Surgical management of urethral damage in neurologically impaired female patients with chronic indwelling catheters.

OBJECTIVE

To evaluate the clinical outcome of female patients with spinal cord injury who underwent a variety of surgical procedures to treat urethral injury and incontinence from prolonged indwelling urethral catheterization.

PATIENTS AND

METHODS

The study included 18 female patients (mean age 53.6 years, range 17-75), most of whom had spinal cord injury, who had indwelling urethral catheterization for a mean of 3.5 years (range 6 months to 30 years); they presented with severe urethral injury and intractable incontinence despite catheterization. Several different surgical operations were used to correct the incontinence, including urethral reconstruction (urethrocleisis) and urethral closure both transvaginally and suprapubically, in association with permanent suprapubic catheterization. The patients were followed for a mean of 4.6 years.

RESULTS

Four patients who underwent transabdominal urethral closure were dry. Four of eight patients who underwent urethral closure transvaginally developed urethral fistulae; these occurred within 3 months of their operation, two being corrected at subsequent operations. Two of six patients who underwent urethral reconstruction were incontinent and this was corrected via a transabdominal closure. Overall, the 18 patients underwent 22 procedures and 16 are dry, i.e. approximately 90% success.

CONCLUSION

Where the urethra is irrecoverably damaged, closure via the transvaginal approach is the preferred approach because it has low morbidity and is tolerated by these severely disabled patients. Urethrocleisis and urethral preservation provide a better option only in a select group of patients.