The early management of the bladder in young male paraplegics - abstract

ABSTRACT

The cause of urinary problems in the management of paraplegia is infection. This infection is iatrogenic and is introduced via a catheter. For some years the Spinal Unit at the University Hospital of the West Indies has been treating paraplegics without the use of a catheter. The patient is put on a regime of manual decompression as soon as he is admitted to the Unit. A history and physical examination are done to exclude the possibility of urethral obstruction or damage. The chief objection to this method of treatment is that the intravescical pressure generated by manual decompression is enough to cause ureteric reflux and finally impaired renal function. The renal function of paraplegics of over three years who had been treated by manual decompression of the bladder was investigated. The blood urea of all patients treated by manual decompression was normal, whereas of those treated by prolonged catheterised had urinary infection but of those treated by manual decompression only one patient had urinary infection. The patients treated by manual decompression all had normal I.V.P.'s and in no case was ureteric reflux demonstrated on micturating cystograms. Manual decompression results in sterile urine and does not damage the urinay tract, urinary problems are caused by infection introduced by a catheter(AU)