Spinal cord injury (SCI) patients require bladder drainage due to neurological bladder dysfunction. International scientific societies recommend early implementation of intermittent catheterization (IC) to limit urological complications, preserve the fertility, preserve the urological function and improve the quality of life of SCI patients. The objective of our study was to analyze the consequences of different type of bladder drainage in SCI patients during the acute phase of trauma.
Methods. - We retrospectively analyzed the types of bladder drainage in SCI patients with bladder/sphincter disorders in the acute phase of trauma at our institution from 2013 to 2018. Data collected were the length of hospitalization, the drainage method used, early complications (urinary tract infection (UTI), blocked indwelling catheter (IUD), urine leakage, pain, trauma or macroscopic hematuria), type of discharge from the hospital, urine culture result, and the use of antibiotic therapy. Our study was descriptive and observational, supplemented by a univariate study in order to know the impact of professional practices on morbidity, specifically on infectious morbidity.

We retrospectively analyzed the types of bladder drainage in SCI patients with bladder/sphincter disorders in the acute phase of trauma at our institution from 2013 to 2018. Data collected were the length of hospitalization, the drainage method used, early complications (urinary tract infection (UTI), blocked indwelling catheter (IUD), urine leakage, pain, trauma or macroscopic hematuria), type of discharge from the hospital, urine culture result, and the use of antibiotic therapy. Our study was descriptive and observational, supplemented by a univariate study in order to know the impact of professional practices on morbidity, specifically on infectious morbidity.

The care pathway of 81 patients was analyzed; all of them had an IUD and among them 56 (69%) benefited from IC. The patients who left the hospital with an IUD after being treated in the resuscitation, orthopedic and resuscitation then orthopedic department were 25.5%, 87.5% and 90.3% respectively.

Taking all care pathways together, 63% of patients left the hospital with an IUD. Among the patients who were managed in intensive care unit and then in orthopedics unit, 80% of patients who had IC in intensive care unit had an IUD  in orthopedics unit. Patients with at least one event on IUD and CI were respectively 40.7% (of which 45.5% had a febrile UTI) and 24.4% (of which 20% had a febrile UTI). In more than 80% of the cases there was no urological cause for maintaining or restoring IUD. A total of 169 urine culture were performed, 136 in resuscitation and 33 in orthopedics. In our population 27 patients had antibiotic treatment for urinary causes, of which 22 left the hospital with IUD. IUD was significantly associated with a higher risk of febrile UTI (p=0.047), non-febrile UTI (p=0.032) and antibiotic use (p<0.001). A duration of exposure greater than or equal to 30 days of IUD was significantly associated with a risk of febrile UI (p=0.017), non-febrile UI (p=0.01) and antibiotic use (p<0.001).

Early implementation of IC is not always initiated despite recommendations. This has a direct impact on the morbidity of patient with SCI from the acute phase of the trauma. Results from this study represent the rationale of a research study that will promote IC as the main bladder drainage in SCI patients in our institution.