SCI Forum Reports
Bladder Management and SCI
February, 2000
The typical pattern of bladder management after spinal cord injury begins with the insertion of a Foley catheter to allow for constant drainage, said Michael E. Mayo, MD, professor in the Department of Urology. Once the patient is medically stabilized, nursing staff perform sterile intermittent catheterization. Later, patients and families learn how to do clean intermittent catheterization (CIC). "Patients with C7 injuries and below usually can manage CIC by themselves," Mayo said. "A lot of men can manage at C6 and some even C5 if they have motivation, adaptive skills and help."
After spinal cord injury, "there is a period of spinal shock during which the bladder shuts down and doesn't contract," Mayo said. "This lasts for a variable period of time, even up to two years. Usually within a matter of months the bladder reflex returns in the majority of patients." Bladder reflex activity can cause incontinence, and medications - such as Ditropan(r), Detrol(r), and Levsin(r) - are prescribed to suppress the reflex. If medication is effective, the patient continues to use CIC.
"Those men who are unable to do CIC, mostly because they are tetraplegic and don't have sufficient upper limb function, can sometimes use external condom catheter drainage without further procedures, " Mayo said.
Often the bladder neck or distal sphincters that connect the bladder to the urethra do not coordinate properly with the bladder, and drainage may be obstructed. Treatment may require bladder neck incision or sphincterotomy (or both), surgical procedures that weaken the sphincter muscles so urine can flow out more easily. A sphincterotomy may scar down and in 50% of cases needs to be repeated after about two years.
An alternative to this surgery is the internal or Wallstent, a stainless steel wire mesh device that is inserted through the urethra and placed in the distal sphincter area to keep it open, allowing urine to flow out. Within about six weeks the mesh becomes firmly incorporated into the urethral wall. The stent is permanent and does not involve surgery.
After these procedures, urination is involuntary and a collection device (such as a condom catheter) must be worn. Because there are no suitable collection devices for females, women cannot benefit from either the sphincterotomy or the stent, and must use a Foley or suprapubic catheter for bladder management if they cannot be managed with intermittent catheterization. "It may not be ideal, but it is the common end result," Mayo said.
Bladder augmentation may be recommended for patients with a reflex bladder in order to increase bladder capacity and keep urine from leaking involuntarily. In this surgical procedure, a segment of bowel is opened up into a patch and used to enlarge the bladder. "We sometimes use a catheterizable abdominal stoma in women and some men so they can catheterize the bladder without having to transfer onto the toilet or lie down," Mayo said.
The NeuroControl VOCARE Bladder System is no longer available.