Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction

Abstract

Objectives: The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. Methods: Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. Results: In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (Po0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. Conclusion: In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

Predictors of low urinary quality of life in spinal cord injury patients on clean intermittent catheterization

“…Walsh et al observed that women with cervical SCI may need as up to 27 minutes to perform CIC and may be more likely than men to require caregiver assistance when catheterizing. In addition, other studies have noted that women can perceive CIC as intrusive, shameful, and aversive, which may further play a role in overall dissatisfaction with CIC. Further more specific studies are needed to better understand the role of sexuality in relation to CIC.…”

“…Prior studies in spinal cord populations showed that female sex predicted poor adherence with CIC and this study demonstrates that women with mature, long‐term spinal cord injuries continue to be dissatisfied with CIC. It is likely because access to the urethra is more challenging for women compared with men and women may need to reposition to successfully perform CIC . Walsh et al observed that women with cervical SCI may need as up to 27 minutes to perform CIC and may be more likely than men to require caregiver assistance when catheterizing.…”

“…Patients who discontinue CIC have reported inconvenience, dislike of CIC, recurrent urinary tract infections (UTIs), incontinence, urethral strictures, and dependence on caregiver as the most common reasons to switch bladder management in small single‐center reports . A survey of 269 patients found that men who are not able to perform CIC cited limited hand function as the most common reason, while women reported inability to sit appropriately for CIC, with limited hand function being the second most common reason that required caregiver assistance with CIC …”

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

“…On the basis of previous data, inadequate UE function is a significant barrier to a patient's adopting of CIC 8 and might have a prominent role in this 'dropout'. In our study, 58.8% of SCI patients who are unable to volitionally void possess the UE function adequate enough to independently perform CIC, whereas 23.3% lack the UE function to self-catheterize.…”

Pharmacodynamic evaluation of Lys5, MeLeu9, Nle10-NKA(4–10) prokinetic effects on bladder and colon activity in acute spinal cord transected and spinally intact rats

“…While this is an effective treatment for complete bladder emptying, significant catheter related problems occur. These include urinary tract infections, bleeding, strictures, and stones, which pose a significant health risk to the individual and account for high costs of healthcare (Cardenas et al 2004; Gregory et al 1984; Singh et al 2011; Yilmaz et al 2014). Voiding of stools are managed by digital rectal stimulation with digital removal of stools, or with enemas, all of which are time consuming and greatly reduce the quality of life of affected individuals and caregivers (Hughes 2014).…”