Clean intermittent catheterisation from the acute period in spinal cord injury patients. Long term evaluation of urethral and genital tolerance.

Abstract

Since its introduction by Lapides, clean intermittent catheterisation (CIC) has dramatically changed the urological management of spinal cord injury (SCI) patients. Since 1978 we have used CIC as a mode of drainage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium and long term. 12-14 Fr PVC catheters are used with lubricant. The objectives of this study were: first, in a population of 159 SCI patients (group 1), to evaluate the overall incidence of complications of CIC; Secondly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC, frequency of urinary tract infections, and rates of urethral strictures were evaluated. The analysis of group 1 showed a rate of lower urinary tract infection of 28% and of cytobacteriological infection of 60%. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5.3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The first factor for acceptance of long term CIC is continence, the second one is the ability to perform CIC independently. In group 3 we found a rate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on CIC. The method and the type of catheters used must also be considered. We need further studies of long term CIC in patients using non-reusable hydrophilic catheters from the acute period to see if these two complications can be prevented.