Experience with self intermittent catheterisation for women with neurological dysfunctions of the bladder.

Self intermittent catheterisation (SIC) was taught to 24 women with neurological diseases involving the bladder. The major causes of neuropathic bladders were traumatic lesions of the spinal cord (17 cases, 70 per cent), diabetes and multiple sclerosis. Patients were aged 16--65 years (mean 36 years). Initial acceptance of the procedure proved to be a temporary problem in some fastidious women, but the majority eagerly accepted the opportunity to be free of permanent drainage equipment. A bladder relaxant drug was used in order to suppress spontaneous detrusor contractions in patients with intact lower motor neurones. A training period of 1 day to 2 weeks, depending on manual dexterity, was sufficient to ensure competence in the technique. All patients were able to perform the procedure with few incidents of infection while in the Hospital, but in four patients it proved to be impractical and was discontinued after 1 to 2 weeks. After discharge home three patients have gone back to permanent Foley drainage. Women who have good home settings or who are able to ambulate to some degree, do well on SIC, but the advantages of prevention of infection and freedom from drainage bags do not, as yet, outweigh the social problems for many women confined to wheelchairs such as architectural barriers, time schedules and suitable clothing. Selected patients must be both well motivated and independent in transfers so that while an excellent solution for some, SIC is far from being the solution for all women with neurological dysfunction of the bladder.