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The following article is reprinted here with permission from The Robson Clinic and The Canadian Paraplegic Association of Ontario. A spotlight on the Charles J. Robson Clinic, Lyndhurst Spinal Cord Centre

Management of the Neurogenic Bladder

A General Overview:

A neurogenic bladder occurs when nerves related to bladder function are impaired as the result of a spinal cord injury or disease process. A number of factors must be considered when deciding on what type of bladder management is best suited to the client. These include level of independence, lifestyle, client's wishes and a urological assessment.

We recommend the assessment include:

There are essentially four alternate methods of bladder management if an individual is not able to void in the normal fashion. These are intermittent catheterization (I.C.), condom drainage, condom drainage combined with I.C., and indwelling catheter.

Intermittent Catheterization:

The process of inserting a catheter into the bladder through the urethra periodically to empty the bladder is known as intermittent catheterization. This method most closely resembles a normal bladder filling and emptying making intermittent catheterization the preferred recommended method of bladder management. In some situations a person may require an anticholinergic medication (such as Ditropan) to prevent the bladder from accidentally emptying between catheterizations.

Condom Drainage:

This method (suitable to only males) is the process of affixing an external condom drainage device to the penile shaft allowing the urine to drain into a collecting bag. This method may be suitable for a man who is not able to perform or arrange to have assistance with intermittent catheterizations. Condom drainage is effective when the bladder muscle contracts involuntarily generating sufficient pressure to force the urine through the sphincter muscle. In some situations the client may require a urethral stent (such as a UroLume) to allow the bladder to drain the urine through the sphincter without creating extreme or unhealthy bladder pressures.

Condom Drainage and Intermittent Catheterization:

This is a combination of the first two types of management. It is recommended in situations when an individual on condom drainage is retaining a significant amount of fluid in the bladder after the bladder has contracted. In most cases the catheterization can be done once, sometimes twice per day.

Indwelling Catheter:

With this method a catheter is retained in the bladder at all times and draining freely into a collection bag. The catheter is held in the bladder by a balloon that is inflated with sterile water. This method is the least preferred type of bladder management and is rarely recommended.

Health Risk Factors of the Neurogenic Bladder:

A major risk associated with the neurogenic bladder is hydronephrosis - urine backing up into the kidney. This reflux is most often caused by extremely high pressures in the bladder. Another cause is recurrent over-distention of the bladder. The condition is a serious health risk which can impair kidney function and, if left untreated can lead to kidney failure and death. Hydronephrosis is always a potential risk regardless of the client's method of bladder management.

The most common complaint associated with all methods of bladder management is bladder infection. This is generally easily treated with an antibiotic and can be minimized with appropriate fluid intake and a supplement of cranberry capsules, in most cases. Other less common risks are stone formation in the kidney or bladder, trabeculation (hardening of the bladder muscle) and trauma to the urethral tract.

It is important to keep in mind the necessity of regular urological evaluations. It is possible that an individual may not be aware of changes in bladder pressures that could eventually impair kidney function. We generally recommend an annual review.

For more information call the Robson Clinic (416) 597-3422 ext. 6218.
 
 

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