Evaluation and management of neurogenic bladder in persons with spinal cord injury

Among persons with neurogenic bladder secondary to spinal cord injury (SCI), historically renal failure has been the most common cause of death. The development of both antibiotics and intermittent catheterization has revolutionized bladder management and substantially decreased renal mortality and morbidity for this population. While renal failure is no longer the most common cause of death in this population, it remains a major source of morbidity and the most frequent secondary cause of death. This review covers the physiology of normal and neurogenic micturition, the historical aspects of classifying neurogenic bladder, and the evaluation and treatment options currently available. Optimal bladder management for persons with neurogenic bladder secondary to SCI should be based on clinical and urodynamic evaluation. The goals of management are to preserve renal function, maintain urinary continence, and prevent urinary tract infections. Urologic management should be directed toward achieving complete bladder emptying at low detrusor pressures and whenever possible to avoid chronic indwelling catheters. Bladder management options can be classified as continuous emptying or intermittent emptying. These classifications may be subdivided into surgical or nonsurgical options. Pharmacologic management options are also considered.