Intermittent self-catheterization in tetraplegic patients: a 6-year experience gained in the spinal cord unit in Prague
Abstract
Objectives: To present a system of urological care for patients with cervical spinal cord injury (SCI) in the Spinal Cord Unit in Prague. Methods: Forty-one out of 412 patients hospitalized with acute SCI between 2007 and 2012 with motor complete SCI (AIS A, B) at the C4-C7 motor level and with sufficient follow-up duration were selected.
Patients were trained using a male bladder catheterization model (37 with a transurethral catheter and 4 with a suprapubic catheter) to perform intermittent catheterization (IC) using an ergohand device, and were later encouraged to perform self-catheterization. Results: On the basis of the motor level of the SCI, 8 out of the 41 study patients were assigned to group 1 (C4), 11 to group 2 (C5), 15 to group 3 (C6) and 7 to group 4 (C7).
All patients in group 1 had an indwelling urinary catheter. In group 2, 6 patients (54.6%) learned to perform IC, with 2 of them needing another person's assistance.
In 5 patients (45.5%), suprapubic cystostomy was maintained (insufficient functional grip, severe autonomic dysreflexia, prompt reflex erection). Group 3 included 12 patients (80%) performing intermittent catheterization and 3 patients (20%) with suprapubic cystostomy (insufficient functional grip, post-bladder-surgery condition, cognitive impairment).
In group 4, only 1 patient (14.3%) had an indwelling catheter due to severe abductor spasticity, whereas the remaining 6 (85.7%) learned to perform IC. Conclusions: These findings suggest that patients with cervical SCI below the C5 motor level are able to learn self-catheterization, which increases independence and decreases the risk of urinary infection and stone formation.