CONCLUSIONS AND TAKE HOME MESSAGES

  1. Basic anatomy and pathophysiology
    1. Every health care professional should have through knowledge of the basic anatomy, physiology, pharmacology, natural history and pathophysiology of the neurogenic bladder associated with spinal cord injury or disease.
  2. Urodynamic study and Diagnosis
    1. It is essential to refer the evaluation of neurogenic bladder-related problems of the patients to urologists with experience in this area
    2. Urodynamic study guides the clinician in advising the patient on the available options for bladder management
    3. There should be a good and rapid communication channels among clinical departments as well as community health care professionals involved in the managements of the SCI patients in order to detect problems and identify risk factors for renal and other diseases related to lower urinary tract dysfunction
  3. Treatment
    1. Patients with acute SCI ultimately return to the community to live their adapted life. Health care professionals in the community should be familiar with basic urologic management initiated in a tertiary center.
    2. The patients can not perceive the evolving bladder dynamics that can be harmful to the kidney. Therefore periodic checkup by a urologist familiar with the conditions found after SCI is essential. Life-long urological surveillance is necessary.
  4. CIC
    1. CIC combined with anticholinergic, and other medications, is the mainstay in the management of the SCI neurogenic bladder. 
    2. Long-term indwelling urethral catheters, and suprapubic tubes should be avoided whenever possible.
  5. UTI
    1. Urinary colonization is very common in patients with neurogenic vesical dysfunction.  As long as lower urinary tract pressures are kept within narrow limits most bacteriuira should not be treated. If symptomatic infection develops it should be treated for short intervals. The goal is absence of symptoms and not an abacteriuric state.
    2. Patients who develop symptomatic urinary infections must be evaluated for abnormal bladder pressures and dysfunction.
  6. Continence
    1. Preservation of urinary continence is an important therapeutic goal in the management of the neurogenic bladder. Altered continence leads to depression, involution, skin problems, skin break down and serious problems with infection, osteomyelitis, tissue loss and even death.
    2. Fortunately methods to achieve continence are largely the same as those used to control bladder pressure. One of the most common reasons for patients to abandon CIC and use catheters is incontinence.
  7. Dysreflexia
    1. Autonomic dysreflexia is a common problem in patients with high spinal cord injuries. It is often related to bladder or bowel distention but any noxious stimulus can be associated with the syndrome. The massive sympathetic discharge that occurs produces very serious hypertension, a wide pulse pressure, a pounding headache and profuse sweating above the level of the injury as well as a very slow heart rate. The syndrome can be lethal.
    2. In most cases investigation will elucidate the inciting stimulus, for example, high pressure detrusor sphincter dysynergia, which can be treated thus preventing the autonomic dysreflexic response.

 

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