The type of bladder dysfunction caused by spinal cord injury varies by segment. When the injury occurs above the level of sacral medulla oblongata, as the urinary center in sacral medulla oblongata remains intact, but the control of the higher urinary center is lost, most of the manifestations are hyperreflexia of the urethra muscle and uncoordinated sphincter of the urethra muscle; if the injury occurs in the sacral medulla oblongata, due to the damage of the urethra muscle center, the urethra muscle is weak, and the treatments for different types of urinary dysfunctions are also different. The incidence of urinary retention caused by spinal cord injury is high, and there are many reports in the literature. Now, we summarize the current status of treatment and care of urinary retention in patients with spinal cord injury in recent years as follows. I. Indwelling catheterization 1. Continuous catheterization Continuous catheterization is for patients with indwelling catheterization, in the early stage of the disease, let it open, so that the bladder stays empty, to avoid too much stretching and fatigue of the urethral muscle in the tension-free state. The urinary catheter is usually clamped after 1 to 2 weeks. Open it every 3~4h to facilitate the bladder to maintain a certain capacity and prevent its contracture. Replace the urinary catheter once every 1 to 2 weeks and flush the bladder with l:5000 furacilin solution once or twice daily. During operation, it is better to choose FoIey’s urinary catheter, which can effectively prevent retrograde urinary tract infection. It is also important to keep the drainage system closed and patent, with the drainage tube and urine collection bag positioned below the level of the bladder. Although long-term indwelling urinary catheter can solve the problem of lower urinary tract obstruction, it may cause bladder contracture, bladder stone, urinary fistula, increase the chances of urinary tract infection, and affect the sex life and rehabilitation training. 2, intermittent catheterization spinal cord injury patients with intermittent catheterization, can make the bladder cycle expansion and emptying, to maintain a nearly normal physiological state, promote the recovery of bladder function. Advantages of intermittent catheterization: (1) effectively prevent urinary tract infection; (2) speed up the recovery of bladder function; (3) facilitate the rehabilitation training such as occupational therapy and exercise therapy; (4) keep the bed sheet clean and effectively prevent pressure ulcers; (5) do not need peripheral catheter. Disadvantages: (1) increased nursing time; (2) night catheterization affects sleep; (3) need to appropriately limit the amount of people. After 3 weeks or 4 weeks after the injury, the spinal cord shock period into the recovery period, this is the best period of bladder training, miss this period of bladder will stop in the irreversible recovery stage. Rehabilitation training 1, reflex urinary training 3d after injury, 2h to 3h open the urinary catheter once. When opening the urinary catheter, the patient is instructed to consciously do normal urination, while knocking the suprapubic area, rubbing the inner thighs, pulling the pubic hair, squeezing the head of the penis, expanding the anus, etc., to look for the trigger point of the stimulation of the urinary reflex, after a period of time of training, the conditioned reflex can be formed, and whenever the bladder fills up, the stimulation of the trigger point, you will be able to discharge the urine. Some patients have aura of bladder filling (such as sweating, rapid heartbeat, etc.), you can stimulate the trigger point to urinate. When operating, pay attention to the movement consistency, do not exert too much force. Three or four weeks after the injury after removal of the urinary catheter before intermittent catheterization, can be repeated massage, percussion, and observation of urination. When massaging and percussing the lower abdomen, it is better to take the lying position and avoid other rehabilitation training. When the bladder is overfilled, avoid massage. 2.Pressurized urination Promote bladder emptying by increasing the pressure in the bladder, applicable to the treatment of patients with decreased activity of the forced urinary muscle accompanied by decreased sphincter function or sphincter insufficiency. The patient’s bladder filling level is assessed and pressure is applied at regular intervals. The most commonly used techniques are CA’ede method and Ualsalva method. Credo method: massage the bladder with hands for 3~5min, roll the fist from the umbilicus to the pubic bone direction with deep pressure, move slowly and gently, and at the same time, ask the patient to inhale by himself to increase the abdominal pressure with the continual pressure to the urine is no longer discharged until the end of the Ualsalva breath-holding method: the patient takes a seated position, leans forward to relax the abdomen, holds his breath, and exerts the Abdominal pressure to the bladder, rectum, pelvic floor, flexion of the knee and hip joints, so that the thighs close to the abdomen, increase abdominal pressure, pay attention to guide the patient to add abdominal pressure to urinate, and strictly control the timing of the pressure to urinate, to avoid the bladder is highly congested and extrusion and rupture, as well as suprapubic pressure caused by urinary reflux. It should be emphasized that it is not safe to press the bladder before the type of bladder is clearly defined, unless the anal sphincter retraction and manual pressure play a synergistic effect of urination at the same time as the bladder reflex, otherwise there is a certain degree of risk in the sphincter hyperreflexia and forced urethra muscle, sphincter dysfunction to do the bladder compression. 3, neurological drug application and supervision of rational use Drugs can improve the function of the bladder urethra after sCI, mainly through the increase or blockade of neuromediators affecting the function of urinary storage and voiding to achieve. The neurotransmitters affecting bladder storage and voiding function and their actions are very complex. Because a given receptor drug may act on many parts of the nervous system, it may be excitatory in some parts and inhibitory in others, making its ultimate effect difficult to estimate. In addition, the efficacy of neurotransmitter action is not static and evolves not only with growth and development, but also with injury, disease, and aging. Therefore, on the basis of the general principles of drug therapy, each patient with bladder dysfunction should be treated differently and individualized drug therapy should be used. Before the administration of drugs, we should understand the purpose of treatment, history of drug use, the basic physiological condition of the patient (including age, vital signs, liver and kidney function, etc.) and pay attention to the requirements and contraindications of drug compounding when dispensing drugs. Evaluation of drug efficacy after administration, observation of adverse drug reactions, and timely targeted treatment. 4, surgical treatment Surgical treatment and monitoring of the bladder urethra structural surgery can increase the capacity and power of the bladder, reduce urethral outlet resistance, such as ileal substitution cystectomy, external urethral sphincterotomy. Zhou Yuhong et al. pointed out that the secretion of intestinal mucus in the pronephric bladder is regular, showing a rising a peak-decreasing trend, but not disappearing, and the number of bladder irrigation should be increased or decreased accordingly in nursing care, i.e., from the postoperative period of 3d, 1 or 2 times per day, to increase to 3 or 5 times per day in the period of 7d, or even more, in order to prevent the occurrence of ureteral blockage, poor urinary drainage, and other complications. Su QiuMian et al. reported that bladder function could be reconstructed using anastomosis of the somatic and sacral nerves below the plane of spinal cord injury. Vesicourethral neurotomy can rebuild urinary function to a certain extent in patients with spastic bladder after spinal cord injury. In addition to antibiotic treatment, those with urinary tract infection before surgery should be encouraged to drink plenty of water and flush the urinary tract. The key step of the surgical approach lies in the accurate localization of the nerve root, so atropine must be prohibited before surgery, and if the patient is taking antimuscarinic drugs, the drugs need to be stopped 7d before surgery, so as not to inhibit bladder contraction by the drugs, which affects the judgment of bladder pressure during surgery. The anastomosed nerves and nerve roots need 6 months to 1 year or more to recover their function after surgery, so the patient’s urinary obstruction still needs to be solved by catheterization and acupuncture and other methods. 5, traditional medicine therapy Chinese medicine theory, spinal cord injury urinary retention belongs to the Chinese medicine “paralysis” category, bruises and injuries, blood stasis and blockage, damage to the dukedong vein, dukedong vein is the main body of the yang qi, just not enough, bladder qi loss, so urinary obstruction; and injury for a long time, the kidney qi deficiency, lack of source of vital essence biochemistry, can not warm the body, coupled with blood stasis Blocking its transportation, more heavy urine retention; and the spleen is a body of water metabolism hub, lying down for a long time to injure the spleen, but also promote the retention of urine. Therefore, acupuncture is mainly used to tonify the kidney and nourish the yin, and the principle of legislation to facilitate urination. After the injury, acupuncture Qihai, Guanyuan to replenish the vital energy, dispel abdominal distension, adjust the bladder qi, pass the obstruction; the middle pole of the bladder of the collection point, Sanyinjiao is the three yin meridian intersection point, the three yin meridians circulate in the lesser abdomen or yin apparatus, can pass the adjustment of the lower jiao of the qi, so that the urination to return to normal. In addition, it can promote diuresis, reduce flatulence and remove dampness by cooperating with Shui Dao, Gui Lai and Yin Ling Quan points. Huiyin point is Chong, Ren, Dudu vein from the lower abdomen out of the body of the confluence, the main treatment of urinary, reproductive evidence. Acupuncture and Moxibustion A Yi Jing: “the main difficult to urinate, the hot in the body, men’s yin end of the cold, women’s blood can not be”. And its localization has perineum superficial and deep transverse muscles and branches of perineal nerve, therefore, it is the main point for treating bladder disorders. The supporting points Guanyuan, Qihai, Zhongji; Kidney Yu, Bladder Yu are all localized points for treating bladder disorders, and together with the main point, they play the role of tonifying the kidney and helping the bladder to qi. The use of acupuncture treatment based on Huiyin acupoints is simple, less invasive, and with remarkable therapeutic effect, which is worth popularizing in clinical rehabilitation treatment. (1) Electro-acupuncture Eights and Huiyang points of spinal cord injury urinary retention belongs to the category of “retention of urine” in traditional Chinese medicine, mostly due to the dysfunction of bladder qi function. The eight Lu, Huiyang point is an acupoint of the bladder meridian, which has the function of regulating the bladder’s qi function. Anatomy of the point: it is under the sacral nerve foramen and the cleft hole of the tailbone, and the nerves emanating from it innervate the pelvic organs such as the uterus, bladder, rectum, etc., and are distributed externally in the anterior and posterior dystrophy. Electroacupuncture directly stimulate the sacral nerve roots of the efferent nerve, passively cause the contraction and diastolic movement of the muscle rhythm of the forced urethra and sphincter of the bladder, increase the coordination function between the two, which is conducive to the formation of the urinary reflex; at the same time electroacupuncture stimulate the afferent fibers of the nerves, reflexively excitation of the spinal cord and the higher urinary center, so that the center of the urinary center to issue impulses to downstream to the bladder, innervating forced urethra and sphincter, and to promote the two coordinated movement. Completion of urinary reflex, so the therapeutic effect is better than the conventional method of taking acupuncture points. Spinal cord injury urinary retention is common in orthopedic surgery, and most patients are treated with acupuncture when they are discharged from the hospital and enter the rehabilitation stage, during which the patients have to rely on indwelling urinary catheters to urinate, and the longer the indwelling urinary catheters are, the higher the chance of infection. This topic was implemented in the Western General Hospital, which was accomplished in collaboration between orthopedic surgeons and acupuncturists, and acupuncture treatment was performed in the acute phase of spinal cord injury. The author realized that when the patient has not yet developed urinary tract infection after spinal cord injury, if the condition permits, the acupuncturist should intervene early to implement acupuncture treatment, and the recovery of bladder function is faster and more effective. This method is simple and easy to promote the application, at the same time, it can shorten the retention time of urinary catheter, reduce the chance of infection, and play a positive role in the recovery of bladder function and paraplegic rehabilitation treatment of patients. (2) scallion leaf treatment “Nei Jing” records: “the bladder, the state of the official, the fluid is hidden, gasification can be out of it”, that the bladder urination and gasification function; waist for the kidney of the house, waist injury can affect the bladder gasification function and trigger urinary closure. There are documents: onion, pungent, warm, with the role of Yang detoxification. Urinary inaccessibility, scallion white with leaves crushed, into the honey, containing the outside. Kidney that is through. Therefore, with the onion leaves crushed, take the juice orally, slag external compresses on the Shen Que point, a one-time treatment efficiency of 98.00%. Modern medicine has proved: drugs can be absorbed through the skin; different parts of the skin structure has certain differences, so that the degree of drug absorption is not the same. Umbilical cord in the process of embryonic development for the abdominal wall of the last closure, the epidermal stratum corneum is the thinnest, the barrier function is the weakest, the easiest to penetrate the diffusion; and the umbilical cord without fat tissue, skin and fascia, peritoneum, so the umbilical cord skin structure is the most conducive to the characteristics of drug absorption. At the same time to be oral onion juice, internal and external use of drugs, and thus achieved ideal efficacy, and in the course of treatment did not find adverse reactions. Lei’s also used onion leaves crushed, juice for internal use, dregs for external application, efficacy is good, the treatment of spinal cord injury urinary retention with safe medication, and easy to take, simple to make, inexpensive, worthy of promotion and application in the clinical and community.