The urine should be kept sterile from the early stages of injury. Common alternatives are repeated catheterisation, continuous drainage using an indwelling catheter, and suprapubic catheterisation.
Tetraplegics and paraplegics with disabilities due to cord injury rather than caudal equina injury, develop involuntary detrusor activity after about 6 weeks. Management is aimed at encouraging this reflex which occurs in response to elevated bladder pressure. This is achieved by avoiding overdistension of the bladder in the early stages, and by tapping in the suprapubic region once reflex responsiveness begins. Firm suprapubic pressure is applied to minimise residual volume.
Spontaneous contractions also occur. Men are given some form of urinary collection eg. a Texas bag - a condom to which is fused a collecting tube leading to a urinary bag. No equivalent system is available for women and they require absorbent pads and plastic pants.
Continued intermittent self-catheterisation is necessary for caudal equina injury since such patients fail to establish an automatic bladder.
Spinal cord injury is also accompanied by calcuria owing to mobilisation of skeletal minerals. Bladder washouts help minimise the formation of bladder stones. However, these can often be crushed if they do develop.
Urinary infection is avoided by maintaining a high fluid volume intake and ensuring a low residual urine volume. Local urinary antiseptics such as mandelic acid may be given when there is evidence of urinary sepsis.
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