No abstract

No abstract

No abstract

Intermittent catheterization is used commonly to treat bladder dysfunction. We treated 10 patients who were experiencing difficulty with intermittent catheterization, 9 of whom had a false urethral passage. Of these patients 6 had previously undergone a bladder neck or urethral operation. Endoscopy was helpful to diagnose the condition. Treatment consisted of stenting in 3 patients, transurethral incision and stenting in 3, and fulguration and stenting in 4. An indwelling catheter was left in place for 2 to 3 weeks, after which intermittent catheterization was resumed with a softer catheter. Two patients again experienced severe difficulty with catheterization and they underwent a continent urinary diversion. When intermittent catheterization becomes difficult or impossible, the presence of a urethral false passage should be suspected as a possible cause.

A total of 56 male spinal cord injury patients on condom catheter drainage was studied prospectively within 6 months of the injuries for 5 years. Low bladder pressures (filling maximum 35 cm. water and voiding maximum 70 cm. water) were ascertained with video-urodynamics. External sphincterotomy was performed when necessary for detrusor-sphincter dyssynergia. Yearly upper tract imaging, serum creatinine levels and urine cultures were obtained. All patients had colonized urine (asymptomatic) during the entire study period. No patient sustained deterioration of the urinary tract on imaging or by serum creatinine determinations during the 5-year interval. We conclude that asymptomatic bacteriuria is of no consequence to the integrity of the upper urinary tract when low pressures are operant.