Over the last few weeks, you have noticed there are options for the removal of urine from the bladder. Selection of an option that is right for you depends on the issues of your bladder. Testing provides the answers to your individual bladder needs.

Type of Injury The type of injury you have is a first clue to what type of bladder function you have. After a spinal cord injury, the bladder is diagnosed as neurogenic, meaning the nerves are not transmitting messages correctly. If the injury is in the cervical or thoracic levels of the spine, a reflexive or upper motor neuron bladder is typically diagnosed. In the lumbar or sacral levels, a flaccid or lower motor neuron bladder is usual. However, for some individuals with SCI from medical issues, spinal cord injury syndromes and those with a mixed type of bladder function, selection of a urine elimination process is not as simple. Testing provides direction.

Urinalysis and Culture and Sensitivity (UA & CS) Laboratory Test Laboratory testing of urine can be performed to assess health indicators, including urinary tract infections (UTI), kidney disease, and diabetes. The urinalysis assesses for acidity (pH), concentration or specific gravity, protein, sugar (glucose), ketones, bilirubin, signs of infection, and blood. Urine quality tests are the amount of white blood cells, red blood cells, bacteria and yeast, casts (tube-shaped proteins), and crystals.

If an infection is determined to be in the urine as indicated by the UA, a C&S is done using the same urine sample. The bacteria in the urine are allowed to grow in a culture dish. This is the culture part of the test. Then different antibiotics are tested to see which will eliminate the specific bacteria. This is the sensitivity part of the test. This process takes three days to complete. If you have an infection, the best choice of antibiotic is prescribed. You must take the entire prescription of the antibiotic to eliminate the bacteria. Even if you feel like the infection is gone, it is not until the entire prescription is taken.

24 Hour Urine Collection In order to check your kidney function through an examination of urine, a collection of urine for one full day may be done. The objective is to see the amount of creatinine that is cleared by your kidneys. This test also assesses protein, urinary hormones, minerals, and other chemicals.

Blood Test A blood sample can indicate how your kidneys are functioning or if you have an infection in your body. Blood Urea Nitrogen (BUN), creatinine levels, and Glomerular Filtration Rate (GFR) are blood tests indications of kidney function. An increased white blood cell count indicates there is an infection somewhere in the body. Also, a blood test can indicate if you have enough hydration in your body to keep the urinary system functioning well.

Post Void Residual (PVR) The post-void residual is a method to see how the amount of urine is left in the bladder after a spontaneous void or incontinence. In this procedure, the individual attempts to void or has a spontaneous or incontinent urine output. A straight catheter is inserted, any urine left in the bladder is removed, and the catheter is immediately removed. If under 75-100ccs of urine is left in the bladder, emptying of the bladder is considered a success. If more than 75-100ccs of urine is left in the bladder, a bladder program is initiated.

Medications can be used to increase the amount of urine eliminated. These include medicines that strengthen bladder contractions and those that affect the sphincters to tighten or relax.

Individuals with a reflexive bladder may find they expel all the urine in their bladder or need a bladder program. Those who have a flaccid bladder may find they can expel all the urine with reflex techniques or need to begin a bladder program.

Bladder Scan One of the simplest assessments of bladder emptying is a noninvasive bladder scan. It is an ultrasound device that is placed on the skin over the bladder area. A transmission gel is placed on the device and skin to project sound waves into the bladder. A diagram of the urine in the bladder can be seen on a monitor with the bladder's amount of urine.

This procedure can replace the post-void residual if the equipment is available. It is typically performed in the acute care hospital, rehabilitation hospital, or healthcare provider's office.

Ultrasound Testing An ultrasound assessment of the entire urinary tract can be performed usually in a testing center. The assessment includes the kidneys, ureters, and bladder. The examination provides a picture of the urinary system structures and can indicate the presence of stone or strictures.

Urodynamic Testing is one of the most important tests of the urinary system after spinal cord injury. This is an assessment of how the urinary system is functioning. It is critical to get the procedure done as soon as you are able, as the information gathered will lead to treatment, if necessary, to keep your urinary system healthy. It is better to have a baseline of your normal to measure any changes that can be quickly adjusted before damage occurs.

In urodynamic testing a sterile, pressure-sensitive catheter is placed in the bladder. This catheter measures pressure in the abdomen, bladder, and urethra. A sensor is placed in the rectum to measure rectal pressure, and a sensor is placed on the abdomen to measure abdominal pressure. Fluoroscopic images may be taken during the procedure. Sterile fluid is slowly dripped into the bladder. As the bladder fills, pressures are measured. You will be asked if you feel any sensations and might be asked to try to empty your bladder. Even if this is not in your typical actions, it is done to gather information.

Results will indicate your risk for reflux of urine into the kidneys, which can damage them. The type of bladder function is identified, high or low pressure, hyperactive or flaccid. Nerve and muscle function are assessed. How the bladder and sphincters contract, if they coordinate, and their competence is analyzed. Depending on the results, treatments can be provided that will improve your urinary system and safety.

Cystoscopy is a procedure where a narrow viewing tube is placed through the urethra into the bladder. This procedure is most likely performed under anesthesia. The examiner then views the inside of the bladder. The cystoscopy is used to look for infection, sources of bleeding, stones, inflammation, cancer, or to remove small tumors. It can also help with the diagnosis of an enlarged prostate. Samples of tissue can be inspected in your body or removed for laboratory review.

Preparing for an assessment of the urinary system is important to the success of the test. For some tests, you will not need to prepare in any way. If you provide urine samples, you will need to clean your urethra prior to providing the sample if you do not catheterize. If you do catheterize, regular pre-catheterization cleaning is effective. You might be asked to increase fluids or hold fluids prior to a procedure. Prior to and following urodynamic testing or cystoscopy, you will be catheterized to ensure you bladder is empty.

Be aware and alert the person performing any procedure, urinary or other, if you have autonomic dysreflexia (AD). During the procedure, tell the examiner if you are uncomfortable, shift your body weight, or develop AD symptoms. Note your discharge instructions. Call the provider if you have unusual bleeding, fever, chills, pain, difficulty urinating or have difficulty catheterizing or symptoms of AD. Use the wallet card to help you explain and detect AD, especially if you have never had symptoms or your healthcare professional is not aware of it.

All these tests are helpful to keep your urinary system running efficiently and effectively. Finding issues early can help with treatment rather than waiting until significant issues arise. Nurse Linda

Pediatric Consideration: The same procedures used for adults are used in the pediatric setting. Infants or small children may be sedated for urinary assessment testing. Older children can take advantage of the Child Life Specialist, who can use calming and distraction techniques.

As with everyone who has a neurogenic bladder, early intervention is the best practice. Your child will be growing and developing so yearly assessments will benefit their progress. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.