Bladder Managment for Adults with Spinal Cord Injury - 5
CLINICAL PRACTICE GUIDELINE
5
Electrical Stimulation and Posterior Sacral Rhizotomy
1. Consider electrical stimulation and posterior sacral rhizotomy in individuals with: High post-void residual volumes. Chronic or recurrent urinary tract infection. Problems with catheters. Reflex incontinence. Reduced bladder capacity and compliance, caused by detrusor hyperreflexia. Intolerance of anticholinergic medication. Detrusor sphincter dyssynergia. Autonomic dysreflexia. 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. 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. Reduction of reflex defecation. Transient nerve damage (rarely long term). 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).
Bladder Augmentation
1. Consider bladder augmentation for individuals who have: Intractable involuntary bladder contractions causing incontinence. The ability and motivation to perform intermittent catheterization. The desire to convert from reflex voiding to an intermittent catheterization program. A high risk for upper tract deterioration secondary to hydronephrosis and/or ureterovesical reflux as a result of highpressure detrusor sphincter dyssynergia. 2. Consider bladder augmentation for females with paraplegia. 3. Consider bladder augmentation for individuals who are at high risk for upper tract deterioration secondary to hydronephrosis and/or ureterovesical reflux as a result of high pressures, secondary to poor bladder wall compliance, and/or detrusor sphincter dyssynergia. 4. Avoid augmentation for individuals who have: Inflammatory bowel disease. Pelvic irradiation. Severe abdominal adhesions from previous surgery. Compromised renal function. 5. Advise individuals of both the early and late complications of reconstructive surgery using intestinal segments.
Continent Urinary Diversion
1. Consider a continent urinary diversion for: Individuals in whom it is not feasible to augment the native bladder. Individuals who cannot access their native urethra because of congenital abnormalities, spasticity, obesity, contracture, or tetraplegia, or who require closure of an incompetent bladder neck. Females with tetraplegia in whom a chronic indwelling catheter has caused urethral erosion.
Bladder Managment for Adults with Spinal Cord Injury
Table of Contents for the Digital Edition of Bladder Managment for Adults with Spinal Cord Injury
Bladder Management for Adults with Spinal Cord Injury
Contents
Foreword
Preface
Acknowledgments
Panel Members
Contributors
Summary of Recommendations
The Consortium for Spinal Cord Medicine
Introduction
Recommendations
Recommendations for Future Research
Appendix A: Economic Considerations for Bladder Management Methods
References
Index
Bladder Managment for Adults with Spinal Cord Injury - Bladder Management for Adults with Spinal Cord Injury
Bladder Managment for Adults with Spinal Cord Injury - i
Bladder Managment for Adults with Spinal Cord Injury - ii
Bladder Managment for Adults with Spinal Cord Injury - Contents
Bladder Managment for Adults with Spinal Cord Injury - Foreword
Bladder Managment for Adults with Spinal Cord Injury - Preface
Bladder Managment for Adults with Spinal Cord Injury - Acknowledgments
Bladder Managment for Adults with Spinal Cord Injury - Panel Members
Bladder Managment for Adults with Spinal Cord Injury - Contributors
Bladder Managment for Adults with Spinal Cord Injury - ix
Bladder Managment for Adults with Spinal Cord Injury - Summary of Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 2
Bladder Managment for Adults with Spinal Cord Injury - 3
Bladder Managment for Adults with Spinal Cord Injury - 4
Bladder Managment for Adults with Spinal Cord Injury - 5
Bladder Managment for Adults with Spinal Cord Injury - 6
Bladder Managment for Adults with Spinal Cord Injury - The Consortium for Spinal Cord Medicine
Bladder Managment for Adults with Spinal Cord Injury - 8
Bladder Managment for Adults with Spinal Cord Injury - 9
Bladder Managment for Adults with Spinal Cord Injury - 10
Bladder Managment for Adults with Spinal Cord Injury - 11
Bladder Managment for Adults with Spinal Cord Injury - 12
Bladder Managment for Adults with Spinal Cord Injury - Introduction
Bladder Managment for Adults with Spinal Cord Injury - 14
Bladder Managment for Adults with Spinal Cord Injury - 15
Bladder Managment for Adults with Spinal Cord Injury - 16
Bladder Managment for Adults with Spinal Cord Injury - Recommendations
Bladder Managment for Adults with Spinal Cord Injury - 18
Bladder Managment for Adults with Spinal Cord Injury - 19
Bladder Managment for Adults with Spinal Cord Injury - 20
Bladder Managment for Adults with Spinal Cord Injury - 21
Bladder Managment for Adults with Spinal Cord Injury - 22
Bladder Managment for Adults with Spinal Cord Injury - 23
Bladder Managment for Adults with Spinal Cord Injury - 24
Bladder Managment for Adults with Spinal Cord Injury - 25
Bladder Managment for Adults with Spinal Cord Injury - 26
Bladder Managment for Adults with Spinal Cord Injury - 27
Bladder Managment for Adults with Spinal Cord Injury - 28
Bladder Managment for Adults with Spinal Cord Injury - 29
Bladder Managment for Adults with Spinal Cord Injury - 30
Bladder Managment for Adults with Spinal Cord Injury - 31
Bladder Managment for Adults with Spinal Cord Injury - 32
Bladder Managment for Adults with Spinal Cord Injury - 33
Bladder Managment for Adults with Spinal Cord Injury - 34
Bladder Managment for Adults with Spinal Cord Injury - 35
Bladder Managment for Adults with Spinal Cord Injury - 36
Bladder Managment for Adults with Spinal Cord Injury - 37
Bladder Managment for Adults with Spinal Cord Injury - 38
Bladder Managment for Adults with Spinal Cord Injury - 39
Bladder Managment for Adults with Spinal Cord Injury - 40
Bladder Managment for Adults with Spinal Cord Injury - 41
Bladder Managment for Adults with Spinal Cord Injury - Recommendations for Future Research
Bladder Managment for Adults with Spinal Cord Injury - Appendix A: Economic Considerations for Bladder Management Methods
Bladder Managment for Adults with Spinal Cord Injury - 44
Bladder Managment for Adults with Spinal Cord Injury - References
Bladder Managment for Adults with Spinal Cord Injury - 46
Bladder Managment for Adults with Spinal Cord Injury - 47
Bladder Managment for Adults with Spinal Cord Injury - 48
Bladder Managment for Adults with Spinal Cord Injury - 49
Bladder Managment for Adults with Spinal Cord Injury - Index
Bladder Managment for Adults with Spinal Cord Injury - Cover4
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