Intrathecal catheter with subcutaneous port for clonidine test bolus injection. A new route and type of treatment for detrusor hyperreflexia in spinal cord-injured patients.
OBJECTIVE
The objective of this study was to assess the feasibitity, technical data and use of intrathecal catheter implantation with subcutaneous port for clonidine test injections and individual evaluation.


METHODS
According to approval of the local ethics committee, 9 consecutive SCI patients (6 men, 3 women) had catheter and port implantation between January 1998 and May 1999. All did not respond to systemic drug therapy in combination to self-clean intermittent catheterisation (SCIC). Implantation was done under general anesthesia. Needle and catheter were Medtronic Infusion Synchromed Intraspinal catheter (Induratrade mark, 8703W). Clonidine test injections were allowed at D5.


RESULTS
There were no complications during operation. Follow-up was 8.2 months (0.5-17). After clonidine bolus injection test and validation, 6 patients decided to have permanent pump implantation, 2 chose other therapies and one did not tolerate clonidine intrathecal injections for blood arterial pressure side effects.


CONCLUSIONS
Intrathecal clonidine may represent a useful conservative treatment of both severe bladder hyperreflexia and spinal spasticity. Its short-term effects can be individually evaluated through bolus injection in subcutaneous port before definitive pump implantation.
Chartier-Kastler
E
E
Department of Urology, G.H. Pitié-Salpêtrière, Paris, France. emmanuel.chartier-kastler@psl.ap-hop-paris.fr
Azouvi
P
P
Yakovleff
A
A
Bussel
B
B
Richard
F
F
Denys
P
P
D000328:Adult; D002408:Catheters, Indwelling; D003000:Clonidine / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000187:drug effects / Q000503:physiopathology; D012021:Reflex, Abnormal / Q000187:drug effects; D013119:Spinal Cord Injuries / Q000150:complications*; D013131:Spine; D013565:Sympatholytics / Q000008:administration & dosage*; D001745:Urinary Bladder Diseases / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology
D013565:Sympatholytics; D003000:Clonidine