A preliminary report on the use of methenamine salts and ascorbic acid in the catheterized spinal cord injured patient

Patients with spinal cord injury often have a complex array of medical probelem. Among the most commonly recognized is the flaccid type of neurogenic bladder dysfunction. This bladder dysfunction predisposes these patient to days or weeks of indwelling or intermittent urethral catherization. Due to the prolonged period during which catheterization is required, these patients are at increased risk of developing recurrent or chronic urinary tract infections. Indwelling catheters and repeated intermittent catheterization produces a continuous bacteriura, even with proper catheter insertion and care. Consequently, microorganisms are able to ascend the urethra and colonize in the bladder. Clinically, it is common to administer agents which keep the colony counts low enough so that the patient does not manifest signs or symptoms of a urinary tract infection. This therapeutic intervention is referred to as a suppressive therapy. Methenamine salts, methenamine mandelate and methenamine hippurate, are among a vareity of pharamacological agents used extensively for this purpose. This study was undertaken to: 1.) Determine in spinal cord injured patients with permanent bladder dysfunction whther any difference exists in the concentration of formaldehyde produced in the urine between two methenamine salts, methenamine mandelate and methenamine hippurate in the commonly used doses; 2.) To determine the concentration of urine formaldehyde attained in spinal cord injured patients with bladder dysfunction during indwelling or intermittent urethral catheterization program; 3.) To determine if concurrent administration of ascorbic acid with the methenamine salts has a significant effect on the levels of formaldehyde produced in the urine.