Question Title: Bladder function in spinal injury patients

I have a spinal cord injury at level L1 (almost complete). My original injury occurred nearly four years ago now. Until recently I have controlled my urinary functions using a combination of Intermittent Self Catheterisation/ indwelling catheters as situations have required. However, recently this has become more and more problematic and a recent urodynamics test in the UK showed that an incontinence sheath and drainage bag system was more appropriate as my bladder is now only holding quite small amounts before spontaneously draining . I have been told that I can either carry on with this system or elect to have a bladder enlargement operation using part of my large intestine. My questions are:(1) Why would my bladder change its' behaviour in this way? and (2) Is such an operation a good idea? - i.e. what are the long term prospects and are there any other alternatines to consider (Oxybutinin seems ineffective in my case).
I look forward to your answer.

-------------------------------------------------------------------------------------------------------------
Dear David,

Incontinence after spinal cord injury and its subsequent bladder management is a complex problem that has become an entire subspeciality n urology. The type of problem resulting from spinal cord damage is related t the level of the injury. C1 to T12 are usually characterized by DSD ( detrusor sphincter dyssynergia), L1 and below have detrusor areflexia. DSD is characterized by uncoordinated action between the sphincter and the bladder. Therefore, when the bladder contracts, the sphincter does not open and the pressure in the bladder is elevated. This elevated pressure is transmitted to the kidneys and can result in renal failure. Detrusor areflexia means the bladder does not contract.The bladder must be emptied mechanically with a catheter.
Urodynamic evaluation is the tool urologists use to determine the type of bladder a patient with a spinal cord lesion has. In your case, clean intermittent catherization was not succesful in keeping the bladder pressure low. Bladder augmentation with a segment of your bowel is recommended to accomplish two things. First, the pressure in the bladder is decreased thus sparing the kidneys and preventing kidney failure. Second, by increasing the bladder capacity, you would be able to hold more and therefore have an increased chance of being dry between catheterizations.
The bladder often changes over time in response to a nerve injury. The process by which this occurs is not well understood. Periodic assessment with urodynamics is therefore mandatory in the setting of spinal cord injury. This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

HFHS MD-KR
*keyword : spinal cord injury

---