1982 Volume 73 Issue 6 Pages 732-739
It has been generally accepted that self-catheterization is a useful treatment for chronic neurogenic bladder dysfunction in these ten years but there is still some uncertainty if it causes infections in undefiled, fresh neurogenic bladder. We have developed new catheter sets fitted for a safe and handy self-catheterization and applied it for 25 old and 24 fresh patients with spinal cord injury. In 25 old injuries of the spinal cord 6 of 8 cases with hydronephrosis, one of 8 cases with vesicoureteral reflux and 15 of 17 cases with urinary incontinence improved these pathological conditions during 63 weeks of follow up period.
Most patients with complete spinal cord lesion used to be incontinent when spasticity of the bladder returns since they have no urinary sensation to control urination. We treated 24 patients with complete cord lesion in spinal shock period by intermittent catheterization, nontouch technic to cause overdistension of their bladder (Program II). Patients were put in free fluid intake and were catheterized three times a day to distend their bladder over than 500ml in each catheterization. Our urinary management, Program II has been applied for all patients with complete spinal cord lesion except for male tetraplegics.
They could start self-catheterization in 12 weeks after injury. Eleven cases remained ice water test negative and thirteen cases recovered their bladder function in 12.8±7.6 weeks after injury. Their bladder contraction revealed very weak, namely upper motor neuron bladder, hypoactive in urodynamic survey. All these cases were free from urinary incontinence with self-catheterization though some case required anticholinergic agent.
The rate of urinary infection was 15.0±15.2 per cent in aseptic intermittent catheterization period of 12weeks duration while it was 18.4±13.0 per cent in self-catheterization period of 23 weeks duration. There was no statistical difference between these two groups. Self-catheterization using our new sets was revealed to be very safe and valuable for paraplegic patient saving them from bothersome urinary incontinence.
