F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
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firm Dow-Corning but it is more expensive. In some patients allergic reactions can be
prevented by first spraying the proximal part of the penis where the condom is fixed
with Nobecutane (New Skin) before applying the Latex solution. Fig. 166 shows the
details of the condom urinal which is connected by a plastic connector with a rubber
tube which in turn is connected with a supra-pubic type of container bag. To apply the
condom the penis, proximal to the glans up to the symphysis pubis, is coated with Latex
solution, then the condom is rolled over on to the penis, leaving about one inch of the
sheath distal to the penis, and gently pressed around the penis until the adhesive is dry.
The distal opening of the condom should be at least J in to avoid back flow of urine
during micturition. For a small child the condom can be substituted by a plastic finger
stall. The adhesive can be removed with ether or surgical alcohol and the condom
should never be removed without first removing the adhesive as otherwise this will be
harmful to the skin of the penis. The condom urinal can also be prescribed in Great
Britain under the Health Service regulations.
From the beginning, the patient has to be made aware by the medical and nursing
staff about the vital importance of his personal hygiene, and the sooner he is trained the
better for his health and future independence. Careful washing and drying the genital
area should be a daily routine to avoid offensive urinary odour which would make the
paraplegic socially unacceptable. Of special importance is the proper use and cleaning of
whatever type of urinal. When applying the urinal, it is essential to ensure that no or
minimal pressure is exerted on the posterior surface of the penis or on the scrotum and
groins and that the penile skin is not twisted under the sheath. Careless handling of the
urinal may result in a pressure sore, especially over the posterior aspect of the penis,
which in one of our patients, admitted from home, resulted in a urethral fistula.
Therefore, the penis must be inspected carefully on removing the urinal every day
and if a skin lesion is found the urinal should not be worn until the lesion is healed.
Furthermore, the urinal should be arranged in such a way that free urine flow is
ensured and reflux of urine into the trousers is prevented, which may occur when the
patient is seated in his chair on an unsuitable rubber cushion. Some years ago, I designed
a horse-shoe shaped sorbo rubber cushion which slopes towards the front and facilitates
the urine flow. The rubber reservoir of the urinal is fixed to the leg and care should be
taken that the holding band is not too tightly fixed.
Paraplegics should be provided with two urinals which should be used alternatively to
ensure regular proper cleaning and drying. For cleaning, the urinal is first soaked in
Steroxol solution (Chlorine and Detergent) and then thoroughly rinsed with plain water.
Thereafter it is soaked for 1-2 hr in 10 per cent Milton solution (Sodium hydrochloride
i per cent sodium chloride 16-8 per cent, chlorate sulphate, carbonate and calcium chlorate)
or 15 per cent Dakins solution (Chlorinated lime, sodium carbonate and boric). For
drying, the urinal should be hung up away from direct heat. At least once a week the
various sections of the urinal should be taken apart and the junction points cleaned
separately. After cleaning the catheter, the patient should wash his hands thoroughly
with soap and running water. His finger nails should be cut short.
For the night, urinals other than the condom type should be discontinued and
replaced by a suitable container. Glass or metal bottles with hard unprotected top rings
