Drawing on Accounts of Long-Term Urinary Catheter Use: Design for the "Seemingly Mundane"

The design of the Foley catheter has not changed since 1937. Scientists interested in medical technology tend to focus on state-of-the-art designs for newsworthy specialties rather than the more mundane technologies of daily life. We interviewed 36 people living with a long-term urinary catheter in the United Kingdom, who described limitations of the current catheter design, including infections and complications and consequences for social life and relationships, and their perceptions of whose responsibility it was to improve the design. All took steps to hide the urine bag, but the need to use a catheter and urine bag had, for some, a very detrimental effect on social life and relationships. People living with long-term catheters are relatively isolated at home and dealing with many different underlying health problems, undermining opportunities to speak with a collective patient voice. Qualitative health researchers could act as a conduit to help stimulate new designs.

Emergency Department Placement and Management of Indwelling Urinary Catheters in Older Adults: Knowledge, Attitudes, and Practice

Indwelling urinary catheters (IUCs) are placed frequently in older adults in the emergency department (ED). Though often a critical intervention, IUCs carry significant risks. Our objective was to examine current knowledge, attitudes, and practice of emergency nurses and other providers regarding IUC placement and management in older adults.

METHODS

We surveyed ED providers at a large, urban, academic medical center. We developed questionnaires using items from previously validated instruments and questions created for this study. We also assessed providers' management of 25 unique clinical scenarios, each representing an established appropriate or inappropriate indication for IUC placement.

RESULTS

129 ED providers participated: 43 nurses and 86 other providers. Ninety-one percent of nurses and 87% of other providers reported comfort with appropriate indications for IUC placement. Despite this, on the clinical vignettes, nurses correctly identified the appropriate approach for IUC placement in only 40% of cases and other providers in only 37%. Practice varied widely between individual providers, with the nurse participants reporting appropriate practice in 16%-64% of clinical scenarios and other providers in 8%-68%. Few nurses or other providers reported reassessing their patients for IUC removal at transfer to the hospital (28% of nurses and 7% of other providers), admission (24% and 14%), or shift change (14% and 8%).

DISCUSSION

Although emergency nurses and other providers report comfort with appropriate indications for IUC placement, reported practice patterns showed inconsistencies with established guidelines. Wide practice variation exists between individual providers. Moreover, nurses and other providers infrequently consider IUC removal after placement.

Management of bladder dysfunction and satisfaction of life after spinal cord injury in Norway

BACKGROUND

There is limited knowledge about bladder dysfunction and bladder management in persons with spinal cord injury (SCI) after discharge from the hospital in Norway. The impact of bladder dysfunction on satisfaction of life has been rarely explored.

SETTING

Community-based survey from Norway.

METHODS

An anonymous cross-sectional postal survey. A questionnaire was sent to the registered members of the Norwegian Spinal Cord Injuries Association. A total of 400 participants, with traumatic or non-traumatic SCI, received the questionnaire.

RESULTS

A total of 248 subjects (62%), 180 men and 68 women, answered the questionnaire. Mean age was 54 years and mean time since injury 13.4 years. A total of 164 participants (66.1%) used intermittent catheterization for bladder emptying (48.5% women versus 72.8% men); more paraplegics than tetraplegics (77.2% versus 55.7%). Recommendations given at the Spinal Cord Units were thoroughly followed by persons who had used catheters more than 5 years. Use of incontinence pads were associated with reduced satisfaction of life.

CONCLUSIONS

The most common method of management of bladder dysfunction is clean intermittent catheterization in Norway. Recommendations were followed more thoroughly by persons who have used intermittent catheterization for more than 5 years. Spinal Cord Units are important source for information and guidance.

Does nurse self-testing affect catheter choice?

BACKGROUND

Involving patients in decision making about their care requires expert knowledge and understanding of patients' perspectives. Knowledge comes from several sources and experience; however, the self-testing of products by health professionals who teach clean intermittent self-catheterisation (CISC) has not been investigated.

AIM

This study aimed to assess the impact of self-testing on catheter evaluation by continence nurses.

METHODS

Sixteen continence nurses self-tested two catheters and completed a questionnaire on their opinions about the catheter, routine self-testing and whether the study would make them change their usual practice.

RESULTS

Almost half of the participants found self-testing intermittent catheters a useful experience and some of those who did not routinely self-test said they would do so in future.

CONCLUSION

Self-testing intermittent catheters can provide useful knowledge to those who teach CISC.

Living with an indwelling urinary catheter

Despite 450,000 people in the U.K. using long-term catheters, there is very little information available about the experience. This study aimed to gain an understanding of patients' perspectives of living with an indwelling urinary catheter.

Effects of urinary catheter education for patients undergoing prostatectomy

In a nonrandomized prospective study, significant decreases in patient anxiety with home urinary catheter management and in length of stay were reported when patients attended the preoperative prostatectomy class with standard postoperative education versus standard postoperative education.

Studying the Quality of Life and Life Satisfaction among Persons with Spinal Cord Injury Undergoing Urinary Management

The purpose of this survey was to investigate quality of life and life satisfaction among persons with spinal cord injury (SCI) who require various types of urinary management. A sample of 230 persons with SCI completed the Quality of Life Index (QLI), the Satisfaction With Life Scale (SWLS), and a demographic data form. Findings of this study indicated that there was no significant difference in QLI and SWLS with regard to the type of urinary management used (reflex voiding, indwelling catheter, suprapubic catheter, intermittent catheterization, external catheter or a combination of intermittent catheterization and external catheter). There also was no significant difference in QLI and SWLS with regard to the level of SCI or the incidence of hospitalizations for urinary infections. There were significantly higher QLI and SWLS scores for those with greater abilities to work, attend school, and participate in activities. There also was a significantly higher QLI for those without skin problems associated with urinary dysfunction.

[The anxiety and types of problems encountered by homecare patients during an intermittent self-catheterization]

The aim of this study was to clarify why a homecare patient had an anxiety and the type of difficulties while having an intermittent self-catheterization at home. We used a questionnaire survey to conduct an oral interview for 25 homecare patients, who regularly had an intermittent self-catheterization. The survey results were codified into single phrase units of meaning, and then separated into categories. The results revealed that 70 to 80% of patients who had an intermittent self catheterization in their own homes experienced an anxiety and encountered difficulties during the process. The findings emphasized the importance of providing a sort of support for homecare patients when they have an intermittent self-catheterization for the first time, as well as the importance of providing continued support until the patients are comfortable with the procedure. For a future support, these patients' anxiety need to be reduced and difficulties related to an intermittent self catheterization resolved during an outpatient visit.

Adolescents' experience with scoliosis surgery: a qualitative study

This article reports a study of adolescents' narrated experiences of undergoing scoliosis surgery. Six adolescents were interviewed. Open and semistructured questions were asked, and a qualitative content analysis of the text was performed. The results are presented in three main categories followed by subcategories. The three main categories of experience were emotional, physical, and social. The emotional aspects that emerged were fear, nightmares, nervousness, and helplessness. These had a great impact on adolescents' well-being before, during, and after the hospital visit. The physical aspects were mobilization, scars, different hip levels, pain, nausea, appetite, and urinary catheter. These aspects caused much discomfort, mostly during the hospital visit. The social aspects were friends, power, coaching and comfort, and sports. Some of the social aspects had a strong negative impact on the adolescents' well-being mostly after the hospital visit. This study suggests that both before and long after the surgery adolescents have strong emotions that they should be better prepared and helped to manage. To optimize perioperative care an interdisciplinary, a holistic approach must be taken that incorporates the complexity and whole of the adolescent's experiences. The findings of this study suggest that perioperative care of adolescents during scoliosis surgery needs to be optimized. To improve patients' psychologic preparation before surgery pediatric nurses should learn more about the individual patient and make care plans from a holistic perspective. Follow-up after discharge should address emotional, social, and physical aspects of the adolescent's health.

Is health-related-quality of life of stroke patients influenced by neurological impairments at one year after stroke?

AIM

The aim of this study was to evaluate which neurological impairments on discharge from rehabilitation services are associated with a worse outcome in terms of health related-quality of life (HRQoL) one year after stroke.

METHODS

We enrolled 528 first-time stroke patients in a multicenter observational study involving 18 Italian inpatients rehabilitation centers. Neurological impairment-related factors, socio-demographic and general clinical variables and process indicators were considered independent variables at discharge. Outcome was represented by the following dependent variables of HRQoL: EuroQoL-5D questionnaire (5D-EQoL) and its derived index (Eq-Index) and a Visual Analogue Score (QoL-VAS).

RESULTS

The strongest predictors of lower HRQoL were an incomplete limbs motor recovery. An incomplete lower limb motor recovery was associated with a lower HRQoL only in the "mobility" domains, whereas a incomplete upper limb motor recovery could predict a lower HRQoL in all domains except "mobility". Regarding cognitive impairments, the presence of neglect at discharge was associated with a lower HRQoL in "self-care", "pain-discomfort" and "anxiety-depression". Female gender, presence of urinary catheter seemed to exert a much lesser role in predicting HRQoL.

CONCLUSION

The results of this study suggest that upper limb motor impairments may have a detrimental impact on the patient's perceived HRQoL one year after stroke.

An evidence-based approach to urinary catheter changes

Many people in the community have a urinary catheter that is routinely changed by a community nurse. People with urinary catheters can experience a number of problems including catheter blockages. A blocked catheter causes great distress and inconvenience to the person and places a strain on the resources of community nursing organizations because of the need for unscheduled visits to change the catheter. A procedure that enabled catheter changes to be planned before they blocked would reduce patient distress and better assist community nursing organizations with resource management. The planned catheter change approach is a procedure that community nurses can use to better plan urinary catheter changes to minimize complications. In this article the author presents the outcomes from the implementation of a planned approach to catheter care in a home nursing service in Melbourne, Australia.

Identifying characteristics of children requiring sedation for urodynamics

The aim of this study was to identify characteristics of children requiring sedation for urodynamics. Findings suggest children between the ages of 3 and 7 are more likely to require sedation for urodynamics when compared to other age groups.

Acceptance and compliance of clean intermittent catheterization among Saudi patients

OBJECTIVE

To determine the applicability, acceptance, and compliance of the option of clean intermittent catheterization CIC when needed by patients in our society.

METHODS

We retrospectively reviewed the files of all patients for whom CIC was conducted at King Khalid University Hospital and Security Forces Hospital, Riyadh, Saudi Arabia, between 1998, and 2006. We considered primary pathology, indication of CIC, age at CIC initiation, and who administered the CIC. We also documented the acceptance and compliance levels of the procedure by the patient over time.

RESULTS

We included 280 patients, of which 118 (42%) were female and 162 (58%) were male in this study. The main pathology was myelodysplasia in 196 (70%) patients, posterior urethral valve in 52 (18.6%) patients, and non-neuropathic bladder sphincter dysfunction in 32 (11.4%) patients. The mean age was 6.49 +/- 4.25 years. Two hundred and fifty-seven (91.7%) families and their children accepted the idea of CIC, and 248 (88.6%) continued with the CIC program. Mothers were responsible for carrying out the procedure in 204 (72.9%) patients. However, in 76 (27.1%) cases, the patient was doing the procedure independently and the average age for a child to master the technique was 8 years. During the last 3 years, an urotherapist took over the educational services and performed outpatient education instead of our previous inpatient education.

CONCLUSION

Clean intermittent catheterization is an appropriate method of treatment for our group of patients. They showed excellent acceptance of and compliance with the procedure, however, we suggest that for complete success, proper education, teaching, and follow-up should be conducted.

In-out catheterization of young children with suspected urinary tract infection: a retrospective journal study

It is important that pediatric nurses know that the methods they use are reliable and the most appropriate for the child's security and well being. In-out catheterization is a sterile invasive method to obtain a urine sample in young children. To confirm this as a reliable method, a study of medical records from 61 children ages 0 to 24 months with suspected urinary tract infections (UTIs) was performed. Each child had produced both a urine sample from an adhesive bag and a urine sample from in-out catheterization. Dipsticks were taken from both samples; and the methods were compared with kappa analysis. Cultures were obtained from the catheter urine. UTI was verified as a growth in the catheter urine in 32 out of 61 children. Catheterized samples of urine with 3+ or 4+ of leucocytes all had a growth of bacteria in the culture. This examination of medical records showed that in-out catheterization is a reliable method to use to confirm UTIs in children 0 to 24 months.

Evaluation of a device to facilitate female urethral catheterization

Urethral catheterization is a skilled procedure that nurses in hospital settings perform routinely. The opening of the female urethra is located within the vulvar vestibule, making insertion of urinary catheters into females a greater technical challenge than in males. Researchers evaluated whether a new device might decrease the time required for catheter insertion, increase the likelihood of inserting the catheter on the first attempt (improved accuracy), and reduce patient discomfort. Comments about the device from both patients and nurses also are reported.

Outcomes and Quality of Life of Adults Undergoing Continent Catheterizable Vesicostomy for Neurogenic Bladder

OBJECTIVES

To evaluate the functional outcomes and quality of life of adult patients with neurogenic bladders who had undergone Casale Spiral Monti vesicostomy.

METHODS

Twelve patients who underwent Casale Spiral Monti vesicostomy from May 1999 to December 2004 were evaluated with the Medical Outcomes Study 36-item short-form health survey to assess for postoperative quality of life. Complications and patient reported continence were also documented.

RESULTS

The 12 patients (mean age 27.4 years) were followed up for a mean of 2.8 years. All 12 reported excellent urinary continence after the procedure, with only 7 patients who had the capacity to self-catheterize. Two patients reported wearing one light pad per day over the stoma. Two patients required one endoscopic dilation each for stomal stenosis, and one patient was readmitted 3 weeks postoperatively for the management of paralytic ileus. Eight patients reported no urinary tract infection since the operation. All 12 patients reported being very satisfied with the procedure.

CONCLUSIONS

The results of this study have demonstrated that Casale Spiral Monti vesicostomy can have dramatic positive effects on the quality of life in adults with a neurogenic bladder by granting them social independence, convenient bladder management, and excellent continence rates.

Suprapubic Catheters—A Shared Understanding, From the Other Side Looking In

OBJECTIVE

The objective of this study was to explore the experiences of people living with a suprapubic catheter.

METHOD

This descriptive study was guided by the philosophy of Gadamerian hermeneutics. Data were gathered via indepth interviews with 6 adults living in the community who had a suprapubic catheter for long-term urinary bladder drainage. Interpretation of the data occurred via thematic analysis of the participants' stories.

RESULTS

Two distinct but interrelated themes emerged. Participants shifted, over time, from negative to positive experiences (psychologically, physically, and practically) to adjustment to life with a catheter. Participants also related that health professionals had not adequately prepared or supported them as they learned to live with a suprapubic catheter. Many of the participants' initial negative experiences were augmented by this deficiency. Issues revolved around perceptions of being psychologically unprepared, the changed body image, altered sexuality, and support needs.

CONCLUSION

The findings of this study revealed that the insertion of a suprapubic catheter brought about significant life changes for the participants. The data highlighted disparities between the needs of people who have a supra-pubic catheter and health professionals' perceptions of their needs.

Managing the self: living with an indwelling urinary catheter

AIMS

This paper reports the findings of a study that aimed to understand the perspectives of community dwelling adults' who lived with a permanently indwelling urinary catheter. The objectives of the research were to: reveal the participants' perspective of living in the community with a permanent indwelling urinary catheter, raise awareness of the experiences of catheterized men and women and to inform community nursing practice.

BACKGROUND

Catheter care is a common nursing intervention. Clinical Nurse Consultants (CNCs) with a focus on continence drove this inquiry because it was believed that Community Nurses may underestimate the impact that a permanently indwelling catheter may have on peoples' lives.

DESIGN

Structured interviews were undertaken with twelve men and nine women (n = 21), aged between 24 and 82 years and who had a permanently indwelling catheter (either urethral or supra pubic) for longer than six months. Analysis of the interview transcripts was a collaboration between the researchers and clinicians.

RESULTS

The most significant finding was that participants wanted to learn urinary catheter self-care as this allowed them to take control and gave relevance to their daily life. Data revealed a learning pattern consisting of seven interrelated themes as people have learned to self-manage: (i) resisting the intrusion of a catheter, (ii) reckoning with the need for a catheter, (iii) being vigilant for signs of problems, (iv) reconciling between the needs of self and others, (v) reclaiming life, (vi) managing self-care, and (vii) taking control.

CONCLUSIONS

We do not suggest that people undergo a straightforward path toward catheter self-care, rather, that the seven interactive themes we have identified may be useful for observation in nursing practice whilst sensitizing nurses to clients' experiences of living with a catheter.

RELEVANCE TO CLINICAL PRACTICE

Promoting self-care of a catheter is not simply about educating clients about their condition or giving them relevant information. It is intrinsically a learning process, observing responses to every day events, such as the identification of the different sounds and sensations that may alert the individual to a full catheter bag, urine that has stopped flowing or signs of impending infection.

A Novel Product for Intermittent Catheterisation: Its Impact on Compliance with Daily Life—International Multicentre Study

OBJECTIVES

This study was undertaken to evaluate patient openness to changing and satisfaction with catheters used in intermittent catheterisation (IC) for urinary retention from neurogenic bladder dysfunction, and to compare patient response to conventional catheters and a novel packaged hydrophilic catheter: LoFric Primo.

PATIENTS AND METHODS

Of 409 patients recruited, 378 (283 males, 95 females; mean age: 43.5 yr) completed a 12-d trial of the novel catheter. The diagnoses were spinal cord lesion in 65.6%, multiple sclerosis in 9.6%, spina bifida in 2.3%, and other neurologic conditions in 22.5%; the mean duration of IC was 4.6 yr. Patients evaluated their current catheter at recruitment and the novel catheter after the 2-wk trial by questionnaire. Patient satisfaction was expressed on a Visual Analogue Scale for seven topics covering use and general satisfaction.

RESULTS

Of the 378 patients, 55.2% were happy to continue with the novel device, which was 74% of patients using standard polyvinyl chloride (PVC) catheters and 36% of those using prelubricated PVC (p=0.04). No individual patient factors were found to be significant in catheter choice. For the whole study population "ability to comply with daily life activities" was maintained with the novel product despite handling and general satisfaction being found more troublesome.

CONCLUSIONS

The main finding was that more than 50% of the patients wished to continue with the novel catheter and reported increased satisfaction regarding introduction of the catheter, handling, time spent, perception of IC, general satisfaction, and ability to cope with daily life.

The downside of ileocystoplasty for persons with cervical spinal cord injury and an indwelling urinary catheter

PURPOSE

To explore the lived experience of persons with cervical spinal cord injury with a urinary catheter in situ, managing mucus in urine following ileocystoplasty

METHOD

Descriptive qualitative methodology was employed. Semi-structured, one-to-one, audiotaped interviews with men (n=6) and a woman (n=1) with cervical-level spinal cord injuries (C4-C6). Analyses of transcribed verbatim transcripts was undertaken using thematic analysis.

FINDINGS

There was a mean of 3.6 years since ileocystoplasty. Six major themes emerged from the data. All participants perceived the surgery had adversely affected their life, in part because regular intervention was needed to manage the significant problem of mucus. There was also an increase in autonomic dysreflexia episodes experienced due to mucus blocking bladder drainage.

CONCLUSION

Consequences of mucus production have impacted negatively upon participants' health and their ability to participate in life situations, as well as increasing their dependence on others.

Adherence to clean intermittent self-catheterization procedures: determinants explored

AIMS & OBJECTIVES

The aim of the current study was to explore factors that hinder or promote adherence to clean intermittent self-catheterization (CISC) procedures in adults.

BACKGROUND

Clean intermittent self-catherization is associated with favourable patient outcomes, but adherence to the procedure is not addressed in the international literature.

METHODS

Relevant factors were explored in two studies. The first study (n = 10) addressed mastery and short-term adherence, whereas the second study (n = 20) addressed long-term adherence in these patients. Determinants of patient adherence were derived from pre-structured interviews with patients, using a content-analysis procedure.

RESULTS

A list of 16 determinants of mastery and short-term adherence and a list of 12 determinants of long-term adherence was found. Most of these determinants were found in both older (>or=65 years of age) and younger patients. However, five determinants of mastery and short-term adherence and six determinants of long-term adherence were specific to patients under the age of 65.

CONCLUSION

Our findings give a first insight into CISC adherence. General determinants of adherence relate to knowledge, complexity of the procedure, misconceptions, fears, shame, motivation and quality and continuity of professional care. Furthermore integrating CISC in everyday life can be difficult. In younger patients, availability of materials, physical impairments and resistance to a sickness role can further compromise adherence.

RELEVANCE TO CLINICAL PRACTICE

Issues of knowledge, fears, motivation and potential psychological impact of performing CISC should be addressed prior to deciding on CISC and instructing patients. Follow-up care should be improved to include re-evaluations of skills, discussing adherence, integrating CISC in daily activities and general coping issues.

Prevalence of Interstitial Cystitis in a Primary Care Setting

In this article, we report a study that assessed the prevalence of interstitial cystitis (IC) in a primary care office using symptom-based and improved diagnosis-based assessment modalities. Over the course of 1 year, all patients > or = 18 years of age who presented for a primary care office visit were administered the Pelvic Pain and Urgency/Frequency (PUF) questionnaire. Patients with potential IC as indicated by PUF score were selected for further interview and, when appropriate, a Potassium Sensitivity Test (PST) or Anesthetic Bladder Challenge (ABC). Those given the PST were queried afterward regarding the tolerability of the test. Of 3883 patients initially surveyed, 13.1% (n +/- 509) reported PUF scores suggestive of probable IC, including 17.5% (357 of 2043) of women and 8.3% (152 of 1840) of men. Overall, 4.3% (168 of 3883) of patients in this primary care population was diagnosed with IC on the basis of history, PUF score, patient interview, and results of the PST or ABC. The PST was found to be comparable to, and in most cases less painful than, several standard office-based procedures. IC is a prevalent disease in the general primary care population. The PUF questionnaire represents an easy-to-use approach for IC symptom screening, and the PST and the ABC are useful and relatively noninvasive adjuncts in the diagnosis of IC.

Patient-perceived discomfort with two coated urinary catheters

Intermittent catheterization is now the preferred method for urethral catheterization of the urinary bladder when an indwelling catheter is not required. Nevertheless, the procedure may cause discomfort or pain. This randomized, prospective study was done to compare patient-perceived discomfort between two commonly used hydrophilic, single-use catheters in women. A total of 196 women referred to the urogynaecology section in the outpatient department were randomized to be catheterized with either a LoFric (n=102) or a SpeediCath (n=94) catheter. Both catheters are hydrophilic, low friction, single-use, disposable catheters. Discomfort was measured using a visual analogue scale (VAS). The results showed no difference in degree of patient-perceived discomfort between the two groups. Median score was 0.75 VAS points in both groups, which indicates little discomfort. Half of all the patients stated that they experienced no discomfort at all.

New female catheterization device

Data from one patient enrolled in the early phase of the ongoing clinical trial evaluating an experimental device called the Cath-Assist are presented. The device is designed to facilitate female urethral catheterization by exposing the vulvar vestibule, isolating the urethral opening, and blocking the entrance to the vagina.

Catheterization options following radical surgery for cervical cancer

This trial assessed the potential benefits of intermittent self-catheterization (ISC) over standard care with suprapubic catheterization (SPC) in the postoperative bladder care of women with early-stage cervical cancer following radical hysterectomy. A prospective randomized controlled trial of 40 women was carried out. The urinary infection rate (catheter specimen of urine) was significantly higher in the ISC group at day 3 and day 5 (42% and 63%) compared to the SPC group (6% and 18%), p=0.05 and p=0.004, respectively. Forty-seven percent of patients randomized to SPC documented having problems arising from the SPC site, of which 23% were shown to have a positive wound swab. Despite a greater urinary tract infection rate, the technique of ISC was seen by women to be more acceptable, allowing fewer disturbances at night, greater freedom to live a normal life and less anxiety/embarrassment compared to SPC.

Outcomes of urinary diversion in children with spinal cord injuries

PURPOSE

To gain a better understanding of the outcomes of the Mitrofanoff procedure for urinary diversion in children with spinal cord injury (SCI).

DESIGN

Descriptive retrospective.

PARTICIPANTS/METHODS

Individuals 6 to 27 years of age with SCI with at least 1 year follow-up after the Mitrofanoff procedure. Objective data collected via retrospective chart review include general demographics and medical/surgical history. Data collected via structured telephone interview include history of adverse urological events, bladder management, bladder management independence scores, patient satisfaction, and quality of life.

RESULTS

Sixteen subjects (13 female, 3 male) with a mean age of 19 years (range 6-27 y) who underwent the Mitrofanoff procedure were interviewed. Length of postoperative follow-up ranged from 1 to 8 years (mean 4.25 y). Complications included stomal stenosis 25% (n=4) with a mean of 19 months to first occurrence of stenosis; urethral incontinence 75% (n=12); renal/bladder calculi 19% (n = 3); and stomal leakage 44% (n=7). Independence scores for bladder management after the Mitrofanoff procedure improved in 84% of subjects with tetraplegia and 25% of subjects with paraplegia. Eighty-eight percent (n 14) were satisfied with the procedure, while 12% (n=2) were somewhat satisfied. A thematic analysis of quality of life revealed that freedom (35%) and independence (35%) were most commonly cited.

CONCLUSION

While some subjects experienced complications, satisfaction was relatively high and level of independence in bladder management was greatly improved. This study demonstrates that the Mitrofanoff procedure is a beneficial option to improve independence and ease of bladder management in children with SCI.

Intermittent self-catheterization appliances for disabled patients

Occasionally, district nurses may be asked to teach a patient intermittent self-catheterization (ISC). However, if the patient has some form of physical disability that reduces their manual dexterity or limits their movement, should this stop the patient undertaking the procedure? This article outlines some of the appliances available to help disabled patients undertake ISC.

Feeling Good in Daily Life: From the Point of View of Boys With Posterior Urethral Valves

PURPOSE

We determined what is important to feel good in daily life when living with a long-term illness that requires daily treatment routines.

MATERIALS AND METHODS

Seven boys between 6 and 16 years old who were born with posterior urethral valves narrated their experiences with daily life. They were on clean intermittent catheterization, had impaired renal function and 2 had undergone transplantation.

RESULTS

Being involved in decisions about themselves was important, as was having their own doctor and nurse. Friends were important. Clean intermittent catheterization was something that worried them in relation to friends and made them feel uncertain about how they would react to it. The boys accepted the catheterization procedure as something that had to be done but they needed strategies to be able to comply. A single event, such as no available toilet, was enough to interrupt treatment.

CONCLUSIONS

In these boys prescribed treatment was a surprisingly small part of their lives. The clean intermittent catheterization routine was sometimes experienced as an obstacle in company with friends. The new challenge might be to achieve compliance with the treatment routine in daily life in a long-term perspective.

Selecting a urinary catheter and drainage system

Selecting the most appropriate urinary catheter and drainage system is an important factor towards patient comfort. Inappropriate selection may introduce an array of unnecessary catheter-associated problems and discomfort for the patient. The author has found that nurses may be able to name or recognize catheters they use, but not other makes and models of similar products produced by other companies. Therefore, selecting a catheter and drainage system can be confusing due to the vast array of catheters, materials used and drainage systems available from various companies. Consideration should also be given as to when catheter care begins: before or following catheter insertion. This article is written to help in the selection of a urinary catheter and drainage system which is best suited for the patient.

Intermittent catheterisation: using a reflective framework

Intermittent catheterisation is a safe and acceptable method of bladder emptying, however, the impact it has on a patient's quality of life may not be fully appreciated by those involved in teaching the procedure. Reflection after an event allows practitioners to critically examine the experience from the nursing and patient perspective and respond to it in relation to current theory, literature and research.

Male urinary catheterisation

This article examines the procedure of male catheterisation and its development as a role now performed by trained nurses, regardless of gentler. The reasons for urinary catheterisation, issues in relation to male sexuality and patient assessment and education are also discussed.

Catheter valves for indwelling urinary catheters: a systematic review

This mini-review aimed to systematically review the evidence on the effect of catheter valves compared to free drainage into a bag for patients with indwelling urinary catheters. Data sources used were Medline, British Nursing Index, CINAHL, Ahmed, EMBASE, EBM Reviews, the Cochrane Library and reference lists of relevant papers. Papers considered were controlled trials comparing the use of a catheter valve with the catheter bag that were published as a full report, or detailed abstract (containing sufficient information to critique) in Dutch, German or English. Two studies with a total of 122 subjects were identified. The main outcome measures considered were reduction of incidence of bladder spasm and urinary tract infection (UTI) and patient preference. No statistically difference in the incidence of bladder spasm or UTI was demonstrated but patients showed a clear preference for the valve. Further research into catheter valves is needed, with larger study groups, which include housebound male and female patients, and longer follow-up period.

Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury

BACKGROUND

The aim of this study was to assess the sexual function and activity in male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury.

METHODS

Eighty-nine patients (mean age 37.6 years with a range of 18-66) were included in the study. We requested all subjects to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5).

RESULTS

Of 89 patients, 60 (67.4%) reported having attempted no sexual intercourse over the past 6 months and 28 (31.5%) presented with IIEF-5 scores less than or equal to 21 points. When subjects were stratified according to the years since injury, 50.0% (16 of 32) with less than 2 years post-injury had no sexual activity, while 77.2 (44 of 57) with 2 years or more post-injury did (P = 0.027). Patients with sexual activity were 40.4% (23 of 57) and 18.8% (6 of 32) in patients who were able and unable to perform self-catheterization, respectively (P = 0.037). Patients with less than 2 years post-injury had 3.3-fold higher risk (odds ratio 3.33; 95% confidence interval 1.01-10.97; P = 0.048) of no sexual activity than those with 2 years or more post-injury on the multivariate model. The other parameters were not appreciably related to sexual activity.

CONCLUSION

Our results demonstrate that sexual activity as well as erectile function is poor in this population. In addition, our findings suggest that years since injury may influence sexual activity of patients with spinal cord injury.

Depressive symptoms of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

STUDY DESIGN

Prospective, cross-sectional study, based on cases of spinal cord injury (SCI).

SETTING

Three outpatient medical departments in Seoul, Korea.

OBJECTIVES

To assess depressive symptoms in patients on clean intermittent catheterization after SCI.

METHODS

In total, 102 subjects (68 males and 34 females, mean age 39.5 with a range of 18-75 years) were included in the primary analysis. A control group of 110 was selected from the routine health checkup. All subjects completed the Beck Depression Inventory (BDI).

RESULTS

For patients and controls, the average total BDI scores were 20.3+/-1.0 and 11.4+/-0.5, respectively (P<0.001). With regard to severity of depression among patient groups, three (3.0%) reported normal; four (3.9%) reported mild to moderate depression; 24 (23.5%) reported moderate to severe depression; and 71 (69.6%) reported severe depression. On the multivariate logistic regression analysis, a positive association with the risk of depression was observed in gender and type of catheterization. Female patients had a 3.8-fold higher risk (odds ratio (OR) 13.83; 95% confidence interval (CI) 1.42-10.31; P=0.008) of depression than male patients. In the same model, patients who were unable to perform catheterization independently had a 4.6-fold higher risk (OR 4.62; 95% CI 1.67-12.81, P=0.003) of depression than those who were able to perform self-catheterization.

CONCLUSIONS

The results demonstrate that the patients with neurogenic bladder secondary to SCI have higher degrees of depression than normal population. In addition, our findings also suggest that depression is closely related to gender and patient's ability to perform self-catheterization.

[Patient satisfaction with two different types of bladder catheters]

BACKGROUND

The insertion of a urinary catheter may cause some discomfort or pain. This study was done in order to compare patient-perceived discomfort with two commonly used coated urinary catheters for in-out catheterisation.

MATERIAL AND METHODS

A total of 196 women were randomised to be catheterised with one of two coated, hydrophilic catheters, either a Lofric or a SpeediCath catheter. Degree of discomfort was recorded on a 10 cm visual analogue scale.

RESULTS AND INTERPRETATION

There was no difference in patient-perceived discomfort between the two catheters. The degree of discomfort was small with both catheters, with a median score of only 0.75 cm on the scale.

A guide to male catheterization and sexuality and quality of life

Male catheterization has traditionally been the domain of the doctor and male nurse but, in modern health care, it is seen as a skill that should be part of the general nurses' education, regardless of their gender. This improves the speed of care for the male patient requiring catheterization and increases quality of care. However, the female nurse may find difficulty in asking questions about the patient's sexual health, which should be included in the assessment, and therefore this subject should be included in the nurse's education.

Health-related quality of life of patients using clean intermittent catheterization for neurogenic bladder secondary to spinal cord injury

OBJECTIVES

To determine the psychological and social status of patients using clean intermittent catheterization for neurogenic bladder according to health-related quality of life (HRQOL).

METHODS

We conducted a prospective trial involving 132 patients (81 men and 51 women, mean age 41.8 years, range 18 to 80 years) using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury. The 150 controls (90 men and 60 women) lived in the same region as the patients and were frequency matched to ensure equal age and sex distributions. HRQOL was measured using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).

RESULTS

The SF-36 scores did not reveal any significant differences between the men and women in the patient group. The SF-36 scores of the patients were significantly lower than those of the general population. When patients and controls were divided into two groups according to sex and age, the SF-36 scores of the patients were significantly lower than the controls across both sex and all age groups, other than the energy and vitality scale, the differences for which were not statistically significant in women and those younger than 50 years.

CONCLUSIONS

Our findings suggest that patients using clean intermittent catheterization because of neurogenic bladder secondary to spinal cord injury generally exhibit a reduced quality of life in all health domains as assessed by the SF-36.

Medical staff attitudes toward family presence during pediatric procedures

OBJECTIVE

Investigate health care providers' perceived advantages and disadvantages of family member presence (FMP) for a wide spectrum of procedures in the pediatric emergency department.

SETTING

Urban tertiary care children's hospital.

PARTICIPANTS

Pediatric emergency department faculty and nurses, pediatric residents.

METHODS

In a written survey, participants rated approval of FMP for 9 procedures: intravenous (IV) placement, urinary catheterization, suturing, lumbar puncture, fracture reduction, chest tube placement, endotracheal intubation, medical resuscitation, and trauma resuscitation. Respondents listed advantages and disadvantages of FMP for patients, families, and staff.

RESULTS

71% (104/146) of the surveys were completed. Attending physicians and nurses provided similarly high approval rating for less invasive procedures, with a decrement in approval for more invasive or life-threatening situations. Attending physicians and nurses were more likely than residents to approve FMP for all procedures except IV placement, suturing, and urinary catheterization, which had similar approval rates for all respondents. Commonly expressed potential advantages were ability to calm the patient, decreased parental "helplessness," and increased parental knowledge that everything was done. Disadvantages included higher anxiety in room, disturbing parental memories, and detriment to success of the procedure. Medical-legal concerns, mistrust of providers, and more difficult teaching environment were uncommonly listed as disadvantages.

CONCLUSIONS

Emergency department staff support FMP for minor procedures, yet express concern regarding the effects of this practice on the family and the success of the procedure. Most attending physicians and nurses support FMP during highly invasive procedures and resuscitations, whereas residents do not. This information provides insight into the educational and systematic requirements of implementation of FMP.

Neuropathic bladder and intermittent catheterization: social and psychological impact on families

Clean intermittent catheterization (CIC) is the mainstay of management in neuropathic vesicourethral dysfunction, both to improve continence and, more importantly, to preserve renal function. We looked at the effects of this procedure on children, adolescents, and their families. In particular, we wished to see if there were any differences between those who successfully catheterized and those who did not. Forty families were enrolled into the study. Ages of children and adolescents (23 females, 17 males) ranged from 1 to 20 years. Most participants (n=31) had spina bifida. Other causes of bladder dysfunction included transverse myelitis, spinal cord injury, and spinal neuroblastoma. Parents were assessed using the Effects of Handicap on Parents semi-structured interview, the Socioemotional Functioning Interview, and a semi-structured interview, specifically designed for the study, which looked at family characteristics and experience related to diagnosis and catheterization. In addition, the Rutter Parental 'A' Scale Questionnaire was used to screen for emotional and behavioural disorders in the child. Results showed that CIC by carer or self-catheterization itself did not cause major emotional and behavioural problems but the bladder problem may act as a focus that puts considerable strain family relationships. Although most parents disliked CIC they complied with the suggested management. It is important that all those involved understand the aims of management and success can be achieved by combined input from medical, psychological, and specialist nursing staff. The problem is lifelong and continued support from a multidisciplinary team is essential.

Association for Continence Advice. Intermittent self-catheterisation

Intermittent self-catheterisation (ISC) has reduced infection hazards and greatly improved the lives of many patients with micturition disorders. The technique is used by male and female patients who experience neurogenic bladder dysfunction or voiding difficulties. Some of the most beneficial results associated with ISC have been reported when the technique is used by people with spina bifida, paraplegia or multiple sclerosis. ISC is the preferred course of management for patients with a hypotonic bladder (a floppy bladder that is unable to contract partially or totally during the micturition cycle).

Life with an indwelling urinary catheter: the dialectic of stigma and acceptance

The purpose of this hermeneutic phenomenology was to describe and interpret the lived experience of long-term users of urinary catheters. Living with a urinary catheter involved a dialectical swing between acknowledgment that the catheter was "a part of me" and feelings of alienation and vulnerability when it was experienced as a stigma. Themes include Adjusting to embodied changes by perceiving the catheter as a "part of me," Shame and responding to shame by normalizing, and Embarrassment and coping with embarrassment by humor. Providers can minimize stigma related to the visibility of the catheter by coaching patients in strategies to manage going out of the home with a minimum of urine accidents or by helping develop ways to conceal the urine bag.

Clinical study of a new urine collection bag

A pilot study of an innovative urine drainage bag that defines a new principle regarding dependent gravity drainage was conducted. Patients and caregivers found improvement in activities of daily living, comfort, convenience, safety, and cost savings as noted by the majority of evaluators.