Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI)

Abstract

Study design: Review. Objectives: To assess current available options for bladder management in SCI patients the post-acute phase. Methods: Relevant articles were extracted from medline and Cinahl between 1966 ± 1999. In addition, references earlier than 1966 that were listed in these articles were identi®ed and extracted. Results: Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. Conclusion: Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the ®rst half of the 20th century to the present 3%. Spinal Cord (2001) 39, 355 ± 361

Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

“…The current trend in managing patients who require an indwelling drainage device is to place an SPT to avoid morbidities specifically associated with an indwelling UC, such as ventral urethral erosion and urethral fistula formation. 1 The problem with this approach is that SPT has its own set of complications including leakage from the SPT site, leakage from urethra or the need for revision of the tube and the complications associated with a surgical procedure. Procedures that may be needed in patients with SPT, such as bladder neck closure because of urethral leakage and SPT site revision because of leakage around the SPT, have been shown to have a 14-31% complication rate.…”

“…1,2 For SCI patients with functional bladder abnormalities, the goal of the urologist is to select the management with the least morbidity, but which is also manageable for the SCI patient in the long term. 3 Efforts are made to minimize the use of longterm indwelling catheters (various types of urethral catheter (UC) and suprapubic catheter (SPT)) secondary to welldocumented complications such as recurrent urinary tract infection (UTI), stones, epididymitis, urethral erosion, fistula formation and cancer.…”

Penile erosion in spinal cord injury – an important lesson

“…Most patients with SCI will use urethral catheterisation, either as indwelling catheterisation or clean intermittent selfcatheterisation (CISC). 1 The use of condom drainage system can render a male SCI patient effectively dry, but can lead to penile or urethral complications in 15-30% of patients. 2 Other commonly reported problems range from allergic reactions and local defects in the skin, to gangrene and partial amputation of the penis.…”

Significance of low compliance bladder in cauda equina injury

“…Methods of treatment and management are also variable, including behavior therapy, adjuvant therapy, medication and surgery. 1,2 In general, an are¯exic neurogenic bladder usually appears in patients with cauda equina injury due to damage of the pelvic nucleus and pudendal nucleus in the sacral cord. 3 However several studies reported atypical ®ndings such as autonomic detrusor contraction (ADC) or low compliance in cauda equina injury.…”