Clean intermittent catheterization revisited

Reduction in lower urinary tract mucosal microtrauma as an effect of reducing eyelet sizes of intermittent urinary catheters

Intermittent catheterization (IC) utilizing conventional eyelets catheters (CECs) for bladder drainage has long been the standard of care. However, when the tissue of the lower urinary tract comes in close proximity to the eyelets, mucosal suction often occurs, resulting in microtrauma. This study investigates the impact of replacing conventional eyelets with a drainage zone featuring multiple micro-holes, distributing pressure over a larger area. Lower pressures limit the suction of surrounding tissue into these micro-holes, significantly reducing tissue microtrauma. Using an ex vivo model replicating the intra-abdominal pressure conditions of the bladder, the intra-catheter pressure was measured during drainage. When mucosal suction occurred, intra-catheter images were recorded. Subsequently affected tissue samples were investigated histologically. The negative pressure peaks caused by mucosal suction were found to be very high for the CECs, leading to exfoliation of the bladder urothelium and breakage of the urothelial barrier. However, a micro-hole zone catheter (MHZC) with a multi-eyelet drainage zone showed significantly lower pressure peaks, with over 4 times lower peak intensity, thus inducing far less extensive microtraumas. Limiting or even eliminating mucosal suction and resulting tissue microtrauma may contribute to safer catheterizations in vivo and increased patient comfort and compliance.

Patterns of neurogenic lower urinary tract dysfunction management and associated factors among Chinese community-dwelling individuals with spinal cord injury

To identify different patterns of neurogenic lower urinary tract dysfunction management among Chinese community-dwelling individuals with spinal cord injury and explore the factors associated with latent classes. This was a cross-sectional study conducted in communities throughout China Mainland. Participants were recruited through the China Association of Persons with Physical Disability and a total of 2582 participants was included in the analysis. The data were collected by a questionnaire consisting of socio-demographic factors, disease-related factors, and a list of 8 bladder management methods. Latent class analysis was used to identify different latent classes of neurogenic lower urinary tract dysfunction management. Then the multinomial logistic regression was applied to analyze the relationship between neurogenic lower urinary tract dysfunction management patterns and socio-demographic and disease-related factors. Neurogenic lower urinary tract dysfunction management pattern among community-dwelling individuals with spinal cord injury was divided into four latent classes: "urinal collecting apparatus dominated pattern" (40.3%), "bladder compression dominated pattern" (30.7%), "intermittent catheterization dominated pattern" (19.3%) and "urethral indwelling catheterization dominated pattern" (9.6%). Multinomial logistic regression analysis found that the employment status, residential region, nursing need, payment method for catheterization products, hand function, time since spinal cord injury, urinary incontinence and concerns about social interaction affected by urination problems were significantly associated with latent classes. Only 19.3% of people used the intermittent catheterization as their main neurogenic lower urinary tract dysfunction management method. More attention needs to be paid to the promotion of the standardization process of intermittent catheterization in community-dwelling individuals with spinal cord injury. The associated factors of the four classes can be used for tailored and targeted interventions to increase the use of intermittent catheterization.

Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study

BACKGROUND

Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure.

AIM

The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI.

DESIGN

This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data.

METHODS

A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis.

RESULTS

Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'.

CONCLUSION

It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

Catching Up With Clean Intermittent Catheterization: Guide to Products, Tips, and Tricks

Clean intermittent catheterization (CIC) is the gold standard for the management of urinary retention. Students with special healthcare needs who require CIC can be supported by school nurses who have knowledge and expertise in the management of CIC including an understanding of available products, reinforcement of proper technique, and resources available to promote student independence. This article will discuss the variety and unique features of CIC products and tips to overcoming barriers in bladder management.

Burden of illness among intermittent catheter users with non-neurogenic urinary retention in Denmark

BACKGROUND

Urinary retention (UR) caused by non-neurogenic conditions is a frequent disorder often requiring the use of intermittent catheterization (IC). This study examines the burden of illness among subjects with an IC indication due to non-neurogenic UR.

METHODS

Health-care utilization and costs were extracted from Danish registers (2002-2016) related to the first year after IC training and compared to matched controls.

RESULTS

A total of 4,758 subjects with UR due to benign prostatic hyperplasia (BPH) and 3,618 subjects with UR due to other non-neurological conditions were identified. Total health-care utilization and costs per patient-year were significantly higher compared to matched controls (BPH: 12,406 EUR vs 4,363, p < 0.000; other non-neurogenic causes: 12,497 EUR vs 3,920, p < 0.000) and driven mainly by hospitalizations. Urinary tract infections (UTIs) were the most frequent bladder complications often requiring hospitalization. The inpatient costs per patient-year for UTIs were significantly higher for cases than controls (BPH: 479 EUR vs 31, p < 0.000; other non-neurogenic causes: 434 EUR vs 25, p < 0.000).

CONCLUSIONS

The burden of illness caused by non-neurogenic UR with need for IC was high and essentially driven by hospitalizations. Further research should clarify if additional treatment measures may reduce the burden of illness in subjects suffering from non-neurogenic UR using IC.

Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections

INTRODUCTION

Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating.

OBJECTIVE

To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC.

METHODOLOGY

A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software.

RESULTS

Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60).

CONCLUSION

We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.

Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele

AIMS

This study was conducted to identify potential risk factors for permanent clean intermittent catheterization (CIC) and incontinence in patients with lipomyelomeningocele (LMMC) and evaluate how LMMC affects bladder function prognosis, measured by urodynamic (UD) score.

METHODS

This retrospective study analyzed the electronic health records of patients who underwent primary neurosurgical repair for LMMC at a single tertiary referral center between January 2012 and December 2016 and were followed at least 3 years after surgery. Data regarding bladder function were obtained from medical records for multiple time points, including before surgery, after surgery but before hospital discharge, 3 months after surgery, and at outpatient visits during follow-up.

RESULTS

This study enrolled 120 patients. At a mean follow-up of 62.6 ± 13.9 months after primary neurosurgical LMMC repair, 22 (18.3%) patients continued to require CIC for bladder emptying, only 7 (31.8%) of whom maintained bladder continence. A multivariate logistic regression model identified age at the time of surgery and the type of LMMC as significant presurgical prognostic risk factors for permanent CIC. In addition, postoperative urinary retention and a UD score greater than or equal to 5 measured 3 months after surgery were identified as significant postsurgical risk factors for permanent CIC and urinary incontinence. A linear mixed model adjusted for age at the time of surgery showed that patients with a transitional or chaotic LMMC type were more likely to experience gradual bladder function decline than patients with other LMMC types.

CONCLUSIONS

This study identified both presurgical (age at the time of surgery, LMMC type) and postsurgical (postoperative urinary retention, UD score greater than or equal to 5 at 3 months postsurgery) risk factors for permanent CIC and urinary incontinence. In addition, LMMC type was identified as a prognostic risk factor for bladder function decline. These results will enhance the current understanding of bladder function outcomes in patients who undergo surgical treatment for LMMC.

The Effect of Video-Assisted Clean Intermittent Catheterization Training on Patients' Practical Skills and Self-Confidence

PURPOSE

This research was carried out in order to examine the effect of clean intermittent catheterization (CIC) training with a video developed by the researchers on patients' ability to practice CIC and self-confidence.

METHODS

The population of the study consisted of patients who had just started performing CIC in the urology polyclinic of a city hospital in Istanbul. The sample consisted of a total of 80 patients, 40 of whom were in the experimental group and 40 in the control group. The experimental group patients were given CIC training with a training video that was downloaded to the mobile phone of the patient, a family member, or caregiver. The patients' practice skills were evaluated by 2 independent observers. The DISCERN Inquiry Form and the Global Quality Score, the Patient Information Form, the CIC Skill Checklist and the Self-Confidence Scale in Clean Intermittent Self-Catheterization were used to collect data.

RESULTS

In the experimental group, consisting of patients who received video-assisted training, the mean scores for the CIC Skill Checklist and the Self-Confidence Scale in Clean Intermittent Self-Catheterization were statistically significantly higher than in the control group (P<0.001), the experience of feeling pain during catheterization was less than in the control group, and the patients in the experimental group experienced statistically significantly fewer complications such as urinary tract infections, urgency, urinary incontinence, hematuria and urethral stricture (P<0.05).

CONCLUSION

Video-assisted CIC training had a positive effect on patients' practical skills and self-confidence.

Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder

INTRODUCTION

Clean intermittent catheterization (CIC) is a mainstay in the management of neurogenic bladder.

OBJECTIVE

To assess the effect of CIC on urinary tract infection and upper renal tract function in pediatric patients with neurogenic bladder, and the influence of duration of CIC on these variables.

STUDY DESIGN

A retrospective study was performed in 67 pediatric patients with neurogenic bladder who started CIC between 2014 and 2019 at our institution. The febrile urinary tract infection (fUTI) rate, renal pelvis diameter (measured by antero-posterior renal pelvis diameter, APPD), bladder wall thickness (BWT) on ultrasound, and creatinine level at 6 months and 12 months of CIC were compared with baseline in all patients. The grade of vesicoureteral reflux (VUR) at 12 months of CIC were also compared with baseline.

RESULTS

There were no significant differences compared with baseline after 6 months of CIC in the rate of fUTI, APPD, and BWT (p > 0.05); however, all of these parameters significantly improved after 12 months of CIC (p < 0.05). The VUR grade was significantly reduced after 12 months of CIC(p = 0.03). There was no significant change in serum creatinine level with any duration of CIC (both p > 0.05).

DISCUSSION

Continuing CIC for more than 6 months had a beneficial influence on protecting the upper urinary tract. Complications of CIC, such as recurrent fUTI and lower urinary tract trauma, are more likely to occur in the early stage of CIC due to poor technique by the caregivers and poor patient compliance underscoring the importance of caregiver education. Study limitations include the retrospective nature and small sample size.

CONCLUSION

CIC for less than 6 months may have limited influence on renal protection; however, a longer duration of CIC (12 months) resulted in significant improvement in outcomes. This study demonstrates the importance of proper caregiver education to establish standardized CIC techniques and to improve CIC quality.

Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective

Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.

Effects of hydrophilic coated catheters on urethral trauma, microtrauma and adverse events with intermittent catheterization in patients with bladder dysfunction: a systematic review and meta-analysis

Background

Hydrophilic coated catheters are recommended to reduce the side effects of intermittent catheterization (IC) in patients with bladder dysfunction. However, there is lack of Level one evidence to support the use of this intervention.

Search methods

Several electronic databases were systematically searched to evaluate complication incidences for hydrophilic coated (HC) and non-hydrophilic catheters (NHC).

Results

Twelve studies were eligible for inclusion in the review. The meta-analyses exploring microscopic hematuria frequencies (RR = 0.69; 95% CI 0.52–0.90) and urethral stricture frequencies (RR = 0.28; 95% CI 0.13–0.60) showed a lower risk ratio associated with HC in comparison to NHC, whereas gross hematuria was no statistically significant difference in two groups. Subgroup analyses of gross hematuria which was grouped according to "catheterization frequency", "single/multiple catheterization" and "self/other catheterization” were performed and the values of combined RR were also no statistically significant difference.

Conclusions

Compared with non-hydrophilic catheters, the hydrophilic coated catheters have positive significance in reducing the incidence of urethral microtrauma and the urethral stricture. However, more studies are warranted for evaluating effects of hydrophilic coated catheters on the incidence of gross hematuria.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11255-022-03172-x.

Results of the patient report of intermittent catheterization experience (PRICE) study

AIMS

Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients' actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC.

METHODS

This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ).

RESULTS

Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a "blocking sensation" during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported.

DISCUSSION/CONCLUSION

Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.

Contemporary management considerations of urinary tract infections for women with spina bifida

INTRODUCTION AND HYPOTHESIS

Urinary tract infections (UTIs) are one of the leading health concerns and causes of hospitalization for adults with spina bifida (SB). The risk factors, evaluation, management, and prevention of UTIs in women with SB must take into consideration their unique pelvic anatomy and function as well as the desire for pregnancy or the occurrence UTI during pregnancy. This article reviews published literature regarding this topic and offers recommendations for UTI evaluation, management, and prevention in the context of the unique pelvic floor health needs of women with SB.

METHODS

A systematic review was conducted using the following keywords: spinal dysraphism, spina bifida, myelomeningocele, meningocele, urinary tract infections, females, and adults. Articles were included if they were in English, published during or after 2000, peer reviewed, included women with spina bifida aged 18 or greater, and included outcomes related to urinary tract infection.

RESULTS

No articles met inclusion criteria.

CONCLUSION

As no articles were found based on the initial search criteria, articles pertaining to neurogenic bladder UTI risks, evaluation, and management were discussed to develop consensus recommendations for the unique care of UTIs in women with SB.

Intermittent catheterisation: the common complications

Intermittent catheterisation (IC) has been in practice for more than 40 years and is considered the gold standard in the management of urinary retention in the neurological bladder. IC has many advantages over indwelling urethral or suprapubic catheterisation, including reducing the risk of infection, protecting the bladder and improving quality of life. However, complications can be caused by the practice of this technique, the most common of which is infection. This review discusses some of the common complications that can occur with the use of intermittent catheterisation, including urinary tract infection (UTIs) and urethral complications. It also highlights the role of the nurse in the management of its complications.

The burden of illness in initiating intermittent catheterization: an analysis of German health care claims data

BACKGROUND

Intermittent catheterization (IC) is a common medical technique to drain urine from the bladder when this is no longer possible by natural means. The objective of this study was to evaluate the standard of care and the burden of illness in German individuals who perform intermittent catheterization and obtain recommendations for improvement of care.

METHODS

A descriptive study with a retrospective, longitudinal cohort design was conducted using the InGef research database from the German statutory health insurance claims data system. The study consisted of individuals with initial IC use in 2013-2015.

RESULTS

Within 3 years 1100 individuals with initial IC were identified in the database (~ 19,000 in the German population). The most common IC indications were urologic diseases, spinal cord injury, Multiple Sclerosis and Spina Bifida. Urinary tract infections (UTI) were the most frequent complication occurring 1 year before index (61%) and in follow-up (year 1 60%; year 2 50%). Resource use in pre-index including hospitalizations (65%), length of stay (12.8 ± 20.0 days), physician visits (general practitioner: 15.2 ± 29.1), prescriptions of antibiotics (71%) and healthcare costs (€17,950) were high. Comorbidities, complications, and healthcare resource use were highest 1 year before index, decreasing from first to second year after index.

CONCLUSIONS

The data demonstrated that prior to initial catheterization, IC users experienced UTIs and high healthcare utilization. While this demonstrates a potential high burden of illness prior to initial IC, UTIs also decreased over time, suggesting that IC use may have a positive influence. The findings also showed that after the first year of initial catheterization the cost decreased. Further studies are needed to better understand the extent of the burden for IC users compared to non-IC users.

Development, validation and application of clinical simulation scenarios for assessment of stomatherapy specialists

OBJECTIVES

to build and validate three clinical simulation scenarios and report the application with candidates for the specialist's degree in stomatherapy.

METHODS

methodological study, building three scenarios and evaluation checklists; content validation with judges, using content validity index and Modified Kappa Coefficient; pre-test and application.

RESULTS

scenarios built based on nursing care for: 1. insufficiency and venous ulcer; 2. demarcation of intestinal stomia; and 3. Clean intermittent catheterization. In the content validation of the 24 items appreciated, 83%, 80%, and 92% were validated without change. In the pre-test, the objectives and checklists were adjusted. In the application, to standardize the evaluation, actors and evaluators were trained previously, and each candidate passed the three stations.

CONCLUSIONS

scenarios built and with validated content, based on evidence and covering the three areas of stomatherapy. The pre-test allowed for adjustments in the scenarios, and the candidates achieved the expected objectives.

Prostate Artery Embolization - Adverse Events and Peri-Procedural Management

As prostate artery embolization (PAE) for treatment of lower urinary tract symptoms attributed to benign prostatic hyperplasia becomes more commonly performed, operator knowledge of the adverse events is essential to inform patient selection, patient preparation, and postprocedural management. The aim of this article is to discuss the incidence, presentation, and management of adverse effects after PAE.

The evidence supporting single-use intermittent catheters in people with spinal cord injury

Intermittent catheterization (IMC) is the accepted evidence-based best practice for bladder management in people with voiding dysfunction due to neurogenic bladder. The two methods for performing IMC over the decades since this practice was introduced are reuse and single-use catheters. There are perceived advantages and disadvantages of each method of performing IMC. There is considerable evidence that single-use IMC is associated with better health outcomes, including reduced risk of urinary tract infection, urethral trauma, and quality of life. People performing IMC also indicate a preference for single-use, although there are advantages of reuse that need to be acknowledged. Ideally, further research is needed in this area, particularly around the washing and storage of reuse catheters, as well as an adequately powered multicenter RCT comparing reuse with single-use IMC, but there are numerous challenges associated with progressing this research.

Difficulties of patients and caregivers in performing clean intermittent catheterization: scoping review

Objective: To identify the main difficulties reported by patients and caregivers in the use of clean intermittent catheterization described in the scientific literature. Methods: Scoping review with studies published in Portuguese, English or Spanish, without date limit, in electronic databases and digital libraries, using descriptors and keywords. Results: 790 studies were identified, including 34 studies published between 1984 and 2019. The main difficulties reported in performing clean intermittent catheterization were related to catheter insertion, pain, discomfort, urethral trauma, public bathrooms with inadequate facilities, physical difficulties and lack of access to necessary inputs. Conclusion: The studies analyzed show the difficulties that patients who use clean intermittent catheterization and their caregivers face on a daily basis, which are related to intrinsic and extrinsic, institutional and governmental factors and can decrease satisfaction and adherence to rehabilitation programs bladder, with an impact on the quality of life of patients and their caregivers. Therefore, it highlights the need for health education for the proper teaching of performing clean intermittent catheterization, emphasizing the importance of the nurse’s role in this process.

Dificuldades de pacientes e cuidadores na realização do cateterismo intermitente limpo: revisão de escopo

Objetivo: Identificar as principais dificuldades relatadas pelos pacientes e cuidadores no uso do cateterismo intermitente limpo descritas na literatura científica. Métodos: Revisão de escopo com estudos publicados em português, inglês ou espanhol, sem limite de data, em base de dados eletrônicas e bibliotecas digitais, utilizando descritores e palavras-chave. Resultados: Foram identificados 790 estudos, sendo incluídos 34 estudos publicados entre 1984 e 2019. As principais dificuldades relatadas na realização do cateterismo intermitente limpo foram referentes a inserção do cateter, dor, desconforto, trauma uretral, banheiros públicos com instalações inadequadas, dificuldades físicas e falta de acesso aos insumos necessários. Conclusão: Os estudos analisados evidenciam as dificuldades que os pacientes usuários do cateterismo intermitente limpo e seus cuidadores enfrentam no dia a dia, que estão relacionadas à fatores intrínsecos e extrínsecos, institucionais e governamentais e podem diminuir a satisfação e a aderência aos programas de reabilitação vesical, com impacto na qualidade de vida dos pacientes e seus cuidadores. Portanto destaca-se a necessidade de educação em saúde para o adequado ensino da realização do cateterismo intermitente limpo, enfatizando a importância do papel do enfermeiro nesse processo.

The role of clean intermittent catheterization in the treatment for detrusor underactivity

OBJECTIVE

To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU).

MATERIAL AND METHODS

A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test.

RESULTS

The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time.

CONCLUSIONS

CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.

Clean intermittent catheterization in patients with spinal cord injury: knowledge of nurses

Introduction: Spinal cord injury results in failure to empty the bladder, leaving the individual exposed to the risk of recurrent urinary tract infection, vesicoureteral reflux and even loss of renal function. Clean intermittent catheterization (CIC) is the method of choice for emptying the bladder in these cases. Although it has a simple technique, its performance should be well oriented in order to avoid complications such as infections or traumas. Guidance for the technique should be performed during the hospitalization period due to the injury and the nurse is responsible for this action. Objective: To evaluate the knowledge of nurses working in a trauma care hospital in relation to clean intermittent catheterization. Methods: Questionnaire constructed based on the guidelines of the European Association of Urological Nurses, applied to 18 nurses from a university hospital, a reference in the treatment of spinal trauma, regarding neurological dysfunction of the lower urinary tract and clean intermittent catheterization. Results: The participants presented expressive knowledge about lower urinary tract neurological dysfunction and CIC. There were errors regarding the CIC technique in the indication of the use of procedure gloves, in the lubrication of the catheter, collection of periodic urine cultures, use of antibiotics and in the need for instructions before discharge from hospital. Conclusion: Although the sample demonstrated knowledge on several issues related to the subject, the errors indicate the need for training and especially awareness of the responsibility of guidance before discharge from hospital.

Cateterismo intermitente limpo no paciente com lesão medular: conhecimento dos enfermeiros

Introdução: A lesão medular resulta em falha no esvaziamento da bexiga, deixando o indivíduo exposto a risco de infecção recorrente de trato urinário, refluxo vesicoureteral e até perda da função renal. O cateterismo intermitente limpo (CIL) é o método de escolha para esvaziamento da bexiga nesses casos. Apesar de ter uma técnica simples, sua realização deve ser bem orientada a fim de evitar complicações como infecções ou traumas. A orientação para a técnica deve ser realizada ainda no período de internação pela lesão, cujo responsável é o enfermeiro. Objetivo: Avaliar o conhecimento dos enfermeiros que atuam em hospital de atendimento ao trauma com relação ao cateterismo intermitente limpo. Métodos: Questionário construído com base nas diretrizes da Associação Europeia de Enfermeiros Urológicos, aplicado a 18 enfermeiros de um hospital universitário, referência no atendimento do trauma raquimedular, a respeito de disfunção neurológica de trato urinário inferior e cateterismo intermitente limpo. Resultados: Os participantes apresentaram conhecimento expressivo a respeito da disfunção neurológica de trato urinário inferior e CIL. Houve erros quanto à técnica do CIL nos quesitos de indicação do uso luvas de procedimento, na lubrificação do cateter, coleta de culturas periódicas de urina, uso antibióticos e na necessidade de orientação antes da alta hospitalar. Conclusão: Apesar de a amostra demonstrar conhecimento em várias questões relacionadas ao tema, os erros indicam necessidade de capacitação e principalmente de conscientização quanto à responsabilidade de orientação antes da alta hospitalar.

Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life

PURPOSE

Intermittent catheterization (IC) is a proven effective long-term bladder management strategy for individuals who have lower urinary tract dysfunction. This study provides clinical evidence about multiple-reuse versus single-use catheterization techniques and if catheter choice can have an impact on health-related quality of life (HRQoL).

METHOD

A prospective, multi-center, clinical trial studied patients who currently practiced catheter reuse, and who agreed to prospectively evaluate single-use hydrophilic-coated (HC) (i.e. LoFric) catheters for 4 weeks. A validated Intermittent Self-Catheterization Questionnaire (ISC-Q) was used to obtain HRQoL. Reused catheters were collected and studied with regard to microbial and debris contamination.

RESULTS

The study included 39 patients who had practiced IC for a mean of 10 years, 6 times daily. At inclusion, all patients reused catheters for a mean of 21 days (SD = 48) per catheter. 36 patients completed the prospective test period and the mean ISC-Q score increased from 58.0 (SD = 22.6) to 67.2 (SD = 17.7) when patients switched to the single-use HC catheters (p = 0.0101). At the end of the study, 83% (95% CI [67-94%]) preferred to continue using single-use HC catheters. All collected reused catheters (100%) were contaminated by debris and 74% (95% CI [58-87%]) were contaminated by microorganisms, some with biofilm.

CONCLUSION

Single-use HC catheters improved HRQoL and were preferred over catheter reuse among people practicing IC. Catheter multiple-reuse may pose a potential safety concern due to colonization by microorganisms as well as having reduced acceptance compared to single use.

TRIAL REGISTRY NUMBER

ClinicalTrials.gov NCT02129738.

Unexpected foreign body in the bladder of a spinal cord injured patient: A case report

Context: Bladder dysfunction is common in patients with spinal cord injuries. Clean intermittent catheterization is a preferred method of neurogenic bladder management among spinal cord injured patients. Some complications may occur due to the use of clean intermittent catheterization.Findings: In this report, we presented a case with an unexpected foreign body detected in the bladder of a patient who used to perform clean intermittent catheterization for her neurogenic bladder management, to our knowledge, which has not been reported in the literature so far.Conclusion/Clinical Relevance: In this case report, we want to emphasis the importance of different kind of foreign bodies remaining in the bladder during clean intermittent catheterization.

Nursing Practice Related to Intermittent Catheterization: A Cross-Sectional Survey

PURPOSE

The purpose of this study was to describe nursing practice and clinical decision-making related to intermittent catheterization (IC).

DESIGN

Cross-sectional survey.

SUBJECTS AND SETTING

Three hundred forty-three nurses responded to the survey, yielding a margin of error of 5.3%. The majority (70%; n = 240) indicated they were RNs, and 15.6% stated they practiced as advanced practice nurses (nurse practitioners or clinical nurse specialists). Most (75.9%; n = 260) held at least one certification in rehabilitation, WOC, or urologic nursing. Most nurses (70.5%; n = 242) indicated 11 or more years of experience in their specialty practice.

METHODS

Data were collected via an electronic questionnaire that comprised 50 items and required 35 to 40 minutes to complete. Ten items queried demographic data and professional background, 13 queried facility policies and practice patterns related to use of IC, and 27 focused on various aspects of decision making regarding IC practice including 8 items related to catheter selection in 4 case scenarios. The questionnaire was completed online after viewing a written explanation of the purpose of the survey. Completion of the questionnaire acted as consent to study participation.

RESULTS

All respondents indicated regularly teaching IC within their practice, and 61.2% (n = 210) stated they were confident that 70% or more of patients or caregivers understood the instructions. However, responses varied considerably when asked who they involved in IC education; less than half (48.1%; n = 165) responded that they included a lay caregiver or family member when teaching a patient to perform IC. Responses also varied when asked about who was included in this education; when asked about catheter selection in 4 clinical scenarios, 9.0% to 20.9% selected inappropriate catheters. Similarly, responses varied when they were asked about use of resources to guide IC practice; 25.4% (n = 87) indicated they relied on their own best practice.

CONCLUSIONS

Findings from 343 nurses experienced in IC teaching showed considerable variability when asked about sources used to guide IC practice, who should be included in IC education, and catheter selection in 4 case scenarios. Additional research and evidence, and consensus-based resources such as clinical guidelines of a decision-making algorithm, are needed.

A systematic review of the content and quality of clinical practice guidelines for management of the neurogenic bladder following spinal cord injury

INTRODUCTION

Neurogenic bladder following acute spinal cord injury (SCI) increases urinary tract infection (UTI) risk and affects quality of life and health system costs.

OBJECTIVES

This study aimed to identify, describe and evaluate quality of clinical practice guidelines (CPGs) for managing neurogenic bladder following SCI.

METHODS

A comprehensive search covered six electronic databases (PubMed, Web of Science, Health Systems Evidence, Cochrane, CINAHL, Epistomonikos) and 12 CPG portals. Inclusion criteria were English language CPG; includes recommendations for managing neurogenic bladder in adults; all phases of care; published 2011 onwards in peer-reviewed journal/CPG portal. For eligible CPGs, key characteristics including years covered by CPG searching and number of neurogenic bladder recommendations were extracted. Quality appraisal used the AGREE II instrument. Appraiser agreement was assessed using the intraclass correlation coefficient.

RESULTS

Searching yielded 4028 citations and eight relevant CPGs. Collectively the CPGs contained 304 recommendations. Over half (160) pertained to assessment, surgery or education. Most surgery recommendations were from older CPGs; more recent CPGs emphasised conservative therapy. Methodological quality across CPGs was good in the domains of 'clarity of presentation' (84% mean domain score), 'scope and purpose' (72%) and 'editorial independence' (68%). There were shortcomings in the domains of 'rigor of development' (52%) 'stakeholder involvement' (42%) and 'applicability' (33%).

CONCLUSION

CPGs for the management of neurogenic bladder following SCI are generally robust in stating their scope and clearly presenting recommendations. Only three CPGs attained domain scores over 70% pertaining to methodological rigor. Future CPGs should also focus on providing implementation / audit resources and incorporating patient perspectives.

Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT

BACKGROUND

People carrying out clean intermittent self-catheterisation (CISC) to empty their bladder often suffer repeated urinary tract infections (UTIs). Continuous once-daily, low-dose antibiotic treatment (antibiotic prophylaxis) is commonly advised but knowledge of its effectiveness is lacking.

OBJECTIVE

To assess the benefit, harms and cost-effectiveness of antibiotic prophylaxis to prevent UTIs in people who perform CISC.

DESIGN

Parallel-group, open-label, patient-randomised 12-month trial of allocated intervention with 3-monthly follow-up. Outcome assessors were blind to allocation.

SETTING

UK NHS, with recruitment of patients from 51 sites.

PARTICIPANTS

Four hundred and four adults performing CISC and predicted to continue for ≥ 12 months who had suffered at least two UTIs in the previous year or had been hospitalised for a UTI in the previous year.

INTERVENTIONS

A central randomisation system using random block allocation set by an independent statistician allocated participants to the experimental group [once-daily oral antibiotic prophylaxis using either 50 mg of nitrofurantoin, 100 mg of trimethoprim (Kent Pharmaceuticals, Ashford, UK) or 250 mg of cefalexin (Sandoz Ltd, Holzkirchen, Germany); n = 203] or the control group of no prophylaxis (n = 201), both for 12 months.

MAIN OUTCOME MEASURES

The primary clinical outcome was relative frequency of symptomatic, antibiotic-treated UTI. Cost-effectiveness was assessed by cost per UTI avoided. The secondary measures were microbiologically proven UTI, antimicrobial resistance, health status and participants' attitudes to antibiotic use.

RESULTS

The frequency of symptomatic antibiotic-treated UTI was reduced by 48% using prophylaxis [incidence rate ratio (IRR) 0.52, 95% confidence interval (CI) 0.44 to 0.61; n = 361]. Reduction in microbiologically proven UTI was similar (IRR 0.49, 95% CI 0.39 to 0.60; n = 361). Absolute reduction in UTI episodes over 12 months was from a median (interquartile range) of 2 (1-4) in the no-prophylaxis group (n = 180) to 1 (0-2) in the prophylaxis group (n = 181). The results were unchanged by adjustment for days at risk of UTI and the presence of factors giving higher risk of UTI. Development of antimicrobial resistance was seen more frequently in pathogens isolated from urine and Escherichia coli from perianal swabs in participants allocated to antibiotic prophylaxis. The use of prophylaxis incurred an extra cost of £99 to prevent one UTI (not including costs related to increased antimicrobial resistance). The emotional and practical burden of CISC and UTI influenced well-being, but health status measured over 12 months was similar between groups and did not deteriorate significantly during UTI. Participants were generally unconcerned about using antibiotics, including the possible development of antimicrobial resistance.

LIMITATIONS

Lack of blinding may have led participants in each group to use different thresholds to trigger reporting and treatment-seeking for UTI.

CONCLUSIONS

The results of this large randomised trial, conducted in accordance with best practice, demonstrate clear benefit for antibiotic prophylaxis in terms of reducing the frequency of UTI for people carrying out CISC. Antibiotic prophylaxis use appears safe for individuals over 12 months, but the emergence of resistant urinary pathogens may prejudice longer-term management of recurrent UTI and is a public health concern. Future work includes longer-term studies of antimicrobial resistance and studies of non-antibiotic preventative strategies.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN67145101 and EudraCT 2013-002556-32.

FUNDING

This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment Vol. 22, No. 24. See the NIHR Journals Library website for further project information.

Medical Management of Neurogenic Bladder for Children and Adults: A Review

Neurogenic bladder is a chronic condition affecting patients of all ages with significant medical and quality of life implications. Goals of treatment consist of protection of the upper urinary tract and promotion of reliable urinary continence. Successful management involves medications and most often bladder drainage via clean intermittent catheterization. This article reviews current literature on medical management to achieve goals of treatment.

User perception of a new hydrophilic-coated male urinary catheter for intermittent use

AIMS

This study investigated user perception and adherence related to a hydrophilic-coated urinary catheter (LoFric® Origo™), available for male patients who practice intermittent catheterization.

DESIGN

The study had a prospective observational design, including patients from 19 European hospitals.

METHODS

A total of 416 patients were eligible for the study; 179 experienced catheter users and 237 de novo. Two questionnaires were filled out, one describing background data and a second, 8 weeks later, evaluating catheter features.

RESULTS

The response rate for the second questionnaire was 88% (365 patients). Patients evaluating the new catheter showed a general satisfaction rate of 81% and 72% kept using it. The hygienic grip of the catheter was appreciated by 85% and the foldable feature by 67%. The results show that convenience, ease of use, and hygienic factors are patient-preferred features for a urinary catheter. These factors were confirmed for the evaluated hydrophilic-coated catheter.

Bladder management during pregnancy in women with spinal-cord injury: an observational, multicenter study

INTRODUCTION AND HYPOTHESIS

Pregnancy in women with spinal-cord injury (SCI) poses a clinical challenge. We hypothesized that changes in the management of neurogenic bladder during pregnancy are commonly required and should receive more attention.

METHODS

Data were collected by retrospective analysis of medical records and via cross-sectional survey of 52 women with SCI, representing 67 pregnancies, at ten Italian neurourological clinics. All participants provided informed consent.

RESULTS

Between 1976 and 2013, 39 participants had one child, 11 had two children, and two had three children. Mean age at the time of SCI was 18 years and at the time of first pregnancy was 30 years. Delivery occurred from weeks 32 to 40 in 98% of first and second pregnancies, and 94% of neonates were healthy. Oxybutynin was used by four women during five pregnancies, which resulted in delivery of healthy babies. Intermittent catheterization was used before 54% of first pregnancies and 39% of second pregnancies. Bladder management was altered during 45% of these pregnancies, and the most common changes were increased use or frequency of intermittent catheterization or use of an indwelling catheter. Urinary tract infections occurred in 48% of pregnancies, and an irregular course was reported in 13% of pregnancies mainly related to tetraplegia and urological complications.

CONCLUSIONS

Pregnancy in women with SCI generally has good outcomes and limited risks but frequently necessitates changes in the management of neurogenic bladder. High levels of awareness and focused monitoring of bladder issues are recommended.