Audit of early bladder management complications after spinal cord injury in first-treating hospitals

The incidence of spinal cord injury is on the increase. It has been observed since World War II that proper initial management of the paralyzed bladder is a key factor in the prevention of complications of the urinary tract and renal function.

All traumatic spinal cord-injured patients admitted to the Thuringian Spinal Cord Rehabilitation Center, Sülzhayn, Germany, between January 1994 and December 1995 were reviewed for the method of initial bladder management, and all complications and events related to the urinary tract during the period from the date of injury/initial treatment in community-based hospitals to the date of transfer to our center were analyzed.

The cohort included 170 spinal cord-injured patients (40 females, 130 males; mean age 35. 6 years). At the time of transfer to the rehabilitation center 48.8% of the patients still had an indwelling urethral catheter, 29.4% had a suprapubic catheter, and only 16.5% of the patients were on intermittent catheterization. The urine cultures were positive in 100, 44 and 28.6%, respectively. Severe complications due to an indwelling urethral catheter were seen in 15 patients.

In contrast to early intermittent catheterization, indwelling urethral catheters are associated with a high complication rate. At the end of this century, the results of this study are most disappointing. There seems to be a lack of knowledge regarding sufficient bladder management in many hospitals and departments initially treating acute spinal cord-injured patients.