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If you cannot empty your bladder naturally, you or your healthcare provider can use a catheter as needed for emptying. This technique is called intermittent catheterisation. It can be done by the patient at home and is recommended for neuro-urological patients.
Intermittent catheterisation prevents many complications associated with catheters that stay in place (indwelling), including a high risk of urinary tract infections.
Intermittent catheterisation must be performed correctly to prevent infection. This is most important in managing the urinary tract of patients with neuro-urological symptoms.
Botulinum toxin injections in the bladder
This treatment is most effective for overactive bladder caused by multiple sclerosis or spinal cord injury.
The drug is given by injection inside the bladder. In this procedure, a device called a cystoscope is inserted in your bladder and the botulinum toxin is injected in the bladder wall using a special needle.
The drug causes the bladder muscle to stop contracting regularly for about 9 months. Repeated injections may be necessary, but the treatment continues to be effective after new injections.
After the injection, the bladder may not empty completely. Intermittent catheterisation may be necessary for a time. Urinary tract infections also may occur with this treatment.
Bladder neck and urethral procedures
A neuro-urological condition might make urination difficult by causing a lot of resistance at the bladder neck or the sphincter. In this case, your doctor might suggest minimally invasive treatment to improve urination and to protect the upper urinary tract.
The urinary sphincter can be cut to reduce the sphincter’s resistance to the passage of urine. The urethra will still be able to close somewhat. Incontinence may occur afterwards and can be managed. In many patients, this procedure has to be repeated. It does not have severe complications. Some patients may be able to have a urethral stent implanted, but the costs, complications, and need for further surgery have limited their use.
Bladder neck incision
Injury and previous procedures can cause the tissue at the bladder neck to thicken or scar. If this has happened, this tissue can be cut to help passage of urine through the bladder neck.