Intermittent Catheters

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.

Sachin Malde,1 Mo Belal,2 Rayan Mohamed‐Ahmed,3 William Gibson,4 Barbara Padilla‐Fernandez,5 Angela Rantell,3 Caroline Selai,6 Eskinder Solomon,1 Paul Abrams7

  1. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
  3. Department of Urogynaecology, King's College Hospital, London, UK
  4. Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
  5. Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
  6. Department of Uro‐Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
  7. Bristol Urological Institute, Bristol, UK
Source: Malde S, Belal M, Mohamed‐Ahmed R, et al. 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. Neurourol Urodyn. 2024;43: 1353‐1362. doi:10.1002/nau.25324.

Intermittent Catheterization Continuity Care on Bladder Function Recovery and Quality of Life in Patients After Radical Hysterectomy for Cervical Cancer: A Quasi-Experimental Study.

Bladder dysfunction is a common complication following radical hysterectomy, affecting patients' QOL. Exploring interventions, particularly IC continuity care, is crucial for identifying strategies to enhance postoperative outcomes.

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.

Analysis of the urine flow characteristics inside catheters for intermittent catheter selection.

In this study, we conducted a numerical analysis on catheter sizes using computational fluid dynamics to assess urinary flow rates during intermittent catheterization (IC). The results revealed that the fluid (urine) movement within a catheter is driven by intravesical pressure, with friction against the catheter walls being the main hindrance to fluid movement.

Comparing an Integrated Amphiphilic Surfactant to Traditional Hydrophilic Coatings for the Reduction of Catheter-Associated Urethral Microtrauma.

Hydrophilic-coated intermittent catheters have improved the experience of intermittent urinary catheterization for patients compared to conventional gel-lubricated uncoated catheters. However, the incorporation of polyvinylpyrrolidone (PVP) within hydrophilic coatings can lead to significant issues with coating dry-out.

Perspectives on technology: Single-use catheters – evidence and environmental impact

Objective: To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration.

Methods: A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single- and multi-use catheters were included in our review. All studies that reported on primary data were narratively summarised.

Results: A total of 11 studies were identified that reported on primary data comparing single- and multi-use catheters. There was no appreciable evidence suggesting reusable multi-use catheters were inferior to single-use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single-use catheters is significant.

Conclusions: The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single-use over multi-use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed.

Calvin C. Zhao,1 Craig V. Comiter,1 Christopher S. Elliott1,2

  1. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
  2. Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, USA
Source: Calvin C. Zhao, Craig V. Comiter, Christopher S. Elliott. Perspectives on technology: Single-use catheters – evidence and environmental impact. BJU International. 2024.  https://doi.org/10.1111/bju.16313.

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.

Yacoub Abuzied,1 Rasmieh Al-Amer,2 Mohammad Y N Saleh,3 Shreemathie Somduth,4 Mohammed AlBashtawy,5 Amira Mohammed Ali6

  1. Department of Nursing, Spinal Cord Injury, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
  2. Faculty of Nursing, Yarmouk University, Irbid, Jordan.
  3. Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan.
  4. Nursing Administration, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
  5. Nursing Community Health, Princess Salma Faculty of Nursing, Al Al-Bayt University, Al-Mafraq, Jordan.
  6. Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt.

Source: Abuzied Y., Al-Amer R., Saleh M. et al. Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study. Int J Nurs Pract. 2024 May 26:e13268. doi: 10.1111/ijn.13268.

Product evaluation of the Luja Micro-hole Zone Technology in clean intermittent self-catheterisation.

Clean intermittent self-catheterisation is a common procedure undertaken by people with bladder dysfunction. However, it is not without its complications, the main one being urinary tract infection.

Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single-use catheters.

To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC).

Intermittent self-catheterisation: the community nurse's role in identifying and overcoming the barriers.

With their expertise and ability to leverage the therapeutic relationship, community nurses are well-placed to manage the complications and challenges associated with intermittent self-catheterisation.

Intermittent self-catheterisation: the gold standard for individuals with bladder dysfunction.

Intermittent self-catheterisation (ISC) has long been identified as the 'gold standard' for drainage of the bladder for individuals with bladder dysfunction. This article will outline identification of appropriate individuals, the types of intermittent self-catheters available, outline how it can improve quality of life for sufferers of bladder dysfunction, outline the complications that may occur and finally, suggest why it should be recommended as the 'gold standard' if it is taught and done correctly.

Single-use catheters: evidence and environmental impact.

To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration.

Investigation of anxiety levels in caregivers who perform clean intermittent catheterization on their children and affecting factors

Purpose: The study aimed to determine the anxiety levels of caregivers who performed clean intermittent catheterization (CIC) on their children and the factors affecting them.

Methods: This descriptive study was conducted between January 6, and May 29, 2023 with caregivers of 42 patients who were followed up by the pediatric nephrology outpatient clinic of a university for CIC. The study data were collected using the "Participant Information Form" and the "State and Trait Anxiety Scale."

Results: According to the results, of the children included in the study, 73.8% were female, 64.3% were diagnosed with spina bifida (SB), and 76.2% received CIC applications 4-6 times a day. All the caregivers were mothers, and 76.2% received CIC training from a doctor. However, 78.6% of them found the training insufficient, leading them to rely on self-experimentation when applying CIC to their own children. None of the caregivers received information or training on the CIC application from nurses, and there were no home visits or telephone counseling provided after the hospital discharge. The mean score for the state anxiety scale among the caregivers was 45.90 ± 10.57, while the mean score for the trait anxiety scale was 46.92 ± 8.43. Significantly higher mean trait anxiety scores were observed among caregivers with chronic diseases who did not receive training on the CIC application (p < 0.05). Additionally, caregivers of children who experienced 3-4 urinary tract infections (UTIs) within the last 3 months also had significantly higher mean trait anxiety scores (p < 0.05). The mean trait anxiety level scores of caregivers of children who had 3-4 UTIs in the last 3 months were significantly higher (p < 0.05).

Conclusions: It was concluded that caregivers' lack of training on CIC implementation, having chronic disease, and having frequent UTIs in their children were effective on anxiety levels.

Canan Sari,1 Birsel C Demirbağ2

  1. Department of Health Care Services, Elderly Care Program, Tonya Vocational School, Trabzon University, Trabzon, Turkey.
  2. Faculty of Health Sciences, Public Health Nursing AB, Karadeniz Technical University, Trabzon, Turkey.

Source: Sari C, Demirbağ BC. Investigation of anxiety levels in caregivers who perform clean intermittent catheterization on their children and affecting factors. Neurourol Urodyn. 2024 Jan 18. doi: 10.1002/nau.25388.

Factors affecting clean intermittent catheterization compliance among children and adolescents with neurogenic bladder due to spina bifida and caudal regression syndrome.

Children and adolescents with neurogenic bladder often need clean intermittent catheterization (CIC) over a long period. Our study aimed to identify factors that affect CIC compliance and to determine if CIC compliance affected short-term urological outcomes among patients in Malaysia.

Rectus Urinoma Leading to Abscess Following Urethral Perforation From Self-Catheterization: A Case Report.

Urinomas are an accumulation of urine in the perirenal or paraureteral space due to urinary tract leakage. Stimulation of an inflammatory response results in the formation of a thick wall that encapsulates the urine.

New micro-hole zone catheter reduces residual urine and mucosal microtrauma in a lower urinary tract model.

Urinary tract infections (UTIs) are the main complication associated with clean intermittent catheterization (CIC) and are facilitated by post-void residual urine and trauma to the mucosa during voiding.

Microbial Transfer by Intermittent Catheters: An In Vitro Evaluation of Microbial Transfer in Catheter With Variable Protective Features.

The purpose of this study was to evaluate the effects of various protective features (eg, catheter cap, introducer tip, and catheter sleeve) of hydrophilic intermittent catheters against contamination with urinary tract infection-associated microorganisms using an in vitro model.

Improved emptying performance with a new micro-hole zone catheter in adult male intermittent catheter users: A comparative multi-center randomized controlled cross-over study.

To confirm the improved performance of the micro-hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs).

Male self-catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi-center, randomized, cross-over study performed across six European sites.

Advances in clean intermittent self-catheterisation: impact on trauma and urinary tract infections.

Intermittent self-catheterisation with hydrophilic coated catheters carries the risk of trauma, bleeding and infection. However, evidence suggest that these risks can be minimised with a new generation of catheters that stay lubricated over time, allowing for comfortable and safe insertion and withdrawal.

A consensus statement on when to start clean intermittent self-catheterization: An untapped resource?

Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately.