title: Intermittent self-catheterization in tetraplegic patients: a 6-year experience gained in the spinal cord unit in Prague.
abstract: OBJECTIVE
  To present a system of urological care for patients with cervical spinal cord injury (SCI) in the Spinal Cord Unit in Prague.
  
  
  METHODS
  Forty-one out of 412 patients hospitalized with acute SCI between 2007 and 2012 with motor complete SCI (AIS A,B) at the C4-C7 motor level and with sufficient follow-up duration were selected. Patients were trained using a male bladder catheterization model (37 with a transurethral catheter and 4 with a suprapubic catheter) to perform intermittent catheterization (IC) using an ergohand device, and were later encouraged to perform self-catheterization.
  
  
  RESULTS
  On the basis of the motor level of the SCI, 8 out of the 41 study patients were assigned to group 1 (C4), 11 to group 2 (C5), 15 to group 3 (C6) and 7 to group 4 (C7). All patients in group 1 had an indwelling urinary catheter. In group 2, 6 patients (54.6%) learned to perform IC, with 2 of them needing another person's assistance. In 5 patients (45.5%), suprapubic cystostomy was maintained (insufficient functional grip, severe autonomic dysreflexia, prompt reflex erection). Group 3 included 12 patients (80%) performing intermittent catheterization and 3 patients (20%) with suprapubic cystostomy (insufficient functional grip, post-bladder-surgery condition, cognitive impairment). In group 4, only 1 patient (14.3%) had an indwelling catheter due to severe abductor spasticity, whereas the remaining 6 (85.7%) learned to perform IC.
  
  
  CONCLUSIONS
  These findings suggest that patients with cervical SCI below the C5 motor level are able to learn self-catheterization, which increases independence and decreases the risk of urinary infection and stone formation.
authors.affiliation: Spinal Cord Unit, University Hospital Motol, Prague, Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Kriz
authors.affiliation: Spinal Cord Unit, University Hospital Motol, Prague, Czech Republic.
authors.forename: Z
authors.initials: Z
authors.lastname: Relichova
mesh_terms: D000328:Adult; D002408:Catheters, Indwelling; D002574:Cervical Vertebrae; D003559:Cystostomy; D018153:Czech Republic; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D007858:Learning; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011187:Posture; D011782:Quadriplegia / Q000209:etiology* / Q000534:rehabilitation; D012648:Self Care; D012656:Self-Help Devices; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation; D001743:Urinary Bladder; D001750:Urinary Bladder, Neurogenic / Q000209:etiology* / Q000534:rehabilitation*; D014546:Urinary Catheterization / Q000379:methods*