Following a spinal cord injury, damage to the innervation of the bladder and sphincters can result in Neurogenic Lower Urinary Tract Dysfunction (NLUTD).  This can lead to problems with the ability to store urine and effectively empty the bladder. The primary aim of management of NLUTD is to protect the upper tracts, ensure complete bladder emptying and prevent incontinence. However, quality of life is of equal importance. Although clean intermittent self-catheterisation (CISC) is considered the gold standard safe bladder emptying; it may not be achievable for all patients. Supra-pubic catheters (SPC) are preferable to indwelling urethral catheters (IDUC) in patients unable to perform CISC in order to protect the urethra from damage. A number of studies have evaluated the clinical outcomes of SPC, however this study aims to evaluate the patient’s experience of suprapubic catheters in the management of NLUTD secondary to spinal cord injury (SCI).

This was a prospective study of 50 patients with SCI who attended the Urology Nurse Specialist SPC Change Clinic. Patient demographics, previous bladder management and number of UTIs and blockages were recorded. In addition, they were asked to complete the Patient Global Impression of Improvement (PGI-I) with reference to insertion of their SPC and whether a they would recommend an SPC to a family or friend in need of similar care.

The average age of the patients was 54.4 (range 18-78) years of whom 58% were male and 42% female. 52% had a cervical SCI, 22% thoracic, 10% lumbar, 16 % Sacral/ Cauda Equina Syndrome/other. The 23/50 patients had an IDUC prior to insertion of SPC. 12/50 were performing CISC and 12/50 were voiding spontaneously. 40/50 reported a PGI-I score of 1 or 2 (see Figure 1) indicating that SPC was an improvement on previous management. 47/50 of patients were likely or extremely likely to recommend an SPC to friends or family in a similar position. Although a number of patients reported recurrent UTIs and blockages, there did not appear to be a correlation between these events and dissatisfaction with their SPC.

This study has shown that despite the complications sometimes associated with their supra-pubic catheters (blocking and urinary tract infections) the majority of patients report that this form of bladder management was an improvement on their previous bladder management method and would recommend this treatment to family or friends.

Supra-pubic catheters are a well tolerated and accepted technique for bladder management following SCI.