Turkish Journal of Physical Medicine and Rehabilitation 2005 , Vol 51 , Num 2

Practical Management of Neurogenic Bladder in the Spinal Cord Injured Patients

Jean Jacques Wyndaele 1
1 Jean Jacques Wyndaele;  Professor of Urology and Chairman, Department of Urology, University Antwerp, Belgium

Neurogenic bladder is a highly prevalent dysfunction among the patients with spinal cord lesion. Past experiences have taught us that a strict management is necessary to prevent complications and also to lower the risk of a life-threatening development. Fortunately, during the recent decades it has become evident that risks can be controlled. This gained control stems from the increasing knowledge of neurophysiology and physiopathology, and also from the improvements that have been made in the utilization of certain diagnostic techniques and the usage of more efficient treatment modalities. The way patients are handled during the first weeks following the occurrence of the primary lesion often determines the life-long outcome; meaning that basically overdistention of the bladder and infection have to be avoided with a correct bladder drainage approach. Furthermore, urodynamic tests are needed, during this period, to determine the activity and coordination of different parts of lower urinary tract (LUT). Intermittent catheterization/self catheterization is the method of choice in the instances where a low pressure reservoir is practically obtainable. However, suprapubic tapping to elicit a reflex bladder contraction, and Valsalva/Crédé manoeuvres to hasten the bladder emptying, should only be used in selected patients. Additional pharmacologic management consists mostly of bladder relaxant drugs. Electrical devices have specific but rare indications. Surgical interventions on the LUT are second level treatments that can only be indicated in certain patients. Indwelling catheters should always be avoided; nevertheless could be the only solution in certain patients. Moreover, external appliances can limit the negative effects of incontinence.  

Keywords : Neurogenic bladder, spinal cord injury