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The kidneys usually function well after spinal cord injury. However, voluntary control of the bladder is usually lost. The bladder can become overfilled, resulting in high bladder pressures, and backing-up of urine into the upper urinary tract can lead to serious complications, including kidney failure. At one time, kidney failure was a common cause of death in people with spinal cord injury, but it is now a rare complication. Modern techniques for bladder management, especially intermittent catheterization, have revolutionized the care of individuals with spinal cord injury. Some major problems with bladder care do persist, however.

Some individuals with spinal cord injury cannot retain urine in their bladder and they urinate involuntarily, even when taking medications designed to suppress bladder contraction. Scientists are working to develop better methods of preventing this involuntary bladder contraction. Some people have an incompetent or “leaky” urethral sphincter, which allows urine to leak from the bladder at inconvenient times-Urologists can sometimes inject artificial material directly into the sphincter to tighten it. Urologists and biomechanical engineers are working to develop an implantable artificial urethral sphincter, but we don’t yet know whether these efforts will be successful.

For people who retain urine in the bladder and are unable to urinate, scientists are now developing methods for computerized electrical control of the bladder. In one system, an electrical stimulator produces contraction of the bladder’s muscles, causing it to empty. This research is still at an early stage but may someday lead to an implantable, artificial system for overall bladder control. The device would keep track of the volume of urine in the bladder, signal when the bladder is full, then stimulate the bladder to empty when so instructed. For some people, electrical stimulation of the bladder may need to be combined with an artificial sphincter system to achieve full bladder control.

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