Self-management status and related factors of patients with intermittent clean catheterization after spinal cord injury / 中国康复理论与实践

ObjectiveTo investigate the status of self-management in patients with spinal cord injury and the related factors. MethodsFrom May, 2020 to February, 2021, 255 patients from a spinal cord injury club were enrolled, and investigated with the general information questionnaire, self-management ability scale, Chronic Disease Self-efficacy Scale through internet. Multiple linear stepwise regression was used to explore the related factors. ResultsThe scores of disease symptom management, daily life management, intermittent catheterization behavior management, emotional management and social return were (40.458±9.122), (33.945±6.800), (36.709±8.736) and (25.011±4.932), respectively. The average score for the single question of daily life management was the highest (3.772±0.755), while emotional management and social return was the lowest (3.573±0.705). Duration of intermittent catheterization, family members' attitude, self-efficacy and occupation were the related factors of symptom management (R2 = 0.135, F = 7.744, P < 0.001). Self-efficacy, duration of intermittent catheterization, use of hydrophilic coated catheters and complications were the related factors of daily life management (R2 = 0.173, F = 13.042, P < 0.001). Self-efficacy, duration of intermittent catheterization, use of hydrophilic coated catheters and medical insurance were the related factors of intermittent catheterization behavior management (R2 = 0.141, F = 10.259, P < 0.001). Self-efficacy, duration of intermittent catheterization, complications and frequency of intermittent catheter in the last week were the related factors of emotional management and social regression dimensions (R2 = 0.282, F = 19.590, P < 0.001). ConclusionThe self-management of patients with spinal cord injury by clean intermittent catheterization is at medium level. Moreover, it may be affected by many factors. Some of them can be targets of intervention.

Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Clean Intermittent Catheterization after Sigmoid Augmentation Cystoplasty and Abdominal Sigmoidostomy: A Case Report / 中国康复理论与实践

Objective:To summarize the nursing care of a patient with clean intermittent catheterization after sigmoid augmentation cystoplasty and abdominal sigmoidostomy for the treatment of neurogenic bladder. Methods:On October 16, 2017, one patient with neurogenic bladder was admitted to Beijing Bo'ai Hospital. Psychological instructions were given to the patient after surgery. Catheter of appropriate type and material was selected, and then the patient was instructed to implement correct and regular clean intermittent catheterization procedures. At the same time, nursing care of abdominal sigmoidostomy was carried out. In order to prevent tube blocking, bladder irrigation was implemented at regular intervals. Follow-up visit was scheduled. Results:After four-month follow-up, the patient completed the whole procedures successfully, and its renal function was protected without severe urinary tract infection, also the patient was with good social adaptation. Conclusion:Comprehensive nursing care is needed in patients after sigmoid augmentation cystoplasty and abdominal sigmoidostomy. Correct and regular clean intermittent catheterization is critical. Psychological nursing, care of abdominal sigmoidostomy and tube blocking prevention should not be neglected, also long-term follow-up is of great significance for the outcome.

Recent Updates in Urinary Catheter Products for the Neurogenic Bladder Patients with Spinal Cord Injury / 대한신경손상학회지

Clean intermittent catheterization (CIC) is one of the core elements of neurogenic bladder management in the patients with spinal cord injury and is effective and safe to maintain low intra-bladder pressure and achieve urinary continence. Until now, the most notable development in urinary catheter products for CIC is the introduction of hydrophilic coating. Fortunately, in Korea, the national medical insurance has recently covered the cost for urinary catheters in this patient group. The purpose of this review is to summarize the history of CIC and the recent development of urinary catheter products. From our review, we would like to suggest a way of thinking that is the way forward for the future to improve the implementation of CIC with minimal morbidity.

Risk factors for recurrent urinary tract infection in children with neurogenic bladders treated by clean intermittent catheterization / 中华实用儿科临床杂志

Objective To identify the risk factors associated with recurrent urinary tract infection (RUTI) in children with neurogenic bladders (NB) who received clean intermittent catheterization (CIC) in order to provide recommendations for reducing the risk of RUTI.Methods Records of 184 children with NB managed by CIC at the Department of Urology Surgery,the First Affiliated Hospital of Zhengzhou University from July 2011 to September 2015 were reviewed and analyzed.According to UTI incidence,they were divided into 2 groups as occasional UTI group (0-1 time/year,OUTI group) and RUTI group (＞ 1 time/year).The clinical and urodynamic data were compared between 2 groups,and the risk factors were identified by regression analysis.Results Of the total patients,147 patients (79.9％) were diagnosed as OUTI and 37 cases (20.1％) as RUTI.Median follow-up lasted for average 27 months (12-39 months).The characteristics of RUTI group was indicated significantly in the study,which included increasing age(7.4 years old vs.5.9 years old),a higher level of spinal lesions,and more vesicoureteral reflux(VUR),and there were significant differences in bladder wall thickness(4.7 cm vs.3.6 cm) and lower bladder compliance compared with RUTI group (all P ＜ 0.05).But there was no statistical significance in gender,antibiotics,hydronephrosis,incontinence,bladder capacity,detrusor overactivity,detrusor sphincter dyssynergia and detrusor leakage point pressure between 2 groups (all P ＞ 0.05).Increasing age,increased bladder wall thickness,lower bladder com-pliance and the presence of VUR were independent risk factors associated with RUTI group (all P ＜ 0.05).Conclusions Increasing age,increasing bladder wall thickness,lower bladder compliance and VUR are the risk factors for RUTI in NB children managed with CIC.It is necessary to follow up video-urodynamic and ultrasound findings in order to identify the high-risk patients and provide the evidence for preventing RUTI.

Early application of clean intermittent catheterization in children with neurogenic bladder / 中华泌尿外科杂志

Objective To investigate the effect of early application of clean intermittent catheterization(CIC) in infants with neurogenic bladder(NB).Methods Eighty-seven children with NB diagnosed in our urodynamic center were less than 1 year old when they first came to hospital from January 2007 to January 2010, and CIC was carried out at different age.Sixty-four patients were followed up for a long time and divided into early CIC group(less than 1 year old children) and late CIC group(more than 3 years old children) according to the treatment time.Early CIC group included 29 patients [19 boys and 10 girls with the mean age of (7.5 ±2.8) months].And 4 cases were suffering from postoperative spina bifida manifesta;22 cases with spina bifida occulta;2 cases with sacral dysplasia;1 case with meningitis.Late CIC group included 35 patients [20 boys and 15 girls with the mean age of (8.0 ±2.9) months].2 cases were suffering from postoperative spina bifida manifesta;28 cases with spina bifida occulta;4 cases with sacral dysplasia;1 case with postoperative pelvic surgery.Before the treatment, there were no significant differences of the bladder compliance (BC), the maximum cystometric capacity (MCC) and the safety bladder capacity (SBC) between two groups.Urodynamic parameters and complications of 64 patients who were successfully followed up for 6 years were compared.Results After 3 years follow up, BC, SBC and MCC in early CIC group [(8.5 ± 1.9) ml/cmH2O, (140 ±25) ml, (142 ±29) ml]were significantly higher than those of late CIC group [(7.0 ± 2.2) ml/cmH2O, (110 ± 31) ml, (120 ± 28) ml;all P ＜ 0.05].After 6 years follow up, BC, SBC and MCC in early CIC group [(12.0 ±2.5) ml/cmH2O, (210 ±26) ml, (230 ±30) ml] were significantly higher than those of late CIC group [(9.3 ± 2.3) ml/cmH2O, (192 ± 31) ml, (205 ± 35) ml;all P ＜ 0.05], and the vesicoureteral reflux rate [24.1％ (7/29)] in early treatment group was significantly less than that in late treatment group [54.3％ (19/35), P ＜ 0.05].Increases in BUN and serum creatinine were found in 6 cases (20.7％) in early CIC group and 17 cases (48.6％) in late CIC group, the difference was significant (P ＜ 0.05).Conclusion For NB patients, the effect of early CIC is better than that of late CIC.

Effect of Innovative Bladder Irrigation Method on Prevention of Urinary Tract Infection in Neurogenic Bladder Patients with Clean Intermittent Catheterization / 中国康复理论与实践

@#Objective To explore the clinical effect of innovative bladder irrigation on prevention of urinary tract infection in neurogenic bladder patients with clean intermittent catheterization after spinal cord injury (SCI). Methods 40 neurogenic bladder patients with clean intermittent catheterization after SCI were divided into observation group (n=20) and control group (n=20). The observation group received innovative bladder irrigation with normal saline 500 ml every other day, and the control group received normal bladder irrigation with normal saline 500 ml every day. Results 4 weeks and 6 weeks after treatment, the incidence of urinary tract infection was lower in the observation group than in the control group (P<0.05). Conclusion The innovative bladder irrigation method can decrease the rate of urinary tract infection in neurogenic bladder patients with clean intermittent catheterization after SCI.

Práticas de cuidado e desafios do autocateterismo intermitente limpo: as vozes dos escolares / Healthcare practices and challenges of the clean intermittent catheterization: the voices of the children

As crianças portadoras de disfunções miccionais, sendo de ordem neurológica (bexiga neurogênica) ou funcionais, necessitam de cuidados especiais para evitar a deterioração do sistema urinário inferior e insuficiência renal. Na maioria dos casos de bexiga neurogênica, indica-se, o cateterismo intermitente limpo. Também indicado para as disfunções não neurogênicas quando não se consegue bons resultados com outros tratamentos. São crianças com necessidades especiais de saúde (CRIANES), com mudanças na sua vida cotidiana e necessidade de cuidados especiais. O enfermeiro necessita interagir com as mesmas, de forma que, na fase escolar, possam juntos, planejar e administrar o autocuidado, necessários para facilitar o processo de viver saudável. Objeto de estudo: o autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional. Objetivos: descrever as práticas de cuidados concernentes ao autocateterismo intermitente limpo realizado pelo escolar portador de disfunção miccional e analisar os desafios para a realização dessa prática de cuidado por esse escolar nos diversos espaços de socialização. Metodologia: estudo de natureza qualitativa, desenvolvido sob o método criativo sensível, através das dinâmicas de criatividade e sensibilidade Corpo Saber e Mapa Falante. Os participantes da pesquisa foram sete crianças portadoras de disfunção miccional, com idade entre 9-11 anos. O cenário de estudo foi um ambulatório de pediatria, situado em um hospital de ensino e pesquisa no estado do Rio de Janeiro. Os dados foram coletados no período entre fevereiro e março de 2015, e foram analisados a partir da análise de discurso em sua corrente francesa, sendo interpretados à luz do autocuidado de acordo com o conceito de Orem, a Teoria do Desenvolvimento Psicossocial de Erik Erikson e da educação em saúde com as concepções freirianas para a educação. Resultados:através da análise da prática de cuidados desses escolares, evidenciamos a preocupação com a higienização das mãos, da região íntima e do óstio de Mitrofanoff e, cuidados com o esvaziamento completo da bexiga. Quanto aos desafios, foram evidenciados a necessidade do uso de dispositivos para a visualização do meato urinário, dificuldades para a visualização do meato uretral feminino no período matutino, no posicionamento para a realização do autocateterismo, a presença de desconfortos com a sondagem uretral, a irregularidade na frequência do autocateterismo, as dificuldades para brincar em função da realização do autocateterismo, a (in) dependência no autocateterismo e o (des)velamento do autocateterismo nos diversos espaços de socialização. Conclusão: Revelou-se uma consciência ingênua na prática de cuidados, assim como fatores ambientais interferindo no autocuidado e riscos de infecção do trato urinário. Os diversos desafios enfrentados pelos escolares, na realização do autocateterismo, apontam para a necessidade de aproximação com estes de forma dinâmica e criativa, facilitando a exposição de suas dúvidas, medos e anseios, e para a promoção da conscientização crítica e a socialização dos saberes, capacitando-os para o autocuidado. Também na divulgação junto aos órgãos competentes, para a adequação social, com vistas à inclusão destas CRIANES nos diversos espaços de socialização.

Children suffering from voiding dysfunction, which stems from a neurological (neurogenic bladder) or a functional disorder, need special care to prevent deterioration of the lower urinary tract and kidney failure. In most cases of neurogenic bladder it is indicated clean intermittent catheterization. Also suitable for non-neurogenic dysfunction when you don`t get good results with other treatments. These are children with special health care needs(CSHCN), with changes in their daily lives. The nurse needs to interact with them, so that, at school age, they can together plan and manage the self-care necessary to facilitate the process of healthy living. Subject: clean intermittent catheterization performed by the children that suffers from voiding dysfunction. Objectives: To describe the practices from care concerning the clean intermittent catheterization performed by the children that suffers from voiding dysfunction and analyze the challenges for the realization of this practice by that children in the various spaces of socialization. Methodology: qualitative study developed under the sensitive creative method, through the dynamics of creativity and sensitivity "Corpo Saber e Mapa Falante". The survey participants were seven children with voiding dysfunction, aged 9-11 years.The study setting was an outpatient pediatric clinic located in a teaching hospital in the state of Rio de Janeiro. Data were collected between February and March 2015 and were analyzed from the speech analysis in its French stream being interpreted in the lightof the self-care according to the Orem concept, the Psychosocial Development Theory of Erik Erikson and of health education with Freirian concepts for education. Results: by analyzing the practice of these children we noted the concern on hands, genitals and the Mitrofanoff ostium hygienization, and, the complete evacuation of the bladder.Regarding the challenges, were highlighted the necessity of devices for visualizing the urinary meatus, difficulties in the visualization of the feminine urethral meatus in the morning, the position to perform the catheterization, the discomfort with the urethral probe, the irregularity in the frequency of catheterization, the difficulties to play due the realization of catheterization, the (in)dependence on autocatheterism and the (un)veiling of autocatheterism in various spaces of socialization. Conclusion: It was revealed an ingenuous consciousness in the practice of cares, as well as environmental factors interfering in the self-care and risk of urinary tract infection.The various challenges faced by the children in performing the catheterization point to the necessity of closer ties in a dynamic and creative way, facilitating the exposure of their doubts, fears and desires, to promote critical awareness and the socialization of knowledge, enabling them for self-care. Also, in the disclosure with the competent organs, to social adaptation, aiming to incorporate such CSHCN in various spaces of socialization.

Effect of Innovative Bladder Irrigation Method on Prevention of Urinary Tract Infection in Neurogenic Bladder Patients with Clean Intermittent Catheterization / 中国康复理论与实践

Objective To explore the clinical effect of innovative bladder irrigation on prevention of urinary tract infection in neurogenic bladder patients with clean intermittent catheterization after spinal cord injury (SCI). Methods 40 neurogenic bladder patients with clean in-termittent catheterization after SCI were divided into observation group (n=20) and control group (n=20). The observation group received in-novative bladder irrigation with normal saline 500 ml every other day, and the control group received normal bladder irrigation with normal saline 500 ml every day. Results 4 weeks and 6 weeks after treatment, the incidence of urinary tract infection was lower in the observation group than in the control group (P<0.05). Conclusion The innovative bladder irrigation method can decrease the rate of urinary tract infec-tion in neurogenic bladder patients with clean intermittent catheterization after SCI.

Diagnosis, Management and Physician Collaboration for Neurogenic Bladder / The Japanese Journal of Rehabilitation Medicine

Neurogenic bladder (NB) is a lower urinary tract dysfunction (LUTD) caused by underlying neural diseases that affect the central nervous system and peripheral nerves. LUTD includes urine storage dysfunction and voiding dysfunction. LUTD causes various lower urinary tract symptoms (LUTS) and has a negative impact on patients' quality of life. In addition, urinary tract infection and upper urinary problems can be associated with LUTD, especially with NB. Thus, the diagnosis and management of NB in patients with underlying neural diseases are very important in patient care. LUTD can be screened by a careful history taking of LUTS and simple, non-invasive measures such as postvoid residual urine measurement and uroflowmetry. A urodynamic study is required for precise evaluation of urine storage function and voiding function. Urine storage dysfunction is predominantly caused by detrusor overactivity (involuntary detrusor contractions during bladder filling) and occasionally caused by sphincter deficiency, while voiding dysfunction is caused by detrusor-sphincter dyssynergia (DSD) and/or impaired detrusor contraction. Urodynamic evaluation is mandatory for proper management of NB. Management of detrusor overactivity includes pharmacotherapy using anticholinergics and selective β3-receptor agonist, and neuromodulation. For refractory cases, surgery such as bladder augmentation can be a treatment option. Pharmacotherapy for voiding dysfunction includes α-blockers for DSD and cholinergic agents for impaired detrusor contraction. However, their efficacy has been limited, and not a few patients with NB need urinary management by clean intermittent catheterization (CIC). The goals of urinary management in patients with NB are to render patients free from significant urinary problems, maintain continence, and provide better quality of life. For this purpose, close collaboration between physicians involved in rehabilitation medicine and urology is very important and should be promoted.

Management of Lower Urinary Tract Dysfunction in Patients with Neurological Disorders

The proper performance of the lower urinary tract is dependent on an intact neural innervation of the individual structures involved. Therefore, any congenital neurological anomalies, diseases, or lesions of the central, peripheral, or autonomic nervous systems can result in lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) secondary to neurological disorders can significantly reduce quality of life (QoL) and may also give rise to serious complications and psychological and social sequelae. The goals of management of LUTD in patients with neurological disorders are to prevent serious complications and to improve the patient's QoL. Understanding the physiology and pathophysiology of micturition is critical to selecting appropriate treatment options. This article provides an overview of the clinical characteristics, diagnosis, and management of LUTD in patients with certain central and peripheral neuropathies and common lesions.

Study on the Changes of Voiding Methods of Patients with SCI after Discharge: Focusing on the Patients Participating in the Regular Urinary Tract Surveillance Program

OBJECTIVE: To examine how consistently patients with spinal cord injured (SCI) after discharge use the clean intermittent catheterization (CIC). METHOD: The participants were 146 SCI patients hospitalized for regular urinary tract surveillance program, who resided in a community for over one year after discharge. The mean age was 40.3 years old and the mean time after injury was 6.2 years, consisted of 118 males and 28 females, and of 68 tetraplegics and 78 paraplegics. RESULTS: At discharge, the CIC as a voiding methods was used by 97 patients, Valsalva or reflexic voiding by 43, indwelling catheterization by 3, and diaper voiding by 3. Atfollow-up, CIC was used by 96, Valsalva or reflexic voiding by 37, indwelling catheterization by 7, and diaper voiding by 6. Among 97 patients who used CIC at discharge, 83 consistently used the CIC (compliance=85.5%). The patients with tetraplegia showed 82.9% of compliance while the patients with paraplega showed 88.0% of compliance, but there was no statistical difference. CONCLUSION: The compliance with the CIC method was comparatively high (85.5%). The CIC method can be effectively applied to the management of neurogenic bladder for the SCI patients residing in a community after discharge.

Clean intermittent catheterization of spinal cord injured patients / 中国康复理论与实践

@#ObjectiveTo investigate the nursing management of clean intermittent catheterization (CIC) of spinal cord injured (SCI) patients.Methods72 SCI patients were randomly divided into two groups: CIC group (37 cases) and sterile intermittent catheterization (SIC) group (35cases); urine cultures were performed before and after catheterization in each group, hand cultures were also performed before catheterization only in CIC group. Results10 cases of CIC group and 11 cases of SIC group had different results of urine culture before and after intermittent catheterization, but there was no statistical difference between two groups (P>0.05). 5 cases had positive results of hand culture, but the colony counting was in the normal range. Follow up was made six months after intermittent catheterization. There were 35 cases (94.59%) in CIC group and 33 cases (94.29%) in SIC group who could urinate regularly with post void residual less than 50 ml. One case in each group had symptomatic urinary tract infection respectively. ConclusionsCIC is a simple, safe and effective method to resolve the bladder dysfunction of SCI patients.

Long-term Followup of Clean Intermittent Catheterization in Spinal Cord Injury Patients / 대한비뇨기과학회지

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.

Long-term Followup of Clean Intermittent Catheterization in Spinal Cord Injury Patients / 대한비뇨기과학회지

Clean intermittent catheterization(CIC) is known as a safe, acceptable method in patient with neurogenic bladder due to spinal cord injury. We studied retrospectively the long term results of CIC in spinal cord injury patients. A total of 34 patients(12 upper. motor neuron lesion and 22 lower motor neuron lesion) was followed for 7 months to 82 months (average followup 31.5 months). Sixteen of 34 patient with high intravesical pressure improved after CIC. Two of 3 with abnormal BUN/Cr level, 13 of 14 with hydronephrosis, and all 12 with vesicoureteral reflux improved after CIC. But one patient with abnormal BUN/Cr was worsen. Before CIC period symptomatic bacteriuria developed in 29 patients, epididymitis in 8 patients and bladder stone in 3 patients. But after CIC, each of them was changed to 15, 1 and 1. In conclusion, We think that CIC is a good method for preservation of renal function and to decrease the urologic complications. But patients should be well motivated, cooperative and able to use their hands for continuous CIC.

Long-term Followup of Clean Intermittent Catheterization in Patients with Neurogenic Bladder / 대한비뇨기과학회지

From 1986 to 1993, we analyzed experiences in clean intermittent catheterization(CIC) of 62 patients with neurogenic bladder who were closely follow up for averaging 25months. Initial urodynamic study revealed hyperreflexic bladder in 21patients: 11 with detrusor sphincter dyssynergia. Areflexic bladder was found in 41patients: l5 with low compliance. Although positive urine culture were relatively frequent(61%), febrile urinary tract infections were rare(3%) and upper urinary tract function was stable. Other complications of CIC(29%) were burning sensation, resist on urethral catheter, epididymitis, scrotal abscess, bladder stone, etc. Although minor complications are not rare, we can conclude that preservation of renal function and improvement of urinary incontinence can achieved with intermittent catheterization and that patient must be well motivated and cooperative and be able to use their hands for continuation of CIC.