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occurred particularly in patients with long-standing suprapubic drainage, in whom the
suprapubic tract was allowed to close spontaneously but it also followed surgical closure.
Actually break-down of the suprapubic tract may occur many years after spontaneous
or surgical closure. We found not infrequently that a breakdown of the scar and the
development of an abscess followed by a fistula could be avoided if, as soon as the patient
noticed the slightest sign of a swelling or inflammation of the scar, diversion of the urinary
stream by a temporary indwelling urethral catheter was introduced immediately and
combined with bladder washouts and treatment with sulphonamides and antibiotics.
If this procedure proved unsuccessful, excision of the whole fibrous track and resuture
became necessary using either fine steel wire or braided nylon rather than catgut as
suture material, as being less likely to cause reactions. However, the best prevention of
this complication is discontinuation of suprapubic drainage at the earliest possible date,
arid our best results were achieved in those paraplegics in whom this was possible after
controlling the bladder infection.
(2) Urethral fistulae and diverticula
The most frequent site of urethral fistulae is undoubtedly the peno-scrotal junction
produced by an indwelling catheter, especially if it is of larger size and left
in situ
for 7
days or longer, as shown in Fig. 167. This results in a pressure lesion of the posterior
urethra followed by a peri-urethral abscess which eventually breaks through the scrotal
skin or urethra at the peno-scrotal junction, as shown in Fig. 167. Griffiths & Walsh
(1961) reported 31 urethral fistulae found in 2,060 (1-5 per cent) male paraplegic patients
admitted to Stoke Mandeville over a period of 16 years, 16 of which were caused by
long-standing indwelling Foley catheters. During that period only 2 patients developed
FIG. 167.
