Key considerations of intermittent catheterisation

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023

AIMS

The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol.

METHODS

The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC.

RESULTS

There is no consensus on the threshold value of PVR that is considered "elevated" or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol.

CONCLUSIONS

There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated" or "significant" PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

A Real-world Data Analysis of Intermittent Catheterization, Showing the Impact of Prelubricated Versus Hydrophilic Catheter Use on the Occurrence of Symptoms Suggestive of Urinary Tract Infections

Background

Systematic reviews have highlighted the lack of evidence on choosing the type of intermittent urinary catheter (IUC) with regard to the occurrence of urinary tract infections (UTIs).

Objective

To describe the incidence and frequency of symptoms suggestive of UTIs (ssUTIs) for prelubricated versus hydrophilic IUCs.

Design, setting, and participants

An observational study of a patient database compiled by UK general practitioners was conducted.

Outcome measurements and statistical analysis

The primary outcome measures were the proportion of patients with at least one ssUTI (prescription of a nonspecific antibiotic with a UTI-related diagnosis, or prescription of a UTI-specific antibiotic) and the mean number of ssUTIs per affected patient in the 12 mo following the index IUC prescription. Comparable prelubricated (“PRELUBE”) and hydrophilic (“HYDRO”) catheter groups were obtained with 1:1 propensity score matching (PSM).

Results and limitations

A total of 5296 patients were included (prelubricated: n = 458; hydrophilic: n = 4838). After PSM, the two groups had similar proportions of patients with ssUTIs at baseline. The proportion of patients with ssUTIs during exposure was similar in the PRELUBE (36.9%) and HYDRO groups (41.5%; p = 0.155). However, among patients having used the same type of catheter throughout the exposure period, the proportion with ssUTIs was significantly lower in the PRELUBE group (44.6%, vs 55.0% for HYDRO; p = 0.015), as was the number of ssUTIs per patient (1.3 vs 1.8; p = 0.036).

Conclusions

When choosing a coated IUC, physicians and patients should not rule out PRELUBE IUCs for safety reasons alone.

Patient summary

Using real-world data compiled by UK general practitioners, we described the incidence and frequency of symptoms suggestive of urinary tract infection in people who were using various types of intermittent urinary catheters. When the same type of prelubricated catheter was used throughout the study period, the incidence of these symptoms was lower than for hydrophilic catheters.

How intermittent self-catheterisation can promote independence, quality of life and wellbeing

Intermittent catheterisation is considered the gold standard for bladder drainage. This article describes intermittent self-catheterisation (ISC) and which patients are likely to benefit from it. Before deciding on a patient's suitability for ISC, health professionals should carry out a full assessment and ensure the patient and/or carers are taught the skills necessary to perform the procedure. ISC enables patients to be more independent because they can choose how often and where to undertake it, which encourages adherence. The range of products is vast; the nurse can guide patients to select the catheter most suited to their individual needs.

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.