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Abstract
IntroductionPersistent urine leakage after suprapubic cystostomy in tetraplegic subjects occurs due to shrinkage of the urinary bladder and bladder spasms. The patient’s social life is adversely affected as clothes become wet, smelly, and require frequent changing, thus increasing the workload of carers.Case presentationA 48-year-old male sustained C-4 complete (AIS:A) tetraplegia while swimming in 2007. Suprapubic cystostomy was performed in 2009. From 2012, this patient had urine leakage around the suprapubic catheter, which became progressively more frequent. Propiverine, then oxybutynin tablets instead of propiverine, oxybutynin transdermal patches, and mirabegron in addition to oxybutynin were tried. An indwelling urethral catheter was used in addition to the suprapubic catheter to alleviate urine leakage when the bladder was undergoing spasms. This patient continued to have leakage around the suprapubic catheter. Leakage of urine was occasionally accompanied by autonomic dysreflexia. Leakage of urine caused huge amounts of extra work for carers, and family. Furthermore, leakage of urine had a significant impact on quality of life, and going out with friends and family. Bladder wall injection of Botox was performed in 2015 and in 2016, which reduced urine leakage.DiscussionBladder wall injection of Botox to treat persistent urine leakage around the suprapubic catheter in spinal cord injury patients with suprapubic cystostomy has not been mentioned in NICE guidelines or publications indexed in PubMed. While recommending suprapubic cystostomy to subjects with tetraplegia, leakage of urine around the suprapubic catheter, which may occur sometime after suprapubic cystostomy, should be included in the conversation so that patients and carers become aware of this potential complication.
Highlights
Persistent urine leakage after suprapubic cystostomy in tetraplegic subjects occurs due to shrinkage of the urinary bladder and bladder spasms
Suprapubic catheters were associated with a low incidence of urethral injury and stricture, but had similar rates of upper tract damage, vesicoureteral reflux, renal or bladder calculi, and symptomatic urinary tract infections compared to urethral catheters
We describe a cervical spinal cord injury patient’s experience of persistent urine leakage which occurred about three years after undergoing suprapubic cystostomy
Summary
The gold-standard treatment for neurogenic detrusor overactivity is anticholinergic medication and intermittent selfcatheterization [5]. Bladder spasms and low compliant bladder predispose to urine leakage around suprapubic catheter in spinal cord injury patients. Injection of Botulinum toxin type A into the urinary bladder of spinal cord injury patients, who have had a suprapubic cystostomy and who leak urine around a suprapubic catheter is not mentioned in this pathway. When leakage of urine occurred, the bladder problems affected adversely how this person with tetraplegia lived and understandably, the SF-Qualiveen score increased This patient required two sittings of Botox injections and a time lapse of a few months after second Botox injection for the adverse impact of urine leakage upon day-to-day life to diminish. Persistent and significant leakage of urine around suprapubic catheter affecting quality of life is a potential complication of suprapubic cystostomy in spinal cord injury patients. While recommending suprapubic cystostomy to tetraplegic subjects, leakage of urine around a suprapubic catheter, which may occur sometime after suprapubic cystostomy, should be included in the conversation so that the patient and the carers become aware of this potential complication
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