F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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drainage described previously. They should be a warning to anybody with less expertise
than Mr Smith against employing this technique of suprapubic catheterization in the
immediate and early management of paraplegics and tetraplegics. Moreover, the state
ment and conclusion made in their latest publication—an account of only 4 patients
(1970)—'in the knowledge that even in the best hands intermittent catheterization pro
duces nearly 40 per cent of infected urine on discharge from hospital it has been decided
to continue with fine suprapubic catheters' are as surprizing as they are misleading.
As their results were based on studies in male patients, comparison should of course,
have been made with the results reported on male patients treated with intermittent
catheterization, of which the authors must have been fully aware, namely 69-4 per cent
out of 157 patients sterile on discharge from hospital (Guttmann & Frankel, 1966),
82-6 per cent out of 92 patients on discharge (Walsh, 1968), 823 per cent on 17 patients
on discharge and 92 per cent on 14 patients on follow up 2 years and longer (Dollfus &
Mole, 1969).
Perineal urethrostomy
There is general agreement that this method suggested by Lewis (1945) is the worst
possible method in the management of bladder paralysis, whether in the acute, early or
late stages, and it is only mentioned here to be condemned. Performed through the
bulbus urethra, it results in scrotal and prostatic sepsis. Moreover, it prevents the patient
from sitting in a wheelchair as the pressure of the catheter against the perineal structure
inevitably produces pressure sores which may be of disastrous type, as was found in the
case of a boy with spina bifida who was transferred to Stoke Mandeville (Fig. 168).
CONCLUSIONS
From all the experiences gained so far, it can now be concluded that the non-touch
technique of intermittent catheterization has proved to be highly effective and superior
to any other form of initial and early management of the paralysed bladder following
complete and incomplete cord and cauda equina lesions, in preventing infection and
fistulae and minimizing stone formation, hydronephrosis and other serious complications
of the uro-genital system.
The non-touch method of intermittent catheterization is considered as a medical and
not a paramedical procedure and, therefore, should be carried out in the initial and
early stages of paraplegia and tetraplegia in both male and female patients by a medical
officer familiar with the details of this method as long as voluntary or reflex function of
the bladder has not fully returned. The custom so long accepted, even in some Spinal
Injuries Centres, to delegate, because of shortage ofmedical staff, this delicate, and for the
patient so vital, initial treatment to nurses and other paramedical staff is to be deprecated.
For, it is as much the responsibility of the administrative authorities, as it is of the
physicians and surgeons in hospitals and, in particular, Spinal Injuries Centres, concerned
with the initial and early treatment of spinal cord injuries, to ensure that sufficient staff
