Clean intermittent catheterization and prevention of renal disease in spinal cord injury patients

Abstract

Upper urinary tract complications have been reported in about 20 ± 30% of spinal cord injury patients. Their pathogenesis is linked to the presence of high-pressure uninhibited detrusor contractions, high leak point pressure and low bladder compliance. The aim of this study was to evaluate the incidence of upper urinary tract complications in two homogeneous groups of spinal cord injury patients with di erent bladder emptying modalities (intermittent catheterization vs. tapping, abdominal straining, Crede's manoeuvre) and the relationship with clinic and urodynamic features. A total of 17 patients (22%) had upper urinary tract complications. The incidence of both urinary tract dilatation and vesicoureteral re¯ux was signi®cantly lower in patients having intermittent catheterization (P=0.03 and 0.04 respectively). Intermittent catheterization thus seems to be e ective in preventing upper urinary tract disease in spinal cord injury patients requiring mechanical bladder emptying modalities. The ®nding of upper urinary tract complications also in patients having intermittent catheterization showing high intravesical pressures stresses the need of adding anticholinergic medications to the rehabilitation regimen of these patients.

Bladder emptying over a period of 10–45 years after a traumatic spinal cord injury

“…Bladder-emptying method agreement with recommendations from studies 8,9 that have shown CIC to be a successful long-term option to bladder emptying in SCI individuals. The increased use of CIC was predominant in males.…”

Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury

“…Furthermore, it has been reported that upper urinary tract complications, for example, urinary tract dilatation and vesicoureteral reflux, are more common in SCI patients with reflex voiding than those with IC. 21 With regard to the etiology, the pathogenesis of these complica- tions is linked to high-pressure uninhibited detrusor contractions, high leak point pressure and low bladder compliance. 21 The presence of urinary tract dilatation and vesicoureteral reflux is not only likely to cause infection but also induces AD in patients with SCI at or above the T6 level.…”

“…21 With regard to the etiology, the pathogenesis of these complica- tions is linked to high-pressure uninhibited detrusor contractions, high leak point pressure and low bladder compliance. 21 The presence of urinary tract dilatation and vesicoureteral reflux is not only likely to cause infection but also induces AD in patients with SCI at or above the T6 level. This background might explain our finding of the highest incidence of symptomatic AD in patients with reflex voiding despite the fact that the percentage of AIS A in these patients was not higher than those of IC and indwelling supra-pubic and urethral catheterization.…”

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11

“…In 1998, Lim et al 4 reported that only 2 (6.7%) of 30 patients with SCI maintained the same IC method for a year after leaving the hospital. Because the appropriate voiding volume for the IC method is 400-450 ml at a time, a patient with an SCI must maintain a timely fluid intake of 1800-2000 ml per day and must perform catheterization every 4-6 h. 5,6 With such a time-dependent regimen, physiological changes in urinary excretion related to fluid intake or environmental changes may lead to unnecessary catheterizations and early emptying attempts or to overdistension of the bladder. 7,8 These difficulties are universally applicable to spontaneous and passive voiding by straining for maintenance of acceptable detrusor pressures and bladder volumes.…”