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.

Comparison of health related quality of life and health related outcomes among male patients with spinal cord injury with indwelling vs intermittent bladder catheterization - A pilot study

The majority of people with Spinal Cord Injury (SCI) have abnormalities in bladder function. It is important for an individual with SCI to understand the merits and demerits of different methods of bladder management. The purpose of the study is to compare the health related quality of life (QOL) and health related outcomes among male patients with SCI on indwelling and intermittent bladder catheterisation. A descriptive comparative study was conducted from June to December 2019 among patients with SCI residing in Calicut District, India. Demographic and clinical data were collected using a structured interview schedule. Quality of life was assessed by Qualiveen -30. Urine culture and Numerical pain scale were used to assess Urinary Tract Infection (UTI) and pain, respectively. The mean Qualiveen 30 score was higher among individuals with indwelling catheterisation 2.426 ± 0.52 than in individuals with intermittent catheterisation 1.746 ± 0.39, which is significant (p =0.0001) and patients with intermittent catheterisation showed better QOL. Mean pain after catheterisation was 5.07 ± 1.44 among persons with indwelling catheterisation while 4.70 ± 1.41 in intermittent catheterisation, which is not significant (p=0.13). The people with indwelling catheterisation are 5.5 times likely to develop UTI than people with intermittent catheterisation (OR 5.5, 95% CI 1.15-26.41). The better QOL and less UTI are demonstrated in patients using intermittent catheterisation over indwelling catheterisation. There is no remarkable difference of pain during catheterisation in both groups. Intermittent catheterisation can be preferred over indwelling catheterisation among persons with SCI.

Comparison of health related quality of life and health related outcomes among male patients with spinal cord injury with indwelling vs intermittent bladder catheterization - A pilot study

The majority of people with Spinal Cord Injury (SCI) have abnormalities in bladder function. It is important for an individual with SCI to understand the merits and demerits of different methods of bladder management. The purpose of the study is to compare the health related quality of life (QOL) and health related outcomes among male patients with SCI on indwelling and intermittent bladder catheterisation. A descriptive comparative study was conducted from June to December 2019 among patients with SCI residing in Calicut District, India. Demographic and clinical data were collected using a structured interview schedule. Quality of life was assessed by Qualiveen -30. Urine culture and Numerical pain scale were used to assess Urinary Tract Infection (UTI) and pain, respectively. The mean Qualiveen 30 score was higher among individuals with indwelling catheterisation 2.426 ± 0.52 than in individuals with intermittent catheterisation 1.746 ± 0.39, which is significant (p =0.0001) and patients with intermittent catheterisation showed better QOL. Mean pain after catheterisation was 5.07 ± 1.44 among persons with indwelling catheterisation while 4.70 ± 1.41 in intermittent catheterisation, which is not significant (p=0.13). The people with indwelling catheterisation are 5.5 times likely to develop UTI than people with intermittent catheterisation (OR 5.5, 95% CI 1.15-26.41). The better QOL and less UTI are demonstrated in patients using intermittent catheterisation over indwelling catheterisation. There is no remarkable difference of pain during catheterisation in both groups. Intermittent catheterisation can be preferred over indwelling catheterisation among persons with SCI.

Management of intractable bladder neck strictures following radical prostatectomy using the Memokath®045 stent

The incidence of vesicourethral anastomotic stenosis (VUAS) post radical prostatectomy varies from 1 to 26%. Current treatment can be challenging and includes a variety of different procedures. These range from endoscopic dilations to bladder neck reconstruction to urinary diversion. We investigated a 2-stage endoscopic treatment, using the thermo-expandable Memokath®045 bladder neck stent to manage patients with VUAS post radical prostatectomy. We retrospectively reviewed 30 patients, between 2013 and 2017, who underwent a Memokath®045 stent insertion following failed primary treatment (dilation and clean intermittent catheterisation) for VUAS. The mean interval time between prostatectomy and Memokath®045 stent insertion was 13 months. The mean follow-up time was 3.6 years with all patients having a minimum of 12-month follow-up. All patients had two previous attempts at endoscopic dilatation with or without incision and a trial of clean intermittent catheterisation. During stage 1, the anastomotic stricture is dilated/incised to diameter of 30 Fr, the stricture length is measured, and a catheter is left in situ. One to 2 weeks later, post haemostasis and healing, an appropriately sized Memokath®045 stent is inserted. The stent is then removed 1-year post-op. Our series of patients had a median age of 62 (54–72). Most patients (26) had a robot-assisted radical prostatectomy (RARP) or salvage procedure. Results showed improvement in IPSS scores, IPSS quality of life scores, Qmax and PVR after the Memokath®045 stent was removed compared to pre-operation. With a minimum of 12 months post stent removal, 93% of patients were fully continent, whilst 7% of patients were socially continent. 2 (7%) patients had their stents removed and not replaced due to re-stricturing and stone formation. However, no urinary tract infections, stricture recurrence or urinary retention was observed in the rest of the cohort (93%). Overall, the Memokath®045 stent was successful in treating 93% of our patients with VUAS. Our series had minimal complications that were managed with conservative measures and in three patients’ re-operation was needed. In conclusion, the Memokath®045 stent is a minimally invasive technique with faster recovery time compared to other techniques such as bladder neck reconstruction or urinary diversion. Additionally, it provides superior patency results compared to other techniques such as bladder neck incision and injection of Mitomycin C. Therefore, this management option should be considered in the management of VUAS.

Intermittent catheterisation: challenges when children move to adult services

Sharon Holroyd, Lead Clinical Nurse Specialist, Calderdale and Huddersfield NHS Foundation Trust, outlines approaches to self-catheterisation for children and young people, [email protected]

Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections

A risk factor model for urinary tract infections in patients with adult neurogenic lower urinary tract dysfunction performing clean intermittent catheterisation was developed; it consists of four domains, namely, (1) general (systemic) conditions in the patient, (2) individual urinary tract conditions in the patient, (3) routine aspects related to the patient, and (4) factors related to intermittent catheters per se. The conceptual model primarily concerns patients with spinal cord injury, spina bifida, multiple sclerosis, or cauda equina where intermittent catheterisation is a normal part of the bladder management. On basis of several literature searches and author consensus in case of lacking evidence, the model intends to provide an overview of the risk factors involved in urinary tract infections, with specific emphasis to describe those that in daily practice can be handled and modified by the clinician and so come to the benefit of the individual catheter user in terms of fewer urinary tract infections.