A PRESSURE MANAGEMENT-SYSTEM FOR THE NEUROGENIC BLADDER AFTER SPINAL-CORD INJURY

One hundred eighteen patients consecutively admitted to a University Rehabilitation Program entered a protocol study of urologic management. Bladder pressures were kept below 30 cms/H2O by urologic treatment. Serial urodynamic, radiographic, bacteriologic, and endoscopic studies were performed at regular intervals. Eighteen patients have been lost to follow-up; 100 patients were followed for a mean 25.4 months with a range of 6 months to 56 months. There were 105 patients with lesions superior to the sacral segments and 13 patients with low lesions. At discharge 11 patients were voiding normally, 105 were continent on an intermittent catheterization (IC) protocol, and 2 patients used condom catheter drainage following sphincterotomy. Bacterial cultures and urinalysis data showed little or no relationship to clinical outcome, and treatment for 387 weeks by antimicrobial agents was not associated with discernible benefit as opposed to no treatment. Five patients developed bladder calculi, and five developed unilateral epididymitis. Bladder pressure was relatively easy to control following spinal cord injury, a result which suggests that high bladder pressure is not a direct result of the neural injury, but rather an evolutionary change as a result of bladder and urethral interactive dysfunction.