Evidence-based Management of the Neurogenic Bladder: A New Clinical Practice Guideline

Among the most challenging complications that we see in individuals with spinal cord injury are those associated with bladder dysfunction. Without an effective long-term plan for managing the neurogenic bladder, these individuals face poor outcomes that hinder their satisfaction with life. Lack of bladder control can result in recurrent infection, skin breakdown, risk for autonomic dysreflexia, chronic disease of the urinary tract, and sexual dysfunction. Rendering care for these complications involves significant health care resources. Moreover, bladder problems interfere with the person's ability to function independently and achieve an optimally satisfying lifestyle.

To address this crucial issue, the Consortium for Spinal Cord Medicine, with the support of Paralyzed Veterans of America, has prepared a new evidence-based clinical practice guideline, which appears in this issue (1). In the tradition of prior guidelines, the Consortium, an interdisciplinary group of experts and professional and consumer organizations has conducted a broad-based and thorough evaluation of the literature, as well as the medical, surgical, nursing, and preventive aspects of clinical care. This guideline is designed to be a resource in planning long-term bladder management for individuals with spinal cord injury or dysfunction. It has been formulated to provide guidance for each step in the process, including identifying bladder dysfunction, performing urodynamic evaluation, evaluating the different methods for bladder management (comparative costs are addressed in the Appendix), the role of medications, stents and surgical interventions, and minimizing complications.

Publication in this journal is an important first step in the dissemination of this guideline to the community of professionals who care for individuals with spinal cord injury. Utilizing its recommendations and incorporating them into plans of care will improve the health and well being of people with spinal cord injury and bladder dysfunction.