The method of draining the bladder after spinal cord lesion has seen significant evolution during the last century. Lately indwelling catheters seem to have regained some credit. Evaluations have shown that for specific patients intermittent catheterization is simply impossible or is refused. One may regret this but more important is to try and optimize the application of alternatives. As always the long-term results will depend equally upon the bladder dysfunction, the method itself and the way the method is applied.
Stickler and Feneley have reviewed the literature on how Foley catheters become encrusted and blocked by crystalline bacterial biofilms. They found evidence that elimination of Proteus mirabilis by antibiotic therapy as soon as it appears in the catheterized urinary tract could improve the quality of life for many patients and reduce the current expenditure of resources when managing the complications of catheter encrustation and blockage. For patients who are already chronic blockers and stone formers, antibiotic treatment is unlikely to be effective owing to the resistance of cells in the crystalline biofilms. Strategies such as increasing fluid intake with citrated drinks could control the problem until bladder stone removal can be organized. This practical information will be of use to many.
