Spinal Cord Injury in Women: Differences encountered in SCI women  

  • Anatomical consideration and its pathophysiological correlation
    • Is DSD in SCI women as dangerous as in men?
      • No. The detrusor pressures in women are much less than those in men because the outlet resistance is lower.
    • Reduced risk of clinically significant UTI: No urethritis, epididymoorchitis
    • SCI women seem to have a slightly lower risk for post-injury urological complications than men do.
  • Anatomical consideration and its correlation with the methods of bladder drainage
    • Lack of an appropriate external collecting device
    • No practical alternative to indwelling catheterization: Indwelling catheter drainage on a long-term basis in women is not well tolerated because significant incontinence around the catheter.
    • Difficulties in performing CISC, especially in tetraplegics
  • Long term indwelling urethral catheter drainage and its outcomes
    • Renal function deterioration: The natural history of urethral catheterization in women indicates that some 50% will erode the urethra within 5 years. This is, in effect, a sphincterotomy, which permits low pressure urinary egress, and though not total incontinence some incontinence is the price paid for the partial sphincterotomy
  • Female SCI patients on intermittent catheterization and its outcomes
    • Female patients had higher infection rate than males [Bennett 1995]
    • Higher incidence of UTI in females with E. coli [Bennett 1995]
    • Perhaps related to the proximity of bowel/stool contamination [Bennett 1995]
  • Complications from catheter management of neurogenic vesical dysfunction [VIDEO]
    • Urethral erosion
      • Can be posterior into the vagina: this can be fixed with a sling
      • If anterior the bladder neck is eroded as well and repair is very difficult
      • In either case and augmentation cystoplasty neourethra
      • For more information, please refer to this
    • Bladder Damage:
      • Fibrosis, diminished bladder capacity, vesicoureteral reflux, bladder calculi
    • Renal and ureteral:
      • Pyelonephritis, stone formation, renal tissue loss, renal unit loss, hypertension
    • Others:
      • Skin breakdown related to urine contamination, progression of pressure ulceration, ostemyelitis, bone loss, sepsis, and death
  • Conclusions
    • In any situations, long-term catheter indwelling should be avoided. Other methods to achieve continence should be sought.
    • Although females are often treated with indwelling catheters the results of such treatment are poor. Incontinence is the most common reason why catheters are used in females, but after 5 years incontinence around the catheter or due to erosion occurs in 75%.
Key Points of This Section
  • Female are thought to suffer less serious complications than males. With SCI that seems unlikely.
  • Catheters are used in women to gain continence, within 5 years 50% of women with catheters are incontinence despite the catheter.
  • Catheter drainage increases very dramatically the upper ans lower tract complications of SCI or disease in women.

References

  • Bennett CJ, Young MN, Darrington H. Differences in urinary tract infections in male and female spinal cord injury patients on intermittent catheterization. Paraplegia. 1995 Feb;33(2):69-72.

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