Effective evidence-based intermittent self-catheterization: an update

Botulinum toxin A injection to the external urethral sphincter for voiding dysfunction in females: A tertiary center experience

AIM

The aim of this study is to examine the functional outcomes of ona-botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD).

METHOD

A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals.

RESULT

We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self-catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVR decreased from 200 to 149 mls (p < 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actual MUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for <6 weeks) and there were no significant long-lasting adverse events.

CONCLUSION

EUS BTX-A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments.

Teaching patients clean intermittent self-catheterisation: key points

Intermittent self-catheterisation (ISC) is recognised as the gold standard for the treatment of neurological bladders. ISC involves the introduction of a catheter by the patient into the bladder and its immediate removal when drainage stops. This process needs to be repeated four to six times a day. Therapeutic patient education (TPE) is commonly used nowadays to treat and care for patients with chronic disease. Community nurses can play an active role in introducing ISC to patients and teaching them to perform it. This review emphasises the important points to consider when teaching patients ISC.

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.

Intermittent self-catheterisation in women: reducing the risk of UTIs

Intermittent self-catheterisation (ISC) is the insertion and removal of a catheter to drain the bladder and is a safe and effective way to preserve renal function. It can be used as a one-off intervention to drain urine post-operatively or to measure residual urine volumes if a bladder scanner is unavailable. ISC can also be used as a long-term option to manage bladder dysfunction, and for some provides an excellent option to maintain independence and improve quality of life. Urinary tract infections are a common complication for women undertaking ISC. This article explores the prevention of urinary tract infections in women undertaking long-term ISC for the management of bladder dysfunction.

Promoting intermittent self-catheterisation to encourage self-care in district nursing patients

Intermittent self-catheterisation (ISC) is deemed the preferred option for the management of urinary incontinence and/or retention in patients requiring a catheter. It also allows patients to self-care, thereby placing fewer demands on district nursing (DN) services and meeting the requirements of the current health policy agenda. Yet many patients who could benefit from ISC in the community still use a long-term urinary catheter. This may contribute to increased morbidity, poorer quality of life, and unnecessary visits from the DN team. This article analyses the role of the district nurse in promoting and supporting the use of ISC with suitable patients.