Later management of the paraplegic bladder

Abstract

BEARING in mind that the urological management must always be dovetailed into the programme of total care, the three main aims at this stage are:1. The maintenance of a free flow of urine from the kidneys. 2. The avoidance of urological complications. 3. The control of incontinence.

Results of bladder training 1966-1974

“…20 per cent of our patients still did not meet our standards as to residual urine immediately prior to discharge, but in no case did the quantities exceed 220 m!. We find this result acceptable, as does Gibbon (1974). As a result of this liberal attitude towards residual urine requirements, the number of patients discharged without catheter has been as high as 96 per cent as compared to 26-95 per cent noted by other authors (Bors & Camarr, 1971).…”

Fatal intra-peritoneal bladder rupture due to blocked catheter in a paraplegic

“…But such a form of treat ment is still being practised (Cook & Smith, 1968;Ascoli, 1975;Melzer et at., 1976;Terbizan & Zurbecky, 1976) so that a small but significant number of paraplegics are being sent home with indwelling urethral catheters. In a female, the in dwelling urethral catheter could lead to erosion of the ventral urethral wall leading thereby to fistula-formation and incontinence (Gibbon, 1974). Catheters when blocked can lead to overdistension of bladder predisposing rarely to its rupture.…”