An 18-yrs-old male is rendered paraplegic after blunt vehicular trauma. After his immediate injuries are resolved, he is admitted to a rehabilitation unit. Inability to void is addressed. Initial management of a patient who has a flaccid neurogenic bladder may include which of the following measures?
|A||Surgical bladder augmentation|
|C||Supravesical urinary diversion|
|D||Limiting fluid intake to less than 300 mL/day|
a. The characteristic pattern that results when a patient has a complete lesion above the sacral spinal cord is detrusor overactivity, smooth sphincter synergia, and striated sphincter .
b. Neurologic examination shows spasticity of skeletal muscle distal to the lesion, hyperreflexic deep tendon reflexes, and abnormal plantar responses.
c. There is impairment of superficial and deep sensation.
d. The striated sphincter dyssynergia causes a functional obstruction with poor emptying and high detrusor pressure.
e. Occasionally, incomplete bladder emptying may result from what seems to be a poorly sustained or absent detrusor contraction.
f. From a functional standpoint the voiding dysfunction most commonly seen in suprasacral SCI represents both a filling/storage and an emptying failure.
g. If bladder pressures are suitably low or if they can be made suitably low with nonsurgical or surgical management, the problem can be treated primarily as an emptying failure; and CIC can be continued, when practical, as a safe and effective way of satisfying many of the goals of treatment.
h. Alternatively, sphincterotomy, stenting, or intrasphincteric injection of botulinum toxin can be used in males to lower the detrusor leak point to an acceptable level, thus treating the dysfunction primarily as one of emptying.