CLEAN INTERMITTENT CATHETERIZATION FROM THE ACUTE PERIOD IN SPINAL-CORD INJURY PATIENTS - LONG-TERM EVALUATION OF URETHRAL AND GENITAL TOLERANCE

Since its introduction by Lapides, clean intermittent catheterisation (CIC) has dramatically changed the urological management of spinal cor d injury (SCI) patients. Since 1978 we have used CIC as a mode of drai nage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium an d long term. 12-14 Fr PVC catheters are used with lubricant. The objec tives of this study were: first, in a population of 159 SCI patients ( group 1), to evaluate the overall incidence of complications of CIC; S econdly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC , frequency of urinary tract infections, and rates of urethral strictu res were evaluated. The analysis of group 1 showed a rate of lower uri nary tract infection of 28% and of cytobacteriological infection of 60 %. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5 .3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The fir st factor for acceptance of long term CIC is continence, the second on e is the ability to perform CIC independently. In group 3 we found a r ate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on CIC. The method and the type of catheters used must also be considered. We need further studies of lon g term CIC in patients using non-reusable hydrophilic catheters from t he acute period to see if these two complications can be prevented.