BLADDER-MANAGEMENT (INITIAL)

SUMMARY

1. Initial indwelling catheter in early stages until spinal shock & bladder areflexia resolves.
2. Attempt TOV in mild SCI patients in whom spinal shock has resolved.
3. An intermittent catheterization (IC) program should be established once patients can tolerate fluid restriction of 2 L/day, as early as 7-15 days post-injury.
4. Urodynamic studies should be performed once spinal shock resolves.
5. IC volumes should be < 500 mL, frequency of catheterization being 4-5x/day, corresponding to a 2-2.5 L fluid restriction.
6. Surveillance investigations: baseline electrolytes and renal function, renal and bladder imaging.
7. Controversial: attempt TOV once fluid management and BP are stable and patient is clinically ready. Measure post-void residual urine, aim to achieve minimal residuals (< 550mls)

BLADDER VOLUMES MAINTAINED BELOW 500 MLS TO AVOID:
1. Vesicoureteral reflux: a phenomenon caused by bladder wall hypertrophy and loss of the vesicoureteric angle
2. Overflow incontinence
3. Hydroureter

Reference(s)

Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.