Objective

Intermittent self-catheterization is the gold standard for patients with central neurologic bladder. It allows to reduce all urinary tract complications and to improve the quality of life.

The factors of good compliance are continence and autonomy regarding the introduction of the catheter. Nevertheless, self-catheterization can be difficult because of the usual shortcomings associated with bladder and sphincter disorders (motor, sensory…).

We found only one study about one adaptive equipment to facilitate the gesture for monoplegic patients.

Observations

This case report concerns a 53-years-old man, left brachial amputated in 1987 because of a motorbike accident associated with primitive progressive multiple sclerosis since 1996. He has an overactive bladder syndrome and dysuria because of a detrusor sphincter dyssynergia and overactive detrusor. Treatments by alpha bloquants then TENS on the tibial posterior nerve and finally neuromodulation of the posterior sacral roots did not succeed.

The indication of self-catheterization was chosen and the patient’s education was organized in Physical Medicine and Rehabilitation unit in University Hospital of Rangueil.

The team of therapists has manufactured adaptive equipment to enable the learning of intermittent self-catheterization despite his amputation. It consists in the realization of a thermo-formed plastic penile support, with a central channel to support the penis and a curved base on both sides for holding the device between the thighs. It was a success and the patient was able to independently urinary catheterism with one hand while the device correctly maintained his penis.

Discussion/Conclusion

Three months later, he no longer needed this assistance.

To conclude, it can be conclude that a multidisciplinary management allowed a monoplegic patient to acquire the self-catheterization technique, avoiding him to undergo surgical treatment.