Treatment goals for neurogenic bladder: i. Preservation of upper urinary tract function. II. To restore or partially restore the function of the lower urinary tract. Third, to improve urinary incontinence and improve the patient’s quality of life. Among them, the primary goal is to protect renal function so that patients can survive in the long term, and the secondary goal is to improve patients’ quality of life.
Principles of treatment for neurogenic bladder, i. First, the primary disease should be treated actively. Second, the choice of treatment modality, the choice should follow the order of conservative first and then surgical.
The common conservative treatment methods for neurogenic bladder are, manipulation-assisted voiding, rehabilitation training, and catheterization therapy.
Catheterization therapy includes: intermittent catheterization, indwelling catheterization, and cystostomy. In the acute phase of primary neurological disease, short-term indwelling catheterization is safe, but long-term indwelling catheterization or cystostomy are associated with more complications.
Intermittent catheterization is an important form of bladder training. Intermittent filling and emptying of the bladder helps restore the bladder reflex and is the gold standard for assisting in bladder emptying. Long-term intermittent catheterization, including sterile intermittent catheterization, and clean intermittent catheterization. Clean intermittent catheterization has been shown to be safe for patients with neurogenic bladder, and sterile intermittent catheterization is more helpful in reducing the incidence of urinary tract infections and bacteriuria.
Points to note for intermittent catheterization: 1. Choose a catheter of appropriate thickness, 12 to 14 Fr is recommended, and women can use 14 to 16 Fr catheter. 2. Operate as aseptically as possible, sterilize the external urethral opening and insert the catheter aseptically through the urethra. 3. Fully lubricate the urethra, lubricant is recommended to avoid complications such as urethral injury. 4. After complete drainage of urine, slight pressure is applied to the suprapubic area while slowly withdrawing the catheter, and the end of the catheter is clamped closed before complete withdrawal of the catheter to prevent urine reflux.6. The frequency of catheterization is on average 4 to 6 times a day, and the bladder volume is less than 400 ml at the time of catheterization.7. Drink more water appropriately so that the daily urine volume is around 2000 ml.8. Regular hospital review, at least once a year.