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D - Bladder Continence

Figure 3.0 Figure 3.0 simplified schematic of the interprofesional, multi -modal delivery of blader continence programs, post-SCI. Neurogenic bladder assessment via history and physical Interprofessional assessment and consultation (physiatry, nursing, PT/OT, urology) Physical interventions (e.g., catheterization; hand dexterity and other non-pharmacological modalities, OT/PT/nursing) Education (physiatry, nursing, urology) Pharmacological intervention Surgical Workup (e.g., urodynamics, laboratory) Practice Profile Published Clinical Practice Guidelines 1. Consortium for Spinal Cord Medicine. Bladder management following spinal cord injury: What you should know. A guide for people with spinal cord injury. Paralyzed Veterans of America: Washington, DC; 2010. 2. Stohrer M, Blok B, Castro-Diaz D, et al. EAU guidelines on neurogenic lower urinary tract dysfunction. Eur Urol. 2009;56(1):81-8. 3. Consortium for Spinal Cord Medicine. Bladder management for adults with spinal cord injury: A clinical practice guideline for healthcare providers. J Spinal Cord Med. 2006;29(5):527-73. 4. Corcos J, Gajewski J, Heritz D, et al. Canadian Urological Association guidelines on urinary incontinence. Can J Urol. 2006;13(3):3127-38. Current Key References 1. Wolfe DL, Ethans K, Hill D, et al. Bladder health and function following spinal cord injury. In: Eng JJ, Teasell RW, Miller WC, et al., eds. Spinal Cord Injury Rehabilitation Evidence. Version 3.0. Vancouver, BC; 2010:1-19. 2. Fonte N. Urological care of the spinal cord-injured patient. J Wound Ostomy Continence Nurs. 2008;35(3):323-31; quiz 332-3. 3. UAB Department of Physical Medicine and Rehabilitation. Bladder Care and Management. SCI Info Sheet #11. Birmingham, AL: Board of Trustees of the University of Alabama; 2008. http://images.main.uab.edu/spinalcord/pdffiles/11-Bladder-2008.pdf Accessed June 27, 2012. 4. Samson G, Cardenas DD. Neurogenic bladder in spinal cord injury. Phys Med Rehabil Clin N Am. 2007;18(2):255-74. 5. Perkash I. Donald Munro Lecture 2003. Neurogenic bladder: past, present, and future. J Spinal Cord Med. 2004;27(4):383-6. 6. Fowler CJ, O’Malley KJ. Investigation and management of neurogenic bladder dysfunction. J Neurol Neurosurg Psychiatry. 2003;74. 7. UAB Department of Physical Medicine and Rehabilitation. Research Review: Urologic complications and management after spinal cord injury. Birmingham, AL: Board of Trustees of the University of Alabama; 2000;2(1). http://images.main.uab.edu/spinalcord/ pdffiles/resrev21.pdf . Accessed June 27, 2012. Neurogenic Bladder Dysfunction Assessments Currently in Use Blader management asesment tools in current use: • Bladder diaries 92/53% • Urodynamics 83/58% - Post-void Residual 100/67% - Maximum Detrusor Volume 83/42% - Reflex Detrusor Volume 58/33% • Cystoscopy 75/33% • Creatinine Clearance 67/42% • Renal Perfusion Scans 33/0% • Renal and Bladder Ultrasound 25/25% Bladder diaries can be helpful in select circumstances. However, the current authors suggest that this is not necessary in routine clinical practice, due to the administrative burden. It’s interesting to note that although 58% of sites routinely perform a urodynamic assessment, 75% of sites report having the equipment available, and 95% report having sufficient equipment for their needs. However, only 25% report its routine use. Similarly, although renal and bladder ultrasounds are only performed routinely in 25% of the sites, 92% report having the service available, within their organization (67% onsite), and 92% of sites deem the service to be adequate overall. Reasons for this discrepancy between available resources and utilization are unclear, and may include individual tolerance of assessment, limited access to a urologist or physiatrist to BLADDER CONTINENCE | BODY STRUCTURE AND FNUCTION 55


D - Bladder Continence
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