2026-06-01
I. Complications
A 45-year follow-up study by Elmelund found that renal failure after spinal cord injury can occur at any time after the injury. In comparison, intermittent catheterization brings the lowest long-term complications. Patients who have long-term self-intermittent catheterization (SIC) may experience pain and complications related to the urethra, scrotum, and bladder. Urethral complications include catheter-related urinary tract infections, urethral stricture, and urethral orifice stricture; scrotal complications include epididymitis, bladder complications include bladder hemorrhage, bladder perforation, and bladder stones.
1. Pain
During the initial stage of intermittent catheterization, pain is often experienced, which may be related to tension and anxiety. The process of inserting or removing the catheter may also cause discomfort, possibly due to bladder spasm or urinary tract infection. Adequate catheter lubrication and correct urethral positioning can reduce the patient's pain. As time goes by and the pain threshold increases, the pain caused by catheter insertion may gradually subside.
2. Urethral Complications
2.1 Urinary tract infection (UTI) is the most common complication in patients undergoing intermittent catheterization. Frequent catheterization can easily cause damage to the urethral mucosa, subsequently leading to infection. Insufficient frequency of intermittent catheterization, urine retention resulting in urinary retention, and disruption of bladder wall blood circulation due to impaired normal metabolic transmission, as well as disruption of the normal immune mechanism of the bladder wall, all increase the risk of infection; inadequate insertion of the catheter during insertion can promote bacterial nourishment and spread, leading to urinary tract infection; Woodbury MG's research suggests that the incidence of urinary tract infection in patients undergoing intermittent catheterization due to spinal cord injury is 2.5 times per person per year, and more than 80% of patients with spinal cord injury will experience at least one urinary tract infection within 5 years. Woodbury's research at the spinal cord rehabilitation center indicates that women are more prone to urinary tract infections, and the influencing factors may be related to the unique anatomical structure of women, the average amount of urine discharged, and non-self intermittent catheterization.
2.2 Urethral stricture is a complication specific to men, with a prevalence of approximately 5%. The risk of its formation increases over time, and it mostly occurs one year after intermittent catheterization. Urethral stricture can occur in the anterior part (bulbar urethra) or the posterior part (prostatic urethra). The possible causes may be low lubrication of the catheter or inappropriate insertion force leading to urethral spasm. Therefore, for patients who perform self-intermittent catheterization for a long time or for auxiliary caregivers, mastering catheter insertion techniques, following a standardized catheter insertion process, and fully lubricating the catheter can effectively reduce the occurrence of urethral stricture. Intermittent catheterization can effectively reduce urinary tract infections and improve the quality of life of patients, but a retrospective study by Greenwell of 126 patients found that intermittent catheterization does not reduce the incidence of urethral stricture compared to indwelling catheterization.
2.3 Urethral orifice stricture, this complication is extremely rare. A spinal cord injury patient experienced this complication during 12 years of self-intermittent catheterization.
3. Scrotal Complications
Epididymitis is characterized by sudden pain in the scrotal area, swelling of the epididymis, significant tenderness, and may be accompanied by fever, epididymal hardening, etc. Due to the dysfunctions in a series of processes such as the contraction of perineal muscles and the closure of the bladder neck in patients with spinal cord injury, semen cannot be expelled, leading to epididymal infection, which is the most common genital infection. During intermittent catheterization, its incidence rate is 3% - 12% within a short period (within one year), and it is over 40% in the long-term (more than one year) process.
4. Bladder-related Complications
4.1 Hematuria often occurs in the early stage of intermittent catheterization and may be related to poor lubrication of the urethral tube coating or unskilled insertion technique. 30% of patients experience long-term hematuria. New onset hematuria may indicate the presence of urinary tract infection or urethral stricture. In Stensballe J's study, it was suggested that hydrophilic-coated catheters can effectively reduce the risk of hematuria in patients.
4.2 Bladder perforation is extremely rare and mostly occurs at the anastomosis site of the expanded bladder.
4.3 Bladder stones. The risk of bladder stones increases with long-term intermittent catheterization. The pathogenesis may be related to the entry of pubic hair, which acts as the center of the bladder stones. Bartel's retrospective study of 2825 patients with spinal cord injury and the occurrence of bladder stones found that different bladder management methods have significant differences in the occurrence of bladder stones. The incidence of bladder stones after bladder fistula surgery was 11%, significantly higher than the 5.6% incidence of bladder stones with indwelling catheterization and the 2% incidence of bladder stones with intermittent catheterization.
II. Preventive Measures
1. The most important preventive measures include: ensuring adequate education for medical staff, enhancing patient compliance, strictly controlling hand hygiene, and using appropriate types and materials of urinary catheters.
2. Cardenas' research indicates that patients with good education can better master intermittent catheterization and conduct timely catheterization in accordance with the requirements of the operation manual. Medical staff, patients, and their families should always have the awareness of maintaining hand hygiene. Before performing the catheterization procedure, they should thoroughly wash their hands with water or soap for more than 5 minutes.
3. It is necessary to select catheters with sufficient lubrication and appropriate length. Catheters with dry surfaces may damage the urethral mucosa, leading to bacterial contamination. It is best to use disposable sterile catheters. For patients with excessive bladder filling, urination should be slow to avoid a sudden drop in abdominal pressure, causing congestion of the bladder mucosa and hematuria.
4. Cranberry juice has been proven to effectively inhibit the growth and reproduction of bacteria in the urethra and bladder, prevent pathogens from adhering to the epithelial cells of the urinary tract, control Helicobacter pylori infection; it can also help maintain the integrity of the bladder wall and maintain the normal pH value of the urethra. A randomized, double-blind, placebo-controlled study suggests that 57 patients with spinal cord injury and neurogenic bladder who continuously took cranberry tablets for six months can effectively prevent urinary tract infections. Appropriate consumption of cranberry can enhance the immune effect and prevent urinary tract infections.
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