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FOCUS ON PSYCHOSOCIAL ISSUES
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U ROLOGY AND CONTINENCE CARE TODAY
2018,Vol 1, No 1
C
atheterisation, particularly
clean intermittent
catheterisation (CIC), is
now considered the mainstay of
treatment for neuropathic bladder
and other bladder issues associated
with incomplete voiding, such as
dysfunctional voiding (Schaeffer and
Diamond, 2014).
Intermittent catheterisation,
which was first described by Lapides
et al in 1972, has revolutionised
bladder care, as well as vastly
improving continence and reducing
associated urinary tract problems
such as urinary tract infections
(UTIs) (Lamin and Newman, 2016).
However, for catheterisation to be of
benefit and to give optimal results,
it usually has to be carried out
between four and six times per day.
For this to happen, there needs to be
good acceptability and adherence,
particularly for those individuals
who begin catheterisation beyond
infancy. This paper looks at some
of the factors that impact on those
undertaking catheterisation.
Psychosocial issues and
self-catheterisation
CIC was shown to be successful
for bladder emptying in children
without genital sensation with
success rates of 94–100% in select
groups. CIC was an easy technique
for most sensate children to learn in
one visit and master in a short time.
Overall, comfort with the technique
was excellent and few problems were
encountered (Alpert et al, 2005).
Another similar study by
Neel (2010) also reviewed the
feasibility of CIC in children with a
sensate urethra and came up with
corresponding findings, but also
suggested that the earlier the CIC is
started, the more accepting the child
is of the procedure.
At the other end of the age
scale, a study by Pilloni et al (2005)
investigated whether intermittent
catheterisation is a valuable
alternative to an indwelling catheter
June Rogers MBE, specialist continence advisor,
Bladder & Bowel UK
IN BRIEF
Catheterisation has improved continence and reduced associated
urinary tract problems.
Intermittent catheterisation has been shown to be acceptable for all
ages, including the elderly.
The role of the nurse is important in teaching and supporting
patients using clean intermittent catheterisation (CIC) to ensure
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Some patients with indwelling catheters may experience poor body
image and negative sexual self-esteem.
KEY WORDS:
Catheterisation
Psychosocial issues
Acceptability
Patient satisfaction
June Rogers
INTRODUCING AND
ACCEPTING CIC
The decision to offer CIC to
patients and families is often
based on underlying medical
problems and the results of relevant
bladder assessments. Although
CIC is commonly used in patients
with neuropathic bladders, with
associated reduced urethral
sensation, there is some belief that
those with urethral sensation may be
reluctant to start CIC (Alpert et al,
2005; Neel, 2010).
To test this theory, a study
was carried out to evaluate the
acceptability of CIC in boys who
had urethral sensation (Alpert
et al, 2005). The study reviewed
a group of boys following the
decision to start CIC, which
was based on the child’s history
and the results of a completed
bladder diary, in accordance with
the recommendations of the
International Children’s Continence
Society (ICCS) (Pohl et al, 2002).
Initiating CIC was considered for
those boys who had lower urinary
tract (LUT) voiding dysfunction,
with or without hydronephrosis,
impaired renal function, and
recurrent UTIs.
i
Practice point
Clinicians working with adolescents
need to be mindful of the particular
developmental needs of this group
and provide appropriate support
as necessary.