title: To cystoscope or not to cystoscope patients with traumatic spinal cord injuries managed with indwelling urethral or suprapubic catheters? That is the question!
abstract: METHODS
  Retrospective review of findings during cystourethroscopic surveillance of symptomatic and asymptomatic patients with indwelling urethral catheters (IUC) and suprapubic catheters (SPC) monitored between January 2003 and December 2008.
  
  
  OBJECTIVE
  To audit and compare findings between symptomatic and asymptomatic patients and between SPC and IUC population. To systematically review the literature including the recent National Institute for Health and Clinical Excellence guidelines on cystoscopic surveillance.
  
  
  METHODS
  Theater management system and the electronic patient records used to retrieve demographics, injury details and operative findings.
  
  
  RESULTS
  Of 925 cystoscopies performed in 507 patients, 449 were performed in 277 patients with IUC/SPC. Only 419 procedures (SPC 264; IUC 155) in 262 patients fit the inclusion criteria. Thirty procedures in fifteen non traumatic patients were excluded. Statistically there was no significant difference in incidence of findings between the symptomatic and asymptomatic group. Recurrent blockage of catheter was predominant in the SPC group and symptomatic urinary tract infections (UTIs) were the most common indications in the IUC group. In the asymptomatic group, there were 44 squamous metaplastic changes in 27 patients. Two of these patients had keratinizing variants. The duration of catheterization ranged from 20 months to 27 years and mean of 13.7 years. The average duration between two cystoscopies in the symptomatic group was 16 months compared with an average 21 months in the asymptomatic group.
  
  
  CONCLUSIONS
  Cystourethroscopic surveillance in high-risk patients with IUC/SPC is essential to diagnose and manage at an early-stage complications associated with IUC/SPC, minimize symptomatology, mitigate aggravation of complications, maintain good health and probably good quality of life.
authors.affiliation: 1] Midland Centre for Spinal Injuries, Oswestry, UK [2] Keele University, Keele, UK.
authors.forename: W S
authors.initials: WS
authors.lastname: El Masri y
authors.affiliation: Midland Centre for Spinal Injuries, Oswestry, UK.
authors.forename: S
authors.initials: S
authors.lastname: Patil
authors.affiliation: Midland Centre for Spinal Injuries, Oswestry, UK.
authors.forename: K V
authors.initials: KV
authors.lastname: Prasanna
authors.affiliation: 1] Midland Centre for Spinal Injuries, Oswestry, UK [2] Keele University, Keele, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Chowdhury
mesh_terms: D002408:Catheters, Indwelling / Q000009:adverse effects*; D003558:Cystoscopy / Q000706:statistics & numerical data; D006801:Humans; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D062885:Urinary Catheters / Q000009:adverse effects*