Urogenital and bowel functions in spinal cord disease

Abstract

The treatment of the bladder in the spinal cord injured patient cornmences from the time of injury. DO NOT INTRODUCE AN INDWELLING CATHETER! After the emergency treatment of the spinal cord injury and any associated injuries is completed at the location of the accident and there is no irnmediately life threatening injury or medical situation, then the urinary bladder is considered. If there is bladder distention, drain the bladder and irnmediately withdraw the catheter. With the transfer of the patient preferably to a spinal cord injury center for treatment of aH injuries, any suspicion of trauma to the urinay tract requires prompt diagnostic efforts. This must include intravenous pyelography, voiding cystourethrography, and cystoscopy if necessary. At this point it may be necessary to introduce a Foley catheter but only for reasons of lower urinary tract trauma. The patient's particular traumatic problem and his general physical condition will determine if and when definitive surgical correction of the injury is undertaken. The object of medical management at this stage is twofold; prevention of overdistention of the bladder wall with the associated nerve and bladder smooth muscle damage, and prevention of infection. Both of these complications cause a thickening of the bladder wall and development of vesicular ureteral r~flux and urinary tract outflow obstruction. If there is no urinary tract trauma, then management of the lower urinary tract in the spinal cord injured patient is by sterile intermittent catheterization every six hours. Fluid intake should be about 1500 mI daily to maintain the urine volumes at less than 500 mI. If the amount of urine drained at each catherization is greater than 500 mI then it may be necessary to catheterize the bladder more frequently or to reduce fluid intake. A urine culture is sent immediately upon institution of intermittent catheterization and every 48 hours thereafter during the initial stages of treatment. Thereafter unless infection is present, a weekly culture will suffice. Irunmediately after each catheterization, 10 to 15 mI of chIorhexaphene