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Spinal Trauma and Voiding Problems (Spastic Spinal Cord Injury (supra…
Spinal Trauma and Voiding Problems
Problems with Voiding Occurs when
Obstruction
Urethral strictures
Prolapsed bladder or mass
BPH
Non obstructive
Long Term Cathertization
Sacral neuromodulation- Fowlers syndrome
Detrusor underactivtity
How do chronic infections cause?
Residual volume of urine then leads to an increased bladder pressure. There is then loss of compliance as there are constant detrusor contractions.
If urine is not drained from the kidney you will get renal damage and hydronephrosis
They happen due to residual volumes of urine that allow stone formation
Treatment for spinal cord injuries
Prevention of autonomic dyreflexia. This is an out of controlled sympathetic discharge across the whole body. Leading to HBP. Happens if the lesion is above T6. A stimulated sympathetic nerve to a noxious stimuli can lead to a severe headache and/or flushing
So what is bladder safety? Bladder safety is a plan that prevents the kidneys from being further damaged by the bladder. From an increased pressure in the bladder, vesicoureteric reflux or chronic infection
Bladder safety and symptom control
Spastic Spinal Cord Injury (supra canal lesion)
Leads to a problem with coordination and voiding of urine
Consequences: reflex bladder contractions. With uncontrolled bladder and sphincter contraction
Happens high up in the CNS normally in tech brain
Flaccid Spinal Cord injury
Lost bladder contraction, guarding reflex and receptive relaxation
Causes the bladder to become areflexic and stress incontient
Conus lesion at S2 S3 and S4.
Causes: spina bifida, sacral fracture and cauda equina
Paraplegic Bladder Management :
Treatment: convene (no indwelling catheter however, promotes incomplete emptying) or a suprapubic catheter
The detrusor leak-point pressure (DLPP) is the lowest detrusor pressure reading at which leakage is observed in the absence of increased abdominal pressure or detrusor contraction.
Loss of complete sensation of when the bladder is full and is now unable to do the guarding reflex
TREATMENT: suprapubic catheter and use anticholinergics, IV Botullium toxin and cytoplasm
MS patients (Urinary incontience)
When with a stick: use DDAVP, antimuscarinics and CISC (clean intermittent self cathertisation)
When still walking give an antimuscarinic and DDAVP (desmopression)