72 URETHRAL VERSUS SUPRAPUBIC CATHETER FOR PATIENTS WITH SPINAL CORD INJURY-INDUCED NEUROGENIC BLADDER: A STUDY USING THE ELEVEN-YEAR NATIONWIDE DATABASE OF TAIWAN

Abstract

INTRODUCTION AND OBJECTIVES: We investigated long term outcomes of the patients with spinal cord injury (SCI) iV induced neurogenic bladder after urological management by applying the 11year nationwide Database. METHODS: In this research, the subset of the National Health Insurance Research Database (NHIRD) of Taiwan, which contains data on all outpatient and inpatient medical benefit claims and covers over 99% of the population accumulated from 1996 to 2006, was analyzed. All SCI patients were included according to the International Classification of Disease (ICD) codes-9, by following diagnostic codes: (1) 806.X, i.e., 806.00iV806.9; (2) 952.X, i.e., 952.00iV952.9; and (3) 907.2. According to the data of all medical benefit claims, the included patients were further divided into three subgroups, suprapubic catheter group, urethral catheter group, and control group, respectively. Evaluation of long term outcomes was performed in four aspects, (1) inflammation and infection; (2) calculus of urinary tract; (3) acute and chronic renal disease. RESULTS: Among the total population of 22.8 millions, 34,227 (0.15%) SCI patients were recruited into the study. In SCI patients, 2,923 (8.54%) had the diagnosis of neurogenic bladder. Of 2,923 patients, suprapubic catheter group was 381 (13.03%), urethral catheter group 64 (2.19%), and control group 427 (14.61%). Male patients more likely to receive suprapubic catheter (p 0.001), but mean age showed no significantly difference among three groups. Although there was no significant difference in geographic location of Taiwan, but suprapubic catheter was more acceptable in higher urbanized area (p 0.001). Urethral catheter group had higher risk than the other two groups in occurrence of acute and chronic renal disease (HR 3.20, p 0.001) and calculus of urinary tract (HR 1.89, p 0.001). There was no obvious difference among all three groups in the incidence of prostatic and epididymo-orchidal infection. However, the duration of occurrence of infection, iatrogenic trauma, renal disease was shorter in suprapubic catheter group (p 0.001). CONCLUSIONS: In our research, regular urethral catheter exchange would have higher risk to get calculus of urinary tract and renal disease than suprapubic catheter. Nevertheless, both urethral or suprapubic catheter don’t increase the infection rate.