General objectives  

General Goals of treatment of SCI neurogenic bladder

  • First line: Kidney preservation
    • Proper urine storage with maintaining low intravesical pressure low
    • Proper urine emptying with maintaining low intravesical pressure low
  • Second line: Urinary control and maintaining dryness
    • Living life without catheter or urinary appliance
    • Social acceptability and adaptability: independence, patient comfort, convenience
  • Third line: UTI control and prevention of AD
  • The utmost important goal of managing the neurogenic bladder in SCI/D patients is maintaining and ensuring low bladder pressure. This is because high bladder pressure either during storage or voiding phase causes deterioration of renal function.

 

Goals for the Specific Conditions

1. Suprasacral Spinal Cord Lesion

  • Situation
    • Bladder: overactive
    • Urethra: with/without DSD
  • Voiding dysfunction most commonly seen: a filling/storage and an emptying failure
  • The bladder pressure should be maintained low with medical or surgical management.
  • If bladder pressure is suitably low or once it is made suitably low with medical or surgical management, the problem can be managed primarily as an emptying failure with CIC.

2. Sacral Spinal Cord Lesion

  • Situation
    • Bladder: areflexic bladder with high or normal compliance
    • Urethra: competent but nonrelaxing smooth sphincter and a striated sphincter without voluntary control.
  • Voiding dysfunction most commonly seen: An emptying failure
  • The bladder pressure should also be maintained low with non-surgical or surgical management.
  • Emptying failure could be managed with CIC.
Key Points of This Section
  • General goals of treatment of the neurogenic bladder due to spinal cord injury or diseases lie in the kidney preservation, urinary control and maintaining dryness, UTI control and prevention of autonomic dysreflexia.

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