Towards a catheter free status in neurogenic bladder dysfunction: a review of bladder management options in spinal cord injury (SCI)

Study design: Review. Objectives: To assess current available options for bladder management in SCI patients the post-acute phase. Methods: Relevant articles were extracted from medline and Cinahl between 1966-1999. In addition, references earlier than 1966 that were listed in these articles were identified and extracted. Results: Catheterisation (indwelling or self intermittent) is still carried out by the majority of SCI patients with more morbidity for indwelling catheterisation. Other methods include condom drainage, suprapubic tapping and supreapubic pressure are used and are associated with less complications. Complicated procedures like sacral anterior root stimulator and entero-cystoplasty are carried out with the onset of or impending complications. Conclusion: Several methods of bladder management are available in the post-acute phase of SCI. The method used has to be based on urodynamic characteristics with the aim of producing a continent bladder with adequate low pressure storage capacity. Modern management of the bladder in SCI has successfully reduced renal related mortality in SCI from 95% in the first half of the 20th century to the present 3%.