Clinical bladder evaluation: A new, cost-effective, clinical method for neurogenic bladder evaluation and rehabilitation

Table 1 Steps of clinical bladder evaluation

	STEPS (note time and amount)	Explanation
1	Removal of catheter/make empty the bladder	Starting of procedure to get an emptied bladder
2	Ask to take water as he/she usually takes it at home. Give multiple gauge pieces near genitalia to hold leaks of urine	Water intake varies among individuals, patient’s water intake at home would reflect his daily life and would give a better idea of leakage and further management
3	Ask to note the feeling of bladder fullness (if any)	Some may have a feeling of fullness as in normal bladder, which would help in better management in terms of the timing of self-CIC
4	Ask to note any leaks (numbers, amount and time)	Gives an idea on upper motor neuron vs lower motor neuron bladder and further management. First leak time gives idea about holding time
5	Weighing dry and wet gauge pieces/pad	To get an idea about volume of leaked urine
6	Weighing soaked gauge pieces (equivalent to urine volume, mg to mL)	Calculate urine volume after conversion = (weight soaked–weight of dry gauges)
7	Apply stimulus to lower abdomen (reflex voiding) and measure leaks of urine	Calculate reflex voiding
8	Ask to self-void, measure amount	Check self-voiding (voluntary efforts)
9	Catheterize the bladder (PVR)	Check PVR, transurethral catheterization is the gold standard for PVR measurements
10	Calculate total bladder capacity	All leaks + reflex voiding + self-voiding + PVR
11	Check eligibility of self- CIC	Decision making and planning for further management

CIC: Clean intermittent catheterization; PVR: Post-void residual.