Treatment and clinical management of voiding disorders after spinal cord injury

  Urinary dysfunction is one of the main obstacles after spinal cord injury, which can easily cause urinary tract infections because of indwelling catheterization and intermittent catheterization, and seriously affect the quality of life of patients.  Urinary dysfunction after spinal cord injury can be divided into the following conditions: 1. Urinary retention: Patients are unable to eliminate urine and must rely on catheters. This condition can be a weakness of the bladder forcing muscles or spasm of the urethral sphincter (increased tone).  2. Leakage: The patient cannot control it and urine will leak out involuntarily. This condition is seen in overactive bladder forcing muscles or weak urethral sphincter.  3.Residual urine: Although the patient can eliminate part of the urine on his own, he cannot empty the bladder completely, and a part of the urine is still not excreted after each urination. If the residual urine exceeds a certain amount, it must be emptied by means of catheterization. This condition is mostly seen when the patient can remove some of the urine through abdominal contraction with pressure or through reflex activity, but not sufficiently.  Process and methods of rehabilitation treatment for voiding disorders: 1.Firstly, comprehensive assessment of bladder function, such as bladder capacity, bladder pressure, residual urine volume, urinary routine and renal function, etc., to exclude urinary tract infection and renal insufficiency.  2.Electrophysiological testing techniques such as electromyography were used to clarify the damage to the spinal cord and cauda equina and conus, and to determine the type of bladder dysfunction for prognosis of bladder function.  3.Treatment measures: (1)Establishment of urinary regularity: this is the most important, as long as the patient can follow the doctor’s requirements, all can establish a regular urinary pattern.  (2) Choice of voiding modality: This includes indwelling catheterization, clean intermittent catheterization, cystostomy and other modalities. If urinary tract infection or overexcitation of the bladder forceps and high pressure in the bladder are present, indwelling catheterization should be used. If the residual urine volume is large or cannot be voided, clean intermittent catheterization is appropriate.  (3) Medication: If the bladder forceps is overexcited or the sphincter tone is too high, oral medication can be used to reduce forceps excitability and urethral sphincter tone.  (4) Nerve block: For those who do not have a significant reduction in forceps or sphincter tone with oral medication, a botulinum toxin block can be used to reduce forceps and sphincter excitability.  (5) Electrical stimulation: used to reduce excitability of the detrusor muscle.  Because evaluation of the bladder requires several days of follow-up, patients are recommended to be hospitalized.