CLINICAL PRACTICE GUIDELINE iii Table of Contents iv v vi vii viii 1 7 F o re w o rd P re f a c e Acknowledgments Panel Members C ontributors Summa ry of Recommendations T h e C o n s o r t i u m f o r S p i n a l C o rd M e d i c i n e GUIDELINE DEVELOPMENT PROCESS METHODOLOGY 13 I n t ro d u c t i o n ANATOMY AND PHYSIOLOGY OF THE UPPER AND LOWER URINARY TRACTS UPPER URINARY TRACT LOWER URINARY TRACT NEUROANATOMY OF THE LOWER URINARY TRACT VOIDING CENTERS CLASSIFICATION OF VOIDING DYSFUNCTION UROLOGIC EVALUATION UROLOGY FOLLOW-UP 17 Recomme ndations INTERMITTENT CATHETERIZATION CREDÉ AND VALSALVA INDWELLING CATHETERIZATION REFLEX VOIDING ALPHA-BLOCKERS BOTULINUM TOXIN INJECTION URETHRAL STENTS TRANSURETHRAL SPHINCTEROTOMY ELECTRICAL STIMULATION AND POSTERIOR SACRAL RHIZOTOMY BLADDER AUGMENTATION CONTINENT URINARY DIVERSION URINARY DIVERSION CUTANEOUS ILEOVESICOSTOMY 42 43 45 50 R e c o m m e n d a t i o n s f o r F u t u re R e s e a r c h Appendix A: Economic Considera tions for Bladder Management Methods R e f e re n c e s Index