The female tetraplegic: an admission of urological failure

To present the long-term follow-up of female patients with tetraplegia managed in our unit, many of who require permanent indwelling catheters or urinary diversions that lead to significant complications and associated morbidity.

Eighty-four female tetraplegics (mean age 31 years, range 13-81) were followed for a mean of 9 years (range 2-30). Three groups of patients were identified, depending on their neurology; 27 patients had complete lesions (Frankel A), 20 had incomplete lesions with poor functional recovery (Frankel B/C) and 37 had incomplete lesions with good function (Frankel D/E).

The patients with complete lesions (Frankel A) were difficult to manage, with 23 of the 27 (85%) treated using indwelling catheters. Three patients underwent diversion and for one patient, the carer performs clean intermittent catheterization (CIC). Of the 20 patients with Frankel B/C lesions, 14 have permanent indwelling catheters, three are able to perform CIC and three void by controlled triggering of detrusor contractions (reflex voiding). The 37 patients with Frankel D/E lesions fared better and only three (8%) require permanent catheters. Of the others, four (11%) use CIC (one following a cystoplasty) and most (30, 81%) use reflex voiding. Most of the 40 patients with permanent catheters had significant problems with bladder stones (55%), leakage and by-passing (35%), and recurrent symptomatic infections (33%). Patients performing CIC fared better, with most needing anticholinergic therapy or subtrigonal phenol; patients who used reflex voiding also needed these two treatments at some stage. Four patients (two with ileal loops and two with indwelling catheters) developed dilated upper tracts.

The urological status of female patients following cervical cord injury depends on the level of injury and recovery. Most patients with Frankel A-C lesions have permanent indwelling catheters and most patients with Frankel D or E lesions void with controlled triggering or use CIC. Although upper tract dilation was seen in only 5%, patients had significant morbidity related to the bladder.