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Neurogenic bladder after spinal cord injury — SCE Neurology MCQ

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HardNeurorehabilitationNeurogenic bladder after spinal cord injurySCE Neurology

A patient with T6 spinal-cord injury has recurrent infections, hydronephrosis and urodynamic high-pressure detrusor overactivity with sphincter dyssynergia while reflex voiding. What management best protects renal function?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Clean intermittent catheterisation combined with treatment to lower storage pressure and structured upper-tract surveillance

The best answer is “Clean intermittent catheterisation combined with treatment to lower storage pressure and structured upper-tract surveillance”. High storage pressure threatens the upper tracts; safe emptying, pressure control and surveillance are priorities. “Continue reflex voiding unchanged” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Restrict oral fluid as the sole intervention” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Use a permanent catheter without review of alternatives” is a credible alternative elsewhere, but it fails the decisive discriminator in this case. “Treat infections only after renal function declines” is a credible alternative elsewhere, but it fails the decisive discriminator in this case.

Reference: NICE CG148 urinary incontinence in neurological disease recommendations: https://www.nice.org.uk/guidance/cg148/chapter/Recommendations