Bladder Managment for Adults with Spinal Cord Injury - 28

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

ical treatment of lower urinary tract dysfunction in individuals with SCI (Abrams et al., 2003). More specific adrenergic blockers (against alpha 1-A adrenergic receptors) are now being used to treat lower urinary tract dysfunction associated with high urethral resistance in individuals with SCI (Abrams et al., 1982). Understanding the risks, benefits, and contraindications of the different alpha-blockers will help the individual with SCI make an informed decision on the type of bladder management to be tried. 1. Consider the use of alpha-blockers on their own or as a supplement to other forms of treatment, such as transurethral sphincterotomy.
(Scientific evidence–II/III; Grade of recommendation– B/C; Strength of panel opinion–Strong)

alpha-blockers and PDE5 inhibitors are prescribed together.
(Scientific evidence–II/III; Grade of recommendation– B/C; Strength of panel opinion–Strong)

Rationale: Phosphodiesterase (PDE5) inhibitors may lower blood pressure, which can be a potential problem, particularly for individuals with a high-level SCI who already have a low baseline blood pressure. A number of individuals with spinal cord injuries take alpha-blockers to improve voiding. Furthermore, individuals with high-level injuries frequently may need nitropaste if they develop autonomic dysreflexia. Combining PDE5 inhibitors with nitrates may cause a precipitous lowering of blood pressure (Thomas et al., 1984). 5. Advise individuals of the potential for complications of alpha-blockers, such as orthostatic hypotension.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Level II and III evidence suggests that urodynamic changes—including less urethral resistance and improved urinary flow rate—have been seen in individuals treated with alpha-adrenergic blockers. When urethral resistance is lessened, detrusor overactivity might also improve (Thomas et al., 1984). 2. Consider avoiding alpha-blockers in individuals who have symptomatic hypotension.
(Scientific evidence–II/III; Grade of recommendation– B/C; Strength of panel opinion–Strong)

Alpha-blockers have the potential to lower blood pressure, which can be a particular concern in individuals with high-level spinal cord injuries because their normal systolic blood pressure is frequently 90–110mm Hg (Thomas et al., 1984). 3. When first prescribing, instruct the individual to take alpha-blockers at night, when supine. These instructions are particularly important for individuals with high-level spinal cord injuries because of the potential for orthostatic hypotension.
(Scientific evidence–II/III; Grade of recommendation– B/C; Strength of panel opinion–Strong)

Rationale: Instruct individuals with SCI to take alpha-blockers at night, when supine. These instructions are particularly important for those with high-level spinal cord injuries because of the potential for orthostatic hypotension and other complications associated with alpha-blockers. A thorough review of all of the potential complications will help the individual with SCI to make an informed decision on the method of bladder management to be used.

Nurs ing Consider ations f or AlphaBlockers
Whether alpha-blockers are used alone or as a supplement to other forms of treatment, individuals receiving alpha-blockers will need to be aware of some necessary precautions and other issues pertaining to the medicine’s use. The type and dose of this and other medications must be done under the care and advice of a physician. Review of medications. To avoid potentially harmful side effects, the use of other antihypertensive agents and phosphodiesterase inhibitors should be reviewed by the prescribing physician prior to beginning an alpha-blocker medication. Introduction of an alpha-blocker. When an alpha-blocker is first started, the individual should be observed for signs and symptoms of syncope: dizziness, nausea, and sweating. If feelings of lightheadedness occur, the individual should be placed in a recumbent position and monitored closely.

Rationale: The risk of orthostatic hypotension will be minimized if the person is in a supine position for the night. Clarification of necessary antihypertensive medications with the primary care provider will prevent individuals from being overmedicated (Thomas et al., 1984). 4. Use phosphodiesterase inhibitors with caution in individuals with a high-level SCI who are on alpha-blockers. Particular caution should be used if

Bladder Managment for Adults with Spinal Cord Injury

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