354
CHAPTER 26
by Gibbon catheter on admission, 5 were sterile on discharge and 4 remained infected.
Of the 2 patients infected by suprapubic cystostomy on admission, one became sterile
following closure of the suprapubic drainage and one remained infected.
This analysis clearly demonstrates the high efficiency of intermittent catheterization
in the prevention and overcoming of infection of the paralysed bladder in the initial
and early stages of traumatic paraplegia. Table 16 demonstrates the neurological lesions
and sterility of the bladder on discharge in males and females, and Tables iya and b show
the length and results of follow-ups in males and females.
The reasons may be discussed why our results in female patients have been less
favourable than in the male. There are several possible explanations for the higher
incidence of infection in females:
1
Anatomically, the development of ascending urethral infection is easier in the female
than in the male. Moreover, some may have been infected before injury. As an example,
a female patient with non-traumatic paraplegia was admitted a short time after the onset
of paraplegia, and the cystogram showed a grossly crenated bladder obviously resulting
from long standing chronic infection before her paraplegia.
2 The preparation for catheterization in the female is more difficult, again on account
of the female anatomy.
3
As pointed out before, in all male paraplegics intermittent catheterization was
universally performed by the medical officers, while, in the female, catheterization was
allowed to be carried out by the nursing staff. It has since been decided that the medical
officer should also perform the intermittent catheterization in the early stages in female
paraplegics and results have improved (Walsh, 1968).
4
In some female cases, intermittent catheterization was abandoned in favour of a
temporary indwelling catheter when an automatic bladder developed before the patient
was able to get up and the bed was wetted between catheterizations. Even then, indwelling
catheters were used in such patients only when the urine was infected, but the presence
of the catheter prevented rapid and complete eradication of the infection. On the other
hand, although the number of female paraplegics was too small at the time of the stastics
to assess whether a higher rate of infection would be reflected in later complications, it is
interesting to note from our results that more women became sterile during follow-up
than became infected.
Recently Frankel (1969) reported an improvement of sterile urine in women since
their intermittent catheterization has been carried out by a medical officer. Although the
figures at the time of the report were small (15), there had been a considerable improve
ment in the state of the women, as 10 out of 15 (67 per cent as compared with under 50
per cent reported in 1966) had sterile urine.
The effects of intermittent catheterization on complications
Hydronephrosis
Thirty-five patients (7-4 per cent) developed hydronephrosis of varying degrees; of
these 14 were unilateral and 21 bilateral. Neurological lesions of these patients is shown
