Abstract
Spinal cord injury (SCI) patients with a neuropathic bladder are more prone to develop catheter-induced urethral trauma than occurs in the general population because many of the SCI patients are on indwelling urethral catheter drainage, or intermittent urethral catheterisation is performed either by them or by their carers. The presenting symptoms of improperly positioned Foley catheter in SCI patients may be at times, peculiar to the SCI patients and these include profuse sweating, bypassing of the catheter, increased spasms, or rarely, full fledged features of autonomie dysreflexia. With the availability of the flexible cystoscope, cystourethroscopy has been performed safely on SCI patients who had sustained catheter-induced urethral trauma, on the bedside, with an immediate, and accurate diagnosis of the extent of urethral trauma, and the presence of urethral false passage(s). Further, flexible cystoscopy has helped to treat the patients with urethral trauma by introducing a flexible tip guide wire under vision into the urinary bladder via the normal urethral channel and subsequently, passing a 12 Fr. Foley catheter over the guide wire, thus avoiding the false passage(s) in the urethra. With this technique, it was possible to avert the need for suprapubic urinary diversion in those SCI patients who had sustained acute urethral trauma. Such endoscopie management of acute urethral trauma in SCI patients is described with illustrative case reports of eight patients seen during a 15 month period.
Similar content being viewed by others
Article PDF
References
de Groat W C . Mechanisms underlying the recovery of lower urinary tract function following spinal cord injury. Paraplegia 1995; 33:493–505.
Rivas D A, Chancellor M B . Flexible cystoscopy in spinal cord injury. Review article. Paraplegia 1994; 32: 454–462.
Batra Y K, Kapoor R, Hemal A K, Vaidyanathan S . Hyponatremia and mental symptoms following vesical ultrasonic lithotripsy. Anaesthesia 1988; 43: 675–676.
Soni B M, Vaidyanathan S, Watt J W H, Krishnan K R . A retrospective study of hyponatremia in tetraplegic/paraplegic patients with a review of literature. Paraplegia 1994; 32: 597–607.
Beaghler M, Grasso M, Loisides P . Inability to pass a urethral catheter: The bedside role of the flexible cystoscopy. Urology 1994; 44:268–270.
Mandal A K, Vaidyanathan S . Management of urethral stricture in patients practising clean intermittent catheterization. International Urology Nephrology 1993; 25: 395–399.
Vaidyanathan S, Soni B M, Fraser M H, Krishnan K R . Oxybutynin in spinal cord injured patients with neuropathic bladder. Reviews in Contemporary Pharmacotherapy 1994; 5: 217–223.
Nickel J C, Costerton J W, McLean R J C, Olson M . Bacterial biofilms: influence on the pathogenesis, diagnosis and treatment of urinary tract infections. Journal of Antimicrobial Chemotherapy 1994; 33, Suppl.A: 31–41.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vaidyanathan, S., Krishnan, K. & Soni, B. Endoscopic management of urethral trauma in male spinal cord injury patients. Spinal Cord 34, 651–656 (1996). https://doi.org/10.1038/sc.1996.117
Issue Date:
DOI: https://doi.org/10.1038/sc.1996.117