Evaluation

• Classify the injury according to level:
  • Sacral: injury at or below S2. Complete lesions result in areflexic, loose bladder, and incomplete lesions can result in spastic bladder.  Can spare external sphincter causing bladder overdistension.
  • Suprasacral: injury above S2. Detrusor-sphincter dyssynergia, combining urinary retention with spastic bladder, risking hydronephrosis.
  • Suprapontine: detrusor hyperreflexia / overactive bladder

Management

Intermittent Cath

Use when:

• Daily urinary output < 2000mL
• Unable to volitionally void after indwelling cath is removed

Do not use when:

• Bladder capacity < 200mL
• Patient or caregiver will be unable to cath by discharge

Useful References

PVA Guidelines: Bladder Management in Adults with Spinal Cord Injury