CLEAN INTERMITTENT CATHETERIZATION AND PREVENTION OF RENAL-DISEASE INSPINAL-CORD INJURY PATIENTS

Upper urinary tract complications have been reported in about 20-30% o f spinal cord injury patients. Their pathogenesis is linked to the pre sence of high-pressure uninhibited detrusor contractions, high leak po int pressure and low bladder compliance. The aim of this study was to evaluate the incidence of upper urinary tract complications in two hom ogeneous groups of spinal cord injury patients with different bladder emptying modalities (intermittent catheterization vs. tapping, abdomin al straining, Crede's manoeuvre) and the relationship with clinic and urodynamic features. A total of 17 patients (22%) had upper urinary tr act complications. The incidence of both urinary tract dilatation and vesicoureteral reflux was significantly lower in patients having inter mittent catheterization (P=0.03 and 0.04 respectively). Intermittent c atheterization thus seems to be effective in preventing upper urinary tract disease in spinal cord injury patients requiring mechanical blad der emptying modalities. The finding of upper urinary tract complicati ons also in patients having intermittent catheterization showing high intravesical pressures stresses the need of adding anticholinergic med ications to the rehabilitation regimen of these patients.