The role of antiseptics in the management of patients with long-term indwelling bladder catheters

Abstract

The long-term urological management of patients with neuropathic bladders has improved substantially since the days of the first world war when it was estimated that 80% of patients with spinal cord injuries died from urinary sepsis within 3 years of injury (Thomson-Walker, 1937). Techniques such as intermittent urethral catheterization, supra-pubic catheterization and external condom drainage have been important in preserving renal function and improving the prognostic outlook for these patients. Long-term indwelling catheterization is still used for some groups however, especially the elderly and those spinally injured patients without sufficient hand function to perform self-intermittent catheterization. Even with modern closed drainage systems nearly all patients undergoing chronic catheterization develop urinary-tract infections (Erickson et al., 1982; Slade & Gillespie, 1985; Wyndale, DeSy & Claessens, 1985). In general, complex mixed communities of drug resistant Gram-negative bacilli are responsible for the infections (Clayton, Chawla & Stickler, 1982; Warren et al., 1982) and these nosocomial organisms are difficult to eliminate from the urinary tract by antibiotic therapy (Macfarlane, 198.5) or by antiseptic bladder washouts (Stickler, Clayton & Chawla, 1987a). In this article we wish to consider the role of antiseptics in the long-term management of these patients. We shall review the procedures that have been advocated in the literature, report on the current practices in spinal units in England and Wales and consider the rational bases of these policies.