Original Article
Spinal Cord advance online publication 13 October 2009; doi: 10.1038/sc.2009.134
Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters
H K Katsumi1, J F Kalisvaart1, L D Ronningen1,2 and R M Hovey1,2
- 1Department of Urology, University of California Irvine, Orange, CA, USA
- 2Long Beach Veterans Administration Hospital, Spinal Cord Injury Unit, Long Beach, CA, USA
Correspondence: Dr HK Katsumi, Department of Urology, University of California Irvine, 333 City Boulevard, West Suite 2100, Orange, CA 92868, USA. E-mail: hkatsumi@uci.edu
Received 17 February 2009; Revised 25 August 2009; Accepted 4 September 2009; Published online 13 October 2009.
Abstract
Objective:
Bladder management for male patients with spinal cord injury (SCI) challenges the urologist to work around physical and social restrictions set forth by each patient. The objective of this study was to compare the complications associated with urethral catheter (UC) versus suprapubic tube (SPT) in patients with SCI.
Methods:
A retrospective review of records at Long Beach Veterans Hospital was carried out to identify SCI patients managed with SPT or UC. Chart review identified morbidities including urinary tract infection (UTI), bladder stones, renal calculi, urethral complications, scrotal abscesses, epididymitis, gross hematuria and cancer. Serum creatinine measurements were evaluated to determine whether renal function was maintained.
Results:
In all, 179 patients were identified. There was no significant difference between the two catheter groups in any areas in which they could be compared. There were catheter-specific complications specific to each group that could not be compared. These included erosion in the UC group and urethral leak, leakage from the SPT and SPT revision in the SPT group. Average serum creatinine for the UC and SPT groups was 0.74 and 0.67 mg per 100 ml, respectively.
Conclusion:
SCI patients with a chronic catheter have similar complication rates of UTIs, recurrent bladder/renal calculi and cancer. Urethral and scrotal complications may be higher with UC; however, morbidity from SPT-specific procedures may offset benefits from SPT. Serum creatinine was maintained in both groups. Overall, bladder management for patients with chronic indwelling catheters should be selected on the basis of long-term comfort for the patient and a physician mind-set that allows flexibility in managing these challenges.
Keywords:
spinal cord injury, bladder management, urethral catheter, suprapubic catheter, complications
