PATIENT NAME:
Care Pathway for MS Patient with Neurogenic Bladder Problems (to be completed at each stage and signed by
relevant health professional)
Stage in Pathway
Plan
Troublesome urinary
symptoms
Dipstick urine
Abnormal urinalysis
Send MSSU
Treat with antibiotics
Discuss with GP
Normal urinalysis
Ongoing Symptoms
Post-micturition
bladder ultrasound
scan
1.Residual volume of
urine less than 150mls
Ongoing symptoms
Discuss contributory
Factors: Fluid intake,
caffeine/alcohol
consumption,
constipation
Patient to complete
three day bladder diary
Reassess after one
month
Post-micturition
bladder ultrasound scan
Add anticholinergics
Discuss with GP, send
guidelines
Repeat Bladder USS if
have further symptoms
Refer for specialist
opinion
Variation
Signed/date
Stage in Pathway
Plan
2.Residual volume of
urine between 150400mls
Teach double voiding,
percussion, positioning,
vibration and
association
Reinforce lifestyle
advice
Rescan after 3 months
Ongoing symptoms
Teach intermittent clean
self catheterisation
Consider
anticholinergics
Discuss with GP, send
guidelines
Patient unable to
manage ICSC
Consider supra-pubic
catheter with flip-flow
valve if suitable or leg
bag
Ongoing symptoms
Refer for specialist
opinion
3. Residual volume of
urine greater than
400mls
Consider immediate
catheterisation
Make urgent referral for
specialist opinion
Variation
Signed/date