The Management of the Bladder in Traumatic Spinal Paraplegia

Abstract

One of the consequences of injury to the spinal cord is disturbance of bladder function. The neurogenic bladder in traumatic spinal paraplegia generally expels its contents involuntarily and incompletely. As a result of urinary incontinence, the paralyzed patient becomes uncomfortable, foul-smelling and socially isolated. Urostasis in the bladder leads to urinary infection, which if not controlled or eradicated, readily spreads to the upper urinary tract and causes irreparable renal damage. Back pressure from the retained urine may eventually cause dilation of the ureter as well as the pelvis and calyces, and consequently further renal destruction. Stagnation of urine, in combination with other factors related to immobilization, promotes the formation of stones, which not only aggravates infection but also destroys kidney function by obstruction. Thus, the paraplegic individual, although no longer doomed to an early death, faces a long-term outlook that remains speculative.