Neurology

Disturbance of bladder function is often a part of a neurological disease.  The bladder is controlled by neural input from many different levels of the nervous system but some parts, such as the spinal cord, are particularly critical.  Diseases that affect the spinal cord are highly likely to be associated with problems of continence.  However, incontinence may also affect patients with cerebral diseases such as strokes or brain injury and various progressive neuro-degenerative diseases including Parkinson's.

Neurogenic Bladder encompasses a range of bladder function and dysfunction. It may represent bladder overactivity (detrusor hyperreflexia), loss of bladder contractility (detrusor arreflexia) or a normally contractile bladder. Detrusor instability represents bladder overactivity from non-neurogenic causes and like Detrusor Hyperreflexia is manifested by urinary urge incontinence, urinary frequency, and urinary urgency. The BladderScan^® aids in the differentiation of urinary incontinence from retention as opposed to overactivity.

• Indications & Applications
• Cost Analysis
• Key Clinical Messages
• Literature

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Indications / Applications

Indications for the use of the BladderScan^® within Neurology;

• Patient with a risk of urinary retention
• Patient after removal of an indwelling foley catheter
• Patient after removal of a Super Pubic catheter.
• Patient with a possible obstruction of the urinary tract
• Patient after spinal/epidural/general anesthesia
• Patient post-operative
• Patient who requires bladder re-training following surgery or bladder dysfunction
• Patient after Stroke
• Patient with a slipped disc

Benefits for the user of BaldderScan^® include;

• The use of the BaldderScan eliminates unnecessary catheterisation
• Ability to recognise urine retention in time
• Performing the a scan using the BladderScan^® takes less time than catheterising a patient
• Reduced use of disposables
• Minimises risk of urinary tract infection and associated costs
• Non-invasive
• Easy to use
• Saves staff time
• BladderScan^® improves the patients quality of life

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Cost Analysis

	Hospital - Cost Justification- Monthly Financed.pdf
	Hospital - Cost Justification-6100.pdf
	Hospital - Cost Justification-Multiple.pdf

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Key Clinical Messages

Pruim E.J. (1999 ECNA Utrecht)
Non-Invasive Bladder Volume Assessment on the Recovery Ward
The study results show that BladderScan™ is an easy to use , non-invasive way of ensuring that your patient is not within the (retention) danger zone with a non invasive ultrsound measurement causing little or no discomfort. Use of the protocol, instead of time limit or palpatation means less or even no unnecessary catheterisations and therefore is an improvement in quality of patient care. Using BladderScan™ is cost effective

Chan H. (1999 AANN 0047-2603/93/2505/0319)
Non-invasive bladder volume measurement
This study shows that out of 104 stroke patients, 6 errors had been made in unnecessary catheterisations (8.57% error rate) and that BladderScan is safe, quick and also accurate.

Moore D.A. (2001)
Using a Portable Bladder Scan to Reduce the Incidence of Nosocomial Urinary Tract Infections
An innovative technology, BladderScan™, was introduced to reduce urinary tract infections and care costs in hospitalized adults. Evaluation revealed reductions in infection rates and overall benefits exceeding costs.

Ridder DJ.M.K. de (1998 Thesis submitted in fulfillment of the requirements for the degree of "medical doctor")
Advances in the Urological Care for Multiple Sclerosis Patients
The Bladdermanager PCI 5000® was used to give the Patient feedback on his bladder volume and to change the catheterization schedule from time dependent to volume dependent. PCI 5000, Bladdermanager® in the management of neurogenic bladder dysfunction in Multiple Sclerosis is presented. The correlation beween catheterized and restrained volume, as well as the accuracy, is excellent for an ultrasound measurement. The target control helps to eliminate partial or unreliable measurements. Also the calculation of the bladder volume is based on measurements in twelve different rights, being more accurate than the classic estimations in three spatial planes. Using the PCI5000Bladdermanager© they were able to improve the urological status in these patients, proving that even in advanced stages biofeedback training techniques can be useful. This is very important from the rehabilitation point of view, since it improves the self-esteem of the patient, decreases his incontinence and consequent social problems, without increasing the level of assistance needed, thus increasing the quality of life. They concluded that the PCI5000 Bladdermanager® can offer several benefits to patients with neurogenic bladder dysfunction, not only by Multiple Sclerosis but also by other etiologies of spinal cord disorders.

Popolo G. del (1999 Univ. of Firenze "I Fraticini")
Bladder volume evaluation in patients with spinal cord injury using either Bladder Manager or BladderScan
These instruments can be considered as a "sensitivity prosthesis"
The aim of our study was to estimate the accuracy of the estimated bladder volume in comparison with the volume voided by catheterization, and to assess whether nurses need training before starting the routinary use of the ultrasound scanner on a ward. The study confirmed the validity and reliability of both instruments.

Udaka F. et.al. (1999 intern report)
Department of Neurological Medicine and Urology, Sumitomo Hospital
Drug Treatment and Management of Urinary Incontinence in Elderly Patients with CNS.
Disorders: Clinical Application of a Portable Ultrasound Bladder Capacity Scanning Device (PCI) with Memory Function. The study was using PCI to monitor a 24-hour urodynamic profile and to assess its applicability for therapeutic purposes. The use of the device with memory function permitted frequent measurement and noctural recording, thus enabling us to grasp the urodynamics in a more physiological fashion. Its vesical capacity alarming function made it feasible to induce voiding with appropriate timing, which proved useful also for voiding training.

Unsworth J. et.al. ( 2002)
Management of bladder problems in patients with multiple sclerosis.
Bladder problems are a common feature of MS, with up to 90% of people experiencing problems. Monitoring frequency/volume of urine is the corner stone of assessment. Another vitally important part of assessing the patient with incontinence, is the measurement of post-void residual urine by using a bladder scanner to measure the residual urine using ultrasound.

Cardenas D.D. (1988 Arch Med Rehab Vol 69)
Residual urine volumes in patients with spinal cord injury: measurement with a portable ultrasound instrument.
The first ultrasound volume determination was comparable to the average ultrasound volume (r²=0.956). For catheterized volumes versus the initial ultrasound volume determination, r² appeared 0.80. The average error was 18% for catheterized volumes within the range 50-700 ml. Our results compare favorably with both real-time scanning using standard equipment and other portable instruments.

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Neurology Literature References

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