Abstract
Forty six (9%) out of 520 patients from the years 1976 to 1982 who used intermittent urethral self-catheterisation (IUSC) as the method of bladder drainage at the moment of discharge from the Swiss Paraplegic Centre of Basel were analysed during their rehabilitation period, on discharge, 3, 6 months later and again 5 years later regarding bacteriological changes and urinary tract infections, behaviour of some problem germs such as Proteus, Klebsiella and Pseudomonas, sterile versus clean catheterisation, catheterisation frequency, complications, continence and acceptance of this method. Only 22 patients continue IUSC, 5 have died, 6 use indwelling catheters and 13 are voiding their neurogenic bladder with other methods.
Average time on IUSC was 6.6 years (0.5-13 years) in the women's group and 4.6 years (0.5-12 years) in the men's group. Of the remaining 22 patients on IUSC, 23% have sterile urines, 36.5% are infected with E. coli and Enterococci, 4.5% with Staphylococci and the remaining 36% still show the problem germs Pseudomonas (4.5%), Proteus (13.5%) and Klebsiella (18%), but there was a reduction from 19 cases with problem germs in 1983 to 11 cases in 1988.
In 1988 5% women and 4% men changed from sterile to clean IUSC (2 out of 11 men using the same catheter for at least 1 week and 2 out of 10 women).
The complication rate was astonishingly low during IUSC: being only 4.3% (2 male patients, one with stricture of the urethra and epididymitis, one with autonomous dysreflexia with bladder overdistension). No anti-cholinergic or alpha-stimulating agents were used nor continuous antibiotic-prophylaxis and only in one female patient was a bladder denervation procedure performed. No deterioration of the upper urinary tract was observed. The degree of continence remained stable throughout the follow-up, and the same applies to the acceptance of IUSC.
The authors conclude that IUSC can be of great help in neuropathic bladder rehabilitation provided that the patients are properly selected, motivated and well instructed and followed throughout the years.
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Bakke A 1986 Clean intermittent catheterization. A valuable treatment regimen? Abstract IMSOP-Meeting Oslo.
Berard E, Depassio J, Pangaud N, Landi J 1985 Self catheterization: urinary complications and the social resettlement of spinal cord injured patients. Paraplegia 23: 386.
Burke D C, Brown D J, Burley H T, Ungar G H 1987 Data collection on spinal cord injuries:urological outcome. Paraplegia 25: 311–317.
Buzelin J M, Voisin E, Cormerais A, Gazeau M 1979 Expérience de l'auto-sondage non stérile dans les neurovessies. Ann Méd Phys 22: 347–355.
Cranne J, Kvaslerud A G 1986 A concept for treatment and follow-up of patients on intermittent catheterization. Abstract IMSOP-Meeting Oslo.
Dechesne B, Pons L, Schellen T 1981 . . . aber nicht aus Stein. Medizinische und psychologische Aspekte von körperlicher Behinderung und Sexualität. Beltz Verlag Weinheim und Basel.
Gardner B P, Parsons K F, Machin D G, Galloway A, Krishnan K R 1986 The urological management of spinal cord damaged patients: a clinical algorithm. Paraplegia 24: 138–147.
Graham S D 1981 Present urological treatment of spinal cord injury patients. Journal of Urologie 126: 1–4.
Hill V B, Davies W E 1988 A swing to intermittent clean self catheterization as a preferred mode of management of the neurpathic bladder for the dextrous spinal cord patient. Paraplegia 26: 405–412.
Hinman J r F 1977 Bacterial exchange during intermittent catheterization. Birth Defects: Original article series 13: 133–137.
Iwatsubo E, Komine S, Yammashita H 1983 Over distension therapy of the bladder for self-catheterization in paraplegics. IMSOP Stoke Mandeville.
Joiner E, Lindan R 1982 Experience with self intermittent catheterization for women with neurological dysfunction of the bladder. Paraplegia 20: 174–153.
Kuhn W 1982 La rééducation mictionelle à long terme au Centre Suisse de Paraplégiques de Bâle, GENULF Bâle.
Kuhn W 1983 Die Bedeutung des Selbstkatheterismus für die Rehabilitation der Blase des Querschnittgelähmten. Thesis University Basle.
Kuhn W, Zaech G A, Koechlin P, Urwyler A 1983 Comparison between female and male spinal cord injuries, 1979-1981, Swiss Paraplegic Centre Basle. Paraplegia 21: 154–160.
Lapides J 1972 Intermittent catheterization and vesicostomy in management of traumatic neurogenic bladder. In: Scott R jr. (ed) Current controversies in urologic management. Saunders Philadelphia 186.
Lapides J, Diokno A C, Gould F R, Lowe B S 1976 Further observations on self-catheterization. Journal of Urologie 116: 169–172.
Lindan R, Leffler E J, Bodner D 1987 Urological problems in the management of quadriplegic women. Paraplegia 25: 381–385.
Madersbacher H 1976 Die neurogen gestörte Harnröhre: Urethrogramm und pathophysiologische Aspekte. Urologe A 15: 1–12.
Madersbacher H, Weissteiner G 1977 Intermittent self-catheterization, an alternative in the treatment of neurogenic urinary incontinence in women. European Urology 3: 82–84.
Madersbacher G, Oberwalder M 1987 The elderly para- and tetraplegic: special aspects of the urological care. Paraplegia 25: 318–323.
Maynard F M, Diokno A C 1984 Urinary infection and complications during clean intermittent catheterization following spinal cord injury. Journal of Urology 132: 943–946.
Maynard F M, Glass J 1987 management of the neuropathic bladder by clean intermittent catheterization: 5 year outcomes. Paraplegia 25: 106–110.
McDermott J P, Timmons L S, Witters D, Stone A R 1989 The compliance of spinal cord injured patients on intermittent catheterization. American Spinal Injury Association (ASIA) 15th annual meeting Las Vegas. Abstracts Digest: 57.
McGuire E, Savastano J A 1983 Long-term follow-up of spinal cord injured patients managed by intermittent catheterization. Journal of Urology 129: 775–776.
Opitz J L 1984 Richtlinien des Blasentrainings. In: Stoehrer M, Palmtag H, Madersbacher H. (eds). Blasenlähmung. Thieme Stuttgart, New York: 42–49.
Stickler D J, Chawla J C 1988 An appraisal of antibiotic policies for urinary tract infections in patients with spinal cord injuries undergoing long-term intermittent catheterization. Paraplegia 26: 215–225.
Stoehrer M, Palmtag H, Madersbacher H 1984 (Hrsg.) Blasenlähmung: Sexualität und Blasenfunktion bei Rückenmarksverletzten und Erkrankungen des Nervensystems. Thieme Stuttgart, New York.
Stover S L 1987 Natural history and clinical course of urinary tract complications in patients with spinal cord dysfunction. Abstract in Rehabilitation R+D Progress Reports. VA Baltimore: 111–112.
Trieschmann R B 1980 Spinal cord injuries: Psychological, social and vocational adjustment. Pergamon Press Oxford.
Wyndaele J J 1987 Urethral sphincter dyssynergia in spinal cord injury patients. Paraplegia 25: 10–15.
Wyndaele J J, Maes D 1989 Experience with long-term intermittent self-catheterization in spinal cord injury patients. IMSOP-Meeting Rome.
Young J S, Burns P E, Bowen A M, McCutchen, R 1982 Spinal cord injury statistic. Experience of the regional spinal cord injury systems. Good Samaritan Medical Center, Phoenix, Arizona.
Zaech G A 1974-1982 Jahresberichte des Schweizerischen Paraplegikerzentrums Basel.
Zrubecky G 1973 Intermittent catheterization with unsterile instruments. Paraplegia 11: 179–181.
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Kuhn, W., Rist, M. & Zaech, G. Intermittent urethral self-catheterisation: long term results (bacteriological evolution, continence, acceptance, complications). Spinal Cord 29, 222–232 (1991). https://doi.org/10.1038/sc.1991.33
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