LONG-TERM SUPRAPUBIC CATHETERIZATION - CLINICAL OUTCOME AND SATISFACTION SURVEY

We report on the clinical outcome and satisfaction survey of long-term suprapubic catheterisation in patients with neuropathic bladder dysfu nction. Between early 1988 and later 1995, 185 suprapubic catheters we re inserted under direct cystoscopic vision. Anti-cholinergic therapy was given to all patients with significant detrusor hyper-reflexia; th e catheters clamped daily for two hours and changed every six weeks. U ltrasonography and assessment of the serum creatinine were used to ass ess the upper renal tracts, and the results of the pre-and post-cathet er video-cystometrography was used to evaluate bladder morphology, cys tometric capacity, maximum detrusor pressure and the presence of vesic o-ureteric reflux. There were equivalent numbers of males and females. The follow-up ranges from 3-68 months. Following catheterisation, the re was a 50% reduction in the average maximum detrusor pressure, bladd er morphology improved in 85% of the cases; the bladder capacity and u pper renal tracts remained unchanged. Vesico-ureteric reflux was aboli shed in 33% of the cases. Complaints were common consisting of recurre nt catheter blockage, persistent urinary leakage and recurrent urinary tract infections. There was a 2.7% incidence of small bowel injury wi th one fatality. However, the general level of satisfaction was high. It is concluded that suprapubic catheterisation is an effective and we ll tolerated method of management in selected patients with neuropathi c bladder dysfunction for whom only major surgery would otherwise prov ide a solution to incontinence. We are encouraged to find preservation of renal function with maintained bladder volumes and reduced maximum detrusor pressures thus justifying the policy of catheter clamping an d anti-cholinergic therapy in the presence of significant detrusor hyp er-reflexia. However, even in expert hands this procedure is not witho ut hazards.