K - BLADDER FUNCTION
When referred a new patient with neurogenic bladder, a focused history and physical exam relevant to the neurogenic condition should be performed. (CUA 2019, p.161; Level C)
Consider referral for urgent investigation if individuals with SCI have any of the following ‘red flag’ signs and symptoms:
- recurrent catheter blockages (for example, catheters blocking within 6 weeks of being changed)
- hydronephrosis or kidney stones on imaging
- biochemical evidence of renal deterioration (i.e., estimated eGFR-write out all algorithm).
Clinicians should be attentive to any modification of general functioning and on the appearance of any new urological symptoms and alarm signs (e.g., pain, increased spasticity, autonomic dysreflexia, infection, fever, and hematuria). (URO 2017, p.588; Level A)
Clinicians should be aware that unexplained changes in neurological symptoms (for example, confusion or worsening spasticity) can be caused by urinary tract disease and consider further urinary tract investigation and treatment if this is suspected. (NICE 2012, p.51; Level C)
Clinicians should assess the impact of lower urinary tract symptoms on the individual’s quality of life, family members, and caregivers and consider ways of reducing any adverse impact. (NICE 2012, p.51; Level C)