Bladder Managment for Adults with Spinal Cord Injury - 32

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

participants with DSD. Several nonrandomized studies have been conducted on the use of different stents for the treatment of DSD with acceptable results (Denys et al., 2004). It is recommended that individuals return for follow-up every 6 months after stent placement. They will be monitored for such problems as difficulty emptying the bladder due to obstructing stent hyperplasia and autonomic dysreflexia, which may require the use of alpha-blockers and/or transurethral bladder neck resection or incisions. 3. Consider avoiding urethral stents in individuals who: Have insufficient hand skills or caregiver assistance to manage a condom catheter. Are unable to maintain a condom catheter. Are female. Have urethral abnormalities.
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Urethral pain.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Rationale: In a multicenter study, 8.5 percent of the study participants required bladder neck surgery after the stent placement; longer follow-up in a small series reported bladder neck surgery following stent placement in 5 out of 7 participants with DSD (Shah, Kapoor, and Badlani, 2003). However, over the long term, stents can undergo encrustations, and a definite risk remains that the stent will migrate into the bladder, necessitating stent removal or replacement. In a longer followup study (up to 7 years), stents were explanted in 22 percent of the participants with DSD. Migration and/or inappropriate placement were blamed as the cause for removal in 38.4 percent of the cases. Other reported complications and problems include irritative symptoms, persistence of autonomic dysreflexia, calculus formation, prostatic infections, tissue growth, and difficulty in removing the stent.

Rationale: An important aspect of the urethral stent/reflex voiding method of bladder management is that the individual must have the ability to put on a condom catheter and have it stay in place. If this is not possible, another method of bladder management is recommended. Because the stent is put in place with an insertion tool, it may be technically difficult to place the stent in the correct position if the individual has urethral abnormalities, such as a urethral diverticulum or strictures. There is some concern that the stent may migrate if the person has had a previous transurethral procedure, such as a sphincterotomy. 4. Advise individuals of the potential for complications of urethral stents, such as: Stone encrustation. Stent migration. Persistence of autonomic dysreflexia. Possible need for removal or replacement. Difficulty with removal. Possible urethral stricture after removal of stent. Urethral trauma. Tissue growth into the stent blocking urine flow.

N u r s i n g C o n s i d e r a t i o n s f o r U re t h r a l Stents
The success of this bladder management option will depend upon the individual’s ability to alter care. A thorough objective and subjective assessment is essential prior to surgery. Preoperative. The focus of care is on the individual’s physical and emotional well-being and on the person’s ability to alter care to facilitate the surgical intervention. Postoperative. The focus of care is on preventing movement of the stent by altering the individual’s activities of daily living. Assistance required. Assistance with transfers will be needed until the stent is adequately epithelized. Individuals with paraplegia should use a slide board to prevent extension of the pelvic area. Individuals with tetraplegia will need to use a mechanical lift until the endourethral stents are stabilized, in approximately 1–3 months. Care of equipment, cosmesis, and interference with social/sexual functioning. See Nursing Considerations for Reflex Voiding. Reversibility. The stent is removable, although the procedure can be difficult and result in urethral scarring and/or stricture. Permanent urinary incontinence will not occur, however, the

Bladder Managment for Adults with Spinal Cord Injury

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