Adesão ao autocuidado do paciente com disfunção neurogênica do trato urinário inferior: validação de instrumento / Adherence to self-care in patients with neurogenic lower urinary tract dysfunction: instrument validation / Adherencia al autocuidado en pacientes con disfunción neurogénica del tracto urinario inferior: validación de un instrumento

RESUMO Objetivo: construir e validar o conteúdo do instrumento de adesão ao autocuidado de pacientes com Disfunção Neurogênica do Trato Urinário Inferior que realizam o autocateterismo intermitente quanto a aparência e conteúdo. Método: Estudo metodológico de validação de conteúdo de instrumento, composto por três etapas: revisão da literatura, construção do instrumento e validação de instrumento, respectivamente. A análise foi realizada através do modelo de Agree, e pelo cálculo de índice de validação de conteúdo, entre 2020 e 2021. Resultados: O Agree II, apresentou resultado de 85,6% e 84,5% para validação dos domínios escopo e finalidade e partes interessadas. Na validação de conteúdo, o item histórico familiar foi retirado do instrumento com índice de vaidade de conteúdo de 0,77. Conclusão: O instrumento contribuirá para oferecer subsídios para a prática profissional e aos pacientes portadores da disfunção.

ABSTRACT Objective: To build and validate the content of the instrument for adherence to self-care for patients with Neurogenic Lower Urinary Tract Dysfunction who perform intermittent self-catheterization as to appearance and content. Method: Methodological study of instrument content validation, composed of three stages: literature review, instrument construction and instrument validation, respectively. The analysis was performed using the Agree model, and by calculating the content validation index, between 2020 and 2021. Results: Agree II, showed a result of 85.6% and 84.5% for validation of the scope and purpose and stakeholder domains. In content validation, the family history item was removed from the instrument with a content vanity index of 0.77. Conclusion: The instrument will contribute to offering subsidies for professional practice and to patients with the dysfunction.

RESUMEN Objetivo: construir y validar el contenido del instrumento de adición al autocuidado de pacientes con disfunción neurogénica del tracto urinario inferior que realizan el autocateterismo intermitente en cuanto a la apariencia y el contenido. Método: Estudio metodológico de validación de contenido de instrumentos, compuesto por tres etapas: revisión bibliográfica, construcción de instrumentos y validación de instrumentos, respectivamente. El análisis se realizó utilizando el modelo de Agree, y mediante el cálculo del índice de validación de contenido, entre 2020 y 2021. Resultados: El Agree II, mostró un resultado de 85,6% y 84,5% para la validación de los dominios de alcance y propósito y partes interesadas. En la validación de contenido, el ítem histórico familiar fue retirado del instrumento con un índice de vanidad de contenido de 0,77. Conclusión: El instrumento contribuirá a ofrecer subsidios para la práctica profesional y a los pacientes con disfunción.

Análise da Satisfação do Paciente com o Cateterismo Vesical Intermitente Limpo / Analysis of Patient's Satisfaction With Clean Intermittent Urethral Catheterization / Análisis de la Satisfaccion del Paciente com Cateterismo Vesical Intermitente Limpio

Objetivos:Comparar e avaliar os atributos de dois cateteres vesicais para pessoa em tratamento com resíduo pós-miccional, no cateterismo intermitente limpo (CIL). Método: Estudo quantitativo, observacional e descritivo desenvolvido em ambulatório de referência para 48 municípios, entre setembro e novembro de 2020. Participaram 50 pacientes com resíduo pós-miccional que realizam CIL, com 44,8 anos de idade média, sendo 72% homens. Foram comparados dois cateteres lubrificados, de diferentes tecnologias, ambos com bolsa acoplada, por sete dias, na frequência de seis cateterismos diários, utilizando instrumento validado de percepção da satisfação do cliente. Os dados foram analisados por meio do software Statistical Package for the Social Sciences (SPSS) Statistics 23.0, e para comparação dos cateteres foi usado o teste não paramétrico de Wilcoxon. Resultados: O cateter de policloreto de vinila (PVC) pré-lubrificado com glicerol alcançou maior satisfação entre os participantes nos atributos avaliados (90% versus 86%) em relação ao cateter hidrofílico de poliuretano (PVP) pré-lubrificado, embora sem significância estatística nos escores parciais e totais do instrumento utilizado. Conclusão: O estudo possibilitou comparar os dois cateteres, e a avaliação do escore geral para ambos foi positiva. Algumas avaliações negativas para determinados atributos são passíveis de melhorias, além de ser esse modelo de estudo capaz de discriminar os cateteres, podendo ser reproduzido.

Objectives:To compare and evaluate the aspects of the use of two bladder catheters for the person undergoing treatment with post-void residual, in clean intermittent bladder catheterization (CIL). Method: Quantitative, observational, and descriptive analysis developed in a reference outpatient clinic, for 48 municipalities, from September to November 2020. Fifty patients with post-void residual, who underwent CVIL, took part in the study. Their average age was 44,8 years old, and 72% of them were male. Two lubricated catheters were compared, from different technologies, both with attached bags, for seven days, six catheterizations a day, using a validated instrument of perception of customer satisfaction. Data were analyzed by the software Statistical Package for the Social Sciences (SPSS) Statistics 23.0, and for the comparison of the two catheters it was used the Wilcoxon's non-parametric test. Results: The polyvinyl chloride (PVC) catheter pre-lubricated with glycerol reached greater participant satisfaction in the evaluated attributes (90 versus 86%) in relation to the hydrophilic polyurethane (PVP) pre-lubricated catheter, although there was no statistical significance on the partial or total scores of the instrument used. Conclusion: The study allowed the comparison of two catheters, and the evaluation of the general score for both was positive. Some negative evaluation for certain attributes is possible to be improved. This kind of study is able to discriminate the catheters, and it can be reproduced.

Objetivo:Comparar y evolución los atributos de las sondas vesicales para personas cometidas a tratamiento de residuo posmiccional, en cateterismo intermitente limpio (CIC). Método: estudio cuantitativo, observacional, descriptivo, realizado en un ambulatorio de referencia, para 48 municipios entre septiembre y noviembre de 2020. Participaron 50 pacientes con residuo posmiccional sometidos a CIC, edad media de 44,8 años, de los cuales el 72% eran hombres. Se compararon dos catéteres lubricados de diferentes tecnologías, ambos con bolsa adherida, durante 7 días, con una frecuencia de 6 cateterismos diarios, utilizando un instrumento validado para la percepción de satisfacción del cliente. Los datos se analizaron con el software SPSS Statistics 23.0 y se utilizó la prueba no paramétrica de Wilcoxon para comparar los catéteres. Resultados: El catéter de PVC - Cloruro de Polivinilo prelubricado con glicerol mostró mayor satisfacción de los participantes en los atributos evaluados (90% versus 86%) en relación con el catéter de PVP - catéter de poliuretano hidrofílico prelubricado, aunque sin significación estadística en el puntajes parciales y totales del instrumento utilizado. Conclusión: El estudio permitió comparar los dos catéteres y la evaluación de la puntuación general de los catéteres fue positiva. Algunas valoraciones negativas para determinados atributos son susceptibles de mejora y pueden ser implementadas, además de ser este modelo de estudio capaz de discriminar entre catéteres, y pudiendo ser reproducido.

Analysis of urodynamics in elderly male patients with indwelling urinary catheterization / 中华老年医学杂志

Objective@#To investigate clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization.@*Methods@#Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups: 60-69-year-old group(n=114), 70-79-year-old group(n=220), and 80-111-year-old group(n=163). According to the catheter indwelling time, the patients were divided into 3 groups: 1-2 weeks group(n=262), 2-4 weeks group(n=47)and over 4 weeks group(n=188). The cause of indwelling urinary catheterization, bladder outlet obstruction, acontractile detrusor and other indicators were observed.@*Results@#The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1%, 274 cases), in that the most common diagnosis was benign prostatic hyperplasia(90.3%, 449 cases). No statistically significant difference in the different catheter indwelling time-related urodynamics between the different age groups was found(χ2=1.606, 0.199 and 2.477, all P>0.05). There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[56.9%(149/262)vs.55.3%(26/47) vs.42.6%(80/188), χ2=9.315, P<0.05)], and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6%(41/262)vs.12.8%(6/47)vs.29.8%(56/188), χ2=15.319, all P<0.05)]. There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P>0.05). Clinical urodynamics had no statistically significant in different age groups(P>0.05).@*Conclusions@#Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.

Analysis of urodynamics in elderly male patients with indwelling urinary catheterization / 中华老年医学杂志

Objective To investigate clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization.Methods Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups:60-69-year old group(n=114),70-79-year-old group (n =220),and 80-111-year-old group (n =163).According to the catheter indwelling time,the patients were divided into 3 groups:1-2 weeks group(n=262),2 4 weeks group(n=47)and over 4 weeks group (n =188).The cause of indwelling urinary catheterization,bladder outlet obstruction,acontractile detrusor and other indicators were observed.Results The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1％,274 cases),in that the most common diagnosis was benign prostatic hyperplasia(90.3％,449 cases).No statistically significant difference in the different catheter indwelling time related urodynamics between the different age groups was found(x2 =1.606,0.199 and 2.477,all P＞0.05).There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups [56.9％ (149/262) vs.55.3％ (26/47) vs.42.6％ (80/188),x2=9.315,P＜0.05)],and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6％ (41/262)vs.12.8％(6/47)vs.29.8％ (56/188),x2 =15.319,all P＜ 0.05)].There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P＞0.05).Clinical urodynamics had no statistically significant in different age groups (P＞0.05).Conclusions Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.

Online health forum as a support for people who perform intermittent vesical catheterization / Fórum virtual de la salud como soporte a personas que realizan cateterismo vesical intermitente / Fórum virtual de saúde como suporte às pessoas que realizam cateterismo vesical intermitente

ABSTRACT Objective: to evaluate the use of an online forum for people with myelomeningocele and their families and the profile of the users, based on intermittent catheterization. Method: a quantitative, cross-sectional, descriptive and exploratory study. Data was collected from users of the online forum, based on an online questionnaire available from March 20 to April 20, 2015. Sample consisted of 30 users. Descriptive statistical data analyses and chi-square test were performed. Results: among users, 27% were people with myelomeningocele and 73% were family members. Age, considering the total sample, ranged from 22 to 58 years old. Women represented 67% of the sample. Most users considered the language used in the forum understandable, and also thought the forum had a proper layout and was easy to navigate. It was noted that the mother and the person with myelomeningocele are the main responsible people for intermittent catheterization; 86% use a simple plastic catheter and 14% use a hydrophilic catheter; 81% do not reuse the catheter, 10% use the same catheter for one day and 9% for up to one week. The main place chosen to perform intermittent catheterization was the bed, followed by the toilet and wheelchairs. Conclusion: the use of the online forum was well evaluated by the users. It can be considered a means to obtain information, create a support network and clarify any doubts, empowering users and contributing to adherence to intermittent catheterization, which is one of the treatments for neurogenic bladder.

RESUMEN Objetivo: evaluar el uso de un fórum virtual para personas con mielomeningocele y sus familiares y el perfil de sus usuarios, según la realización del cateterismo vesical intermitente. Método: estudio cuantitativo, transversal, descriptivo y exploratorio. Se realizó la recolección de datos con usuarios del fórum virtual, en base a una encuesta online, disponible desde el 20 de marzo al 20 de abril de 2015. La muestra estuvo compuesta por 30 usuarios. Se realizaron los análisis estadísticos, descriptivos y test chi cuadrado. Resultados: de los usuarios, 27% eran personas con mielomeningocele y 73% familiares. La edad, considerándose toda la muestra, osciló entre los 22 y 58 años. El sexo femenino representó el 67% de la muestra. La mayoría de los usuarios consideró que el lenguaje utilizado en el fórum es comprensible, la imagen es adecuada y tiene una fácil navegación. Se observó que la madre y la propia persona con mielomeningocele son las principales responsables por la realización del cateterismo vesical intermitente; 86% utilizan catéter de plástico simple y 14% el catéter hidrofilico; 81% no reutilizan el catéter, 10% utilizan el mismo catéter durante un día y el 9% incluso hasta una semana. El principal lugar de realización del cateterismo vesical intermitente fue la cama, seguida de la letrina y la silla de ruedas. Conclusión: el uso del fórum virtual fue bien evaluado por los usuarios. Se lo puede considerar un medio para obtener informaciones, formación de red de apoyo y aclarar dudas, empoderando a los usuarios y contribuyendo a la adhesión al cateterismo vesical intermitente, que es uno de los tratamientos para la vejiga neurogénica.

RESUMO Objetivo: avaliar o uso de um fórum virtual para pessoas com mielomeningocele e seus familiares e o perfil dos usuários, de acordo com a realização do cateterismo vesical intermitente. Método: estudo quantitativo, transversal, descritivo e exploratório. A coleta de dados foi realizada com usuários do fórum virtual, com base em um questionário online, disponibilizado de 20 de março a 20 de abril de 2015. A amostra foi composta de 30 usuários. Foram realizadas análises estatísticas descritivas e teste qui-quadrado. Resultados: dos usuários, 27% eram pessoas com mielomeningocele e 73% familiares. A idade, considerando a amostra total, variou de 22 a 58 anos. O sexo feminino representou 67% da amostra. A maioria dos usuários considerou a linguagem utilizada no fórum compreensível, o visual adequado e a navegação fácil. Foi observado que a mãe e a própria pessoa com mielomeningocele são os principais responsáveis pela realização do cateterismo vesical intermitente; 86% utilizam cateter de plástico simples e 14% o cateter hidrofílico; 81% não reutilizam o cateter, 10% utilizam o mesmo cateter durante um dia e 9% por até uma semana. O principal local de realização do cateterismo vesical intermitente foi a cama, seguida pelo vaso sanitário e cadeira de rodas. Conclusão: o uso do fórum virtual foi bem avaliado pelos usuários. Ele pode ser considerado um meio para obtenção de informações, formação de rede de apoio e esclarecimento de dúvidas, empoderando os usuários e contribuindo para a adesão ao cateterismo vesical intermitente, que é um dos tratamentos para a bexiga neurogênica.

Social Determinants of Health in the lives of urinary catheter users / Determinantes Sociales de Salud en la vida de usuarios de cateterismo urinario / Determinantes Sociais de Saúde na vida de usuários de cateterismo urinário

ABSTRACT Objective: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. Method: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Results: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. Conclusion: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

RESUMEN Objetivo: Identificar la influencia de factores de los determinantes sociales de salud en las condiciones de vida de pacientes usuarios de cateterismo urinario intermitente. Método: Investigación descriptiva realizada en centro de Rehabilitación. Participaron 243 pacientes con vejiga neurogénica, usuarios de cateterismo urinario intermitente limpio. Estudio realizado entre marzo de 2012 y octubre de 2015, aplicando entrevista apoyada por instrumento semiestructurado, y análisis por estadística descriptiva. Resultados: La mayoría de los pacientes era de sexo masculino, edad entre 16 y 64 años, solteros, con enseñanza primaria e ingresos familiares entre 2 y 3 salarios mínimos. Los determinantes sociales de salud encontrados estuvieron relacionados a aspectos socioeconómicos, demográficos y condiciones de salud. Conclusión: Los hallazgos señalan una compleja relación entre los determinantes sociales de salud y las condiciones de vida de estos pacientes usuarios de cateterismo urinario intermitente limpio, presentando vulnerabilidad en relación a algunos aspectos de las condiciones de salud.

RESUMO Objetivo: Identificar a influência de fatores dos determinantes sociais de saúde nas condições de vida de pacientes usuários de cateterismo urinário intermitente. Método: Pesquisa descritiva realizada em um Centro de Reabilitação com 243 pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo. O período do estudo foi de março/2012 a outubro/2015, utilizando-se entrevista com apoio de um instrumento semiestruturado e análise por estatística descritiva. Resultados: A maioria dos pacientes era do gênero masculino, idade entre 16 e 64 anos, solteiros, com ensino fundamental e renda familiar mensal de 2 a 3 salários mínimos. Os determinantes sociais de saúde encontrados foram relacionados aos aspectos socioeconômicos, demográficos e condições de saúde. Conclusão: Os achados assinalam para uma complexa relação entre os determinantes sociais de saúde e as condições de vida desses pacientes usuários de cateterismo urinário intermitente limpo, apresentando uma vulnerabilidade com relação a alguns aspectos das condições de saúde.

Interface da diretriz terapêutica do autocateterismo vesical na perspectiva legal / Interface of therapeutic guideline for self-catheterization in the legal perspective / Interfaz de la directriz terapéutica del autocateterismo vesical en la perspectiva legal

Objetivo: identificar as diretrizes terapêuticas do autocateterismo em pacientes acometidos por bexiga neurogênica na perspectiva legal, confrontando a proteção constitucional do direito à vida com os postulados de ordem ética e social do Enfermeiro. Método: trata-se de um ensaio teórico-reflexivo, realizado no período de maio de 2016 a janeiro de 2017, a partir de atividades de campo prático da residência multiprofissional da Universidade Federal do Amazonas. Resultados: o profissional enfermeiro desempenha um papel de grande importância em relação à assistência desde os cuidados de promoção de saúde em situações aguda e crônica da lesão medular. Com o avanço da tecnologia, o status de cuidar e as práxis de enfermagem vêm sofrendo mudanças significativas, exigindo assim novas diretrizes, ações e orientações. Considerações Finais: entende-se que a prática de autocateterismo pode ocasionar lesão na estrutura uretrovesical. Logo, higiene, conforto físico, e a reeducação vesical são imprescindíveis para a prevenção de sequelas no paciente e promoção de bem-estar. A enfermagem vem ao logo do tempo construindo e fortalecendo os seus cenários de atuações, diante disso precisamos de um novo estado reflexivo e transformador para a profissão.

Objective: to identify the therapeutic guidelines of self-catheterization in patients affected by neurogenic bladder from a legal perspective, confronting the constitutional protection of the right to life with the ethical and social postulates of a nursing. Methods: theoretical-reflexive essay, carried out in the period from May 2016 to January 2017, from practical field activities of the multiprofessional residence of the Federal University of Amazonas. Results: the nursing professional plays a very paramount importance in relation to patient's assistance as healthcare promotion in acute and chronic spinal cord injury. With the advancement of technology, the care status and nursing praxis have undergone significant changes, therefore requiring new guidelines, actions and guidance designed for the new scenario. Final Considerations: it is understood that the practice of self-catheterization can cause damage to the urethrovesical structure. Thereby, hygiene, physical comfort, and bladder re-education are essential for prevention of sequelae in the patient and promotion of well-being. Nursing comes over time by building and strengthening their performance scenarios and in front of this we need a new reflective and transforming state for the profession.

Objetivo: identificar las directrices terapéuticas del autocateterismo en pacientes acometidos por vejiga neurogénica en la perspectiva legal, confrontando la protección constitucional del derecho a la vida con los postulados de orden ético y social del enfermero. Método: se trata de un ensayo teórico-reflexivo, realizado en el período de mayo de 2016 a enero de 2017, a partir de actividades de campo práctico de la residencia multiprofesional de la Universidad Federal del Amazonas. Resultados: el profesional enfermero desempeña un papel de gran importancia en relación a la asistencia desde los cuidados de promoción de salud en situaciones aguda y crónica de la lesión medular. Con el avance de la tecnología, el status de cuidar y las praxis de enfermería vienen sufriendo cambios significativos, exigiendo así nuevas directrices, acciones y orientaciones. Consideraciones Finales: se entiende que la práctica de autocateterismo puede ocasionar lesión en la estructura uretrovesical. Por lo tanto, la higiene, el confort físico, y la reeducación vesical son imprescindibles para la prevención de secuelas en el paciente y la promoción del bienestar. La enfermería viene al momento del tiempo construyendo y fortaleciendo sus escenarios de actuaciones, ante eso necesitamos un nuevo estado reflexivo y transformador para la profesión.

Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries

ABSTRACT Introduction Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. Objective To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. Materials and Methods A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. Results The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. Conclusions Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Adherence to Anticholinergic Therapy and Clean Intermittent Self-Catheterization in Patients With Multiple Sclerosis / 대한배뇨장애요실금학회지

PURPOSE: To evaluate adherence to anticholinergic therapy (AT) and clean intermittent self-catheterization (CISC) in patients with multiple sclerosis (MS) and to identify factors associated with poor adherence. METHODS: This single-center study prospectively included 49 patients suffering from MS who had been prescribed AT and/or CISC. Adherence was evaluated using a self-report questionnaire. The Expanded Disability Status Scale (EDSS), Patient Global Impression of Improvement, Mini-Mental State Examination, Urinary Symptom Profile, and Hospital Anxiety and Depression (HAD) instruments were administered, and the number of daily anticholinergic pills and/or catheterizations was noted. Whether patients were receiving concomitant intradetrusor botulinum toxin injections was assessed, as were barriers to treatment, side effects, number of spontaneous micturitions, reasons for the prescription, satisfaction, and difficulties. RESULTS: Only 38% of patients were adherent to AT. Experiencing side effects was related to nonadherence (P=0.02). Only 29% of patients were adherent to CISC. More intense voiding dysfunction (P<0.001), a higher frequency of CISC (P=0.03), and a higher EDSS score (P=0.02) were associated with better adherence. Conversely, the HAD score (P<0.001), depression (P<0.001), the persistence of spontaneous micturition (P<0.001), a blocking sensation during catheterization (P=0.04), and the need to adapt one's posture or gesture to perform catheterization (P=0.04) were associated with poorer adherence. CONCLUSIONS: Adherence to AT and CISC was poor in patients with MS suffering from bladder dysfunction. Several factors related to nonadherence were identified in this study, and addressing these factors might help to improve treatment adherence.

Adherence to the Clean Intermittent Catheterization Following a Customized Intensive Education Program for Patients with Emptying Failure

PURPOSE: The purpose of this study is to investigate adherence to the clean intermittent catheterization (CIC) and influencing factors on the adherence following a customized intensive education program (CIEP). METHODS: This work is a retrospective descriptive study. The subjects were 226 emptying failure patients who learned in a CIEP from January 2012 to July 2014. The program developed in 2011 and consisted of 1) customized theoretical education; based on the results of urologic tests, underlying disease, or surgery of the patients, 2) hands-on practice until the trainees were able to master the techniques, 3) questions about the process of catheterization and what he/she needs to know. 4) at follow-up, the survey about adherence and barrier to CIC. Clinical characteristics; the level of satisfaction, understanding, and self-confidence; the barrier in medical records were reviewed. RESULTS: The short-term adherence rate (median 22 days) is 87.6% and the long-term adherence rate (median 112 days) is 50.4%. The biggest obstacle is time management. The levels of satisfaction, understanding, and self-confidence are very high. The variable of Income is the only factor that has influence on adherence. CONCLUSION: Despite the CIEP, the adherence rate is relatively low. In addition to the education, emotional and psychological supports and regular follow-up are needed to improve long-term adherence.

Intermittent Self-catheterization in Older Adults: Predictors of Success for Technique Learning / 대한배뇨장애요실금학회지

PURPOSE: The main goal of this retrospective study is to explore the predictors of success in learning clean intermittent self-catheterization (CISC) in patients over 65 years of age. The secondary goal is to assess whether in this population, the risk of failure to perform CISC is greater, compared with patients under 65 with similar pathologies. METHODS: All patients older than 65 consulting between January 2011 and January 2016 for learning CISC were included. A control population younger than 65 matching with sex, body mass index, and pathology was selected. RESULTS: One hundred sixty-nine of the 202 patients (83.7%) over 65 succeeded in learning CISC. Obesity (P < 0.05), low pencil and paper test (PP test) (P < 0.01) and low functional independence measure (FIM) (P < 0.01) scores were risk factors of failure. No significant differences were found with sex or pathology. In multivariate analysis, low PP test perineum access (odds ratio [95% confidence interval], 2.30 [1.32–4.42]), low FIM motor (1.04 [1.01–1.08]), and FIM cognition (1.18 [1.03–1.37]) scores were independent factors of learning failure. Compared to control group, age over 65 was not predictive of failure (P=0.15). CONCLUSIONS: Our study shows that success in learning CISC does not depend on age but on difficulties in mobility, access to perineum and probably cognitive disorders.

Fatores associados ao conhecimento de pacientes e cuidadores acerca do cateterismo vesical intermitente limpo: revisão integrativa / Factores asociados con el conocimiento de pacientes y cuidadores acerca del cateterismo vesical intermitente limpio: revisión integrativa / Factors associated with the knowledge of patients and caregivers about clean intermittent urethral catheterization: an integrative review

RESUMO Objetivo Identificar na literatura os fatores associados ao conhecimento de pacientes e cuidadores acerca do cateterismo vesical intermitente limpo que dificultam ou facilitam o procedimento. Método Revisão integrativa da literatura nas bases de dados MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS e LILACS. Resultados Após a revisão por pares, 13 estudos primários compuseram a amostra. A síntese do conhecimento foi realizada em duas categorias: Fatores associados ao conhecimento de pacientes e cuidadores sobre o que dificultam o procedimento e Fatores associados ao conhecimento de pacientes e cuidadores acerca do que facilitam o procedimento. Os fatores que dificultam e facilitam o procedimento relacionaram-se, respectivamente, à necessidade de informação e a sentimentos negativos, uso de linguagem de fácil compreensão, aplicação de folhetos informativos, entre outros. Conclusão Há escassez de artigos publicados sobre a temática, e os que foram identificados apresentaram baixo nível de evidência, exigindo, portanto, maior empenho e compromisso por parte de profissionais de saúde e pesquisadores para utilizarem desenhos mais robustos.

RESUMEN Objetivo Identificar en la literatura los factores asociados con el conocimiento de pacientes y cuidadores acerca del cateterismo vesical intermitente limpio que dificultan o facilitan el procedimiento. Método Revisión integrativa de la literatura en las bases de MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS y LILACS. Resultados Después de la revisión por pares, 13 estudios primarios compusieron la muestra. La síntesis del conocimiento fue realizada en dos categorías: Factores asociados con el conocimiento de pacientes y cuidadores acerca de lo que dificulta el procedimiento y Factores asociados con el conocimiento de pacientes y cuidadores acerca de lo que facilita el procedimiento. Los factores que dificultan y facilitan el procedimiento se relacionaron, respectivamente, con la necesidad de información y con sentimientos negativos, uso de lenguaje de fácil comprensión, aplicación de folletos informativos, entre otros. Conclusión Existe escasez de artículos publicados acerca de la temática, y los que fueron identificados presentaron bajo nivel de evidencia, por lo que se requiere mayor empeño y compromiso de la parte de los profesionales sanitarios e investigadores en la utilización de diseños más robustos.

ABSTRACT Objective To identify the factors associated with the knowledge of patients and caregivers about Clean Intermittent Urethral Catheterization in the literature which hinder or facilitate the procedure. Method An integrative review of the literature conducted in the MEDLINE/PubMed, CINAHL, Cochrane, Web of Science, SCOPUS and LILACS databases. Results 13 primary studies were included in the sample after the peer review. A synthesis of knowledge was performed in two categories: Factors associated with the knowledge of patients and caregivers which hinder the procedure and Factors associated with the knowledge of patients and caregivers which facilitate the procedure. Factors that hinder and facilitate the procedure respectively related to the need of information and negative feelings, use of easy-to-understand language, and application of information leaflets, among others. Conclusion There is a shortage of published articles on the subject, and those which were identified had a low level of evidence, therefore requiring greater commitment and effort on the part of health professionals and researchers to use more robust designs.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

ABSTRACT Objective To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. Material and Methods Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content). Results The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. Conclusion The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Clean Intermittent Self-Catheterization as a Treatment Modality for Urinary Retention: Perceptions of Urologists / 대한배뇨장애요실금학회지

PURPOSE: Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients’ perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. METHODS: A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. RESULTS: Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. CONCLUSIONS: This questionnaire gave valuable insights into urologists’ perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses.

A Survey of Urinary Catheterization for the End-of-life Cancer Patients in a Palliative Care Unit

<p>Introduction: The urination state of patients in the palliative care unit varies according to their age, performance status, underlying disease, and the presence of delirium. However, there are currently few reports concerning the urination state of these patients. Here, we report the current state of urinary catheterization in our hospital palliative care unit. Methods: A total of 249 consecutive patients hospitalized between January 2012 and December 2013 in our hospital palliative care unit were included. We retrospectively investigated the numbers and causes of urinary catheterization along with the background of the patients (age, underlying disease, and average length of hospital stay). Results: Of the 249 patients, 124 (49.8%) used a urinary catheter. The median period of catheterization was 6 days. Excluding continuation of the previous physician’s orders, the main cause of urinary catheterization was reduced activities of daily living after admission. In 12 cases (9.7%), the catheter was removed because of discomfort of the patients. Conclusion: Approximately half of all patients treated in our palliative care unit received urinary catheterization. As a cause of urinary catheterization, reduced activities of daily living after admission was the most frequent. Since the urination state affects the quality of life in palliative care patients, it is important to consider the appropriate adaptation of urinary catheters.</p>

Quality of life of patients using intermittent urinary catheterization / Qualidade de vida de pacientes usuários do cateterismo urinário intermitente / Calidad de vida de pacientes usuarios de cateterismo vesical intermitente

ABSTRACT Objectives: measure and compare the quality of life of neurogenic bladder patients using intermittent urinary catheterization who were going through rehabilitation in Brazil and Portugal. Method: multicenter, quantitative, cross-sectional, observational-analytic and correlational study executed in Brazil and Portugal. Two data collection tools were used, being one questionnaire with sociodemographic and clinical data and the World Health Organization Quality of Life-bref. Patients were included who were over 18 years of age, suffering from neurogenic urinary bladder and using intermittent urinary catheterization. Results: in the sample of Brazilian (n = 170) and Portuguese (n = 52) patients, respectively, most patients were single (87-51.2%; 25-48.1%), had finished primary education (47-45.3%; 31-59.6%) and were retired (70-41.2%; 21-40.4%). Spinal cord injury was the main cause of using the urinary catheter in both countries. The Brazilian patients presented higher mean quality of life scores in the psychological domain (68.9) and lower scores in the physical domain (58.9). The Portuguese patients presented higher scores in the psychological domain (68.4) and lower scores in the environment domain (59.4). The execution of intermittent urinary self-catheterization was significant for both countries. Conclusions: in the two countries, these patients' quality of life can be determined by the improvement in the urinary symptoms, independence, self-confidence, social relationships and access to work activities.

RESUMO Objetivos: mensurar e comparar a qualidade de vida de pacientes com bexiga neurogênica em uso do cateterismo urinário intermitente em processo de reabilitação, no Brasil e em Portugal. Método: estudo multicêntrico, Brasil e Portugal, quantitativo, transversal, observacional-analítico e correlacional. Foram utilizados dois instrumentos de coleta, um questionário de dados sociodemográficos e clínicos e World Health Organization Quality Life-bref. Foram inclusos pacientes maiores de 18 anos, com bexiga urinária neurogênica, e usuários do cateterismo urinário intermitente. Resultados: na amostra de pacientes brasileiros (n = 170) e portugueses (n = 52), respectivamente, a maioria era solteira (87-51,2%; 25-48,1%), com ensino fundamental (47-45,3%; 31-59,6%), aposentada (70-41,2%; 21-40,4%). A lesão medular foi a principal causa do uso do cateter urinário nos dois países. Os pacientes brasileiros apresentaram média de escores mais elevados de qualidade de vida no domínio psicológico (68,9) e menos elevados no domínio físico (58,9). Os pacientes portugueses apresentaram escores mais elevados no domínio psicológico (68,4) e menos no domínio ambiente (59,4). A realização do autocateterismo urinário intermitente foi significativa para os dois países. Conclusões: nos dois países, a qualidade de vida desses pacientes pode ser determinada pela melhora dos sintomas urinários, da independência, autoconfiança, relações sociais e acesso a atividades laborais.

RESUMEN Objetivos: mensurar y comparar la calidad de vida de pacientes con vejiga neurogénica en uso de cateterismo vesical intermitente durante el proceso de rehabilitación en Brasil y en Portugal. Método: estudio multicéntrico, Brasil y Portugal, cuantitativo, trasversal, observacional-analítico y correlacional. Fueron utilizados dos instrumentos de recolecta, un cuestionario de datos sociodemográficos y clínicos y el World Health Organization Quality Life-bref. Fueron inclusos pacientes mayores de 18 años, con vejiga urinaria neurogénica, y usuarios de cateterismo vesical intermitente. Resultados: en la muestra de pacientes brasileños (n = 170) y portugueses (n = 52), respectivamente, la mayoría era soltera (87-51,2%; 25-48,1%), con educación fundamental (47-45,3%; 31-59,6%), jubilada (70-41,2%; 21-40,4%). La lesión medular fue la principal causa del uso del catéter urinario en los dos países. En promedio, los pacientes brasileños presentaron scores de calidad de vida superiores en el dominio psicológico (68,9) e inferiores en el dominio físico (58,9). Los pacientes portugueses presentaron scores superiores en el dominio psicológico (68,4) y inferiores en el dominio ambiente (59,4). La ejecución del autocateterismo vesical intermitente fue significativa para los dos países. Conclusiones: en los dos países, la calidad de vida de esos pacientes puede ser determinada por la mejora de los síntomas urinarios, de la independencia, autoconfianza, relaciones sociales y acceso a actividades laborales.

Telenursing manual for providing care to patients using clean intermittent urinary catheterization / Manual de teleenfermería para la atención al usuario de cateterismo urinario intermitente limpio / Manual de telenfermagem para atendimento ao usuário de cateterismo urinário intermitente limpo

Objective: To develop and evaluate apparent and content validity of a telenursing manual to support nurses in the care delivery of patients using clean intermittent urinary catheterization. Methods: Methodological study addressing the development and validation of a telenursing manual. The expert group who validated the telenursing manual was composed of 11 nurses. An inter-rater level of agreement of 70% was considered for each aspect of the instrument. Results: The following levels of agreement were obtained for each aspect: Language 97%, Content 97.7% and Objectives, Relevance, Functionality and Usability 100% each. Conclusion: The manual is available for access and represents an important initiative for the field of telenursing in Brazil, assisting nurses in the telecare provided to patients using clean intermittent urinary catheterization.

Objetivo: Elaborar y validar la apariencia y el contenido de un manual de teleenfermería para apoyar al enfermero en la atención al cliente que usa catéter urinario intermitente limpio. Método: Estudio metodológico sobre la construcción y validación de manual de teleenfermería. La apariencia y el contenido del manual fueron validados por 11 enfermeros peritos, considerando para validación un nivel de concordancia del 70% entre los peritos para cada aspecto del instrumento utilizado. Resultados: El manual de teleenfermería fue validado en apariencia y contenido considerando el nivel de concordancia entre los peritos para cada uno de estos aspecto: Lenguaje 97%; Contenido 97,7%; y, Objetivos, Relevancia, Funcionalidad y Usabilidad 100% cada uno. Conclusiones: El manual está disponible para ser accedido y representa una iniciativa importante para el campo de la teleenfermería en Brasil, ayudando al enfermero en la práctica de la teleatención al usuario de cateterismo urinario intermitente limpio.

Objetivo: Elaborar e validar em aparência e conteúdo um manual de telenfermagem para subsidiar o enfermeiro no atendimento ao cliente com bexiga neurogênica, usuário de cateterismo urinário intermitente limpo. Método: Estudo metodológico sobre a construção e validação de manual de telenfermagem. O manual foi validado em aparência e conteúdo por 11 enfermeiros peritos; para tanto, considerou-se válido cada aspecto do instrumento que atingiu o nível mínimo de concordância de 70% entre os peritos. Resultados: O manual obteve, para cada aspecto avaliado, os seguintes níveis de concordância - Linguagem: 97%; Conteúdo: 97,7%; e Objetivos, Funcionalidade, Usabilidade e Relevância: 100% cada. Conclusão: O manual encontra-se disponível para acesso e representa uma iniciativa importante para o campo da telenfermagem no Brasil, auxiliando o enfermeiro na realização do teleatendimento e atendimento ao usuário de cateterismo urinário intermitente limpo.

Tradução dos sentimentos de familiares no cuidar da criança dependente do cateterismo intermitente limpo / Translation of family members' feelings in caring for children dependent on clean intermittent catheterization / Traducción dos sentimientos de los miembros de la familia en el cuidado de los niños a cargo de la cateterización intermitente limpia

Objetivo: compreender os sentimentos vivenciados pelos familiares ao cuidar da criança com bexiga neurogênica dependente do cateterismo. Método: pesquisa qualitativa desenvolvida em um ambulatório de pediatria de um hospital universitário, com 12 familiares. Para análise dos resultados utilizou-se a análise de conteúdo na modalidade temática. Resultados: emergiram três categorias analíticas: os medos no processo de cuidar da criança dependente do cateterismo; a negação da nova realidade; e a preocupação com a saúde futura da criança. Assim, a pesquisa aponta o quão complexo é o processo de cuidar dos familiares, pois não engloba apenas os aspectos técnicos, mas todo o envolvimento emocional dos mesmos diante da nova realidade de cuidar. Conclusão: é indispensável reconhecer e compreender os sentimentos dos familiares no processo de cuidar das crianças com bexiga neurogênica, aceitando suas fragilidades e dificuldades.

Objective: to understand the feelings experienced by family members caring for children with neurogenic bladder dependent on catheterization. Method: qualitative study of 12 family members at a university hospital pediatric clinic. Thematic content analysis was used. Results: three analytical categories emerged: fears in caring for children dependent on catheterization; denial of the new situation; and concern for the children's future health. The research thus shows how complex the process of caring for the family is, because it comprises not only technical aspects, but all their emotional involvement in the new care situation. conclusion: it is essential to recognize and understand the fears and difficulties of families caring for children with neurogenic bladder, and to accept their weaknesses and difficulties.

Objetivo: comprender los sentimientos experimentados por los miembros de la familia para cuidar del niño con vejiga neurogénica cateterismo dependientes. Método: investigación cualitativa realizada en una clínica pediátrica de un hospital universitario, con 12 miembros de la familia. Se utilizó el análisis de contenido en la modalidad temática. Resultados: surgieron tres categorías analíticas: temores en el cuidado de cateterismo hijo a cargo; la negación de la nueva realidad; y la preocupación por la salud futura del niño. Así, la investigación muestra lo complejo que es el proceso de cuidar a la familia, ya que no cubre sólo los aspectos técnicos, pero todos la implicación emocional de la misma en la nueva realidad de cuidar. Conclusión: es esencial reconocer y comprender los miedos y las dificultades de la familia en el cuidado de los niños con vejiga neurogénica, aceptar sus debilidades y dificultades.

Simulation of human urethral catheterization to implement urodynamic testing in mice / 中国病理生理杂志

AIM: Cystostomy is the traditionary method for detecting urodynamic indexes in mice, which de-stroys the continuity of the bladder, and there are significant differences between this method and the clinically used trans-urethral method.This study aims to develop an appropriate urethral catheter to investigate the advantages and application val-ue of transurethral method for urodynamic test.METHODS:A pediatric intravenous catheter was used for urethral catheter-ization on 8 female mice, and linked to connect the catheter to baroreceptor and micropump.The epidural catheter was also used as manometry tube.RESULTS:Using this method, the following urodynamic indicators has been successfully cap-tured:basal bladder pressure (BBP), bladder leak point pressure (BLPP), maximum voiding pressure (MVP), maxi-mum bladder capacity ( MBC ) , post-void residual urine volume ( PVR ) , voiding volume ( VV ) , efficiency of voiding ( EV) and bladder compliance ( BC) .CONCLUSION:This is the first successful simulation used in human body to a-chieve mouse urodynamic testing through the urethra catheter, which avoids the impact of cystostomy on urodynamics in mice, and the mice are able to keep long-term survival after tests for the follow-up molecular and genetic experiments.

Traumas uretrais pela introdução do cateter uretral: conduta do enfermeiro / Urethral traumas by the introduction of urethral catheter: conduct of nurses

Este estudo teve como objetivo avaliar a conduta do enfermeiro frente ao traumatismo de uretra ocasionado pela inserção do cateter uretral. Este estudo teve aprovação do Comitê de Ética em pesquisa da Escola de Enfermagem de Ribeirão Preto - Parecer 466/12 e foi realizado em um Hospital Universitário em duas etapas: na primeira etapa, descritiva, foi efetuada consulta ao sistema eletrônico do hospital que trata de notificações sobre eventos adversos dos pacientes. Nessa etapa foi utilizado instrumento de perguntas objetivas elaborado pelo próprio pesquisador. Na segunda, quase-experimental pós teste, foram coletados os dados relacionados a autoconfiança de enfermeiros, que participaram de cenário simulado de baixa fidelidade. Nessa etapa para obtenção dos dados foi aplicado um questionário de caracterização dos sujeitos e instrumento já validado, de autoconfiança na Assistência de Enfermagem à Retenção Urinária (EAAERU), a qual encontra-se dividida em cinco fatores: 1) "Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas", 2) "Intervenções prévias ao cateterismo urinário", 3) "Intervenções realizadas após o cateterismo urinário"; 4) "Comunicação, consentimento e preparo dos materiais para realização do cateterismo urinário", e 5) "Avaliação objetiva da RU" (retenção urinária). Os dados da primeira etapa foram analisados por estatística descritiva e os dados da segunda etapa foram codificados e digitados duplamente em planilhas do aplicativo Excel®, exportados e analisados no programa SPSS (Statistical Package for Social Science) ®, versão 22.0, como a escala original. Os resultados demonstram que na primeira fase do estudo entre as 5300 notificações do serviço, apenas 27 (1,96%) estavam relacionadas a problemas urinários. Entre essas, cinco diretamente ao cateterismo urinário. Na segunda fase do estudo, a amostra foi composta por 53 enfermeiros, entre os quais a maior parte era do sexo feminino, com idade média de 36 anos, menos de dez anos de formação. Entre eles a maioria cursava ou já haviam cursado pós-graduação. Segundo os entrevistados todos 53 (100,0%) já realizaram o cateterismo urinário e 46 (86,8%) já vivenciaram dificuldades no procedimento. A maioria já avaliou trauma uretral ocasionado pela passagem do cateter. A conduta tomada nessa circunstância foi comunicar o fato e solicitar avaliação de outro profissional (médico e/ou outro enfermeiro). Após atividade simulada de trauma uretral, na avaliação da autoconfiança, a EAAERU demonstrou boa confiabilidade na sua aplicação (? 0,966). Os menores escores encontrados na autoconfiança dos profissionais estiveram relacionados aos fatores 1) "Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas" e 5) "Avaliação objetiva da RU". Observou-se ainda associação positiva entre a autoconfiança e a frequência de realização do cateterismo urinário. Conclui-se que os traumas de uretra são comuns na prática clínica, porém pouco notificados. Com relação à autoconfiança na introdução do cateterismo urinário em que ocorrem situações de trauma de uretra há dificuldade na tomada de decisão e na avaliação objetiva da RU. Uma vez que o cateterismo é de competência do enfermeiro, são necessários programas e instrumentos que capacitem os profissionais para tais situações

This study aimed to evaluate the conduct of the nurse to the urethral trauma caused by the insertion of urethral catheter. This study was approved by the Ethics Committee in research of the College of Nursing in Ribeirão Preto - Opinion 466/12 and was performed in University Hospital in two stages: in the first stage, descriptive, a question was made on the hospital's electronic system, which deals with notifications about adverse events of patients. In this stage, it was used an instrument of objective questions elaborated by the researcher herself. In the second stage, quasi-experimental posttest study, the data related to self-confidence of nurses who participated in simulated low-fidelity scenario was collected. In this stage, to obtain the data, it was applied a characterization questionnaire of subjects and already validated instrument of Self-Confidence Scale of Nursing Care in Urinary Retention (EAAERU), which is divided in five factors: 1) "Interventions performed during urinary catheterization and/or in iatrogenic situations", 2) "Prior interventions to performing urinary catheterization", 3) "Interventions performed for urinary catheters"; 4) "Communication, consent and preparation of materials for performing urinary catheterization", and 5) "Objective evaluation of the urinary retention". The first stage's data were analyzed by descriptive statistic and the second stage's data were codified and double typed in spreadsheets in the Excel® app, exported and analyzed in the SPSS program (Statistical Package for Social Science)®, version 22.0, like the original scale. The results demonstrate that in the first stage of the study, among the 5300 notifications of service, only 27 (1,96%) were related to urinary problems. Among these, five directly related to urinary catheterization. In the second stage of the study, the sample was made by 53 nurses, among which most were women, with an average age of 36 years, less than ten years of formation. Among them, most were attending or had already attended postgraduate. According to the interviewers, all 53 (100,0%) had performed urinary catheterization and 46 (86,8%) had gone through trouble during the process. Most of them had evaluated urethral trauma caused by the introduction of the catheter. The conduct taken in this circumstance was to communicate the fact and request the evaluation of another professional (Doctor and/or another nurse). After simulated activity of the urethral trauma, in the self-confidence evaluation, EAAERU showed good reliability on its application (?=0,966). The lowest scores found in the professionals' self-confidence were related to the factors 1) "Interventions performed during urinary catheterization and/or in iatrogenic situations" and 5) "Objective evaluation of the urinary retention". It was also observed positive association between the self-confidence and the performance of urethral catheterization. It is concluded that urethral traumas are common on clinical practice, however little notified. With regard to self-confidence to the introduction of urethral catheterization in which occur urethral trauma situations, there is difficulty in decision making and objective evaluation of the urinary retention. Once the catheterization is the nurse's responsibility, programs and tools are necessary to enable professionals in such situations