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  • Title: The female tetraplegic: an admission of urological failure.
    Author: Singh G, Thomas DG.
    Journal: Br J Urol; 1997 May; 79(5):708-12. PubMed ID: 9158506.
    Abstract:
    OBJECTIVE: To present the long-term follow-up of female patients with tetraplegia managed in our unit, many of who require permanent indwelling catheters or urinary diversions that lead to significant complications and associated morbidity. PATIENTS AND METHODS: Eighty-four female tetraplegics (mean age 31 years, range 13-81) were followed for a mean of 9 years (range 2-30). Three groups of patients were identified, depending on their neurology; 27 patients had complete lesions (Frankel A), 20 had incomplete lesions with poor functional recovery (Frankel B/C) and 37 had incomplete lesions with good function (Frankel D/E). RESULTS: The patients with complete lesions (Frankel A) were difficult to manage, with 23 of the 27 (85%) treated using indwelling catheters. Three patients underwent diversion and for one patient, the carer performs clean intermittent catheterization (CIC). Of the 20 patients with Frankel B/C lesions, 14 have permanent indwelling catheters, three are able to perform CIC and three void by controlled triggering of detrusor contractions (reflex voiding). The 37 patients with Frankel D/E lesions fared better and only three (8%) require permanent catheters. Of the others, four (11%) use CIC (one following a cystoplasty) and most (30, 81%) use reflex voiding. Most of the 40 patients with permanent catheters had significant problems with bladder stones (55%), leakage and by-passing (35%), and recurrent symptomatic infections (33%). Patients performing CIC fared better, with most needing anticholinergic therapy or subtrigonal phenol; patients who used reflex voiding also needed these two treatments at some stage. Four patients (two with ileal loops and two with indwelling catheters) developed dilated upper tracts. CONCLUSIONS: The urological status of female patients following cervical cord injury depends on the level of injury and recovery. Most patients with Frankel A-C lesions have permanent indwelling catheters and most patients with Frankel D or E lesions void with controlled triggering or use CIC. Although upper tract dilation was seen in only 5%, patients had significant morbidity related to the bladder.
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