Management of Bladder Dysfunction Follow-up

  • Author: Ramon S Lansang Jr, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: May 4, 2011
 

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).[15]
    • 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.
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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.[16] 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.
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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.
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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.
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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.

Specialty Editor Board

Teresa L Massagli, MD  Professor 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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, 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.

References

  1. Barrett DM, Wein AJ. Voiding dysfunction. Diagnosis, classification, and management. In: Gillenwater JY, et al, eds. Adult and Pediatric Urology. 2nd ed. St Louis:. Mosby Year Book;1991:1001-99.

  2. Braddom RL. Physical Medicine and Rehabilitation. Philadelphia:. WB Saunders Co;1996:555-79.

  3. Lisenmeyer TA, Stone JM. Neurogenic bladder and bowel dysfunction. In: De Lisa J, ed. Rehabilitation Medicine. Philadelphia:. Lippincott-Raven Publishing;1998:1073-106.

  4. Bradley WE. Physiology of the urinary bladder: Campbell's Urology. Philadelphia:. WB Saunders Co;1986.

  5. Thomas TM, Plymat KR, Blannin J, Meade TW. Prevalence of urinary incontinence. Br Med J. Nov 8 1980;281(6250):1243-5. [Medline].

  6. Linsenmeyer TA, Culkin D. APS recommendations for the urological evaluation of patients with spinal cord injury. J Spinal Cord Med. 1999;22(2):139-42. [Medline].

  7. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil. Mar 1995;76(3):272-80. [Medline].

  8. Wein AJ. Lower urinary tract function and pharmacologic management of lower urinary tract dysfunction. Urol Clin North Am. May 1987;14(2):273-96. [Medline].

  9. Kaufman JM, Fam B, Jacobs SC, et al. Bladder cancer and squamous metaplasia in spinal cord injury patients. J Urol. Dec 1977;118(6):967-71. [Medline].

  10. Hoffman BB, Lefkowitz RT. Adrenergic receptor antagonists: The Pharmacologic Basis of Therapeutics. New York:. Pergamon Press;1990.

  11. Duncan PW, Zorowitz R, Bates B, et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke. Sep 2005;36(9):e100-43.

  12. Giannantoni A, Di Stasi SM, Stephen RL, et al. Intravesical capsaicin versus resiniferatoxin in patients with detrusor hyperreflexia: a prospective randomized study. J Urol. Apr 2002;167(4):1710-4. [Medline].

  13. de Sèze M, Wiart L, Joseph PA, et al. Capsaicin and neurogenic detrusor hyperreflexia: a double-blind placebo-controlled study in 20 patients with spinal cord lesions. Neurourol Urodyn. 1998;17(5):513-23. [Medline].

  14. de Sèze M, Wiart L, de Sèze MP, et al. Intravesical capsaicin versus resiniferatoxin for the treatment of detrusor hyperreflexia in spinal cord injured patients: a double-blind, randomized, controlled study. J Urol. Jan 2004;171(1):251-5.

  15. Kuhlemeier KV, Lloyd LK, Stover SL. Long-term followup of renal function after spinal cord injury. J Urol. Sep 1985;134(3):510-3. [Medline].

  16. DeVivo MJ, Fine PR, Cutter GR, Maetz HM. The risk of renal calculi in spinal cord injury patients. J Urol. May 1984;131(5):857-60. [Medline].

  17. Brindley GS, Rushton DN. Long-term follow-up of patients with sacral anterior root stimulator implants. Paraplegia. Oct 1990;28(8):469-75. [Medline].

 
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The pons is a major relay center between the brain and the bladder. The mechanical process of urination is coordinated by the pons in the area known as the pontine micturition center (PMC).
Large stellate urinary bladder stone. Image courtesy of Wikimedia Commons.
 
 
 
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