Bladder management practices in spinal cord injury patients: A single center experience from a developing country

Abstract

Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country.

Design: Questionnaire based cross sectional survey

Setting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan

Participants: All patients with SCI (irrespective of duration, level and etiology)

Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis.

Outcome Measures: Not applicable

Results: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same ‘disposable’ catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection.

Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.

Keywords:

• Bladder management
• Clean intermittent catheterization
• Survey
• Paraplegia
• Quadriplegia
• Complications
• Quality of life
• Pakistan

Conclusions

In the largest spinal rehabilitation unit of Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. UTI was significantly lower in patients performing CIC. The majority of patients reuse the catheter for financial reasons.

Acknowledgments

Authors gratefully acknowledge the critical review of the manuscript by Fiona JVW Stephenson FRCN, RN Fellow of the Royal College of Nursing SCI Nurse Specialist Co-Founder International Network of SCI Nurses Member of the ISCoS Education and Disaster Committees We also acknowledge the valuable support of Dr Muhammad Fahim, Consultant at KRL Hospital, Islamabad during data collection.

Disclaimer statements

Conflict of Interest None

Source of funding and grants None.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.