Abstract
Immediately following spinal cord injury there is a phase of spinal shock during which time the bladder is paralysed and becomes overdistended unless emptied by catheterisation. If the bladder wall is overstretched there is initial loss of contractility, followed by interstitial fibrosis within the detrusor muscle. However, if overdistension and infection are avoided during the immediate and early period after injury to the spinal cord, most patients develop satisfactory compensatory mechanisms of bladder emptying.
There are two possible regimes of catheterisation, either indwelling or intermittent, both of which are associated with infection. The probability of infection with indwelling catheters is too high to be acceptable. Intermittent catheterisation also carried a considerable risk, but ways have been devised which make this method satisfactory. A trial of management techniques for the prevention and control of urinary tract infection during intermittent catheterisation was conducted on 36 acute traumatic paraplegics and tetraplegics admitted to the Royal Perth Hospital Spinal Injuries Unit during 23 consecutive months. Precautions were taken to ensure that the technique of catheterisation was of a very high standard, but this in itself did not prevent urethral bacteria from being carried into the bladder. To eradicate these micro-organisms, two bactericidal antibiotics (kanamycin and Colistin) were injected into the bladder via the catheter immediately prior to withdrawal.
During the acute phase of management a total of 3036 catheterisations were performed on 27 male patients and in this time 16 episodes of significant bacteriuria occurred. The incidence of significant bacteriuria in the male patients was 1 per 190 catheterisations (0.5 per cent.). A total of 1547 catheterisations were carried out on nine female patients, resulting in nine episodes of significant bacteriuria. The incidence of significant bacteriuria in the female patients was 1 per 172 catheterisations (0.6 per cent.).
Ninety-one per cent. of patients discharged were catheter-free with low residual urines and without bacteriuria and have generally remained so during follow-up.
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Pearman, J. Prevention of urinary tract infection following spinal cord injury. Spinal Cord 9, 95–104 (1971). https://doi.org/10.1038/sc.1971.17
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DOI: https://doi.org/10.1038/sc.1971.17