Treatment of the bladder after suprapubic cystostomy / P.W. Nathan.

  • Nathan, Peter, 1914-2002.
Date:
[1947]
Catalogue details

Licence: Public Domain Mark

Credit: Treatment of the bladder after suprapubic cystostomy / P.W. Nathan. Source: Wellcome Collection.

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    Reprinted from The Lancet, July 12, 1947, p. 47 TREATMENT OF THE BLADDER AFTER SUPRAPUBIC CYSTOSTOMY P. W. Nathan M.B. Lond., M.R.C.P. From a Neuro surgical Unit During the campaign in Italy the two neurosurgical units of the British Army in that country received many cases of traumatic paraplegia or paraparesis. When these cases became numerous, the problems of the treatment of the bladder in which a suprapubic cysto- stomy had been performed urgently demanded a solution. As there is no generally accepted treatment for the bladder with an indwelling suprapubic catheter, the following investigation was undertaken. TREATMENT The treatments investigated fall into three groups : (1) mechanical treatment, (2) sulpha chemotherapy, and (3) combined mechanical and sulpha chemotherapy. A fourth, control, group consisted of patients having no treatment and those having penicillin intramuscularly. The latter category of control was necessary, because many of the patients were receiving at the time penicillin for the wounds involving the meninges, and it seemed possible that this might have had some effect in sterilising the urinary tract. MECHANICAL (1) Tidal drainage.—The apparatus used was that described by Lawrie and Nathan (1939). It was attached to the supra¬ pubic catheter. This method has the disadvantage that, for a few days after the catheter is changed, there is leaking round the catheter whenever the pressure rises. The irrigating fluid used in all the mechanical methods was either proflavine sulphate 1 in 10,000 in isotonic saline, or neutralised acri- flavine 1 in 5000 in isotonic saline ; the relative value of these two solutions was not investigated. (2) Tidal drainage with acid buffered solution.—It was thought that, if the urine could be kept sufficiently acid (or sufficiently alkaline), bacteriostasis might be maintained. The strengths of solutions were found which were necessary to maintain the urine at pH 5-2 for three hours and at various values of pH above this. When it soon became obvious that this was an inefficient method of controlling infection, an attempt was made to combine the 'buffered acid solution with a solution of mandelic acid ; but by this time other methods had proved much more successful, so this was abandoned.