100 Jahre Urologie in Deutschland

Intermittent Catheterization and Urinary Tract Infection: A Comparative Study Between Germany and Brazil

PURPOSE

The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC).

DESIGN

A quantitative, descriptive, correlational study.

SUBJECTS AND SETTING

The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management.

METHODS

Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC.

RESULTS

Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022).

CONCLUSIONS

Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.

[The relevance of catheterization in neurourology]

Together with comprehension and therapy of neurogenic failure of the storage function of the urinary bladder, intermittent catheterization as a pressure-free voiding method without residual urine, represents a major principle of therapy in lower urinary tract dysfunction. Aseptic intermittent catheterization is recommended in Germany and Europe and seems to be acceptable even in long-term application with low complication rates. It is a precondition that patients are seen for clinical and urodynamic reevaluation at risk-adapted time intervals. The major focus is on early recognition and avoidance of threatening complications. The most important preventive measures are the motivation and compliance of the well-educated patient and the use of careful catheterization techniques with individually optimized catheters.Although aseptic intermittent catheterization has been used effectively for many years there is still a lack of randomized controlled studies for some important questions of details and an optimal catheter has still to be defined. Furthermore, valid conclusions based on well-conducted studies on the self-estimated quality of life of patients with intermittent catheterization, especially those with catheterization by attendant, are urgently needed. Intermittent catheterization is never a ready-made solution but always an individually tailored treatment for patients with lower urinary tract dysfunction.