Neurogenic bladder training

Neurogenic bladder §CVA: Initially have acute urinary retention (detrusor areflexia) and the reason is unknown. Urinary incontinence (detrusor hyperreflexia with uninhibited bladder contraction and without detrusor sphincter dyssynergia) is the most common following acute CVA.

§Suprasacral spinal cord lesion: Initial spinal shock (detrusor areflexia) and the reason is unknown Uninhibited bladder contraction (detrusor hyperreflexia with detrusor sphincter dyssynergia) gradully return after 6 to 8 weeks

§Sacral lesion The combination of detrusor areflexia and an intact sphincter helps contribute to bladder overdistention

§Peripheral lesion: The most common lesion is due to DM A sensory neuropathy is the most common finding Decreased bladder sensation, chronic bladder overdistention, and increased residual volumes may result from bladder overdistention secondary to decreased sensation of fullness

Bladder training §Incontinence caused by the bladder: Behavioral:Scheduled voiding Pharmacologic:Anticholinergics, antispasmodics, TCA, Ca antagonists, and prostaglandin inhibitors Supportive:Diapers, external condom catheter, ICP, and indwellimg catheter

§Incontinence caused by the sphincter Behavioral:Scheduled voiding, pelvic floor exercises, and biofeedback Pharmacologic:Alpha-adrenergic agonists, estrogen, and injectable periurethral collagen Supportive:Same as with bladder

§Retention caused by the bladder: Behavioral:Scheduled voiding combined with suprapubic tapping, Valsalva, and Crede Pharmacologic:Cholinergic agonist, intravesical prostaglandin, and narcotic antagonists Supportive:ICP and indwelling catheter

§Retention caused by the sphincter: Behavioral:Biofeedback, suprapubic tapping, and anal strectch Pharmacologic:Alpha-adrenergic blockers, baclofen, diazepam, and dantrolene Supportive:Same as with bladder

§ICP 1, 2, 3, 4 principle §Balanced bladder: Self-voiding amount >200 ml Residual volume <100 ml for 3 days Self-voiding amount: residual volume >2:1 (3:1, 4:1,…) Interval of micturition >2hr