• Urethral catheterization

Kaufman et al. 1977
USA
Downs & Black score=15
Case series
N= 62

Population: SCI; 4 groups: Group 1 – 25 patients with permanent bladder catheters for more than 10 years, group 2 – 24 patients with permanent catheters for less than 10 years, group 3 – 11 patients with short-term (around time of injury only) catheter drainage, group 4 – 2 patients with bladder diversions.
Treatment: Urinalysis and urine cultures, Cystoscopy and bladder biopsies on all patients. Urethral biopsies in 29 patients
Outcome Measures: Incidence of squamous metaplasia of bladder or urethra, and bladder cancer.

• Mean time with indwelling catheter: group 1: 18.8 years, group 2: 3.9, group 3: < 1 year, group 4: 2 and 24 years.
• Few patients had suprapubic catheters
• Squamous cell carcinoma found in 6 patients (10%), but 5 patients (20 %incidence) were in group 1 and had had catheters in place for mean of 21 years.
• Only 1 patient had tumor visible endoscopically
• Squamous metaplasia present in 80% of group 1, 42% of group 2, 20% of group 3, and 1 of 2 patients in group 4 (24 years use of indwelling catheter)
• Cytology was negative in all patients (with and without cancer)
• Presence of cystitis, urinary tract infection, renal impairment, pain,  did not correlate with cancer incidence.
• Gross and microscopic hematuria did correlate with bladder cancer.

Locke et al. 1985
USA
Downs & Black score=13
Case series
N=25

Population: SCI patients with indwelling catheters: Length of indwelling catherization = 17.6 yrs.
Treatment: SCI patients with indwelling catheters were evaluated for presence of bladder malignancy.
Outcome Measures: Urinalysis, urine culture, cytology, serum urea, creatinine, white cell count, hematocrit. Excretory urography results, cystoscopy results.

• Cystoscopy results indicated suspicious lesions in 4 patients and squamous cell carcinoma in 2.
• Excretory urography results indicated:
  • Bladder calculi in 7 patients.
  • Renal calculi in 5 patients.
  • Normal in 9 patients.
  • 1 patient had a surgically absent kidney.
• Bacteriuria universally present.

Suprapubic catheterization

Sugimura et al. 2008
New Zealand
D&B=16
Case series
N=149

Population: Gender: males=124, females=25; Level of injury: quadriplegia=96, paraplegia=68
Treatment: SCI patients managed with SPC were retrospectively reviewed for complications.
Outcome Measures: UTIs and other complications assessed over a mean follow-up period of 68 (3-179) months.

• 49% of patients experienced no complications
• 29% experienced UTIs.
• The most common lower tract complication was bladder stones (22%).
• Renal complication was seen in 20 out of 149 patients.
• Only 6% of patients experienced renal scarring.
• 11 patients experienced urethral incontinence

MacDiarmid et al. 1995
USA
Downs & Black score=15
Case Series
N=44

Population: Traumatic SCI with indwelling suprapubic catheter for > 1 year: Age = 36 yrs; Gender: males = 31, females = 13; Level of injury: paraplegia, tetraplegia; Severity of injury: complete, incomplete; Follow-up from time = 69 mnths; Duration of catheterization = 58 mnths.
Treatment: Assessment of urological/renal complication rate associated with suprapubic cystostomy drainage. (80% of patients had videourodynamic studies)
Outcome Measures: Urological and renal complication rate.

• Percentages reported for various complications:0% renal deterioration, 0% vesicoureteral reflux, 0% clinical bladder carcinoma, 11% incontinence, 100% asymptomatic bacteriuria, UTIs: 43% uncomplicated and 9% complicated, 5% hematuria, 7% renal calcul, 41% bladder calculi, 36% blocked cystostomy tubes; 3 patients developed abscesses.

Peatfield et al. 1983
England
Downs & Black score=11
Case Series
N=41

Population: SCI: Level of injury: paraplegia = 15, tetraplegia = 25.
Treatment: Long-term follow-up (minimum of 8 years) of those managed originally by subrapubic catheter as reported in 1976.
Outcome Measures: Mortality, renal function.

• 15/41 had died, 2 due to renal causes; 10 year survival rate 68%, 15 year 63%.
• 22 of 23 surviving, evaluable patients had normal blood urea levels.
• IVP Results: 15 Normal, 3 bilateral pelvic/ureter dilation, 2 kidney stones, 3 non-functioning kidneys.

Sheriff et al. 1998
England
Downs & Black score=8
Observational
N=185

Population: MS, SCI: Age = 17-71 yrs; Gender: males = 80, females = 77.
Treatment: Long-term (3 – 68 mo) follow-up of those managed by subrapubic catheter and in some cases, anticholinergic therapy.
Outcome Measures: Evaluation of role of suprapubic catheterisation, serum creatine levels, ultrasonography, videocystometrography, and satisfaction survey.

• Primary indications for insertion included failed IC due to poor hand function, persistent incontinence, recurrent UTIs or bulbar strictures.
• In patients using suprapubic catheter for > 2 years - no apparent decline in renal function.
• 10% complication rate, including 2.7% incidence of small bowel injury
• Overall complaint rate -30%. Most common was recurrent catheter block (18%), persistent urinary leakage (8%) and a recurrent symptomatic UTI rate of 4%.
• 48% of patients had bladder calculi requiring intervention.
• Bladder capacity remained stable, detrusor pressure significantly decreased, and previously trabeculated bladder became smooth.
• Satisfaction survey indicated that for a variety of questions (e.g., impact on life, pleasure with the switch, would you do it again, etc.) 70-90% of those responding answered favourably.

Hackler 1982
USA
Downs & Black score=7
Case Series
N=31

Population: SCI: Level of injury: all above T11; Time since injury> 5 yrs.
Treatment: Assessment of urological/renal complication rate associated with suprapubic cystostomy drainage of >=5 year vs condom or Foley catheter drainage.
Outcome Measures: Intravenous urography (IVU) and cystourethrogram (CUG) evaluated at >= 5 years post-injury.

• Renal complication rate is greater after 8 years of suprapubic cystostomy (SPC) than for those with 20 years use of condom or to a lesser extent Foley catheter drainage.
• Percentages reported for various complications: Normal - 39% with suprapubic vs 51% Foley and 66% condom; Caliectasis (calculi) - 50% with SPC vs 24% Foley and 23% condom; Hydronephrosis - 10% with SPC vs 19% Foley and 10% condom.
• 6 patients were on anticholinergic medications. 4/6 maintained normal urinary tracts.