Specific Aspects of using Intermittent Catheterization

Author Year
Country
Research Design
Score
Total Sample Size

Methods

Outcome

Polliack et al. 2005
Israel
RCT
PEDro=6
N=24

Population: Study group: Mean age: 42.7 yr; Gender: males=9, females=4; Level of injury: paraplegic=5, tetraplegia=8; Control group: Mean age: 53.46 yr; Gender: males=6, females=5; Level of injury: paraplegic=6, tetraplegic=5. Injury severity: AIS A-D.
Treatment: Patients were randomized to 1) volume-dependent intermittent catheterization (IC) as measured by a portable ultrasound device (PUD) or 2) time dependent IC; F/U period 12-30 d.
Outcome Measures: Frequency of catheterization, time to perform, total cost, complications.

  1. Compared to the control group, the study group had 6 fewer catheterizations/day (44% decrease), required 20 minutes less time to perform volume measurements and catheterizations (49% decrease), and experienced 46% less cost (p<0.001).

Akkoc et al. 2013
Turkey
Crosssectional
N=195

Population: SCI: Mean age: 38.2 yr; Time post-injury: 54.9 mo; Gender: male=145, female=50; Etiology of injury: traffic accidents (39.3%), fall from height (36.1%), jumping into the sea (7.9%).Bladder management: normal spontaneous micturition (NSM)=28, micturition with assisted maneuvers (MAM)=8, aseptic intermittent catheterization by patient (IC-P)=79, aspectic IC by an attendant/caregiver (IC-A)=65, Indwelling catheterization (IDC)=15.
Treatment: Administration of the King’s Health Questionnaire to evaluate bladder management methods on patients’ quality of life (QoL).
Outcome Measures: QoL, general health perception, incontinence impact, role limitations, physical limitations, social limitations, personal relationships, emotions, sleep/energy, and symptom severity.

  1. There was no observed difference between bladder management groups in general health perception, personal relationships, and sleep/energy domain scores.
  2. The NSM group had better QoL, while IC-A had the poorest QoL in most of the domains.
  3. There was a significant difference among urinary incontinence groups only in symptom severity scores, for patients with urinary incontinence several times/d, and those with urinary incontinence several times a week were found to be significantly higher than of patients without urinary incontinence (P<0.001 and P=0.018).

Pannek & Kullik
2009b
Germany
Post-test
N=41

Population: Mean age: 39.5 ±14yr; Gender: male=31, female=10; level of injury: C=9, T=23, L=9; Level of injury: Paraplegia=28, Tetraplegia=13; mean time post-injury=4 yr.
Treatment: Bladder management via intermittent self-catheterization, anticholinergic therapy, BTX-A.
Outcome Measures: the Qualiveen questionnaire, urodynamics, treatment success.

  1. Bladder management was successful in 14 patients. Of the 27 patients with treatment failure, 16 reported decreasing efficacy of BTX-A injections and 11 reported significant detrusor over activity despite anticholinergic therapy in both groups.
  2. Qualiveen scale ratings concerning patient’s fears and feelings were greater for patients with suboptimal bladder function; all patients listed as having treatment failure were incontinent.
  3. Depression has an impact on QoL, but only continence was directly related to QoL. Level of injury was not significant to influence QoL.

Woodbury et al. 2008
Canada
Observational
N=912

Population: Intermittent Catheterization (IC) users:Mean age: 47 yr; Gender: male=57%, female=50%; Non IC users: Mean age: 53 yr.
Treatment: 36-item self-report questionnaire.
Outcome Measures: Urinary tract infections (UTI), risk factors (sex, age, level of injury, number of catheterizations), quality of life (QoL).

  1. Mean frequency of UTIs for IC users was 2.6±2.6 in the last 12 mo.
  2. Among IC users, females had a significantly greater number of UTIs than males (p=0.003).
  3. Sex, number of catheterizations, age, and severity of injury were each correlated with infection rate.
  4. Time lost from social activities due to UTIs lead to poorer QoL than the actual number of UTIs or days lost from work.

Oh et al. 2006
Korea
Prospective Controlled Trial
N=282

Population: SCI patients =132: Mean age: 41.8 yr (range 18-80 yr); Gender male=81, female=51; Injury level: cervical=36, noncervical=96; Severity of injury: paraplegic=24, tetraplegic=108; Duration of catherization use: 24.2 mo.Controls=150: Mean age: 41.8 yr; Gender: male=90, women=60.
Treatment: Health related quality of life (HRQoL) questionnaire to determine psychological and social status of patients.
Outcome Measures: HRQoL measured by the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36).

  1. SF-36 scores did not reveal significant differences between the men and women in the patient group.
  2. SF-36 scores of patients were significantly lower compared to controls (physical functioning: p<0.001; role-emotional functioning: p=0.002; vitality: p<0.064; mental health: p<0.001; social functioning: p<0.001; bodily pain: p=0.025; general health: p=0.013).

Ku et al. 2006
Korea
Case Series
N=140

Population: Gender: males=100, females=40; Severity of injury: complete=34, incomplete=106; Time post-injury= 17 yr.
Treatment: Review of urological medical records from January 1987 to December 2003 on patients with SCI. Methods of bladder management included spontaneous voiding, clean intermittent catheterization (IC), suprapubic or indwelling catheters.
Outcome Measures: Patients with epididymo-orchitis, variables associated with risk.

  1. Overall, 39 patients had epididymo-orchitis.
  2. Epididymo-orchitis was more common for patients on IC than with indwelling urethral catheterization (p=0.03).
  3. Rate of urethral stricture: 0% urethral catheterization, 4.3% voiding spontaneously, 18.2% IC, and 2.8% suprapubic catheter.
  4. Patients on IC had a 7 fold higher risk (odds ratio, 6.96; 95% CI, 1.26-38.53, p=0.026).
  5. IC was an independent risk factor for epididymo-orchitis.

Ord et al. 2003
England
Case Series
N=457

Population: SCI with >6 mo on any 1 form of management: Mean age: 29-40 yr for various groups; Gender: males=402, females=55; Level of injury: T3 – T9; Severity of injury: complete, incomplete; Follow-up time=48-107 mo.
Treatment: Assessment of various bladder management methods (i.e., sphincterotomy, condom, intermittent catheter (IC), indwelling urethral catheter, suprapubic catheter+ combinations of each).
Outcome measures: Bladder stone formation rate.

  1. Both forms of indwelling catheterization had an increased risk of getting bladder stones and requiring hospitalization for bladder stones over IC and condom drainage with or without sphincterotomy.
  2. Relative to IC, hazard ratio was 10.5 for suprapubic catheters and 12.8 for indwelling urethral catheters.
  3. Incidence density ratio (like odds ratio) was 40.7 for developing bladder stones for indwelling catheters relative to IC. Condom incidence density ratio was 7.5 relative to IC.
  4. % Annual risk for stone formation: Condom & Sphincterotomy 0%; IC 0.2%; Expression voiding with or without condom 0.5%; Indwelling catheter 4% (first stone), 16% (subsequent stone).

Weld & Dmochowski 2000
USA
Case Series
N=316

Population: SCI: Mean age: 33.9-41.0 yr; Gender: males=313, females=3; Level of injury: suprasacral=269, sacaral=47; Severity of injury: complete=45, incomplete=271; Mean follow-up=17.8-19.3 yr for various groups.
Treatment: Assessment of various bladder management methods (i.e., intermittent catheterization (IC), voiding spontaneously, indwelling urethral catheter, suprapubic catheter).
Outcome Measures: Urological complication rate (epididymitis, pyelonephritis, upper tract stone, bladder stone, urethral strictures, periurethral abscess, vesicoureteral reflux, abnormal upper tracts).

  1. Frequency of those managed by IC, voiding spontaneously, suprapubic and urethral catheterization was 92, 74, 36 and 114 subjects respectively.
  2. Complication rates for the above groups were 27.2%, 32.4%, 44.4% and 53.5% respectively.
  3. Urethral catheter users had the highest rates for epididymitis, pyelonephritis, upper tract stone, bladder stone, urethral strictures and periurethral abscess.
  4. Suprapubic catheter users had the highest rates for vesicoureteral reflux and abnormal upper tracts.

Jensen et al. 1995
Norway
Case Series
N=12

Population: Age Range=17-72 yr; Gender: males=11, females=1; Severity of injury: complete, incomplete; Time post-injury: 3-7 mo.
Treatment:Three ultrasonographic measurements of residual urine after Intermittent catheterization.
Outcome Measures:  Residual urine volume; urinary tract infections (UTI).

  1. 7 patients had 50-100mL residual urine; 2 patients had >100mL residuals.
  2. 9 patients had >1 UTI during hospital stay.
  3. No correlation between residual urine volume and UTI incidence (r=0.19 (mean), p=0.52; r=0.16 (max), p=0.63).

Perrouin-Verbe et al. 1995
France
Case Control
N=188

Population: Group 1 (clean intermittent catheterization, IC): Mean age: 38 yr; Gender: males=113, females=46; Level of injury: thoracic=67, conus medullaris syndrome=20, cauda equina syndrome=22; Severeity of injury: tetraplegia=50, Group 2 (Patients who discontinued clean IC after 2 yr=8): Mean age: 38 yr; Gender: males=8; Level of injury: C=1, T=4, TL=1, LS=2; Severity of injury: Frankel grade: A=6, D=2; Group 3 (Patients performing clean IC for over 5 yr, N=21): Mean age: 37.3 yr; Gender: males=21; Level of injury: C=2, T=10, TL=6, LS=3; Severity of injury: Frankel grade: A=17, B=1, C=2, D=1; Duration of cean IC=9.5 yr.
Treatment: Data of SCI patients using clean IC was retrospectively reviewed.
Outcome Measures: Infection rate (urinary tract and genital), incontinence, duration of clean IC use, complications, procreation, patient satisfaction (visual analogue scale).

Group 1:

  1. 95 patients had asymptomatic cytobacteriological infection; 45 had symptomatic lower urinary tract infection.
  2. Males had a significantly higher rate of infection than females (p<0.05); epididymitis (n=16), stricture (n=8).
  3. Deterioration of the upper urinary tract was seen in 3 patients and was correlated with high intravesical pressure.

Group 2:

  1. Even with use of anticholinergic drugs, 5 patients were incontinent.
  2. Mean time before discontinuance of catheterisation was 5.25 yr.
  3. Reasons for discontinuance included persistent incontinence (n=5), upper urinary tract deterioration (n=1), catheterisation difficulty (n=4), urethral stricture (n=1).

Group 3:

  1. Group comprised of 10 with detrusor areflexia; 11 with DESD (7 used anticholinergic drugs).
  2. Symptomatic infections less than once every two yr in most patients but 2-4/yr in 4 patients.
  3. Catheterization was difficult (n=11) or impossible (n=5) for some.
  4. Rate of urethral stricture was 19% and epidydimitis was 28.5%; these rates increased with the number of yr of clean IC use.

Nanninga et al. 1982
USA
Case Series
N=85

Population: Gender: males=71, females=14, Level of injury: paraplegia=56, tetraplegia=29; Severity of injury: complete=64, incomplete=21.
Treatment: Patients on intermittent catheterization followed for 11 mo (range 6-72).
Outcome Measures: Excretory urogram and cystogram at 6 mo intervals. Urine culture. Serum urea and creatinine.

  1. 12 developed reflux, 16 developed ureterectasis or hydroureternephrosis. 11 of these 28 had elevated creatinine.
  2. 64 had at least 1 urinary tract infection (UTI), 1 had bladder calculi.
  3. Treatment in 15: Increased frequency of catheterization. Avoiding short duration high fluid intakes. 3 had sphincterotomy. 10 were converted to indwelling catheterization.
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