Date Published: October 26, 2011
Publisher: Hindawi Publishing Corporation
Author(s): Subramanian Vaidyanathan, Bakul Soni, Gurpreet Singh, Peter Hughes, Tun Oo.
When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.
Many patients with spinal cord injury and neuropathic bladder dysfunction require long-term indwelling catheter drainage or intermittent catheterisations. Repeated urethral catheterisation exposes these patients to the risk of urethral trauma. Sometimes, urethral catheterisation, especially when performed by an inexperienced health professional, may cause injury to urethra and create a false passage. Urethral trauma can lead to profuse bleeding per urethra. When a false passage is created by traumatic catheterisation, subsequent urethral catheterisations may be difficult or even impossible. In such an instance, it is advisable to perform flexible cystoscopy instead of trying urethral catheterisation blindly. By performing flexible cystoscopy, the urologist is able to assess the extent of urethral trauma, exact site of urethral injury, and direction and depth of urethral false passage [1, 2].
Flexible cystoscopy and urethral catheterisation over a guide wire in spinal cord injury patients should be carried out by an experienced doctor. Even in the hands of a senior doctor, this procedure may prove to be difficult. When the first attempt to insert a catheter over a guide wire is unsuccessful, the doctor should seek help from a senior urologist immediately. The aim should be to perform this procedure safely without producing any complication.