title: Hydronephrosis and renal failure following inadequate management of neuropathic bladder in a patient with spinal cord injury: Case report of a preventable complication.
abstract: BACKGROUND
  Condom catheters are indicated in spinal cord injury patients in whom intravesical pressures during storage and voiding are safe. Unmonitored use of penile sheath drainage can lead to serious complications.
  
  
  METHODS
  A 32-year old, male person, sustained complete paraplegia at T-11 level in 1985. He had been using condom catheter. Eleven years after sustaining spinal injury, intravenous urography showed no radio-opaque calculus, normal appearances of kidneys, ureters and bladder. Blood urea and Creatinine were within reference range. A year later, urodynamics revealed detrusor pressure of 100 cm water when detrusor contraction was initiated by suprapubic tapping. This patient was advised intermittent catheterisation and take anti-cholinergic drug orally; but, he wished to continue penile sheath drainage. Nine years later, this patient developed bilateral hydronephrosis and renal failure. Indwelling urethral catheter drainage was established. Five months later, ultrasound examination of urinary tract revealed normal kidneys with no evidence of hydronephrosis.
  
  
  CONCLUSIONS
  Spinal cord injury patients with high intravesical pressure should not have penile sheath drainage as these patients are at risk for developing hydronephrosis and renal failure. Intermittent catheterisation along with antimuscarinic drug should be the preferred option for managing neuropathic bladder.
authors.affiliation: Regional Spinal Injuries Centre, Southport and Formby District General Hospital, Town Lane, Southport, PR8 6PN, United Kingdom. subramanian.vaidyanathan@nhs.net.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Vaidyanathan
authors.forename: Fahed
authors.initials: F
authors.lastname: Selmi
authors.forename: Kottarathil Abraham
authors.initials: KA
authors.lastname: Abraham
authors.forename: Peter
authors.initials: P
authors.lastname: Hughes
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Singh
authors.forename: Bakul
authors.initials: B
authors.lastname: Soni