F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
357
the Second World War reported previously (Guttmann, 1953) and other authors with
even higher percentage of calculosis (see later).
URETHRAL FISTULAE
In spite of the many thousands of intermittent catheterizations performed in this large
number of patients during the many years of study, there has been not a single case of
urethral, peno-scrotal or vesico-vaginal fistula. This is now confirmed by other workers
in this field and Jacobson & Bors (1970), in their report on spinal cord injury in Viet
namese Combat pointed out that none of their patients treated with intermittent cathe-
terization developed peno-scrotal pathology. For the sake of the paralysed patients, this
achievement alone, apart from the other satisfactory results obtained, more than justifies
the amount of effort expended on this form of management of the spinal bladder in the
early stages following spinal cord injury. Moreover, the amount of money spent on equip
ment and personnel for intermittent catheterization at these early stages of bladder
paralysis is more than compensated by the avoidance of prolonged and even permanent
hospitalization later for costly treatment of complications developing as a result of
inadequate management of the bladder in the early stages. Thus, by proper initial treat
ment of the paralysed bladder much misery and chronic invalidism and indeed early
death of these patients can be greatly minimized or altogether prevented.
In recent years more and more workers in the field of traumatic paraplegia in this and
other countries confirmed most encouraging results with intermittent catheterization
as the method of choice in the immediate and early management of the paralysed bladder.
Walsh (1968) published a report of 97 patients (92 male and 5 female) treated at Stoke
Mandeville since the publication of 1966 mentioned above, the majority of whom (60)
were admitted within 48 hours of injury. Of the 92 early cases studied, 85 (92-4 per cent)
were admitted with sterile urine and 76 (82-6 per cent) were discharged with sterile
urine. Only one case was found to have a stone in the left renal calculus and showed a
bilateral vesical ureteric reflux. The stone was removed surgically and the patient
discharged with sterile urine and mild degree of hydronephrosis on the left side. Dollfus &
Mole (1969) published their experience on intermittent catheterization covering a period
of 3 years and 4 months after injury. Eighty-two per cent of urines were sterile in men
and 67 per cent in women. Fourteen patients were followed up after discharge up to 2
years and their urine was found sterile in 92 per cent. Other authors who reported
encouraging results are Brussatis (1953); Rossier & Brumer (1964); Ehalt (1965); Bors
(1967); Comarr (1968); Hardy (1968); Key (1968); Cibeira (1968); Adler (1969); Talbot
(1970); Gibbon
et al.
(1969); Jacobson & Bors (1970); Pearman (1971). Hardy's state
ment (1968) that the incidence of calculus formation has quite considerably dropped since
his use of intermittent catheterization in selected cases represents an interesting confir
mation of our experience. At the second meeting of the Group of Neuro-Urological
Research of the Faculty of Medicine of the University of Saar (Homburg) in Mulhouse,
France (November, 1970), Legner, an experienced urologist, declared that intermittent
catheterization by the method described here was the only right method also for the
urologist.
