The Urological Complications Associated with Long Term Management of Quadriplegics with or without Chronic Indwelling Urinary Catheter

Park, Won Hee; Choi, Ho Cheol; Jung, Kwan Kyu; Shim, Hong Bang

Abstract

The most optimal voiding method for the quadriplegic patient has not been established due to the limitations imposed by deficient upper extremity function as well as the increased incidence of external sphincter dyssynergia. Our study was designed to compare the incidence of urological complications and renal deterioration for post-traumatic quadriplegic patients managed with or without a chronic indwelling urinary catheter. Our retrospective study was performed in the 21 patients in a catheterized group and 69 in a non-catheterized group followed at the Korea Veterans Hospital. Mean patient age was 25.8 years and 24.3 years , mean followup interval was 13.6 years and 19.6 years respectively. The followup interval and mechanism, level and degree of injury for the two groups were similar. Overall, the incidences of renal and bladder calculi, pyelonephritis, gross hematuria, epididymitis, urethrocutaneous fistula and vesicoureteral reflux were not significantly different in the catheterized and noncatheterized groups. 4 patients died during the followup. One of these patients died of bladder adenocarcinoma which was directly related to the urological complication. IVPs demonstrated that the incidences of renal deteriorations were 2 in the catheterized group and 20 in the noncatheterized group. The first onset of renal deteriorations developing after spinal cord injury were mean 11.0 years and 14.7 years respectively and were not significantly different between the two groups Our study suggests that the decision to manage quadriplegics with or without an indwelling catheter should not be based on relative risk of urological complications. We could decide voiding method in these patients, considering their comforts, conveniences and qualities of life.