Perrouin-Verbe B, Labat J J, Richard I, Mauduyt de la Greve I, Buzelin J M, Mathe J F
Department of Rehabilitation, Hôpital St Jacques, Nantes, France.
Paraplegia. 1995 Nov;33(11):619-24. doi: 10.1038/sc.1995.131.
Since its introduction by Lapides, clean intermittent catheterisation (CIC) has dramatically changed the urological management of spinal cord injury (SCI) patients. Since 1978 we have used CIC as a mode of drainage in the acute period, during the period of bladder retraining as a measurement of residual urine, and in some instances in the medium and long term. 12-14 Fr PVC catheters are used with lubricant. The objectives of this study were: first, in a population of 159 SCI patients (group 1), to evaluate the overall incidence of complications of CIC; Secondly to study two groups of patients: group 2 (n = 8) consisted of patients who had performed CIC for over 2 years before discontinuance; group 3 (n = 21) consisted of patients on CIC for over 5 years (mean length of use: 9.5 years). The reasons for acceptance of long term CIC, frequency of urinary tract infections, and rates of urethral strictures were evaluated. The analysis of group 1 showed a rate of lower urinary tract infection of 28% and of cytobacteriological infection of 60%. Chronic pyelonephritis was never observed and infection was always confined to the lower urinary tract which is in accordance with other studies. The rate of epididymitis and urethral stricture was 10% and 5.3% respectively. Sixty two per cent of group 2 remained incontinent, and 89% of group 3 showed a satisfactory degree of continence. The first factor for acceptance of long term CIC is continence, the second one is the ability to perform CIC independently. In group 3 we found a rate of urethral stricture of 19%, and of epidydimitis of 28.5%. These two complications (urethral tolerance and urethroprostatic infection) increased with the number of years on CIC. The method and the type of catheters used must also be considered. We need further studies of long term CIC in patients using non-reusable hydrophilic catheters from the acute period to see if these two complications can be prevented.
自拉皮德斯引入清洁间歇性导尿术（CIC）以来，它极大地改变了脊髓损伤（SCI）患者的泌尿外科管理方式。自1978年起，我们在急性期将CIC用作引流方式，在膀胱再训练期间作为残余尿量的测量方法，并且在某些情况下用于中长期。使用带有润滑剂的12 - 14 Fr聚氯乙烯导管。本研究的目的是：第一，在159例SCI患者群体（第1组）中，评估CIC并发症的总体发生率；第二，研究两组患者：第2组（n = 8）由在停止使用前已进行CIC超过2年的患者组成；第3组（n = 21）由进行CIC超过5年的患者组成（平均使用时长：9.5年）。评估了接受长期CIC的原因、尿路感染频率以及尿道狭窄发生率。对第1组的分析显示下尿路感染率为28%，细胞细菌学感染率为60%。从未观察到慢性肾盂肾炎，且感染始终局限于下尿路，这与其他研究一致。附睾炎和尿道狭窄的发生率分别为10%和5.3%。第2组中62%的患者仍有尿失禁，第3组中89%的患者显示出令人满意的控尿程度。接受长期CIC的首要因素是控尿，第二个因素是独立进行CIC的能力。在第3组中，我们发现尿道狭窄发生率为19%，附睾炎发生率为28.5%。这两种并发症（尿道耐受性和尿道前列腺感染）随着CIC使用年限的增加而增加。使用的导管方法和类型也必须予以考虑。我们需要对急性期使用不可重复使用的亲水导管的患者进行长期CIC进一步研究以查看这两种并发症是否能够预防。
