Compliance with clean intermittent catheterization in spinal cord injury patients: a long-term follow-up study

Abstract

Study design: Retrospective review of medical notes. Objective: To evaluate spinal cord injury (SCI) patients' compliance with bladder emptying method at long-term period after discharge and determine the frequency of urinary tract infections (UTIs). Setting: Inpatient rehabilitation unit of tertiary research hospital. Methods: Bladder management method of 164 new spinal cord injured patients were noted at discharge from rehabilitation center and follow-up. Patients were questioned whether they continued the initial bladder emtying method at follow-up, reasons for discontinuation and the history of treated UTIs. Results: The most common bladder management method at discharge from inpatient rehabilitation center was clean intermittent catheterization (CIC) (63.4%). At follow-up 42% of the patients who used CIC changed their bladder emptying method. Rate of reverting to urethral indwelling catheter (IC) was 21.4%. Reasons for the patients who switched to IC application were recurrent UTIs, incontinence, nephrolithiasis, dependence on care givers and urethral strictures. For all patients, the frequency of treated UTI in 1 year was 38.8%. The number of UTIs were highest in patients using IC. Conclusion: Many factors, including urological complications, patient's preference, living environment, life-style and level of injury should be considered in deciding the method of bladder management in SCI patients. The CIC is a reliable and effective method in selected SCI patients. Despite changes in bladder emptying method, CIC was the most preferred method at long-term follow-up. Education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

Urethral strictures in men with neurogenic lower urinary tract dysfunction using intermittent catheterization for bladder evacuation

“…4,19 However, the occurrence rate of urinary strictures in men with NLUTD using IC for bladder evacuation seems to be higher than previously reported, and the odds of sustaining a stricture are increased in this population. Approximately 25% of men with NLUTD using IC for bladder evacuation can be affected.…”

Bladder management in individuals with chronic neurogenic lower urinary tract dysfunction

“…In the present study, 41% of the patients used IC for bladder evacuation, which is in accordance with some other reports. 6,17 Other authors have observed lower (that is, 15-33%) 2,14,15,18 or higher (that is, 66-78%) IC rates. 19,20 The discrepancies are the result of differences in the study populations, study designs, national health-care systems and follow-up duration between the studies.…”

“…6,7,17 However, the reported frequencies of IC following rehabilitation are very heterogeneous. In the present study, 41% of the patients used IC for bladder evacuation, which is in accordance with some other reports.…”

How many spinal cord injury patients can catheterize their own bladder? The epidemiology of upper extremity function as it affects bladder management

“…14 Importantly, the UE function is not the only barrier patients have to the adoption of CIC. Anatomic considerations (gender, BMI), 2,13 uncontrolled incontinence 15 and cognitive impairment following concomitant brain injury 16 may also affect the adoption and continuance of CIC. Thus, increased attention to these areas is necessary.…”