Fluid balance and continence care
Barbara Smith, Linda Field in 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.
Catheters, Pads, and Pants
Linda Cardozo, Staskin David in Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
UrethrAl CAtheterizAtion Definition urethrAl cAtheterizAtion is the pAssAge of A tube through the urethrAl os into the blAdder to drAin the blAdder of urine. this process mAy be done on An intermittent bAsis or As A permAnent indwelling ArrAngement. Intermittent cAtheterizAtion mAy be chronic or A onetime event for An Acute pAtient cAre need, for exAmple, Urinary retention or drug AdministrAtion. Indwelling cAtheterizAtion is the pAssAge And Anchoring of A cAtheter for An extended period of time. the cAtheter is not immediAtely removed but is stAbilized to the skin through An Anchoring device such As A leg strAp [1]. Designs And MAteriAls CAtheters hAve evolved over the yeArs As new mAteriAls Are developed And pAtient needs And demAnds dictAte chAnges in the mArket. Choice of mAteriAls And design Allows the best cAtheter to be employed. There is not one cAtheter thAt does All, but the vAriety currently AvAilAble permits pAtients And cAre providers the opportunity to choose the best cAtheter for the specific need of the pAtient. However, depending on the locAtion of prActice And the mAcroeconomic environment, third-pArty pAyers or other externAl forces mAy At times dictAte the cAtheter used (tAble 45.1).
Intervertebral disk prolapse
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
Bladder management is guided by urodynamic findings to allow adequate bladder emptying while maintaining satisfactory continence and preserving upper urinary tract function. Most cases of disk prolapse resulting in lower urinary tract dysfunction occur in the lower lumbar region, below the level of the spinal cord. This results in a lower motor neuron–type lesion characterized by impaired detrusor contractility or detrusor areflexia with normal compliance. Intermittent catheterization is usually offered in patients with poor bladder contractility. Impaired bladder compliance, if present, is usually associated with conus injuries and myelopathy. Many patients with symptomatic disk disease, however, have preserved detrusor function but are plagued by frequency, urgency, and urge urinary incontinence. Anticholinergic medications can be given in such patients after assurance of adequate bladder emptying.
Effect of intravesical botulinum toxin injection on symptoms of autonomic dysreflexia in a patient with chronic spinal cord injury: a case report
Published in The Journal of Spinal Cord Medicine, 2019
Il-Young Jung, Kyo Ik Mo, Ja-Ho Leigh
The patient had initially used a clean intermittent catheterization regimen for bladder management. However, there was no caregiver available to help with his voiding and care. Consequentially, a suprapubic catheter was inserted into his bladder for long-term care, because he had recurrent urinary tract infections and epididymitis caused by an indwelling urethral catheter. As bladder distension can be one of the causes of autonomic dysreflexia, despite the patients taking an α-blocker (alfuzosin) and anticholinergics (solifenacin), a urodynamic study was performed 1 month after the outpatient visit. Neurogenic detrusor overactivity was confirmed at the terminal phase. The bladder capacity and detrusor pressure at the maximum cystometric capacity were 420 mL and 34 cmH2O, respectively, meaning that the detrusor pressure was not high, and the bladder had a normal volume (Fig. 1).
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.
Related Knowledge Centers
- Benign Prostatic Hyperplasia
- Bladder
- Urinary Tract Infection
- Spinal Cord
- Urinary Catheterization
- Spina Bifida
- Multiple Sclerosis
- Urethral Stricture
- Male Infertility