Urological services
For an SCI program to provide competent
care, urological evaluation and management are
required. Maintaining optimal urological health
is one of the main priorities in the medical care
of an individual with SCI. Bladder evaluation
and management are ongoing and often require
adjustment, according to the individual needs of
each patient. The facility should be able to provide
evaluation for, and teaching of, various bladder
management programs, as well as education about
sexuality and fertility. To meet these goals, the SCI
program should be associated with a urologist who
is available to consult on a regular basis.
Testing of the upper and lower urinary tracts
is required, either at the facility or by making
arrangements at another facility. Although there
is no clear consensus about which tests should
be regularly performed from a screening point of
view, the availability of a number of diagnosticstudies is desirable. These include renal scans to
evaluate kidney function and abdominal CT scans
and ultrasounds to evaluate anatomy. Testing of
the lower urinary tracts may include urodynamics
to evaluate bladder and sphincter function,
cystography to evaluate bladder anatomy and
identify vesico-ureteral reflux, and cystoscopy to
visually evaluate bladder and sphincter anatomy.
Even though there is no consensus on the exact
timing and choice of testing, many SCI centers
recommend a baseline evaluation of the upper
tracts during the acute rehabilitation phase, with
annual follow-up thereafter. Lower tract testing
is often initiated when spinal shock subsides
and annually thereafter. Additional consultation
and testing is performed based on screening test
results and as clinically indicated. Results of these
diagnostic tests are used to guide prescription of
a bladder management plan that optimizes the
person’s independence.