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Objective: To evaluate whether reconstructive hand surgery could improve the ability of tetraplegic patients to perform clean intermittent self-catheterization (CIC). Materials and methods: The subjects were patients with complete traumatic tetraplegia admitted to the Nagano Rehabilitation Center between 1977 and 1996. A total of 63 subjects were included in this study with an age range of 18 ± 73 years (mean 38.2 years). Reconstructive hand surgery was performed on 44 hands (28 cases). Current urological conditions were assessed by interview or mail questionnaire. Results: Fifty-one per cent (22/43) of the patients with C6 level of tetraplegia and 86% (12/ 14) of those with C7 or C8 neurological level of injury could perform CIC independently and only one subject needed assisted CIC. Conclusion: CIC is the preferred option for people with tetraplegia. Reconstructive hand surgery is thus recommended to make urological management more independent for a selected group of people with tetraplegia. Spinal Cord (2000) 38, 541 ± 545

A follow up study of urological management was carried out on 38 cervical spinal cord injury patients who were admitted to the Nagano Rehabilitation Centre Hospital and whose surgical reconstructions of their paralytic hands were performed since 1977. Self catheterisation was possible after reconstructive hand surgery in patients whose lowest functioning cord segment was C5-6. All of them had been unable to perform self catheterisation before surgery. Handling of instruments related to the act of urination was possible in two patients where the lowest functioning cord segment was C6-7 and where ileal conduit forma tion and reconstructive hand surgery had been performed.

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