Kj. Weld et Rr. Dmochowski, Effect of bladder management on urological complications in spinal cord injured patients, J UROL, 163(3), 2000, pp. 768-772
Purpose: The optimal method of bladder management in spinal cord injured pa
tients remains controversial. We investigated the association of type of bl
adder management with urological complications in these patients.
Materials and Methods: We retrospectively reviewed the medical records, upp
er tract imaging and video urodynamics of 316 posttraumatic spinal cord inj
ured patients. Mean followup plus or minus standard deviation since injury
was 18.3 +/- 12.4 years. Patients were categorized according to bladder man
agement method, including chronic urethral catheterization, clean intermitt
ent catheterization, spontaneous voiding and suprapubic catheterization in
114, 92, 74 and 36, respectively. No significant differences in patient age
at injury, followup interval, or level, completeness or mechanism of injur
y were noted among bladder management method groups. Infection, stone disea
se, urethral complications and radiographic abnormalities were recorded.
Results: Of the 398 complications recorded 236 developed in 61 (53.5%) pati
ents on chronic urethral catheterization, 57 in 25 (27.2%) on clean intermi
ttent catheterization, 57 in 24 (32.4%) who voided spontaneously and 48 in
16 (44.4%) on suprapubic catheterization, The intermittent catheterization
group had statistically significant lower complication rates compared with
the urethral catheterization group and no significantly higher complication
rates relative to all other management methods for each type of complicati
on studied. The percent of patients with complications was greater in the c
hronic urethral catheterization group only 5 years after injury, while the
percent in all other management groups remained similar up to 15 years afte
r injury.
Conclusions: Clean intermittent catheterization is the safest bladder manag
ement method for spinal cord injured patients in terms of urological compli
cations. Inappropriate selection of a bladder management method not only ad
versely affects patient quality of life, but also has a significant detrime
ntal impact on the economic status of the health care system.