Clean intermittent catheterization in long-term management of neurogenic bladder in spinal cord injury: Patient perspective and experiences.

OBJECTIVES: Bladder dysfunction due to spinal cord injury has a significant impact on the overall health and quality of life of an individual. Clean intermittent catheterization is the gold standard for bladder management and is recommended due to having the lowest complication rate. Transitions from intermittent catheterization to other less optimal strategies, such as indwelling catheter, are quite common. However, the research documenting patient perspectives, and epidemiological and demographic factors related to such transition is limited. METHODS: Data from patients with spinal cord injury rehabilitated with clean intermittent catheterization were collected. Demographic and epidemiological details of the patients were documented from the inpatient records. Appropriate statistical tests were applied to the values. RESULTS: Among the 45 participants, 68.89% continued clean intermittent catheterization. In those who discontinued clean intermittent catheterization, the median duration of practicing clean intermittent catheterization was 3.5 months. The commonest difficulty among compliant patients was carrying out clean intermittent catheterization in outdoor environments due to the unavailability of toilet facilities. Urinary tract infection was the most common (17.78%) complication noted. Dependence (20.00%) was a major procedural difficulty followed by pain. Adaptations to remain continent in special conditions were diapers and condom catheters. The duration of clean intermittent catheterization practiced influenced discontinuation of clean intermittent catheterization. With an increase in the duration of clean intermittent catheterization practiced after discharge, the risk of discontinuation of clean intermittent catheterization decreased with an adjusted odds ratio of 0.773 (95% confidence interval 0.609-0.982). CONCLUSIONS: People with spinal cord injury have many challenging issues in the regulation of bladder function at their level inclusive of procedural difficulties, environmental barriers and medical complications, and understanding of which will help to establish a comprehensive and a holistic program to provide remote/community care.

Treatment of a Chronic, Nonhealing Neuropathic Ulcer in a Pediatric Patient With Spinal Dysraphism: A Case Report.

A neuropathic ulcer results from repetitive trauma to a hyposensitive distal extremity, usually on a weight-bearing bony prom-inence. In addition to neuropathy, deformities and adapted walking patterns increase the risk of these wounds in children with spinal dysraphism. Information about treatment strategies for these wounds is limited. PURPOSE: The purpose of this case study was to describe the management of a chronic, nonhealing neuropathic ulcer on the dorsum of the left foot of an 11-year-old boy with spinal dysraphism. METHODS: Autologous platelet-rich plasma (PRP), obtained using a double centri-fuge technique, was applied weekly underneath a nonadherent dressing and a below-knee plaster of paris cast. Complete non-weight-bearing was encouraged. RESULTS: The patient presented with a 9 cm2 wound and a Pressure Ulcer Scale for Healing (PUSH 3.0) score of 13, which was of 6 months' duration. For the first 3 weeks, the autologous PRP and plaster cast were applied weekly. After 3 weeks, the wound was 2.25 cm2 (PUSH score 7) and treatment was changed to moistened saline dress-ings underneath the cast. The wound was healed after 5 weeks. No adverse effects were observed. CONCLUSION: Studies are needed to evaluate the safety and effectiveness of autologous PRP in neuropathic ulcer management in pediatric populations and to obtain evidence for optimal management of these wounds in persons with spinal dysraphism.