Long-term urologic management of the patient with spinal cord injury.

The primary goal of bladder management in the patient with a spinal cord injury is to achieve adequate bladder drainage, low-pressure urine storage, and low-pressure voiding. This will help prevent urinary tract infections, bladder wall damage, bladder overdistention, vesicoureteral reflux, and stone disease. Bladder retraining is indicated in all patients with disorders of the spinal cord and the brain. The basic aim is to provide bladder drainage without indwelling catheters and, if possible, without leg bags. Bladder retraining is usually begun with intermittent catheterization, with the use of alpha blockers to improve drainage in patients who are wearing leg bags or with anticholinergic drugs to improve continence. However, bladder retraining may be contraindicated in patients with vesicoureteral reflux or stone disease and in patients with impending renal failure. It is therefore important to evaluate all patients with neurogenic bladder using urodynamics, nuclear scanning, renal ultrasound, and voiding cystourethrography. In patients with stone disease, intravenous urography may also be required. Understanding of the basic neurologic lesion and bladder dysfunction is therefore vital to bladder retraining or transurethral surgery to provide adequate voiding. The regular periodic follow-up of all patients is vital to protect renal function.