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Thread: Bladder management

  1. #1
    Senior Member
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    Bladder management

    Hey was wondering what are the bladder management options for acute female SCI's? Any info appreciated.

  2. #2
    Females do have less options. Generally during the acute (ICU) phase, it is best to stay with an indwelling urethral catheter, as this allows the body to diurese (get rid of excess fluids) that is commonly needed after severe trauma.

    Once the woman is ready for rehabilitation, there should be a discussion about the discharge plan and long term goals. If she can do intermittent self catheterization, this is the preferred method. Medications nearly always must be taken to prevent leakage between caths and to keep bladder pressures down.

    Some women with limited hand function cannot do their own caths this way, and an early Mitrofanoff should be considered if this would allow more independence. An augmentation can be done at that time, or delayed until later if needed.

    If the woman cannot do her own catheterizations, and does not have the resources for frequent attendant care to do this at home, this may not be a practical method.

    Padding is an option for some women if their bladder empties on its own without excessive residuals or high pressures. Done right, padding can be successful, but the woman has to drink enough fluids and change her padding often enough to avoid skin burning and breakdown. In addition, may insurances including Medicare do not cover the cost of padding, while they will cover external condom catheters for men (sex discrimination, I think).

    Many women do settle on an indwelling catheter as the easiest to manage. A suprapubic catheter has the advantage of preventing some of the urethral damage that a urethral catheter will cause long term. Unfortunately indwelling catheters also bear a higher risk of UTIs, stones, and bladder cancer than the methods mentioned above.

    Urinary ostomy surgeries such as ileal conduits or Indiana pouches should be preserved for those times when there are no other options, as these are extensive surgeries.

    The VoCare system used to be an option, but currently is not available in the USA, and required extensive surgery.

    (KLD)

  3. #3
    Senior Member mattcorregan's Avatar
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    klj,
    what are your issues, is your bladder spastic or flaccid, are you incomplete and do you intermittent cath now? i'm an incomplete c5 (granted i'm a male) and i interm cath. i'm currently taking ditropan-xl and imiprimene (sp) because my bladder pressures were too high. i think as far as bladder pressures are concerned that men and women would have similar issues. also acorda is looking for participants for a phase 3 clinical trial of 4-ap http://www.acorda.com/. you may already know this. it has been shown in phase 2 trials to improve bladder function. that's my 2 cents, hope that was what you were looking for

  4. #4
    Senior Member
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    Thanks for your reply. My mistake I meant for chronic female SCI's.
    What exactly is the VoCare system? and Mitrofanoff? Suprapubic has been the only option presented to me when hand function is limited are there others? Also I'm not on any meds, should I be?
    Mattc - so far as I can tell there seems to be more options for males. Regarding 4-ap trial, don't think this is available to trial in little New Zealand (yet).

    [This message was edited by klj on 04-18-03 at 11:38 PM.]

  5. #5
    You can use the search function to get a lot of previous posts about the Mitrofanoff, which is a surgically made conduit from your bladder to your belly button (using your appendix or section of small bowel). This allows you to cath through your belly button instead of the difficult procedure of doing it through your urethra (men have no idea how hard this is for women!!! Imagine having to insert the catheter behind your scrotum.).

    The VoCare system is an electrical stimulation system that is implanted on the spinal nerves, after cutting the sensory nerves to the bowel and bladder that controls urination, defecation (and in men, erection). It is still available in Europe and Singapore as the Brindley Bladder Stimulator.

    (KLD)

  6. #6
    I'm a c6 22 years post (or 23, I'll do te math one day). I was cathed for the first year out of rehab. Getting in and out of bed was a drag ( as I need help dressing) so I went with the indwelling foley for 10 years or so. In '96 I had the Mithronoff done. Best thing for me.

    Cath independently. Pee and toss.

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