Longterm indwelling urethral catheterization for neuropathic bladders--an audit.

An audit was performed on 17 patients with neuropathic bladders managed on longterm indwelling urethral catheters with a duration of at least eight years. The accumulated duration of continuous catheterization of this study group was at least 231 man years. The effects on the upper urinary tracts were studied by annual imaging alternating between limited intravenous urograms and ultrasonography, together with serum creatinine estimations. A grading system for upper tract changes was introduced. About a quarter of the patients on indwelling urethral catheter drainage developed early calyceal dilatation. Three patients were converted to suprapubic catheterization and three had ileoconduit diversion. The reasons were analysed. Although urine cultures were consistently positive with mixed organisms, all instances of clinical urinary tract infections were easily controlled by short courses of antibiotics. In six patients who had cystoscopic examinations, no tumour transformations were noted. Other complications encountered included bladder stones (2), clinically significant urethral fissuring (1) and bleeding per urethra (1). The three considerations for prescribing bladder management are discussed. With good catheter management and regular changes, we conclude that indwelling urethral catheter is a serious option for longterm drainage of neuropathic bladders.