Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI.
A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained.
In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively.
SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.
"However, despite the beneficial effects of CIC on urinary drainage, patients using CIC because of neurogenic bladder secondary to SCI generally exhibit a reduced QoL in all health domains as assessed by the Medical Outcomes Study Short Form 36 . If patients have uncontrollable incontinence or intermittent catheterization is not suitable, indwelling Foley catheter placement or suprapubic catheters can also be considered [65-67]. "
[Show abstract][Hide abstract] ABSTRACT: The proper performance of the lower urinary tract is dependent on an intact neural innervation of the individual structures involved. Therefore, any congenital neurological anomalies, diseases, or lesions of the central, peripheral, or autonomic nervous systems can result in lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) secondary to neurological disorders can significantly reduce quality of life (QoL) and may also give rise to serious complications and psychological and social sequelae. The goals of management of LUTD in patients with neurological disorders are to prevent serious complications and to improve the patient's QoL. Understanding the physiology and pathophysiology of micturition is critical to selecting appropriate treatment options. This article provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with certain central and peripheral neuropathies and common lesions.
Korean journal of urology 09/2012; 53(9):583-92. DOI:10.4111/kju.2012.53.9.583
"Reported complications during long-term care of suprapubic cystostomy include urine infection, stones in urinary bladder, renal calculi, haematuria, neoplastic changes occurring in urinary bladder, at the site of cystostomy or in the suprapubic tract [9,10]. Dislodgement of catheter requiring re-operation, or migration of tip of catheter through patulous bladder neck into urethra probably do occur but have not been publicised in medical literature. "
[Show abstract][Hide abstract] ABSTRACT: ABSTRACT:
Although complications related to suprapubic cystostomies are well documented, there is scarcity of literature on safety issues involved in long-term care of suprapubic cystostomy in spinal cord injury patients.
A 23-year-old female patient with tetraplegia underwent suprapubic cystostomy. During the next decade, this patient developed several catheter-related complications, as listed below: (1) Suprapubic catheter came out requiring reoperation. (2) The suprapubic catheter migrated to urethra through a patulous bladder neck, which led to leakage of urine per urethra. (3) Following change of catheter, the balloon of suprapubic catheter was found to be lying under the skin on two separate occasions. (4) Subsequently, this patient developed persistent, seropurulent discharge from suprapubic cystostomy site as well as from under-surface of pubis. (5) Repeated misplacement of catheter outside the bladder led to chronic leakage of urine along suprapubic tract, which in turn predisposed to inflammation and infection of suprapubic tract, abdominal wall fat, osteomyelitis of pubis, and abscess at the insertion of adductor longus muscle
Suprapubic catheter should be anchored securely to prevent migration of the tip of catheter into urethra and accidental dislodgment of catheter. While changing the suprapubic catheter, correct placement of Foley catheter inside the urinary bladder must be ensured. In case of difficulty, it is advisable to perform exchange of catheter over a guide wire. Ultrasound examination of urinary bladder is useful to check the position of the balloon of Foley catheter.
Patient Safety in Surgery 10/2011; 5(1):27. DOI:10.1186/1754-9493-5-27
[Show abstract][Hide abstract] ABSTRACT: This review of management of the neurogenic bladder due to spinal cord injury focuses specifically on the most current literature
(2007–2009) regarding therapies offered in the United States. Urodynamic surveillance, indwelling and intermittent catheterization,
sphincterotomy, urinary diversion, continent catheterizable stomas, and botulinum toxin usage are all reviewed.
KeywordsSpinal cord injury-Neurogenic bladder-Indwelling catheter-Urinary diversion-Botulinum toxin type A-Urodynamics
Current Bladder Dysfunction Reports 06/2010; 5(2):107-113. DOI:10.1007/s11884-010-0047-6
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