PARIS, FRANCE (UroToday.com) - This group out of Taiwan investigated long term outcomes of the patients with spinal cord injury (SCI)-induced neurogenic bladder after urological management, such as suprapubic cystostomy or regular exchange of urethral Foley catheterization, by applying the 11-year nationwide Database.
In this research, the subset of the National Health Insurance Research Database (NHIRD) of Taiwan, which contains data on all outpatient and inpatient medical benefit claims and covers over 99% of the population accumulated from 1996 to 2006, was analyzed. All SCI patients were included according to the International Classification of Disease (ICD) codes-9, by following diagnostic codes:
- 806.X, i.e., 806.00–806.9 (fracture of vertebral column with SCI);
- 952.X, i.e., 952.00–952.9 (spinal cord lesion without evidence of spinal bone injury); and
- 907.2 (late effect of SCI).
According to the data of all medical benefit claims, the included patients were further divided into three subgroups, suprapubic catheter group, urethral catheter group, and control group, respectively. Evaluation of long term outcomes was performed in four aspects,
- inflammation and infection;
- calculus of urinary tract;
- iatrogenic trauma and complication;
- acute and chronic renal disease.
Among the total population of 22.8 million, 34,227 (0.15%) SCI patients were recruited into the study. In SCI patients, 2,923 (8.54%) had the diagnosis of neurogenic bladder. Of 2,923 patients, suprapubic catheter group was 381(13.03%), urethral catheter group 64(2.19%), and control group 427(14.61%). Male patients were more likely to receive suprapubic catheter (p <0.001), but the mean age showed no significantly difference among three groups. Although there was no significant difference in geographic location of Taiwan, suprapubic catheter was more acceptable in higher urbanized area (p <0.001). Urethral catheter group had higher risk than the other two groups in the occurrence of acute and chronic renal disease (HR = 3.20, p <0.001) and calculus of urinary tract (HR = 1.89, p<0.001). Both urethral and suprapubic catheter groups had higher incident rate in iatrogenic trauma and complication than control group (HR = 4.26, p <0.001 and HR = 6.42, p =0.031, respectively). There was no obvious difference among all three groups in the incidence of prostatic and epididymo-orchidal infection. However, the duration of occurrence of infection, iatrogenic trauma, renal disease was shorter in suprapubic catheter group (p <0.001).
In our research, regular urethral catheter exchange would have higher risk to get calculus of urinary tract and renal disease than suprapubic catheter. Nevertheless, both urethral or suprapubic catheter increase the tendency of iatrogenic trauma or complication, but not in infection rate.
Presented by Lin CC,1 Lin ATL,1 Wei HM,2 and Chen TJ,3 at the 27th Annual European Association of Urology (EAU) Congress - February 24 - 28, 2012 - Le Palais des Congrès de Paris, Paris, France
1 Taipei Veterans General Hospital, Dept. of Surgery, Urological Division, Taipei, Taiwan, 2 Taipei Veterans General Hospital, Dept. of Medical Affair & Planning, Taipei, Taiwan, 3 Taipei Veterans General Hospital, Dept. of Family Medicine, Taipei, Taiwan