Contemporary role of suprapubic cystostomy in treatment of neuropathic bladder dysfunction in spinal cord injured patients.
BACKGROUND
The management of neuropathic bladder dysfunction secondary to spinal cord injury is controversial. With the introduction of clean intermittent catheterization (CIC) and anti-cholinergic medication, urinary tract deterioration in this population has declined. Nevertheless, this strategy is problematic for patients who are unable to perform CIC. Suprapubic cystostomy (SPC) is widely viewed as a secondary option, which has a high satisfaction rating among patients, with acceptable clinical efficacy. Despite early reports of long-term renal and bladder complications, recent evidence has demonstrated that improved anti-cholinergic pharmacotherapy and bladder maintenance strategies can enhance SPC efficacy, with diminished morbidity. We set out to review the current literature on SPC in the neuropathic bladder setting and to clarify future management direction.


METHODS
This investigation consisted of a literature search of the MEDLINE and PUBMED databases. Inclusion criteria were related to SPC, indwelling catheterization, urodynamics, spinal cord injury and bladder dysfunction. Our analysis comprised 56 studies, including retrospective analyses and case reports. Investigations regarding surgical technique as well as short and long-term efficacy were also included.


RESULTS
Early studies reported accelerated renal deterioration and lower urinary tract complications, including stones, recurrent infections and blocked catheters. Procedural complications were generally rare. In contrast, recent investigations, in which patients were managed with anti-cholinergics, frequent catheter changes and bladder washing, and volume maintenance procedures demonstrated similar morbidity profiles to CIC.
Division of Urology, Department of Surgery, McGill University Health Center, Montreal, Quebec, Canada.
Andrew
A
Feifer
Jacques
J
Corcos
D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003559:Cystostomy / Q000009:adverse effects / Q000266:history; D019317:Evidence-Based Medicine; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000209:etiology; D001750:Urinary Bladder, Neurogenic / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D014546:Urinary Catheterization / Q000009:adverse effects
D018680:Cholinergic Antagonists