Nursing Care of the Patient With Neurogenic Bladder After Kidney Transplantation: A Case Report.

OBJECTIVE: Urologic complications are among the most common complications after kidney transplantation. These complications are urinary retention, hematuria, hemorrhage, urinary leakage, vesicoureteral reflux, pyelonephritis, and nephrolithiasis. Although neurogenic bladder is one of the indications for kidney transplantation, it is not considered in the literature to be an expected complication after transplantation. In this case, we discuss the nursing care of a patient who underwent kidney transplantation from a living donor and developed neurogenic bladder. CASE REPORT: A 60-year-old woman underwent kidney transplantation from a living donor, and neurogenic bladder developed in the patient 1 year after kidney transplantation. Clear intermittent catheterization treatment was administered for the kidney transplant recipient with neurogenic bladder. Clear intermittent catheterization treatment was stopped in the patient who had frequent urinary tract infections and, alternatively, sacral neuromodulation treatment was administered to the patient. CONCLUSIONS: The nursing care of a patient with neurogenic bladder after kidney transplantation aims to prevent excessive bladder distension, infection, stone formation, vesicoureteral reflux, renal failure, urinary tract damage, and incontinence, and to ensure regular and complete discharge of the bladder. The most common treatment modalities for these objectives are permanent or intermittent catheterization, sacral neuromodulation, and medical therapy. In the care of the patient with neurogenic bladder after kidney transplantation, nurses should provide appropriate care related to treatment options and bladder training, plan urination schedules of the patient, and monitor for possible complications.

Factors Influencing the Use of Intermittent Bladder Catheterization by Individuals With Spina Bifida in Brazil and Germany.

PURPOSE: Intermittent catheterization (IC) often is essential for individuals with spina bifida/myelomeningocele (SBM) and neurogenic bladder. This study aimed to identify and analyze the factors that influence the use of IC. DESIGN AND METHODS: Descriptive study with convenience sampling. Data were collected using printed (Brazil) and online (Germany) questionnaires, and analyzed using multivariate logistical regression and analysis of variance. The study included 100 Brazilian and 100 German patients, aged 0-55 years, with SBM who utilized IC. FINDINGS: Intermittent catheterization was used by 188 of the 200 patients. Three variables were important for predicting who did or did not use IC: no discontinuation of IC, absence of technical difficulty, and daily frequency of IC. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggest that difficulties with IC use experienced by spina bifida patients and their family members that predicted full discontinuation tended to be personal variables, rather than demographic or medical characteristics.

Ensayo clínico piloto para evaluar las características, preferencia de producto y calidad de vida de usuarios de cateterismo vesical intermitente: testando un nuevo set / No disponible

Teniendo en cuenta que el cateterismo intermitente es el tratamiento de primera elección para el manejo de la vejiga neurógena, quisimos estudiar si un nuevo set aportaría ventajas al usuario en su sondaje, tanto en el manejo como en sus relaciones sociales y su calidad de vida

We wanted to research if a new set would offer advantages to the catheter user taking into account that intermittent catheterization becomes the method of choice for neurogic bladder management. For that reason, we included social relationship domains and quality of life in patients with stoma in the study

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.

Care of spinal cord injury in non-specialist settings.

Patient with spinal cord injuries have individualised care routines to help prevent complications. Disruption to these routines following admission to non-specialist settings can have long-term consequences. This article focuses on the key long-term problems of pressure ulcers, bladder and bowel dysfunction, and autonomic dysreflexia. Nurses working on general wards need to consider how to manage these problems when caring for patients with spinal cord injury.

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.

Healthcare Costs Associated with Hydrophilic-Coated And Non-Coated Urinary Catheters for Intermittent Use In the United States.

This health economic evaluation simulated a cohort to compare hydrophilic-coated to non-coated catheters for intermittent catheterization. By using a Markov model, lifetime costs and catheter-related complications were investigated. Results determined that the use of hydrophilic-coated catheters save money and reduce treatment-related complications.

Cateterismo intermitente limpo em crianças com bexiga urinária neurogênica: o cuidado do familiar no domicílio / Clean intermittent catheterization in children with neurogenic urinary bladder: home care by relatives / Cateterismo intermitente limpio en niños con vejiga urinaria neurogénica: el cuidado de la familia en casa

A pesquisa buscou conhecer os cuidados realizados pelo familiar à criança portadora de bexiga neurogênica que necessita de cateterismo vesical intermitente limpo, no domicilio. Trata-se de um estudo qualitativo, realizado em ambulatório de pediatria de um hospital universitário, localizado na cidade do Rio de Janeiro. A coleta dos dados deu-se com 12 familiares através de entrevistas semiestruturadas, no período de janeiro a julho de 2014. Para o tratamento dos dados foi utilizada a análise de conteúdo de Bardin, dando origem a três categorias analíticas: Organizando o ambiente e a criança para o cateterismo; Preparo das mãos para a realização do cateterismo; A realização da técnica pelo familiar. Conclui-se que o cateterismo é realizado conforme a técnica descrita em literatura, mas existem determinados familiares que realizam inadequadamente certos passos da técnica. Sugere-se a realização de protocolos de orientação aos familiares para uniformização de condutas e grupos de apoio aos mesmos.

This qualitative study to examine care provided by family members to children with neurogenic bladder needing clean intermittent catheterization at home was conducted at a pediatric outpatient department of a university hospital in Rio de Janeiro City. Data was collected by semi-structured interviews of 12 family members, between January and July 2014. Data were examined using Bardin content analysis, resulting in three categories: organizing the environment and the child for the catheterization; preparing hands to perform the catheterization; and the technique performed by the family member. It was concluded that catheterization is performed according to the technique described in the literature, but certain family members perform some steps of the technique inappropriately. We suggest producing guidance protocols for family members to standardize conduct, and holding support groups for them.

La investigación tuvo como objetivo conocer la atención realizada por la familia al niño portador de vejiga neurogénica que necesita cateterismo vesical intermitente limpio en su residencia. Se trata de un estudio cualitativo, realizado en una clínica pediátrica ambulatoria de un hospital universitario ubicado en la ciudad de Río de Janeiro. La recolección de datos se llevó a cabo con 12 familias a través de entrevistas semiestructuradas, en el período de enero a julio de 2014. Para estudio de datos se utilizó el análisis de contenido de Bardin, dando lugar a tres categorías de análisis: La organización del ambiente y del niño al cateterismo; Preparación de las manos para la realización del cateterismo; La realización de la técnica por la familia. Se concluye que el cateterismo se realiza según la técnica descrita en la literatura, pero hay algunos miembros de la familia que realizan inadecuadamente algunos pasos de la técnica. Se sugiere la realización de protocolos de orientación a los familiares con vistas a uniformizar las conductas y grupos de apoyo a los mismos.

Long-term follow-up study of outcomes of bladder management in spinal cord injury patients under the care of the Midlands Centre for Spinal Injuries in Oswestry.

STUDY DESIGN: Retrospective longitudinal study of short- and long-term urinary complications in chronic spinal cord injury (SCI) patients managed at the Midlands Centre for Spinal Injuries (MCSI). SETTING: MCSI, Oswestry, UK. METHOD: A total of 185 SCI patients were admitted to the MCSI between 1984 and 1989. Only 119 patients who met the following criteria were included: traumatic SCI, Frankel grade A-D, admission within 6 weeks post injury, regular annual follow-up or alternate year at MCSI, follow-up longer than 8 years. Follow-up ranged between 8 and 21 years with a mean of 17.7 (s.d.=1.98). The method of bladder drainage varied from the time of injury. Drainage was by indwelling urethral catheterisation (IndUC) before admission to the MCSI. Within 24 h of admission, assisted clean intermittent catheterisation (ACIC) by the nursing staff was commenced. This was followed by clean intermittent self catheterisation (CISC) once the patient was mobilised in the wheel chair and trained in the procedure. When detrusor reflex activity develops, patients with good hand function were given a choice between CISC and reflex voiding (RV). Patients with poor hand function are given the choice between RV, suprapubic catheters or ACIC during hospitalisation and after discharge. Only a minority of these patients choose ACIC following discharge. RV was supplemented occasionally by sphincterotomy. There were 99 males and 20 females (5:1). The age at the time of injury was 16-63 years with a mean of 29 (s.d.=12). Instead of a single method, a pattern of bladder management was analysed in the context of three continuous phases: Phase1 preadmission to MCSI. Phase2 during first hospitalisation at MCSI. Phase3 post discharge. In each phase, the patients were divided into those with and without complications. The complications were analysed in relation to the management and other relevant factors. RESULTS: The total complication rate at all stages was 62%. Complications of the upper urinary tract accounted for 22.6%. These results compared favourably with published material. CONCLUSION: The sequential system of supervised bladder management commencing with brief IndUC followed by IntC and/or RV remains effective in keeping the complication rate relatively low in SCI patients, who undergo regular surveillance and timely intervention. SPONSORSHIP: The project was supported by SPIRIT, a charitable not for profit trust that supports teaching, training, clinical research and dissemination of knowledge about all aspects of spinal paralysis in the UK.

Review of intermittent catheterization and current best practices.

Intermittent catheterization is the insertion and removal of a catheter several times a day to empty the bladder. This type of catheterization Is used to drain urine from a bladder that is not emptying adequately or from a surgically created channel that connects the bladder with the abdominal surface (such as Mitrofanoff continent urinary diversion). Intermittent catheterization is widely advocated as an effective bladder management strategy for patients with incomplete bladder emptying due to idiopathic or neurogenic bladder dysfunction. Urologic nurses are at the forefront of educating and teaching patients how to self-catheterize. Catheterizations performed in institutions, such as acute and rehabilitation hospitals and nursing homes, are done aseptically. Historically, however, intermittent catheterization has been performed by the patient in the home environment using a clean technique involving the re-use of catheters. New guidelines released in the past three years have recommended changes to the practice of re-using catheters. Currently, nurses use their clinical judgment to determine which technique and type of catheter to use, in conjunction with patient preference. Differential costs and insurance coverage of catheters/echniques may also influence decision making. The authors provide an overview of the indications, use, and complications associated with intermittent catheterization, present current guidelines on self-catheterization and treatment of catheter-associated complications, detail types of catheters, and review clinical practice of intermittent catheterization.

Botulinum toxin type A for the treatment of urinary tract dysfunction in neurological disorders.

Botulinum toxin type A injections represent an important therapeutic option for patients with neurogenic urinary dysfunction in whom conservative treatment has not been effective. The nurse's role in ensuring that these patients receive appropriate assessment and treatment is discussed.

Care needs of persons with long-term spinal cord injury living at home in the Netherlands.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To describe the care received, care needs and preventability of secondary conditions according to persons with long-term spinal cord injury (SCI) living at home. SETTING: The Netherlands. METHODS: A questionnaire was sent to all members of the Dutch SCI Patient Organisation. From a list of 26 SCI secondary conditions, participants chose the five conditions they perceived as most important. For each of these conditions, they described the type of care they received, their need for (extra) care and its preventability. RESULTS: Response rate was 45% (n=453) and mean time after injury was 13.3 years. In case of secondary conditions, participants were more likely to visit their general practitioner (58%) than another medical specialist (29%) or rehabilitation specialist (25%). For all most-important secondary conditions, care was received in 47% and care, or extra care, was needed in 41.3%. Treatment was the type of care most often received (29.5%) and needed (17.2%). However, for information and psychosocial care, the care needed (12.2 and 9.9%, respectively) was higher than the care received (7.6 and 5.9%, respectively). Thirty-four percent of all most-important secondary conditions were perceived as preventable, the rate increasing to 52.8% for pressure sores, of which 29.9% were considered to be preventable by the participants themselves. CONCLUSIONS: This study showed substantial unmet care needs in persons with long-term SCI living at home and underlines the further improvement of long-term care for this group. Information, psychosocial care and self-efficacy seem to be the areas to be enhanced.

[Assessment in a urological department of nurses' workload for neurological patients]. / Evaluation de la charge en soins paramédicaux des patients neurologiques dans un service d'urologie.

OBJECTIVES: To assess the nurses' workload in care of the neurological patients operated in a department of urology and compare it to the nurses' workload of oncological patients. METHOD: Between 2006 and 2007, a prospective study was realized in 15 consecutive patients with neurogenic voiding dysfunction managed by laparoscopic cystectomy and ileal conduit urinary diversion. The nurses' workload was assessed by the soins infirmiers individualisés à la personne soignée (SIIPS) indicator. Three types of care were so estimated: basic care, technical care and relational care. Results were compared with the first 15 patients in whom, during the same period, a laparoscopic cystectomy and ileal conduit urinary diversion was performed to treat a bladder cancer. RESULTS: The nurses' workload in basic care was higher for the neurological patient's compared to the oncological patients the day before the intervention and from the third postoperative day until the 8th postoperative day. The nurses' workload in relational care was higher in the neurological patient's the 2nd, 3rd, 6th and 7th postoperative days. No difference was noted in terms of technical care between both groups. CONCLUSION: Except the operative day and the first postoperative day, the nurses' workload in relational and basic care is higher in the neurological patient's than in the oncological patients. No difference was noted in terms of technical care between both groups.

Vejiga neurogénica en pacientes con lesiones medulares. parte ii. paciente con lesión medular por traumatismo / Neurogenic bladder in patients with spinal cord injury. part ii. patient with traumatic spinal cord injury

Los programas de adiestramiento o reeducación vesical son esenciales para el éxito de las metas de rehabilitación final de cada persona. Estos programas deben incorporarse al plan total de asistencia de enfermería, de modo que todos los tur- nos de personal de enfermería asistan al paciente en unaforma coherente y significativa. Por supuesto, si el paciente alcanza finalmente el control de la vejiga dependerá de la causa de la pérdida de su control, del grado de lesión cerebraly de las infecciones u otras complicaciones que existan. Laintervención de la enfermera en esta cuestión debe individua- lizarse, ser ingeniosa y rigurosa.

Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre.

The consequences of malignant spinal cord compression (MSCC) can be devastating. If not detected early, MSCC can result in paralysis and significant bowel and bladder dysfunction that is not improved by treatment. Patients have to cope with sudden and unexpected disability alongside a diagnosis of advanced cancer. A multidisciplinary group was established within a cancer centre to review the care of patients with MSCC. Two linked studies were carried out: a staff questionnaire sent to senior medical staff and all nurses and an audit of documentation. The documentation audit reviewed the notes of 50 patients who had received radiotherapy for MSCC. The symptoms patients presented with on admission and before discharge demonstrated that many experienced significant physical problems as a consequence of developing MSCC. Usually, these symptoms were either unaffected by treatment, or had deteriorated further by the time of their discharge from hospital. The average number of days between admission with MSCC and death was 58.6 days (range 2 to 319 days). The project identified variations in practice in a range of aspects of care and provided clear evidence for the need to develop interventions in relation to specific concerns.

Neurogenic continence. Part 2: Neurogenic bladder management.

This article addresses physical and psychosocial issues in neurogenic bladder management. The impact of neurogenic bladder and its assessment will be discussed. There are a wide range of treatment options available to manage neurogenic bladder dysfunction and this article offers an overview of key management techniques, including non-invasive techniques, self-intermittent and suprapubic catheters, medication and surgical management. The importance of the nursing role in assessment, teaching and supporting patients by enabling them to make informed choices about their bladder management is addressed.

Plan de Cuidados Urológicos al paciente lesionado medular espinal con vejiga neurógena / No disponible

No disponible