Long-term analysis of suprapubic cystostomy drainage in patients with neurogenic bladder

Objective: We assessed the roles of suprapubic cystostomy in patients with neurogenic bladder and analyzed the complications and their courses. Patien ts and Methods: We reviewed 118 patients with neurogenic bladder managed wi th suprapubic cystostomy. The original diseases were spinal cord injury in 90, degenerative disease of the central nervous system in 15, spina bifida in 6, cerebral palsy in 3, pontine bleeding in 1, Parkinson's disease in 1, brain tumor in 1, and dysgenesis of the external sphincter in 1. Fifty-six (62.2%) of spinal cord-injured patients demonstrated cervical damage. Rena l function, urinary pH and white blood cell values were measured and evalua ted after insertion. The stone-free rate after insertion was estimated by t he Kaplan-Meier method. Results: Indications for cystostomy were failure of clean intermittent catheterization in 62 (52.5%) and Crede's maneuver in 2 , severe urethral damage in 30 (25.4%), replacement of urethral catheter in 3, worsening of the original disease in 15 (12.7%), deterioration of the g eneral condition in 2, mental retardation in 2, and traumatic vesical ruptu re in 1. Frequent complications were formation of the bladder calculi in 30 (25%) and urinary leakage through the urethra in 11 (10%). No fatal compli cations occurred. The stone-free rates 5 and 10 years after insertion were 77 and 64%, respectively. The urinary pH of the stone-forming group was sig nificantly higher than that of the stone-free group. The high urinary pit g roup (>7.24) had a higher risk of stone formation. Conclusions: Although co ntinuous cystostomy drainage is not considered to be ideal management for b ladder emptying, some patients with neurogenic bladder may benefit from thi s procedure. Copyright (C) 2000 S. Karger AG, Basel.