Effect of bladder management on urological complications in spinal cord injured patients

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.