eMedicine Specialties > Physical Medicine and Rehabilitation > Rehabilitation Protocols

Bladder Management: Follow-up

Author: Ramon S Lansang Jr, MD, Consulting Staff, Department of Orthopedics, Charleston Area Medical Center
Contributor Information and Disclosures

Updated: Jan 26, 2009

Follow-up

Further Outpatient Care

  • An outpatient visit one month after discharge is recommended.
  • Provide support for patients with SCI who are unable to meet their needs independently by arranging for nursing services and attendants for home care.
  • Diagnostic follow-up
    • Patients with indwelling catheters must undergo annual cystoscopy for detection of bladder tumors since they have increased risk for squamous cell and transitional cell carcinoma if they have had indwelling catheters for more than 10 years. Recommend cystoscopy more frequently if patient has increased risk factors (eg, smoking, history of recurrent urinary tract infections).
    • Annual renal and bladder ultrasounds are recommended.
    • Perform voiding cystourethrogram as needed.
    • Schedule dimercaptosuccinic acid scanning as indicated.
    • Determine glomerular filtration rate as needed.
    • Order urinalysis and urine culture with sensitivity at least once a year and as needed.

Complications

  • Bladder infections are the most common complication of neurogenic bladder. Use of prophylactic antibiotics on patients on chronic intermittent catheterization still is controversial. Avoid use of prophylactic antibiotics in patients with indwelling Foley catheters.
  • Vesicoureteral reflux is associated with renal deterioration, especially in the presence of recurrent infection. Most deaths from renal complications in patients with neurogenic bladder are secondary to reflux.
  • Pyelonephritis often is associated with reflux, kidney stones, and obstruction. Recurrent pyelonephritis is associated with renal deterioration.
  • Approximately 8% of patients with SCI develop renal calculi in the form of kidney and bladder stones. Bladder stones usually are associated with indwelling Foley catheters. Struvite stones and calcium phosphate make up more than 90% of cases of stone formation. Nephrolithiasis is indicative of renal deterioration.
  • Patients with SCI and more than 10 years with an indwelling catheter have higher incidence of squamous and transitional cell carcinomas compared with the general population.

Prognosis

  • The prognosis for recovery depends on the type, severity, and location of the lesion causing the bladder problem. Most patients with SCI with complete lesions remain on intermittent or indwelling catheterization for the rest of their lives.
  • Some reversible causes, such as polyneuropathy secondary to vitamin B deficiency, improve with metabolic correction.
  • Surgical correction of bladder problems secondary to anatomic derangements, such as prostatic hypertrophy and pelvic floor weakness, improves symptoms in most cases.
  • Patients with upper motor neuron lesions such as strokes, MS, and spinal cord pathology may have to depend on medications for the rest of their lives, although some recovery may be expected.

Patient Education

  • Proper techniques of intermittent self-catheterizations to include the timing and frequency of such techniques
  • The effects of oral medications on bladder function
  • The effectiveness and techniques of facilitative bladder emptying maneuvers, such as the Credé and Valsalva maneuvers
  • Efficient use of assistive devices used in bladder care
  • Possible long-term comorbidities and complications
  • Management of some emergencies, such as absence of urine output secondary to kinked catheter
  • Prevention of potential complications such as urinary tract infection, bladder cancer, and urolithiasis
  • For excellent patient education resources, visit eMedicine's Kidneys and Urinary System Center and Cancer and Tumors Center. Also, see eMedicine's patient education articles Bladder Control Problems, Bladder Cancer, and Understanding Bladder Control Medications.

Miscellaneous

Medicolegal Pitfalls

  • Failure to identify urinary tract infections could lead to urosepsis.
  • Failure to identify reflux could lead to renal failure.
  • Failure to identify abnormal bladder mechanics such as dyssynergia could lead to inappropriate management.
  • Failure to perform cystoscopy for patients who have had long-term indwelling catheters may lead to missing a diagnosis of bladder cancer.
 


More on Bladder Management

Overview: Bladder Management
Differential Diagnoses & Workup: Bladder Management
Treatment & Medication: Bladder Management
Follow-up: Bladder Management
References
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Further Reading

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Keywords

bladder management, urine, bladder, urination, urinary tract, urinary tract infection, incontinence, bladder problems, urinary tract infections, urinary incontinence, urinary problems, bladder control, urinary retention, neurogenic bladder dysfunction, voiding disorders, neurologic conditions, spinal cord injury, SCI, spinal cord disease, cerebrovascular accident, CVA, stroke, traumatic brain injury, TBI, multiple sclerosis, MS, dementia, social embarrassment

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Contributor Information and Disclosures

Author

Ramon S Lansang Jr, MD, Consulting Staff, Department of Orthopedics, Charleston Area Medical Center
Ramon S Lansang Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Teresa L Massagli, MD, Residency Director, Professor, Department of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine
Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
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