Löfgren and Norrbrink  stated that in order to improve treatment outcome, health care professionals should listen to, respond to and respect the patient’s knowledge, experience and wishes. But some spinal cord injury patients may not be fully aware of the possible deleterious effects of unmonitored penile sheath drainage or long-term indwelling urinary catheter drainage. Our patient was informed that he could develop urine infections, worsening of vesicoureteric reflux and renal damage if he continued with sheath drainage. However, health professionals were unable to persuade this patient to perform intermittent catheterisation and take antimuscarinic drug. This case raises the importance of repeated discussions with the spinal cord injury patients to highlight the possibility of developing serious complications such as bilateral hydronephrosis and renal failure with unmonitored penile sheath drainage.
Price and associates  observed that the factors most frequently associated with renal deterioration were: (1) vesicoureteral reflux, (2) renal calculi, (3) recurrent pyelonephritis as demonstrated by calyceal blunting, and (4) recurrent decubitus ulcers, the latter usually in combination with other factors. Our patient had grade 1 vesicoureteric reflux on right side, left renal calculi and urine infections. This patient also had intravesical pressure exceeding 100 cm water when detrusor contraction was initiated by suprapubic tapping. A combination of high intravesical pressures, vesicoureteric reflux, renal calculi, and urine infections resulted in renal failure in this patient.
Kuo and Liu  administered OnabotulinumtoxinA 200 U detrusor injections to 33 patients with chronic spinal cord injuries; these injections were repeated every six months for four times. Patients were instructed to perform clean intermittent catheterization during the treatment and follow-up periods. Although mean bladder capacity increased from 207 to 412 ml and mean detrusor pressure decreased from 39.8 to 20.6 cm of water, the glomerular filtration rate decreased from 93.4 to 83.5 ml/min (P = 0.028). These authors were unable to demonstrate any improvement in glomerular filtration rate over a 24-month period in patients with chronic spinal cord injury, who received repeated detrusor injections of OnabotulinumtoxinA. We recommend intermittent catheterisation and antimuscarinic drugs by mouth as the preferred method of managing neuropathic bladder in spinal cord injury patients.
Prostate volume and Prostate Specific Antigen levels are lower in men with spinal cord injury and are inversely related to the patient’s age at the time of sustaining spinal cord injury. It is not clear as to whether this effect is mediated directly or indirectly by impaired nerve supply to the prostate. A study of 113 spinal cord injury patients (mean age 61.3 years) and 109 age-matched able bodied subjects (mean age 65.4 years) revealed significantly smaller prostate in spinal cord injury patients, as measured by ultrasound scan and digital rectal examination than those observed in able bodied subjects. Serum testosterone levels were lower in spinal cord injury patients when compared to able bodied subjects.  The subject of this case report sustained complete paraplegia as a result of spinal cord injury when he was 32 years old. Therefore, this patient has reduced likelihood of developing enlargement of prostate gland. However, occurrence of prostatic diseases (benign hypertrophy of prostate or carcinoma of prostate) should not be disregarded in spinal cord injury patients.
Good communication between healthcare professionals and patients is essential. National Institute for Health and Clinical Excellence (NICE), United Kingdom  recommends that the advice given to patients should be supported by evidence-based written information tailored to the patient’s needs. Treatment and care, and the information patients are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities. We have started providing written information to spinal cord injury patients regarding possible complications of unmonitored penile sheath drainage and long-term indwelling catheter drainage (urethral as well as suprapubic catheter).
Hoffman and associates  from the Northwest Regional Spinal Cord Injury System, University of Washington, Seattle, WA, USA produced an in-person lecture and discussion series called the SCI Forum and videotaped it for on-demand viewing from their website. The Internet has the potential to provide user-friendly health information to people living with disabilities. Video media helps to enhance understanding and retention of health information compared to written or in-person instruction only. Thus advances in digital media and the Internet have made it possible to deliver more current, interesting, and useful information to people with spinal cord injury. In our spinal unit, we conduct inpatient education sessions. We try to publish in open access journals so that health professionals, carers and spinal cord injury patients can obtain information regarding management of spinal cord injury while browsing the internet.