To clamp or not to clamp? Bladder management by suprapubic catheterization in patients with neurogenic bladder dysfunction.
OBJECTIVE
In a small subset of patients with neurogenic lower urinary tract dysfunction, insertion of suprapubic catheters (SPC) cannot be avoided. If SPC has to be utilized, catheter clamping and anticholinergic medication are often recommended, but evidence supporting this view is scarce. We determined the influence of anticholinergic medication and catheter clamping on urodynamic parameters and the status of the urinary tract in patients with chronic suprapubic catheterization.


METHODS
In a retrospective study, the results of urodynamic testing, sonographic evaluations, and urinalyses of 85 patients with chronic (>1 year) suprapubic catheterization due to neurogenic bladder dysfunction were analyzed.


RESULTS
The 51 male and 34 female patients (mean age 55 years) were managed with an SPC for 65.3 ± 48.0 months. Forty patients had an SPC for more than 60 months. Comparing the results before SPC insertion with the last follow-up examination, no significant differences in detrusor compliance and maximum detrusor pressure were detected, whereas bladder capacity significantly decreased. In three patients, alterations of the upper urinary tract were found. The results were not significantly different between the patients using anticholinergic medication and/or catheter clamping and those who did not.


CONCLUSIONS
According to our study, routine use of anticholinergic medication and clamping of catheter does not seem to be necessary to preserve detrusor compliance and renal function in patients with SPC and neurogenic bladder dysfunction.
Pannek
Jürgen
J
Chefarzt Neuro-Urologie, Schweizer Paraplegiker-Zentrum, Guido A. Zäch Strasse 1, 6207 Nottwil, Switzerland. juergen.pannek@paranet.ch
Göcking
Konrad
K
Bersch
Ulf
U
D000328:Adult; D000368:Aged; D002408:Catheters, Indwelling; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003250:Constriction; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000503:physiopathology; D001750:Urinary Bladder, Neurogenic / Q000503:physiopathology / Q000628:therapy*; D014546:Urinary Catheterization / Q000295:instrumentation / Q000379:methods*; D014552:Urinary Tract Infections / Q000453:epidemiology
D018680:Cholinergic Antagonists