Urethral catheter removal 3 days after radical retropubic prostatectomy is feasible and desirable

The purpose of this work was to assess the feasibility of urethral catheter removal 3 days after radical retropubic prostatectomy (RRP). Twenty-two patients who underwent RRP with a watertight eight-suture vesicourethral anastomosis had their urethral catheter removed usually on postoperative day (POD) 3. The average day of urethral catheter removal was POD 3.2. At 3 months, 56% of patients required no or one protective pad to stay dry and 68.4% of patients 'never leaked' or 'leaked occasionally'. Following RRP, the urethral catheter can be removed as early as POD 3 if the intraoperative anastomosis is watertight without compromising urinary continence.

Meanings and practical knowledge of people with long-term urinary catheters

The lived experience of people with long-term indwelling urethral catheters is described and interpreted. This hermeneutic (interpretive) phenomenologic study used Merleau-Ponty's philosophy and van Manen's methodology. Fourteen adults aged 35 to 95 years who had worn a catheter more than 4 months (range = 6 months to 18 years) comprised the purposive sample. Data were obtained through audiotaped and transcribed interviews conducted in the homes of participants. The study provided both meanings and practical knowledge related to the experience of catheter use. Despite its drawbacks, participants recognized the device's value in their daily lives and weighed its positive features against concerns associated with long-term use. Individual meanings included making aesthetic harmony with a new catheter, the convenience of the catheter compared with the inconvenience of incontinence, and the catheter as a symbol and reminder of one's mortality. Practical knowledge related to participants' awareness of their catheter needs and practices, such as features of supplies, intervals for changes, catheter insertions, emptying the urine bag, and changes associated with sex. Knowledge of the lived experience with a urinary catheter can assist nurses in sensitive decision making about care and help them become better patient advocates.

Teaching ISC technique

Intermittent self-catheterisation (ISC) is an extremely intimate technique and those teaching it must be aware of both verbal and non-verbal behaviour by patients throughout the procedure. The instructor needs to be empathetic, supportive and skilled in the technique, as the patient faces a change in both lifestyle and body image. Psychosexual awareness means being alert to any sexual anxieties the patient may have.

Intermittent self-catheterisation and the female patient

The use of intermittent self-catheterisation (ISC) in the treatment of bladder disorders has increased in recent years. Manufacturers have also been developing a range of new catheters to make the procedure safer, easier and more comfortable for the patient. Patients may be taught intermittent self-catheterisation in the hospital, clinic or home setting. The amount of follow up and support given varies widely. Recent government policies aim to empower the patient to make decisions about their care (DoH 2000a, DoH 2001a). This article examines the factors that affect female patients whose bladder dysfunction is managed by ISC.

Understanding urinary catheter problems from the patient's point of view

Nurses are provided with a unique viewpoint in this article by examining the lived experience of individuals with long-term urinary catheters. Fourteen adults (ages 35-95) who had used a catheter from 6 months to 18 years were interviewed. In their own words, study participants discussed how they respond to catheter-related problems, urinary tract infection, leaking/ blocking, catheter discomfort, and autonomic dysreflexia. Using this insight will help clinicians implement mutually developed care-plan goals with patients as partners.

Reflective, holistic care after radical penectomy

This case study describes the management of a patient with complex problems by a urology nurse specialist. Penile amputation and the creation of a colostomy had a severe impact on body image so the patient's care required a holistic approach. He also needed the support of community nurses, and collaboration between them and the urology nurse specialist prevented fragmentation of his care in the end stages of his life.

Urine flowing: a phenomenological study of living with a urinary catheter

The experience of living with a long-term urinary catheter was investigated with a community-dwelling sample of 14 adults ranging in age from 35 to 95 who had worn a catheter for 6 months to 18 years. Data were obtained by audiotaped face-to-face interviews. Merleau-Ponty's phenomenology and van Manen's methodology guided the study. Living with a urinary catheter was found to be like living with the forces of flowing water. People were keenly aware of the flow of urine through their catheters, and they noticed when their bags needed emptying or when urine drainage seemed sluggish or obstructed. The metaphor of urine flowing like water may provide a teaching heuristic for assisting clients in adjusting to living with a catheter. Implications for further research focus on understanding the relationship between sensitivity to the dynamics of urine flow and urinary tract infection.

Catheterisable continent urinary diversion (Mitrofanoff principle)--clinical experience and psychological aspects

48 Mitrofanoff principles (MTR) were performed on 46 patients (male : female ratio, 30 : 16) with a mean age of 9.1 years (range 2.5 to 24 years). The primary diagnoses were neurogenic bladder in 11, infravesical obstruction in 7 and bladder exstrophy-epispadias complex in 28 patients. The most common type of conduit was appendix (38 cases); other conduits were constructed from the ileum (seven) and ileocaecum (one). In two cases with bladder substitution the uterine tube and tubularised bladder stump were used as perineal MTR. 33 of the 46 children underwent augmentation cystoplasty in conjunction with the MTR procedure. The Malone procedure for antegrade colonic enema (ACE) was performed at the same stage with MTR in eight cases. To achieve continence, bladder neck reconstruction was performed in 32 patients and the bladder neck was closed in four patients during the same operation and MTR procedure. The mean follow-up period was 28.7 months (range one month to 57 months). To assess the psychological aspects of the MTR procedure, the Rosenberg Self-Esteem Scales were completed by 12 children older than eight years of age. Nine patients had problems with the MTR (19.5 %). Three appendiceal MTR had strictures at the skin level, 2 of which needed minor surgical revisions. A mucocele formation at the skin level of an appendix was removed successfully. We did not observe any complaints among the other appendiceal conduits. All the tapered ileum conduits were difficult to catheterise, and 1 of them had a leakage from the stoma. None of the three transversely tubularised ileum MTRs had problems with catheterisation or leakage. A stricture of the conduit from the uterine tube was observed. 36 of the 42 patients are now continent, giving a ratio of 86 %. The results of the Rosenberg Self-Esteem Scales revealed that there was an increase in the percentage of patients with high self-esteem, and a decrease in depressive feelings after the MTR procedure. We conclude that the MTR procedure provides excellent continence, offers good prospects of a socially acceptable life with increased self-esteem, and the appendix seems to be the ideal organ for continent urinary diversion, with the transverse tubularised ileal tube as a second choice.

Clean intermittent self-catheterisation and children

The best chance for good renal health and continence for children with a neuropathic bladder is clean intermittent self-catheterisation. In order to maximize potential for good renal health and continence the child and family need to be well supported by the multidisciplinary team, making good use of the knowledge of the children's urology specialist nurse who is able to provide relevant information, advice and education. With support many children with a neuropathic bladder are able to achieve continence while maintaining good renal health.

Troubleshooting common problems associated with long-term catheters

A catheter complications survey study, carried out over a 2-year period in three Bristol health districts, recorded 506 emergency referrals during a 6-month period (Kohler-Ockmore and Feneley, 1996). A further detailed study on 54 of the patients showed that 48% experienced catheter blockage and 37% reported urine bypassing. Urinary catheterization can cause many health problems; bacteriuria is inevitable in long-term catheterized patients (Cravens and Zweig, 2000). This article identifies some of the common problems that can occur with long-term catheters, makes recommendations and applies an evidence-based approach to catheter care. In order to identify and treat the associated problems, it is necessary to understand the anatomy and functions of the bladder. The article addresses this before examining the problems, which include: catheter blockage; bypassing of urine; catheter rejection and balloon non-deflation; and latex allergy. The psychological and social aspects, although not covered in this article, are also important and should always be considered along with all other aspects of care.

Urinary incontinence treatment preferences in long-term care

OBJECTIVE

To elicit preferences for different urinary incontinence (UI) treatments in long-term care (LTC) from groups likely to serve as proxy decision makers for LTC residents.

DESIGN

A descriptive, comparative study of preference for UI treatments of frail older adults, family members of nursing home (NH) residents, and LTC nursing staff. Surveys were mailed to families and self-administered by staff. Older adults were interviewed.

SETTING

Four LTC facilities and two residential-care facilities in Los Angeles.

PARTICIPANTS

Four hundred and three family members of incontinent NH residents were mailed surveys. Sixty-six nursing staff caring for these incontinent residents and 79 older adult residents of care facilities (nine cognitively intact NH respondents and 70 residential care residents) answered surveys.

MEASUREMENTS

Preference rankings between seven paired combinations of five different UI treatments were measured on an 11-point visual analog scale, with the verbal anchors "definitely prefer" this treatment, "probably prefer" this treatment, and "uncertain." Respondents gave open-ended comments as well.

RESULTS

Forty-two percent of family members (171/ 403) returned the mailed survey. Of all respondents, 85% "definitely" or "probably" preferred diapers, and 77% "definitely" or "probably" preferred prompted voiding (PV) to indwelling catheterization. Respondent groups occasionally differed significantly in their preferences. In choosing between treatment pairs using a visual analogue scale, nurses preferred PV to diapers significantly more than did older adults or families (both of whom preferred diapers) (F (2,295) = 13.11, P < .0001). Older adults, compared with family and nurse respondents, showed a significantly stronger preference for medications over diapers (F (2,296) = 41.54, P < .0001). In open-ended responses, older adults stated that they would choose a UI treatment based in part upon criteria of feeling dry, being natural, not causing embarrassment, being easy, and not resulting in dependence. Nurses said that they would base their choice of UI treatment upon increasing self-esteem and avoiding infection.

CONCLUSIONS

Although there was wide variation within and between groups about preferred UI treatment, most respondents preferred noninvasive strategies (diapers and PV) to invasive strategies (indwelling catheters and electrical stimulation). Older adults preferred to a greater degree medications and electrical stimulation, therapies directed at the underlying cause of UI. Despite data documenting that diapering is a less time intensive way to manage UI and that toileting programs are difficult to maintain in LTC, nurses viewed PV as "natural" and strongly preferred it to diapering. Several family members and older adults viewed PV as "embarrassing" and "fostering dependence." These data highlight the need to elicit preferences for UI treatment among LTC residents and their families.

Evaluation of two coated catheters in intermittent self-catheterization

Intermittent self-catheterization (ISC) has addressed the problems of mechanical or functional urological voiding since the 1970s. Patient quality of life is enhanced by the increased independence and security offered by ISC (Lapides et al, 1972). A randomized, comparative crossover study was undertaken in two centres to evaluate the performance of SpeediCath (Coloplast) and Lofric (Astra Tech) catheters. A total of 27 subjects were recruited, all of whom had been performing ISC more than twice a day for longer than 3 months with a coated catheter. Each catheter was used for 1 week to assess catheter performance and acceptability. There were no significant differences recorded for the performance of each catheter. However, SpeediCath demonstrated favourable statistical significance in relation to ease of use, speed of use, and the concept of water as an integral part of the packaging of the catheter.

The active urine collection device: a novel continence management system focusing particularly on the needs of disabled women

PURPOSE

This paper introduces a novel incontinence management system which applies space technology to the problem of urinary incontinence. The purpose of this paper is to invite comments and suggestions from professionals in the disability and rehabilitation field.

METHOD

Severe urinary incontinence is a distressing condition for which there are few satisfactory management solutions. We have been able to develop a compact liquid handling system that can cope with the initial surge of urine which characteristically reaches a high flow rate of around 25 ml/sec. By using a sophisticated system of filters, the device can cope with mixed streams of urine and air which are inevitable when a non-invasive patient/device interface is used. The next phase of the project is to develop prototype devices with the aid of users to produce an effective appliance that users and carers find practical and acceptable to use.

CONCLUSION

With the aid of users, carers and rehabilitation experts we hope to develop an excellent user-friendly product. We believe this device can make a positive contribution to the quality of life of disabled people with continence difficulties.

InstantCath from Hollister: pre-lubricated self-catheterization

Over the centuries a variety of substances have been used to make a hollow tube to pass through the urethra to empty a poorly functioning bladder. The ancient Greeks used dried water reeds from the riverbank. The Romans and the Egyptians experimented with gold and silver. Following the industrial revolution stainless steel was used and catheters are still manufactured today using stainless steel. PVC and plastic catheters became popular in the 1970s and various hydrophilic coatings have been added to provide self-lubrication of the catheter when it comes into contact with water. The most recent development in the clean, intermittent self-catheterization (CISC) range is the Hollister InstantCath which is a self-lubricating catheter that does not require any water. It has shown itself to be well received by patients and is a welcome addition to the choice available to healthcare professionals and their patients when instigating CISC as therapy.

Experiences of micturition problems, indwelling catheter treatment and sexual life consequences in men with prostate cancer

Men with prostate cancer (n=25) were interviewed, focusing on experiences of micturition problems, indwelling catheter treatment and sexual life consequences. Narrations were found to be practical and technical descriptions rather than emotional, and experiences were described with reduction and negligence regarding personal well-being and the impact of problems. Phenomenological-hermeneutic analysis was used and findings ordered in subthemes and themes of meaning. Micturition problems, catheter treatment and sexual life problems were all phenomena that radically affected the clients' autonomy and life quality and changed the life continuum. Impact from the disease was either accepted or not and related to what had already been borne in life. Experiences were linked together, each of them giving rise to feelings of physical deterioration and fear of ridicule, and hidden from others. Maintaining self-image and social role was important and connected with the degree of perceived deprivation of life content. Responsibility for medical decisions was left to professionals while everyday problems with micturition, catheters and sexual life were regarded as the men's sole responsibility. Findings were interpreted to mean that comparing the personal situation with that of others worse off made the life situation look better. The clinical implication of this study was that because the men came forward with their problems when given time to talk in their own way these areas should be given time and interest in the nursing care. Interpretation did not provide a unified picture of problems. Thus, nurses will have to seek men's individual experience actively and give legitimacy to patients' problems by opening up opportunities to speak about otherwise concealed problems. Then it may be possible to provide solutions that may ease the men's burdens.

Urinary catheters for intermittent use

The long-term use of intermittent catheterisation is often suitable for patients with voiding problems who are able to perform self-care. Use of the technique may result in fewer urinary tract problems, the achievement of continence and improvements in quality of life.

Improving community catheter management

A poorly managed indwelling urethral catheter can significantly reduce quality of life. The formulation of a community catheter management policy led to the development of standards encouraging a proactive, holistic approach to care.

Parent behavior and child distress during urethral catheterization

ISSUES AND PURPOSE

Researchers need a clear understanding of the natural behaviors parents use to help their children cope. This study describes the relationships between naturally occurring parent behaviors and child distress behaviors during urethral catheterization.

DESIGN AND METHODS

In this descriptive study, researchers videotaped the behaviors of parent-child interactions during urethral catheterization.

RESULTS

Parents used distraction to maintain calm behavior during the first part of the procedure and used more reassurance when the children started to become distressed. Seven of the nine children displayed calm behavior at least half the time following distraction. Parental reassurance did not decrease distress behavior in most children.

PRACTICE IMPLICATIONS

Early implementation of developmentally appropriate nursing interventions to decrease child distress is imperative. Parents may need specific instruction and practice to continue the use of distraction throughout procedures, even when the child is upset.