INFLUENCE OF URINARY MANAGEMENT ON UROLOGIC COMPLICATIONS IN A COHORTOF SPINAL-CORD INJURY PATIENTS

Objective: To study urologic complications in patients with spinal cor d injury (SCI) in relation to their bladder management, Design and Set ting: A cohort study of patients with SCI in a rehabilitation center. Participants: One hundred eighty-two patients were studied; demographi c data, disease characteristics, and urologic history were obtained fo r each. Intervention: Patients responding to a questionnaire were give n a clinical exam. Their medical records were reviewed, with particula r attention given to the following urologic complications: Lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal re flux, and renal failure. Results: Results are reported for 123 patient s. Time since SCI was 8 years. Intermittent catheterization was the ma in method of bladder management. Only 32 patients had changed their me thod of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicou reteral reflux occurred in 26% of patients using percussion. Trauma re lated to catheterization was the main problem with intermittent cathet erization, responsible for a high rate of orchiepididymitis. Conclusio n: Intermittent catheterization is the most-used method of bladder man agement, but with a nonnegligible rate of urethral trauma in men. Perc ussion and Crede maneuver appear to be acceptable techniques of bladde r management if the patient is closely monitored. (C) 1998 by the Amer ican Congress of Rehabilitation Medicine and the American Academy of P hysical Medicine and Rehabilitation.