Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters

Abstract

Objective: Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI. Methods: A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained. Results: In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively. Conclusion: SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.

Quality of life and urological morbidity in tetraplegics with artificial ventilation managed with suprapubic or intermittent catheterisation

“…A newer study 7 reported that almost every of the examined 45 SCI patients with SPC (mean SPC period 14.3 years) suffered at least one symptomatic UTI, but only 30% had more than one UTI per year, 15% had UTI accompanied by fever, 11% suffered catheter-associated septicaemia and 4% incurred pyelonephritis.…”

“…Existing data are inconsistent, older trials reported high rates, whereas newer retrospective studies allocate constant kidney function even after decades of SPC usage. 3,6,7 A retrospective study concerning symptomatic UTI 3 compared 34 tetraplegic SPC patients (follow-up 8.6 years) with 27 SCI-IC patients (mainly paraplegics, follow-up 9.9 years). The incidence of symptomatic UTI was lower in the SPC group (12 vs 26%), but not significantly.…”

“…7 Unfortunately there is a lack of recent studies concerning the correlation between SCI level of lesion and development of kidney calculus, but there is some evidence that such correlation is at least supposable.…”

Reply to Katsumi et al.

“…1 By comparing transurethral and suprapubic catheters, stating that the risks of the two are even, the authors create the impression that using any of these options may be a good choice for the long-term treatment of patients with spinal cord injury. In my view, this statement has to be put into perspective.…”

A scoping review of important urinary catheter induced complications

“…Among the most common urinary catheter complications are: anaphylaxis (allergic reaction to latex), cytotoxicity and hypersensitivity [37 40], symptomatic bacterial infection [19,41 51], catheter blockage (due to calculi and encrustations) [52 60], catheter fracture and malignancy [61], hematuria (blood in urine) [ 52,59, 62 64], intravesical knotting [4, 65 67], inflammation (due to pyelonephritis and epididymitis) [44,56,[58][59]62,68], erosion and periurethral abscess [56,59,62], mechanical trauma (partial damage, perforation and urinary leakage) [11 12, 52, 55, 69 73], urethral fistulae [59,62], urethral stenosis and stricture [56,62,72], and urosepsis [62 63, 74 76]. While several studies have investigated the morbidity and mortality associated with urinary catheters [52,62], to date no comprehensive review has been performed which has focused specifically on identifying and analyzing important complications caused or exacerbated by the mechanical interaction (i.e., physical contact) between the catheter and urinary tract.…”