Bladder Managment for Adults with Spinal Cord Injury - 8

BLADDER MANAGEMENT FOR ADULTS WITH SPINAL CORD INJURY

The benefits of clinical practice guidelines for the spinal cord medicine practice community are numerous. Among the more significant applications and results are the following: Clinical practice options and care standards. Medical and health professional education and training. Building blocks for pathways and algorithms. Evaluation studies of guidelines use and outcomes. Research gap identification. Cost and policy studies for improved quantification. Primary source for consumer information and public education. Knowledge base for improved professional consensus building.

viduals with SCI choose the approach that will work best for them.
METHODOLOGY

Metaworks, Inc. performed a systematic review of the literature published since 1993 that describes bladder management after traumatic spinal cord injuries in the adult population. The focus of the review was the evaluation of various modalities of bladder management intended to maintain and preserve a functional urinary tract. In general, the review procedures followed the best methods used in the evolving science of systematic review research (Cook, Mulrow, and Haynes, 1997; Sacks et al., 1987). Systematic review is a scientific technique designed to minimize bias and random error by first conducting a comprehensive search of the literature and then use a preplanned process for study selection.
L I T E R AT U R E S E A R C H

Methodology
Gra ding of the Scientific Evide nce
OBJECTIVE

The literature search included both electronic and manual components. Medline (via PubMed) was searched back to 1993 for citations using the following Medical Subject Heading [MeSH] terms and keywords: 1. Bladder, neurogenic [MeSH] OR neurogenic bladder OR neuropathic bladder. 2. Spinal cord injuries [MeSH] OR paraplegia [MeSH] OR quadriplegia [MeSH] OR tetraplegia. 3. Urination disorders (MeSH] OR urinary OR urologic OR bladder OR kidney calculi [MeSH] OR hydronephrosis [MeSH] OR kidney failure [MeSH] OR vesicoureteral reflux [MeSH] OR renal failure. 4. #2 AND #3. 5. #1 OR #4 limits: publication date from 1993 to November 30, 2001, English, human. In addition, two strategies were used to identify papers that may not have been indexed on Medline by the time of the search cutoff date. The PubMed search included a keyword search for the prior 6 months, using terms indicating spinal cord injury and urologic management, with no limits; and Current Contents was searched for the past year, using similar search terms. The Cochrane Library and National Guidelines Clearing House were searched for any recent systematic reviews or clinical guidelines on the subject, which could have been sources for further references. A manual check of the reference lists of all accepted papers and of recent reviews was performed to supplement the above electronic

The objective of this Metaworks, Inc., project was to provide methodologic support services for the development of clinical practice guidelines by the Consortium for Spinal Cord Medicine, sponsored by the Paralyzed Veterans of America. The main component of the project was to conduct a systematic review of the recent English language literature on bladder management of individuals with spinal cord injuries. The focus of the review was the evaluation of various types of bladder management methods, taking into consideration each one’s advantages/indications, disadvantages/contraindications, impact on prevention of upper tract (kidney) and lower tract (bladder) complications, and consequences on social life (e.g., lifestyle independence, sexuality, cost).
BACKGROUND

Bladder management is a crucial element in improved outcomes for individuals with spinal cord injury. The goal is to maintain and preserve a functional, infection-free genitourinary system by preventing upper and lower tract complications with a management system that is compatible with an injury-free lifestyle. The ultimate goal of therapy is to achieve and maintain adequate bladder drainage with low-pressure urine storage and voiding. There is no “gold standard” for methods of bladder management, so this review is intended to provide insight into each method and to help indi-

Bladder Managment for Adults with Spinal Cord Injury

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