Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms of detrusor overactivity, including urinary urgency, frequency, and urge incontinence. Reports involuntary bladder contractions, high-pressure voiding, and incomplete emptying. History significant for upper motor neuron lesion (e.g., spinal cord injury, MS, or stroke). Denies hematuria or dysuria.
Clinical Examination Findings
Physical exam reveals hyperreflexia and increased muscle tone in lower extremities. Digital rectal exam (DRE) demonstrates increased anal sphincter tone and absent voluntary contraction. Bladder scan shows significant post-void residual (PVR) volume. Neurological assessment confirms UMN signs (spasticity, positive Babinski).
Treatment Protocol
Initiate anticholinergic therapy (e.g., Oxybutynin or Solifenacin) or Beta-3 adrenergic agonists to manage detrusor overactivity. Implement a scheduled clean intermittent catheterization (CIC) program to ensure bladder emptying and prevent high-pressure storage. Consider urodynamic study for further pressure-flow assessment.