Acute clinical management

In the acute stage, urethral catheterisation is recommended, unless priapism* is present, whereby supra-pubic catheterisation should be performed. The catheter should initially be left on free drainage.

* Priapism – presence of persistent erection

Ongoing clinical management

Urodynamic studies are recommended to inform ongoing bladder management. This gives a baseline prior to starting ongoing bladder management and checks for any abnormalities.

Guidelines (EAU 2003)

• Urodynamic investigation is necessary to document the (dys-)function of the lower urinary tract.
• The recording of a bladder diary is highly advisable.
• Free uroflowmetry and assessment of residual urine is mandatory before invasive urodynamics is planned.
• Video urodynamics is the gold standard for invasive urodynamics in patients with neuropathic lower urinary tract dysfunction. Should this not be available, then a filling cystometry continuing into a pressure flow study should be performed.
• A physiological filling rate and body-warm saline must be used.