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Options for independent bladder management in patients with spinal cord injury and hand function prohibiting intermittent catheterization


  • Igor Sorokin,

    Corresponding author
    1. Division of Urology, Urological Institute of Northeast New York, Albany Medical College, Albany, New York
    • Correspondence to: Igor Sorokin, M.D., 23 Hackett Blvd. Albany, NY 12208. E-mail:

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    • PGY-2 Urology Resident.
  • Elise De

    1. Division of Urology, Urological Institute of Northeast New York, Albany Medical College, Albany, New York
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    • Assistant Professor of Surgery.

  • Roger Dmochowski led the peer-review process as the Associate Editor responsible for the paper.
  • Conflict of interest: Elise J.B. De, M.D. F.A.C.S. AMS—Consultant and Clinical Investigator Allergan—Speaker and Clinical Investigator Astellas—Speaker Amgen—Clinical Investigator Boston Scientific—Clinical Investigator Ferring—Clinical Investigator Medpace—Clinical Investigator.



Choosing the appropriate bladder management strategy for the spinal cord injury patient with neurogenic bladder and hand function prohibitive of self catheterization (urethral or stomal) catheterization is complex and based on limited literature. We have catalogued the available data in this review.


A literature review was conducted on external sphincterotomy, suprapubic tube, ileal conduit, and ileovesicostomy between 1994 and 2012. Articles on neurogenic bladder focused primarily on spinal cord injury were included. Important aspects of each technique, patient selection, urologic events, and quality of life are described.


The available literature consists primarily of level 3 data. Patient reported outcomes were rarely measured. External sphincterotomy is a good option for males who are candidates for an external catheter and who wish to avoid a complicated reconstruction—most will need re-operations for failure. Suprapubic tube is an option in both genders. Complaints usually involve urine leakage and urinary tract infection, which typically resolve with conservative measures. There is some evidence to support patient satisfaction. Ileal conduit is an option for all patients with quadriplegia, offering continuous drainage and absence of foreign material. Many providers and patients will choose more conservative options first. The ileovesicostomy is best applied to small bladders with severe overactivity. The “reversibility” of this procedure makes it attractive to those not interested in an ileal conduit and who have had complications from prolonged suprapubic tube placement. The authors conclude with recommendations for future research, most importantly more standard reporting of objective data. Neurourol. Urodynam. 34:167–176, 2015. © 2013 Wiley Periodicals, Inc.