Bladder and Bowel Dysfunction in Korean Children with Down Syndrome and Parental Quality of Life.

PURPOSE: Children with Down syndrome (DS) are more likely to experience bladder bowel dysfunction (BBD) than typically developing children, which could in turn have a serious effect on children with DS and on their parents and other family members. This study aimed to explore the prevalence of BBD in Korean children with DS and its effect on parental quality of life (QOL). DESIGN AND METHODS: To assess BBD and parental QOL, we used self-administered questionnaires (Dysfunctional Voiding Symptom Score [DVSS], Rome IV criteria, and World Health Organization Quality of Life scale [WHOQOL-BREF]) for parents of children with DS. We collected data from 86 parents between September and October 2017 through an online community website. RESULTS: DVSS was elevated in 26.7% of the children with DS. Specifically, 14% had daytime urinary incontinence, and 33.7% had functional constipation. Moreover, 18.6% of children had BBD according to the DVSS and Rome IV criteria. The sensitivity and specificity of DVSS to functional constipation was 55.17% and 87.72%, respectively. The BBD score and total parental QOL score were statistically correlated (r = 0.291, p = 0.007). CONCLUSIONS: Although children with DS are a high-risk group for BBD, their BBD symptoms are often overlooked because of their intellectual disability. Consequently, this could negatively affect children's and family's health and QOL in the long term. PRACTICE IMPLICATIONS: Health-care providers should reconsider a routine check-up of BBD in children with DS. If a child has BBD, health-care providers should consult a urologist to determine the appropriate diagnosis and intervention.

Intermittent catheterisation: challenges when children move to adult services.

Sharon Holroyd, Lead Clinical Nurse Specialist, Calderdale and Huddersfield NHS Foundation Trust, outlines approaches to self-catheterisation for children and young people, sharon.holroyd2@cht.nhs.uk.

Intermittent urethral catheterisation: the reality of the lubricants and catheters in the clinical practice of a Brazilian service.

AIMS AND OBJECTIVES: To identify how catheters and lubricants have been used among patients using intermittent urinary catheterisation in rehabilitation. BACKGROUND: The clean intermittent urinary catheterisation technique is an invasive procedure can cause discomfort, pain and urethral traumas. The use of lubricants and lubricated urinary catheters reduces the friction between the catheter and the urethral mucosa, minimising the risks. DESIGN: A descriptive exploratory design was used. METHODS: Quantitative and descriptive study developed at a rehabilitation centre of a University Hospital in the interior of the state of São Paulo, Brazil, at the Intermittent Urinary Catheterisation Outpatient Clinic, between June 2012-December 2014. After ethical approval, the data were collected through an interview with the support of a semistructured questionnaire, held during the nursing consultation. Among the users, patients using intermittent urinary catheterisation were interviewed, over 18 years of age and minors younger than eight years accompanied. Descriptive statistical analysis was applied. RESULTS: Most of 214 (100·0%) patients were interviewed were male, single, young adults and with a primary medical diagnosis of bone marrow injury and myelomeningocele. Most patients perform the urinary catheterisation between four and six times per day. For the procedure, the majority uses polyethylene (polyvinyl chloride) catheter and, as a lubricant, 2·0% lidocaine hydrochloride on the catheter itself. Many mention lack of sensitivity when passing the catheter. CONCLUSION: In the study sample, a risk of urethral traumas was evidenced, related to the inappropriate use of catheters and lubricants. For the patients' safety, the professionals need to acknowledge the importance of the appropriate use of lubricants and lubricated catheters to implement evidence-based practices that mobilise public policies. RELEVANCE TO CLINICAL PRACTICE: The use of evidences demonstrates that the appropriate use of lubricants for intermittent urinary catheterisation is fundamental for patient safety and the performance of the best practices.

Exploring the role of practical nursing wisdom in the care of patients with urinary problems at the end of life: a qualitative interview study.

AIMS AND OBJECTIVES: This study examined how nurses understand urinary problems at the end of life, and identified sources of evidence upon which they base their practice through semi-structured qualitative interviews. The aim was to decide whether research or interventions (such as formulation of best practice guidelines) could improve continence care at the end of life. BACKGROUND: There is little evidence in nursing literature to indicate how nurses should manage urinary problems at the end of life. Evidence is particularly lacking regarding the insertion of indwelling urinary catheters. DESIGN: This was an applied qualitative interview study which used the 'guided interview' approach. METHODS: Twelve participants who worked in two hospital wards and one hospice were interviewed about management of patients with urinary problems approaching the end of life. The transcribed interviews were organised using the qualitative analysis software qsr NVivo version 10 (QSR International, Melbourne, Australia). Constant comparison was used to analyse the interviews. RESULTS: The patient and their family were a key concern of all interviewees. Participants focused on processes including: giving care, making decisions, managing uncertainty and assimilating knowledge. These processes are mediated by 'phronesis' or practical wisdom. CONCLUSIONS: Within each of the processes (giving care, making decisions, managing uncertainty and assimilating knowledge), participants approached each patient as an individual, using experience, patient wishes, available resources, clinical knowledge and advice from colleagues to provide care. A generalised set of guidelines on managing urinary problems at the end of life would probably not be useful. RELEVANCE TO CLINICAL PRACTICE: There is uncertainty about what constitutes best practice in specific areas of continence care at the end of life such as indwelling urinary catheter insertion. A careful approach is needed to ensure that the intellectual and moral knowledge that constitutes practical wisdom is shared and developed throughout teams.

Behavioral Characteristics of Bowel Movement and Urination Needs in Patients With Dementia in Taiwan.

Patients with dementia, especially those with advanced dementia, may not be able to express their bowel movement and urination needs using lucid language, and instead do so through behaviors. The aim of the current study was to understand and compare the behavioral characteristics of bowel movement and urination needs in patients with dementia. Observations were made by caregivers of 187 patients with dementia based on the Behavior Checklist developed by the research team for bowel movement and urination. Sixteen behavioral characteristics were identified for both bowel movement and urination; among these, anxiety, taking off/putting on clothes inappropriately, restlessness, attempting to go elsewhere, scratching skin, repeated behavior, and making strange sounds were commonly reported. Facial expressions of sorrow, restlessness, and anxiety were the three most common behaviors related to bowel movement needs, whereas anxiety, taking off/putting on clothes inappropriately, and constant moaning were the most common behaviors for urination needs. The findings suggest that the common behavioral characteristics could be seen as indicators of excretion need and the others can be used to distinguish between the need for bowel movement and urination.

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.

Successful intermittent self-catheterization teaching: one nurse's strategy of how and what to teach.

Learning how to perform intermittent self-catheterization (ISC) can be a daunting task for the patient with a newly diagnosed voiding dysfunction. The nurse can facilitate this learning process by working with the patient until knowledge and confidence is gained to successfully perform self-catheterization. Teaching ISC requires a knowledgeable and skilled nurse who can recognize the patient's physical and psychological readiness; instruct the patient in anatomy, physiology, and the disease process, as well as guide the patient through the procedure. With a comprehensive teaching program, the patient is empowered to care for his or her own urologic health and accomplish an important step in regaining independence. This article describes one nurse's strategy for teaching patients to become confident and competent in performing ISC.

Accessing and evaluating urologic health information: differences by race/ethnicity and gender.

Patients with urologic symptoms seek information from a variety of sources outside the traditional health care arena. There are differences between the genders and racial/ethnic groups related to sources consulted and confidence in those sources.

Traces: making sense of urodynamics testing--part 12: videourodynamics testing.

Videourodynamics testing combines radiographic images of the lower urinary tract with physiologic tracings from multichannel urodynamics testing to provide a more comprehensive evaluation of lower urinary function than either modality completed alone. Part 12 of the Traces series describes the role of videourodynamics testing in evaluation of the lower urinary tract and its unique contribution to the diagnosis of specific lower urinary tract disorders.

Restoring and maintaining urinary function.

OBJECTIVES: To describe surgical urinary diversion methods, nursing management, and survivorship issues in urologic cancer survivors. DATA SOURCES: PubMed, Scopus, Cochran Reviews, Core 25 online texts. CONCLUSION: Options exist for patients that require urinary diversion, although long-term symptoms may persist. IMPLICATIONS FOR NURSING PRACTICE: Nurses must be knowledgeable about obstructive uropathy and understand the surgical options for urinary diversion following a cystectomy; pre- and post-operative needs exist for the cancer patient, family, and caregiver. Following completion of active treatment, a survivorship care plan summarizes active treatment and complications, plans long-term health outcomes and surveillance, and communicates with the primary care provider.

Complementary and alternative therapies for urinary symptoms: use in a diverse population sample qualitative study.

Study participants reported a range of remedies used to treat urinary symptoms, from popular products, such as saw palmetto, to less commonly known remedies, such as moabi. Participants learned about remedies through social network rather than from their primary care provider.

Traces: making sense of urodynamics testing--Part 11: quantitative analysis of micturition via the voiding pressure flow study: pressure-flow nomograms.

The voiding pressure flow study is the gold standard for evaluating micturition. Part 10 of the Traces series described techniques for evaluating micturition via the voiding pressure flow study; it focused on interpretation of results qualitatively via inspection and classification of flow pattern, detrusor contraction amplitude and duration, pelvic floor muscle response to voiding, and urethral resistance. This article discusses quantitative analysis of the voiding pressure flow study using nomograms that measure the magnitude of urethral resistance (bladder outflow obstruction) and/or detrusor contraction strength.

Traces: making sense of urodynamics testing--Part 10: evaluation of micturition via the voiding pressure-flow study.

Part 10 of the Traces series focuses on urodynamics evaluation of micturition via the voiding pressure-flow study (VPS). This article reviews techniques for generating a high-quality voiding pressure-flow study and initial interpretation of findings. Part 11 of the Traces series will focus on advanced analysis of the VPS using nomograms that measure the magnitude of urethral resistance (bladder outflow obstruction) and detrusor contraction strength.

Exploring urinary catheters: the perspectives of patients and nurses.

This literature review is part of a larger dissertation project that explores the lived experience of patients using long-term urinary catheters and nurses' attitudes towards urinary catheters. Systematic examination of the literature revealed six relevant primary research studies. These were critically appraised to assess their worth. Further studies were also reviewed, although these were often from neighbouring fields as relatively little research has been undertaken in this field. Findings suggest that there is a disparity between the care that nurses provide to patients with long-term catheters and the holistic care that patients need. Furthermore, nurses' decision-making skills are hampered by poor multidisciplinary documentation practices in the acute sector. It is concluded that nurses' attitudes towards urinary catheters do affect the care that patients receive.

Traces: making sense of urodynamics testing.

Urodynamics testing is used to describe lower urinary tract function, and diagnose functional disorders affecting the bladder, urethra, and pelvic floor. Urologic clinicians play a central role in urodynamics testing; they are primarily responsible for performing more than 75% of evaluations completed in North America. While the value of a well-done urodynamics assessment is well established, comparatively few clinicians have received formal training in the area. This article describes hydrodynamic principles underlying the measurement of intravesical, abdominal, and detrusor pressures. This is the first in a series of articles that will review principles of best urodynamics practices.

Urine leakage in persons with spinal cord injury and using long-term Foley catheters: a simple solution.

STUDY DESIGN: To visualize residual urine in a bladder using a regular Foley catheter and then using a modified Foley catheter. OBJECTIVES: To determine whether a modified Foley catheter eliminates or reduces a catheter-associated deposition of residual urine around the balloon and whether this reduction eliminates catheter leakage. SETTINGS: A patient with chronic spinal cord injury using a Foley catheter and experiencing significant refractory urine leakage around the catheter. METHODS: The design of a Foley catheter and the way it drains lead to the constant presence of small amounts of residual urine at the base, surrounding the balloon. The Foley catheter was modified using a cook catheter punch to make two extra holes just below the balloon. RESULTS: A cystogram of an unmodified Foley catheter showed the presence of residual urine around the Foley balloon. A cystogram of a modified Foley catheter eliminated this residual urine around the balloon. After the modification there was no more leakage around the Foley catheter. CONCLUSION: Modification of the catheter, as described, eliminated the residual urine around the catheter balloon and eliminated clinical urine leakage around the Foley catheter.