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FOCUS ON INTERMITTENT SELF-CATHETERISATION
i
20
UROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
O
ver the last few decades,
the use of intermittent
self-catheterisation (ISC)
to control or assist voiding has
become widespread. Increasingly,
more treatments, both medical
and surgical, are possible because
of ISC. Alongside this increase in
use has been the development and
evolution of intermittent catheters
themselves. There are also a number
of National Institute for Health and
Care Excellence (NICE) guidelines
advocating the use of ISC (
Table
3
). Of course, there will always be
patients who cannot or will not
perform ISC on themselves, either
because of physical, practical or
psychological impediments; however,
it is equally true that not all patients
who could benefit from using ISC are
necessarily being offered it (Dingwall
and McLafferty, 2006).
Lapides et al first published
their findings on ISC in 1972, which
showed that the procedure was
associated with less urinary tract
infections (UTIs) than indwelling
catheterisation, and that it greatly
improved the quality of life of
patients with bladder problems.
This 1972 paper and subsequent
Intermittent self-catheterisation
indwelling catheters for benign
prostatic hyperplasia (BPH) or
urethral strictures. Incomplete
emptying, i.e. in neurogenic or
hypotonic bladders, can also be
successfully managed with ISC,
as can that caused by surgical
intervention such as Botox treatment
for overactive bladders or following
insertion of mid-urethral tape
for urinary incontinence. Indeed,
many surgical procedures which
have become standard nowadays
would not be possible without ISC.
Continent urinary diversions, such as
neobladders, enterocystoplasties, or
urinary pouches, e.g. the Mitrofanoff,
all rely on the patient being able to
successfully self-catheterise to void
(European Association of Urology
Nurses [EAUN], 2013).
Other indications for the use
of ISC include bladder or urethral
investigations and intravesical
instillation of drugs directly into the
Rachel Leaver, lecturer practitioner, urological
nursing, UCLH and London South Bank
University, UCLH NHS Foundation Trust
IN BRIEF
If a patient cannot empty their bladder completely, intermittent
self-catheterisation (ISC) may be an acceptable treatment option.
Learning ISC can be daunting for patients and unless taught
properly and the patient is given time to learn at their own pace,
compliance may be a problem (Logan et al, 2008).
There are a huge variety of catheters available for ISC and each
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suits their needs.
KEY WORDS:
Intermittent self-
catheterisation (ISC)
Patient education
Performing ISC
Complications
RACHEL LEAVER
publications by Lapides et al (1974,
1976) and Diokno et al (1983)
outlined the main advantages of ISC,
which included:
i
Preventing or overcoming
infection by regular emptying
of the bladder
i
No real increased infection rate
using a clean rather than a
sterile procedure
i
Promoting a ‘normal’ pattern of
filling and emptying stages
of micturition
i
Protecting the upper urinary tract
i
Improving symptoms
i
Promoting independence
i
Improving quality of life.
INTERMITTENT
CATHETERISATION
Indications
There are several indications for
using catheters — both indwelling
(see
pp. 28–34
) and intermittent
(
Tables 1
and
2
).
Although not all patients are
suitable for ISC, it is increasingly
becoming an option, either as
treatment or as a consequence of
having surgery (Van Achterburg et
al, 2007).
ISC is used to manage voiding for
individuals with various problems,
including those who, historically,
were routinely managed with
i
Practice point
Intermittent self-catheterisation is
a means of giving patients control
over when to void. For some cases,
this may be preferable to more
invasive procedures, especially if
the patient is unfit for surgery or
further intervention.