Bladder Managment for Adults with Spinal Cord Injury - 36

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

broeck et al., 1997; van der Aa et al., 1999). As a result, the use of anticholinergic medication is greatly reduced (Creasey and Dahlberg, 2001). The rhizotomy also reduces sphincter spasticity, allowing good flow rates of urine, and abolishes autonomic dysreflexia caused by contraction or distention of the bladder (Egon et al., 1998; Koldewijn et al., 1994, Schurch, Rodic, and Jeanmonod, 1997; Schurch et al., 1998). 2. Avoid electrical stimulation combined with posterior sacral rhizotomy for: Individuals who have poor or absent bladder contractions. Individuals who are unable to expand the bladder due to fibrosis. Females who are unable to transfer or be transferred or to manage clothing. Males who are unwilling to lose reflex erection.
(Scientific evidence–III; Grade of recommendation–C; Strength of panel opinion–Strong)

Reduction of reflex defecation. Transient nerve damage (rarely long term).
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Posterior rhizotomy from S2–4 abolishes reflex erection, reflex ejaculation, and sacral sensation, if present. It may also reduce reflex defecation by abolishing sacral spinal reflexes, though intramural and pelvic reflexes are preserved. Anterior sacral roots may be accidentally damaged by handling while performing posterior rhizotomy, but this damage is usually transient, though it may delay the use of the stimulator for several months until the anterior roots recover function (Brindley, 1994). 4. Advise individuals with SCI of the potential for complications of electrical stimulation, such as: Contamination of the device. Malfunction of the device. Transient nerve damage (rarely long term).
(Scientific evidence–None; Grade of recommendation–None; Strength of panel opinion–Strong)

Rationale: Electrical stimulation activates the sacral parasympathetic nerves to the bladder; these must therefore be intact, even if descending tracts in the spinal cord have been damaged. The simplest way to determine if they are intact is to demonstrate reflex bladder contraction on bladder filling. This may require testing in the absence of anticholinergic medication (Chua, Tow, and Tan, 1996; Egon et al., 1998; Schurch, Rodic, and Jeanmonod, 1997). Bladder capacity in the absence of reflex contraction should be large enough to allow several hours between voids (van Kerrebroeck et al., 1997). This capacity can be tested while inhibiting reflex contraction using anticholinergic medication or spinal, caudal, or general anesthesia. Restoring the ability to void via the urethra requires the ability to collect urine in a toilet, bottle, or leg bag. Tetraplegic females who void via the urethra need to be able to transfer or be transferred onto a toilet, commode, or bedpan. Tetraplegic males who cannot manage a urine bottle should be assessed for their ability to retain a condom drainage system (Creasey and Dahlberg, 2001). 3. Advise individuals with SCI of the potential for complications of posterior sacral rhizotomy, such as: Loss of reflex erection and reflex ejaculation. Loss of sacral sensation.

Rationale: The risk is 1 percent that the implant will become infected. The risk of faults in the implant is 1 fault per 20 implant-years; faults are treated by repair or replacement of the implant, and individuals can revert to intermittent or indwelling catheterization while awaiting repair (Brindley, 1995). The external controller may develop faults, but it can be repaired or replaced without surgery. Sacral nerves may be damaged accidentally by applying electrodes incorrectly.

Nursing Considerations for Electrical Stimulation
Individuals who choose this method of bladder management will have to learn how to use the device. A thorough assessment for appropriateness of the procedure is essential. Preoperative. The individual’s physical and emotional well-being will be assessed. The ability to manipulate the device and to capture urine, either in a receptacle or on the toilet, will be determined prior to treatment intervention. Intraoperative. During the surgery, efforts will be made to ensure safety and prevent complications, such as deep vein thrombosis and pressure ulcers.

Bladder Managment for Adults with Spinal Cord Injury

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