NONOPERATIVE MANAGEMENT OF THE URINARY-TRACT IN SPINAL-CORD INJURY

Various options exist for the management of the lower urinary tract in chronic spinal cord injury. These options include chronic indwelling catheterization, urethral sphincterotomy, and intermittent catherizati on supplemented with anticholinergic agents. Sixty-four spinal cord in jured patients, treated with intermittent catheterization and antichol inergic therapy, were evaluated for long-term efficacy in maintaining upper tract status and preservation or improvement in continence. Comp lications of therapy were also evaluated. Therapy was based upon initi al urodynamic evaluation followed by limited subsequent evaluation of the urinary tract. Mean follow-up was 54 months. Only 1 patient develo ped hydronephrosis. Fifty-nine patients either became continent or exp erienced improved continence on therapy. Eight patients required surgi cal procedures either to increase outlet resistance (2) or to decrease intravesical pressures (6). The most common complication of therapy w as urinary tract infection. Thirty-nine infections occurred in 23 pati ents, 16 of which were febrile. Fifteen patients were non-compliant wi th treatment recommendations. The only factor related to therapeutic c omplications which reached statistical significance was non-compliance with therapy. The combined use of intermittent catheterization and an ticholinergic agents provides an effective means to prevent hydronephr osis and establish continence in chronic spinal injury. (C) 1995 Wiley -Liss, Inc.