Prevalence of Interstitial Cystitis in a Primary Care Setting

In this article, we report a study that assessed the prevalence of interstitial cystitis (IC) in a primary care office using symptom-based and improved diagnosis-based assessment modalities. Over the course of 1 year, all patients > or = 18 years of age who presented for a primary care office visit were administered the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. Patients with potential IC as indicated by PUF score were selected for further interview and, when appropriate, a Potassium Sensitivity Test (PST) or Anesthetic Bladder Challenge (ABC). Those given the PST were queried afterward regarding the tolerability of the test. Of 3883 patients initially surveyed, 13.1% (n +/- 509) reported PUF scores suggestive of probable IC, including 17.5% (357 of 2043) of women and 8.3% (152 of 1840) of men. Overall, 4.3% (168 of 3883) of patients in this primary care population was diagnosed with IC on the basis of history, PUF score, patient interview, and results of the PST or ABC. The PST was found to be comparable to, and in most cases less painful than, several standard office-based procedures. IC is a prevalent disease in the general primary care population. The PUF questionnaire represents an easy-to-use approach for IC symptom screening, and the PST and the ABC are useful and relatively noninvasive adjuncts in the diagnosis of IC.

Patient-perceived discomfort with two coated urinary catheters

Intermittent catheterization is now the preferred method for urethral catheterization of the urinary bladder when an indwelling catheter is not required. Nevertheless, the procedure may cause discomfort or pain. This randomized, prospective study was done to compare patient-perceived discomfort between two commonly used hydrophilic, single-use catheters in women. A total of 196 women referred to the urogynaecology section in the outpatient department were randomized to be catheterized with either a LoFric (n=102) or a SpeediCath (n=94) catheter. Both catheters are hydrophilic, low friction, single-use, disposable catheters. Discomfort was measured using a visual analogue scale (VAS). The results showed no difference in degree of patient-perceived discomfort between the two groups. Median score was 0.75 VAS points in both groups, which indicates little discomfort. Half of all the patients stated that they experienced no discomfort at all.

New female catheterization device

Data from one patient enrolled in the early phase of the ongoing clinical trial evaluating an experimental device called the Cath-Assist are presented. The device is designed to facilitate female urethral catheterization by exposing the vulvar vestibule, isolating the urethral opening, and blocking the entrance to the vagina.

Catheterization options following radical surgery for cervical cancer

This trial assessed the potential benefits of intermittent self-catheterization (ISC) over standard care with suprapubic catheterization (SPC) in the postoperative bladder care of women with early-stage cervical cancer following radical hysterectomy. A prospective randomized controlled trial of 40 women was carried out. The urinary infection rate (catheter specimen of urine) was significantly higher in the ISC group at day 3 and day 5 (42% and 63%) compared to the SPC group (6% and 18%), p=0.05 and p=0.004, respectively. Forty-seven percent of patients randomized to SPC documented having problems arising from the SPC site, of which 23% were shown to have a positive wound swab. Despite a greater urinary tract infection rate, the technique of ISC was seen by women to be more acceptable, allowing fewer disturbances at night, greater freedom to live a normal life and less anxiety/embarrassment compared to SPC.

Outcomes of urinary diversion in children with spinal cord injuries

PURPOSE

To gain a better understanding of the outcomes of the Mitrofanoff procedure for urinary diversion in children with spinal cord injury (SCI).

DESIGN

Descriptive retrospective.

PARTICIPANTS/METHODS

Individuals 6 to 27 years of age with SCI with at least 1 year follow-up after the Mitrofanoff procedure. Objective data collected via retrospective chart review include general demographics and medical/surgical history. Data collected via structured telephone interview include history of adverse urological events, bladder management, bladder management independence scores, patient satisfaction, and quality of life.

RESULTS

Sixteen subjects (13 female, 3 male) with a mean age of 19 years (range 6-27 y) who underwent the Mitrofanoff procedure were interviewed. Length of postoperative follow-up ranged from 1 to 8 years (mean 4.25 y). Complications included stomal stenosis 25% (n=4) with a mean of 19 months to first occurrence of stenosis; urethral incontinence 75% (n=12); renal/bladder calculi 19% (n = 3); and stomal leakage 44% (n=7). Independence scores for bladder management after the Mitrofanoff procedure improved in 84% of subjects with tetraplegia and 25% of subjects with paraplegia. Eighty-eight percent (n 14) were satisfied with the procedure, while 12% (n=2) were somewhat satisfied. A thematic analysis of quality of life revealed that freedom (35%) and independence (35%) were most commonly cited.

CONCLUSION

While some subjects experienced complications, satisfaction was relatively high and level of independence in bladder management was greatly improved. This study demonstrates that the Mitrofanoff procedure is a beneficial option to improve independence and ease of bladder management in children with SCI.

Intermittent self-catheterization appliances for disabled patients

Occasionally, district nurses may be asked to teach a patient intermittent self-catheterization (ISC). However, if the patient has some form of physical disability that reduces their manual dexterity or limits their movement, should this stop the patient undertaking the procedure? This article outlines some of the appliances available to help disabled patients undertake ISC.

Feeling Good in Daily Life: From the Point of View of Boys With Posterior Urethral Valves

PURPOSE

We determined what is important to feel good in daily life when living with a long-term illness that requires daily treatment routines.

MATERIALS AND METHODS

Seven boys between 6 and 16 years old who were born with posterior urethral valves narrated their experiences with daily life. They were on clean intermittent catheterization, had impaired renal function and 2 had undergone transplantation.

RESULTS

Being involved in decisions about themselves was important, as was having their own doctor and nurse. Friends were important. Clean intermittent catheterization was something that worried them in relation to friends and made them feel uncertain about how they would react to it. The boys accepted the catheterization procedure as something that had to be done but they needed strategies to be able to comply. A single event, such as no available toilet, was enough to interrupt treatment.

CONCLUSIONS

In these boys prescribed treatment was a surprisingly small part of their lives. The clean intermittent catheterization routine was sometimes experienced as an obstacle in company with friends. The new challenge might be to achieve compliance with the treatment routine in daily life in a long-term perspective.

Selecting a urinary catheter and drainage system

Selecting the most appropriate urinary catheter and drainage system is an important factor towards patient comfort. Inappropriate selection may introduce an array of unnecessary catheter-associated problems and discomfort for the patient. The author has found that nurses may be able to name or recognize catheters they use, but not other makes and models of similar products produced by other companies. Therefore, selecting a catheter and drainage system can be confusing due to the vast array of catheters, materials used and drainage systems available from various companies. Consideration should also be given as to when catheter care begins: before or following catheter insertion. This article is written to help in the selection of a urinary catheter and drainage system which is best suited for the patient.

Intermittent catheterisation: using a reflective framework

Intermittent catheterisation is a safe and acceptable method of bladder emptying, however, the impact it has on a patient's quality of life may not be fully appreciated by those involved in teaching the procedure. Reflection after an event allows practitioners to critically examine the experience from the nursing and patient perspective and respond to it in relation to current theory, literature and research.

Male urinary catheterisation

This article examines the procedure of male catheterisation and its development as a role now performed by trained nurses, regardless of gentler. The reasons for urinary catheterisation, issues in relation to male sexuality and patient assessment and education are also discussed.

Catheter valves for indwelling urinary catheters: a systematic review

This mini-review aimed to systematically review the evidence on the effect of catheter valves compared to free drainage into a bag for patients with indwelling urinary catheters. Data sources used were Medline, British Nursing Index, CINAHL, Ahmed, EMBASE, EBM Reviews, the Cochrane Library and reference lists of relevant papers. Papers considered were controlled trials comparing the use of a catheter valve with the catheter bag that were published as a full report, or detailed abstract (containing sufficient information to critique) in Dutch, German or English. Two studies with a total of 122 subjects were identified. The main outcome measures considered were reduction of incidence of bladder spasm and urinary tract infection (UTI) and patient preference. No statistically difference in the incidence of bladder spasm or UTI was demonstrated but patients showed a clear preference for the valve. Further research into catheter valves is needed, with larger study groups, which include housebound male and female patients, and longer follow-up period.

Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury

BACKGROUND

The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury.

METHODS

Eighty-nine patients (mean age 37.6 years with a range of 18-66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5).

RESULTS

Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did (P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively (P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01-10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity.

CONCLUSION

Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury.

Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

STUDY DESIGN

Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).

SETTING

Three outpatient medical departments in Seoul, Korea.

OBJECTIVES

To assess depressive symptoms in patients on clean intermittent catheterization after SCI.

METHODS

In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18-75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).

RESULTS

For patients and controls, the average total BDI scores were 20.3+/-1.0 and 11.4+/-0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42-10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67-12.81, P=0.003) of depression than those who were able to perform self-catheterization.

CONCLUSIONS

The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.

[Patient satisfaction with two different types of bladder catheters]

BACKGROUND

The insertion of a urinary catheter may cause some discomfort or pain. This study was done in order to compare patient-perceived discomfort with two commonly used coated urinary catheters for in-out catheterisation.

MATERIAL AND METHODS

A total of 196 women were randomised to be catheterised with one of two coated, hydrophilic catheters, either a Lofric or a SpeediCath catheter. Degree of discomfort was recorded on a 10 cm visual analogue scale.

RESULTS AND INTERPRETATION

There was no difference in patient-perceived discomfort between the two catheters. The degree of discomfort was small with both catheters, with a median score of only 0.75 cm on the scale.

A guide to male catheterization and sexuality and quality of life

Male catheterization has traditionally been the domain of the doctor and male nurse but, in modern health care, it is seen as a skill that should be part of the general nurses' education, regardless of their gender. This improves the speed of care for the male patient requiring catheterization and increases quality of care. However, the female nurse may find difficulty in asking questions about the patient's sexual health, which should be included in the assessment, and therefore this subject should be included in the nurse's education.

Health-related quality of life of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

OBJECTIVES

To determine the psychological and social status of patients using clean intermittent catheterization for neurogenic bladder according to health-related quality of life (HRQOL).

METHODS

We conducted a prospective trial involving 132 patients (81 men and 51 women, mean age 41.8 years, range 18 to 80 years) using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury. The 150 controls (90 men and 60 women) lived in the same region as the patients and were frequency matched to ensure equal age and sex distributions. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).

RESULTS

The SF-36 scores did not reveal any significant differences between the men and women in the patient group. The SF-36 scores of the patients were significantly lower than those of the general population. When patients and controls were divided into two groups according to sex and age, the SF-36 scores of the patients were significantly lower than the controls across both sex and all age groups, other than the energy and vitality scale, the differences for which were not statistically significant in women and those younger than 50 years.

CONCLUSIONS

Our findings suggest that patients using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury generally exhibit a reduced quality of life in all health domains as assessed by the SF-36.

Medical staff attitudes toward family presence during pediatric procedures

OBJECTIVE

Investigate health care providers' perceived advantages and disadvantages of family member presence (FMP) for a wide spectrum of procedures in the pediatric emergency department.

SETTING

Urban tertiary care children's hospital.

PARTICIPANTS

Pediatric emergency department faculty and nurses, pediatric residents.

METHODS

In a written survey, participants rated approval of FMP for 9 procedures: intravenous (IV) placement, urinary catheterization, suturing, lumbar puncture, fracture reduction, chest tube placement, endotracheal intubation, medical resuscitation, and trauma resuscitation. Respondents listed advantages and disadvantages of FMP for patients, families, and staff.

RESULTS

71% (104/146) of the surveys were completed. Attending physicians and nurses provided similarly high approval rating for less invasive procedures, with a decrement in approval for more invasive or life-threatening situations. Attending physicians and nurses were more likely than residents to approve FMP for all procedures except IV placement, suturing, and urinary catheterization, which had similar approval rates for all respondents. Commonly expressed potential advantages were ability to calm the patient, decreased parental "helplessness," and increased parental knowledge that everything was done. Disadvantages included higher anxiety in room, disturbing parental memories, and detriment to success of the procedure. Medical-legal concerns, mistrust of providers, and more difficult teaching environment were uncommonly listed as disadvantages.

CONCLUSIONS

Emergency department staff support FMP for minor procedures, yet express concern regarding the effects of this practice on the family and the success of the procedure. Most attending physicians and nurses support FMP during highly invasive procedures and resuscitations, whereas residents do not. This information provides insight into the educational and systematic requirements of implementation of FMP.

Neuropathic bladder and intermittent catheterization: social and psychological impact on families

Clean intermittent catheterization (CIC) is the mainstay of management in neuropathic vesicourethral dysfunction, both to improve continence and, more importantly, to preserve renal function. We looked at the effects of this procedure on children, adolescents, and their families. In particular, we wished to see if there were any differences between those who successfully catheterized and those who did not. Forty families were enrolled into the study. Ages of children and adolescents (23 females, 17 males) ranged from 1 to 20 years. Most participants (n=31) had spina bifida. Other causes of bladder dysfunction included transverse myelitis, spinal cord injury, and spinal neuroblastoma. Parents were assessed using the Effects of Handicap on Parents semi-structured interview, the Socioemotional Functioning Interview, and a semi-structured interview, specifically designed for the study, which looked at family characteristics and experience related to diagnosis and catheterization. In addition, the Rutter Parental 'A' Scale Questionnaire was used to screen for emotional and behavioural disorders in the child. Results showed that CIC by carer or self-catheterization itself did not cause major emotional and behavioural problems but the bladder problem may act as a focus that puts considerable strain family relationships. Although most parents disliked CIC they complied with the suggested management. It is important that all those involved understand the aims of management and success can be achieved by combined input from medical, psychological, and specialist nursing staff. The problem is lifelong and continued support from a multidisciplinary team is essential.

Intermittent self-catheterisation

Intermittent self-catheterisation (ISC) has reduced infection hazards and greatly improved the lives of many patients with micturition disorders. The technique is used by male and female patients who experience neurogenic bladder dysfunction or voiding difficulties. Some of the most beneficial results associated with ISC have been reported when the technique is used by people with spina bifida, paraplegia or multiple sclerosis. ISC is the preferred course of management for patients with a hypotonic bladder (a floppy bladder that is unable to contract partially or totally during the micturition cycle).

Life with an indwelling urinary catheter: the dialectic of stigma and acceptance

The purpose of this hermeneutic phenomenology was to describe and interpret the lived experience of long-term users of urinary catheters. Living with a urinary catheter involved a dialectical swing between acknowledgment that the catheter was "a part of me" and feelings of alienation and vulnerability when it was experienced as a stigma. Themes include Adjusting to embodied changes by perceiving the catheter as a "part of me," Shame and responding to shame by normalizing, and Embarrassment and coping with embarrassment by humor. Providers can minimize stigma related to the visibility of the catheter by coaching patients in strategies to manage going out of the home with a minimum of urine accidents or by helping develop ways to conceal the urine bag.

Clinical study of a new urine collection bag

A pilot study of an innovative urine drainage bag that defines a new principle regarding dependent gravity drainage was conducted. Patients and caregivers found improvement in activities of daily living, comfort, convenience, safety, and cost savings as noted by the majority of evaluators.