Science Alert: Intermittent Catheterization – An Old Technique With a New Twist

Posted by Maria Åberg Håkansson, February 16, 2017

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Did you know that intermittent catheterization has been practiced since around 300 BC? The therapy certainly has deep roots involving a lot of innovative solutions, such as river reeds and onion stems for the catheter, and animal fat as lubrication.

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Over the years, the therapy and the catheters have evolved, and there is newly published research supporting the cost-effectiveness and advantages of hydrophilic coated catheters for intermittent catheterization.

In this month’s Science Alert we look into the technique and find that it is useful in many different indications. For example, two publications describe the use of intermittent catheterization in association with Botox injections or in patients with stoma. There is also a new publication proposing that antibiotic prophylaxis should be discontinued among children with spina bifida practicing intermittent catheterization. The aim is to prevent bacterial resistance.

Barriers to patient acceptance have also recently been highlighted in the context of intermittent catheterization. A new tool has been validated with the aim of understanding these barriers in order to optimize teaching and adherence. The importance of an individual catheter choice and the central role of the nurse when learning intermittent catheterization are once again identified.

You will find a summary from these articles in this blog post! 


Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review.

https://www.ncbi.nlm.nih.gov/pubmed/28117329

Author and Origin

Shamout S, Biardeau X, Corcos J, Campeau L. Canada

Summary

Review comparing different types of catheters and techniques for intermittent catheterization in the adult neurogenic population.

Conclusions

Hydrophilic coated catheters were found to reduce the risk of urinary tract infections (UTI) and urethral trauma, and to improve patient satisfaction when compared with non-hydrophilic-coated catheters. More studies are warranted.

Comments

Systematic review verifying previous ndings of UTI/trauma risk reduction and improved patient satisfaction associated with use of hydrophilic coated catheters for intermittent catheterization. 

 

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Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253566/

Author and Origin 

Rognoni C, Tarricone R. Italy

Summary

Health economic evaluation that uses modeling to compare hydrophilic coated to non-coated catheters for intermittent catheterization.

Conclusions

A life-long use of hydrophilic coated instead of non-coated catheters avoids on average 24 urinary tract infections (UTIs). Use of hydrophilic-coated catheters is also associated with higher expected quality of life – and one extra year of life. The estimated cost is 20,458 EUR per patient.

Comments

Cost-effectiveness analysis of hydrophilic coated catheters for intermittent catheterization concluding that they reduce UTIs, and increase life expectancy and quality of life at reasonable costs.

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Intermittent catheterisation after botulinum toxin injections: the time to reassess our practice.

https://www.ncbi.nlm.nih.gov/pubmed/28116467

Author and Origin 

Collins L, Sathiananthamoorthy S, Fader M, Malone-Lee J. UK

Summary

Observational study of intermittent catheter use in 240 patients who received botulinum toxin injections for their lower urinary tract symptoms (LUTS).

Conclusions

Of all patients, 18% were using intermittent catheterization prior to injections and continued afterward. 82% received botulinum toxin injections without the need for intermittent catheterization and without significant voiding symptoms.

Comments

Study observing the use of intermittent catheterization in association with Botox injections. The authors recommend intermittent catheterization for those with troublesome voiding symptoms and raised post-void residuals.


Continent catheterizable tubes/ stomas in adult neuro-urological patients: A systematic review.

https://www.ncbi.nlm.nih.gov/pubmed/28139848

Author and Origin 

Phé V, Boissier R, Blok BF, Del Popolo G, Musco S, Castro-Diaz D, Padilla Fernández B, Groen J, Hamid R, ‘t Hoen L, Ecclestone H, Kessler TM, Gross T, Schneider MP, Pannek J, Karsenty G. France

Summary

Review of observational studies investigating the effectiveness and complications of continent cutaneous stoma or tube in adult neuro-urological patients.

Conclusions

A total of 213 patients were included. After approximately 3 years, the ability to catheterize was ≥84%. Thus, a stoma or tube seems to enable intermittent catheterization and is an alternative to indwelling catheters in adult neuro-urological patients.

Comments

Review summarizing the clinical evidence around continent cutaneous stoma and supporting it as a solution to enable intermittent catheterization in adult neuro-urology patients.


The influence of antibiotic prophylaxis on bacterial resistance in urinary tract infections in children with spina bifida.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5228098/

Author and Origin 

Zegers SH, Dieleman J, van der Bruggen T, Kimpen J, de Jong-de Vos van Steenwijk C, Zegers B. The Netherlands

Summary

Randomized controlled trial investigating antibiotic prophylaxis and bacterial resistance in 176 children with spina bifida. All practiced intermittent catheterization and were followed for 18 months.

Conclusions

A total of 88 patients continued antibiotic use and 88 stopped. Of those who stopped, 38 restarted due to recurrent urinary tract infections (UTI) or specific parental request, but lower bacterial resistance was seen.

Comments

Study providing evidence of increased bacterial resistance with antibiotic prophylaxis among children with spina bifida practicing intermittent catheterization. Open access.


Intermittent catheterization acceptance test (I-CAT): A tool to evaluate the global acceptance to practice clean intermittent self-catheterization.

https://www.ncbi.nlm.nih.gov/pubmed/28090660

Author and Origin 

Guinet-Lacoste A, Kerdraon J, Rousseau A, Gallien P, Previnaire JG, Perrouin-Verbe B, Amarenco G. France

Summary

Study describing the development and validation of the Intermittent Catheterization Acceptance Test (I-CAT) for evaluating psychological acceptance of intermittent catheterization.

Conclusions

After validation, 14 items remained in the I-CAT form. It is believed that this questionnaire will help in reducing psychological barriers and improving patients’ acceptance of intermittent catheterization.

Comments

Study identifying a new valid tool (I-CAT) for evaluating acceptance of intermittent catheterization. This tool may be useful in teaching and optimizing adherence to intermittent catheterization.


The female experience of ISC with a silicone catheter.

https://www.ncbi.nlm.nih.gov/pubmed/28132559

Author and Origin 

Logan K. UK

Summary

Observational survey evaluating patient satisfaction in 37 women learning intermittent catheterization.

Conclusions

Women seem to need more time for learning intermittent catheterization. For example, the majority needed 2 days to master the technique but a few weeks to build up confidence.

Comments

Study highlighting the specific needs of women when learning intermittent catheterization. This includes the importance of individual catheter choice and the role of the nurse.


This blog post is an extract from the Science Alert from February 2017 (76040-USX-1702)

Topics: Science Alert, Clean Intermittent Catheterization (CIC)