The Role of Intermittent Catheterization in the Recovery of Bladder Function in Patients with Spinal Cord Injury

The vast majority of patients with spinal cord injury experience urinary retention, and clinical management requires the use of catheterization to drain urine. Although traditional indwelling catheterization can alleviate urinary retention to a certain extent, long-term use of indwelling catheters is associated with several risks, including:

Mechanical irritation from the catheter disrupts the sterile environment of the bladder and urethra, increasing the risk of urinary tract infections or stone formation. Recurrent urinary tract infections may further lead to renal failure and, in severe cases, result in deterioration of spinal cord injury or even patient death.

Prolonged indwelling catheterization can cause the bladder to lose its urine storage function. Due to the long-term absence of normal contraction and expansion stimuli, the bladder is prone to fibrosis and contracture, making it difficult to restore normal urine storage capacity.

Long-term indwelling catheterization is also unfavorable for patients’ daily care after discharge from the hospital.

Recent related studies have shown that intermittent catheterization not only reduces the incidence of urinary tract infections, but also helps promote effective recovery of bladder function. At present, this method has become the most commonly used bladder management approach in clinical practice. Intermittent catheterization has the following advantages:

(1) It promotes the recovery of voiding function in patients with spinal cord injury and reduces post-void residual urine volume.

(2) By strictly following a planned fluid intake, it prevents excessive bladder overdistension, while periodic bladder filling and emptying can stimulate the recovery of bladder function.

(3) It not only helps prevent an increase in intravesical pressure, but also allows appropriate bladder filling to ensure adequate mucosal blood supply, thereby reducing the risk of infection.

(4) It avoids complications associated with long-term indwelling catheterization.

Compared with traditional indwelling catheterization, intermittent catheterization overcomes its disadvantages and achieves a more physiological optimal state. This method can prevent excessive bladder overdistension, reduce the incidence of urinary tract infections, and decrease post-void residual urine volume.

Li Hua et al. from the Department of Rehabilitation Medicine, The First Hospital of China Medical University, conducted clinical studies and found that patients in the intermittent catheterization group showed significantly better outcomes than those in the indwelling catheterization group in terms of time to spontaneous voiding, residual urine volume, and bladder capacity, with statistically significant differences. In addition, the overall treatment effectiveness and the incidence of urinary tract infections were also significantly better in the intermittent catheterization group. These findings suggest that intermittent catheterization has superior clinical efficacy and higher safety in promoting bladder function recovery in patients with spinal cord injury.

In summary, intermittent catheterization enables patients with spinal cord injury to regain spontaneous voiding function more rapidly, reduces residual urine volume, increases bladder capacity, and demonstrates good clinical efficacy. It also effectively lowers the incidence of urinary tract infections and offers a high level of safety.

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