Neurogenic lower urinary tract dysfunction (NLUTD) is described by the International Continence Society (ICS), as an abnormal function of the bladder and urethra in the context of clinically confirmed neurologic disorder [1]. It is commonly seen following spinal cord injury (SCI), leading to over 80% requiring the use of a catheter [2]. Bladder management in patients with spinal cord injuries is focused on maintaining continence, facilitating bladder emptying, and preventing complications such as urinary tract infections, and upper urinary tract compromise/renal failure [3]. Clean intermittent catheterization (CIC) is considered the gold standard option for bladder management in patients with NLUTD, however, patients may not be able to perform CIC and often switch to other less optimal methods. Reasons for discontinuation or non-adoption of CIC include technical difficulty performing self-catheterization, maintaining clean technique without assistance, need to transfer to catheterize, and difficulty catheterizing outside the home, such as in a public restroom. The decision on which management option to use is ultimately up to the patient, but studies show that providers play a significant role in the decision-making process. When determining which management is best, providers must consider the patient’s cognition, hand function, ability to manage clothing, social context, functional mobility, quality of life, and availability of support. Improper bladder management can lead to medical consequences such as infections and loss of renal function. When managing patients with neurogenic lower urinary tract dysfunction, a team approach involving surgeons, urodynamicists, physical medicine/rehabilitation specialists, nursing, social work, physical therapy, and occupational therapy can be helpful. We can learn from the occupational therapists’ approach, which evaluates motor and processing skills, client values, beliefs, spirituality, and life roles, promoting greater engagement and participation in urinary health. It is essential that providers understand the occupational therapists’ approach, training patients on techniques to provide the full range of bladder management options available today.

This video abstract is a mini didactic lecture on adaptive techniques designed for staff education, a collaboration between a neurourologist and an experienced occupational therapist who focuses on adaptive techniques for bladder management in patients with spinal cord and other neurological injuries.

Specific adaptive technology and reasoning are presented. Closed and open system catheters are compared, handle grips suggested for specific hand functions, leg spreaders with mirrors for improved urethral visualization, and labial spreaders are described for women to assist with better access to the urethra. Clothing retractors and adaptive clothing can impact ease of technique.

Over 80% of patients with spinal cord injuries require the use of a catheter after injury. This number is also high in other neurologic diagnoses impacting bladder and hand function. Hand function, clothing management, and functional mobility are important factors to consider when choosing bladder management options. Adaptive techniques to improve success include closed catheter systems, handle grips, leg spreaders and mirrors, clothing retractors and adaptive clothing, and training in an approximate real-life scenario such as the clinic bathroom. Lastly, utilizing a team approach by including an occupational therapist can improve the accessibility of options for bladder management, independence, and ultimate outcome in patients who perform self-catheterization.

Gajewski, J. B., & Drake, M. J. (2018). Neurological lower urinary tract dysfunction essential terminology. Neurourology and urodynamics, 37(S6), S25–S31. https://doi.org/10.1002/nau.23758
Manack, A., Motsko, S. P., Haag-Molkenteller, C., Dmochowski, R. R., Goehring, E. L., Jr, Nguyen-Khoa, B. A., & Jones, J. K. (2011). Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourology and urodynamics, 30(3), 395–401. https://doi-org.elibrary.amc.edu/10.1002/nau.21003
Hamid, R., Averbeck, M. A., Chiang, H., Garcia, A., Al Mousa, R. T., Oh, S. J., Patel, A., Plata, M., & Del Popolo, G. (2018). Epidemiology and pathophysiology of neurogenic bladder after spinal cord injury. World journal of urology, 36(10), 1517–1527.

Continence 7S1 (2023) 100950
DOI: 10.1016/j.cont.2023.100950