Problems of decatheterization in long-term spinal cord injury patients.

There were 50 men with a mean age of 43.5 years subjected to urodynamic analysis and decatheterization. Of these 50 patients 41 had had indwelling catheters from 1 to 29 years, with a mean of 7.3 years, and 9 had suprapubic catheters from 1 to 14 years, with a mean of 9.8 years. Previous attempts at decatheterization in about 70 per cent of these patients had failed owing to severe autonomic dysreflexia and fear of progressive upper tract damage. Of the 50 patients 15 (30 per cent) had had vesicoureteral reflux and 16 (32 per cent) had been treated repeatedly for bladder and kidney stones. Detrusor-sphincter dyssynergia was detected in 58 per cent of the patients. All patients with suprapubic tubes had a contractile bladder, compared to only 33 per cent of the patients with indwelling catheters. After transurethral sphincterotomy all patients were decatheterized, which resulted in marked general improvement, amelioration of autonomic dysreflexia and easy control of urinary tract infection in 80 per cent of the cases.