Three months after a complete spinal cord injury at the T10 level, a 34-year-old man has a neurogenic bladder. Video urodynamics show detrusor overactivity with coordinated failure of relaxation of the external sphincter during voiding attempts. Renal ultrasound is normal. Which long-term management best protects the upper tract?
- A Indwelling urethral catheter drainage permanently
- B Alpha blocker monotherapy with timed voiding
- C Clean intermittent self-catheterisation combined with an antimuscarinic agent ✓
- D Crede manoeuvre with fluid restriction
Correct answer: C. Clean intermittent self-catheterisation combined with an antimuscarinic agent
Explanation
A suprasacral cord lesion produces a spastic (upper motor neurone) bladder with detrusor sphincter dyssynergia, generating high storage pressures that threaten the upper tracts. Clean intermittent catheterisation empties the bladder safely while an antimuscarinic lowers detrusor pressure during filling, and this combination is the standard of care. An indwelling catheter invites infection and stones, alpha blockers do not treat overactivity, and the Crede manoeuvre raises bladder pressure further.
Reference: Smith and Tanagho's General Urology, 19th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.