethral resistance and improve voiding. Though earlier adrenergic blockers were less urologic-specific, they were commonly used for med-

Bladder Managment for Adults with Spinal Cord Injury

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