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Pathophysiology of Detrusor Underactivity/Acontractile Detrusor
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Juan José Andino, John T. Stoffel
Bladder drainage may be achieved with clean intermittent catheterization or an indwelling catheter. Although there are no data-based recommendations on how often to catheterize, the authors recommend a catheterization schedule that focuses on improvement of symptoms while preserving patient safety. For example, if a patient is bothered by nocturia only, catheterization before bed may result in significant improvement in quality of life. It is important to consider potential complications from starting catheterization when prescribing this treatment. In a retrospective study of 308 patients with spinal cord injury followed over 18 years, upper tract changes were more frequent in patients with indwelling catheters (18%) compared to those using intermittent catheterization (IC) (6.5%) and fewer long-term complications were associated with IC.45,46 In patients with indwelling catheters, suprapubic placement often provides a more feasible option and prevents urethral damage. The risk of stones and symptomatic infections is likely unchanged with suprapubic location compared to urethral catheters. The risk of malignancy secondary to indwelling catheters should be discussed prior to committing to this management strategy.47 Continent stoma may be an option for patients unable to perform intermittent catheterization per urethra. Common stoma techniques employ appendix, small bowel, or bladder flaps.48 Ultimately, bladder management has to be individualized based on the patient's mobility, dexterity, and impact on quality of life.
Paediatric Urology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Jemma Hale, Arash K. Taghizadeh
The goal is ensuring good urinary drainage. Good urinary drainage protects against symptoms, infection and declining function. This is the central principle that all urologists apply to their daily practice. It is the basis of advice given to patients with recurrent infections to drink well and void regularly. It is why intermittent catheterisation (perhaps counter intuitively) reduces the risk of the patients who perform it. It is why urinary tract stomas reduce infection risk despite opening the urinary tract to the skin.
Fluid balance and continence care
Published in Barbara Smith, Linda Field, Nursing Care, 2019
If the cause is an obstruction, such as an enlarged prostate gland, it may be possible to remove the obstruction by surgery. If the cause is constipation, then the administration of aperients may help. If the cause of a partial obstruction cannot be removed, then the Crede manoeuvre can be employed. This manoeuvre involves expelling urine by applying gentle pressure on the suprapubic area (McDowell and Burgio, 1992). This technique should be used with caution and by a healthcare professional trained in the technique in order to avoid any damage from excessive pressure. Intermittent catheterisation, in which a catheter is inserted into the bladder two or three times a day to empty any urine, may be used. If the problem is severe, a permanent catheter may be the best (and sometimes the only) solution. Care of the patient with a permanent catheter is addressed later in this chapter.
Cost-effectiveness analysis of hydrophilic-coated catheters in long-term intermittent catheter users in the UK
Published in Current Medical Research and Opinion, 2023
Hannah Baker, Brooke Avey, Line Overbeck Rethmeier, Stuart Mealing, Marie Lynge Buchter, Márcio Augusto Averbeck, Nikesh Thiruchelvam
Methods used to assist emptying of the bladder for those who are unable to void naturally are transurethral or suprapubic indwelling catheters and intermittent catheters (ICs)3. According to the EAU guidelines and the National Institute of Health3,4, intermittent catheterization, whenever possibly aseptic, is the gold standard. “Clean” intermittent catheterization, popularized by Lapides et al.5, was found to be the safest method for bladder emptying, with the lowest potential for urological complications in patients with a SCI6. Despite this, UTIs are still a common complication seen in catheter usage, in a retrospective study with a 12-year follow-up, chronic or recurrent urinary tract infections were present in 42% of patients performing clean intermittent self-catheterization7.
The inFlow intraurethral valve-pump for women with detrusor underactivity: A summary of peer-reviewed literature
Published in The Journal of Spinal Cord Medicine, 2022
Siobhan M. Hartigan, Roger R. Dmochowski
For women with urinary retention due to DUA, there are currently no surgical or pharmaceutical remedies to restore detrusor contractility. These patients are most commonly directed towards bladder management with either indwelling urinary catheter per urethra, suprapubic tube, or CIC. Intermittent catheterization has become a standard treatment for persons with spinal cord injuries and other forms of chronic urinary retention.13,14 This procedure can be performed by patients or their caregivers using sterile or clean catheters to provide intermittent routine bladder emptying every three to six hours. While a thorough review of the limitations of CIC is beyond the scope of this paper, it is important to note that CIC is not without complications, including urethral strictures, false passages, hematuria, bacteriuria, and labial erosion.15 It also requires the patient to have adequate manual dexterity and visual and cognitive ability or have a reliable caretaker to perform catheterization 4–8 times per day.
Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients
Published in The Journal of Spinal Cord Medicine, 2022
Patrick J. Shenot, Seth Teplitsky, Andrew Margules, Aaron Miller, Akhil K. Das
Males with cervical SCI and significant upper extremity dysfunction often depend upon caregivers to perform intermittent catheterizations. Women with SCI may find self-catheterization difficult, not only due to impaired upper extremity function but also due to the challenges of conveniently accessing the female urethra. Unfortunately, tetraplegic women often rely on either an indwelling catheter or the creation of an incontinent urinary stoma. Highly motivated female SCI individuals can be managed successfully by the creation of a continent abdominal stoma which is much more accessible and requires less dexterity to access than the native urethra. Significant and common complications such as stomal stenosis, difficulty with catheterization, and stomal incontinence are reported in up to one-third of adult patients with neurogenic bladder who undergo continent catheterizable stoma creation.16 These high rates of complications make the native urethra the preferred site for intermittent catheterization when practical.