FATE OF UPPER URINARY TRACTS IN PATIENTS WITH INDWELLING CATHETERS AFTER SPINAL-CORD INJURY

Several modes of urinary tract drainage exist for the spinal cord-inju red (SCI) patient, but the use of an indwelling catheter is discourage d. We retrospectively reviewed the charts of our traumatic SCI patient s followed twenty years or more since initial injury to compare urinar y tract preservation and the incidence of urologic complications in pa tients with neurogenic bladders voiding spontaneously with those using long-term indwelling catheters. Eighty-one patients with long-term in juries were identified; 73 of them fit the study criteria. Forty-one p atients voided spontaneously having a balanced bladder or performing i ntermittent catheterization or have undergone sphincterotomy or vesico stomy, and 32 had indwelling suprapubic or Foley catheters. Renal func tion measured by creatinine clearance was. similar in both groups: 81. 3 +/- 20.2 mL/min for spontaneous voiders and 83.7 +/- 24.9 mL/min for catheterized patients. Review of urinary tract imaging and incidence of complications in both groups was very comparable, with the exceptio n that the catheterized group had a higher prevalence of scarring and calicectasis on radiologic imaging of the upper urinary tracts which w as statistically significant. Of the remaining population, in 6 of 81 patients, bladder cancer developed, and they underwent radical cystect omy and urinary diversion and 2 had proximal diversion alone. Of the 6 patients with bladder cancer, 2 were spontaneous voiders with transit ional cell carcinoma (TCC) developing. Three of the 6 patients had ind welling catheters: in 1 patient TCC developed, in 1 adenocarcinoma, an d in 1 squamous cell carcinoma. In 1 patient TCC developed in a defunc tionalized bladder after ileal conduit formation. Based on this study, we can conclude that in select groups of SCI patients, the choice of an indwelling catheter may be made if other methods fail, provided pat ients undergo regular upper urinary tract imaging and cystoscopy.