External catheters: hazards and benefits of their use by men with spinal cord lesions

Urinary tract status was reviewed in 60 men with spinal cord injury who had external bladder drainage from 1 to 159 months. Before use, 34 (57%) patients were free of roentgenographic abnormalities, and 27 (79%) of these developed changes. Twenty-six (43%) patients of the total group initially had morphologic defects; 5 (19%) of these became free of abnormalities, while 21 (81%) did not improve or showed progression. Glomerular filtration rate improved in 2 (3%) of the total study group, deteriorated in 12 (20%), and remained stable in 46 (77%). Infection persisted in 32 (53%); 10 (31%) of the positive cultures grew multiple isolates. In 18 (56%) of those patients with positive urine cultures, tissue invasion was indicated by the presence of antibody-coated bacteria. After external drainage 5 (8%) required sphincterotomy, 3 (5%) supravesical diversion, and 2 (2%) suprapubic cystotomy. Patient histories and examinations revealed tendencies toward poor hygiene and inattention to adequate bladder emptying. Equipment obstruction was common because of twisting or improper placement of drainage apparatus. It was concluded that although carefully monitored external catheters may accomplish adequate drainage and sterile urine, the hazards of infection and overdistention are great and must be countered by medical monitoring and ongoing patient education.