Surgical management of urethral damage in neurologically impaired female patients with chronic indwelling catheters

Objective To evaluate the clinical outcome of female patients with spinal c ord injury who underwent a variety of surgical procedures to treat urethral injury and incontinence from prolonged indwelling urethral catheterization . Patients and methods The study included 18 female patients (mean age 53.6 y ears, range 17-75), most of whom had spinal cord injury, who had indwelling urethral catheterization for a mean of 3.5 years (range 6 months to 30 yea rs): they presented with severe urethral injury and intractable incontinenc e despite catheterization, Several different surgical operations were used to correct the incontinence, including urethral reconstruction (urethroclei sis) and urethral closure both transvaginally and suprapubically, in associ ation with permanent suprapubic catheterization. The patients were followed for a mean of 4.6 years, Results Four patients who underwent transabdominal urethral closure were dr y, Four of eight patients who underwent urethral closure transvaginally dev eloped urethral fistulae: these occurred within 3 months of their operation . two being corrected at subsequent operations. Two of six patients who und erwent urethral reconstruction were incontinent and this was corrected via a transabdominal closure. Overall, the 18 patients underwent 22 procedures and 16 are dry, i.e. approximate to 90% success, Conclusion Where the urethra Is irrecoverably damaged, closure via the tran svaginal approach is the preferred approach because it has low morbidity an d is tolerated by these severely disabled patients, Urethrocleisis and uret hral preservation provide a better option only in a select group of patient s.