Clean intermittent catheterization in long‐term management of neurogenic bladder in spinal cord injury: Patient perspective and experiences

Abstract

Bladder dysfunction due to spinal cord injury has a significant impact on the overall health and quality of life of an individual. Clean intermittent catheterization is the gold standard for bladder management and is recommended due to having the lowest complication rate. Transitions from intermittent catheterization to other less optimal strategies, such as indwelling catheter, are quite common. However, the research documenting patient perspectives, and epidemiological and demographic factors related to such transition is limited. Methods: Data from patients with spinal cord injury rehabilitated with clean intermittent catheterization were collected. Demographic and epidemiological details of the patients were documented from the inpatient records. Appropriate statistical tests were applied to the values. Results: Among the 45 participants, 68.89% continued clean intermittent catheterization. In those who discontinued clean intermittent catheterization, the median duration of practicing clean intermittent catheterization was 3.5 months. The commonest difficulty among compliant patients was carrying out clean intermittent catheterization in outdoor environments due to the unavailability of toilet facilities. Urinary tract infection was the most common (17.78%) complication noted. Dependence (20.00%) was a major procedural difficulty followed by pain. Adaptations to remain continent in special conditions were diapers and condom catheters. The duration of clean intermittent catheterization practiced influenced discontinuation of clean intermittent catheterization. With an increase in the duration of clean intermittent catheterization practiced after discharge, the risk of discontinuation of clean intermittent catheterization decreased with an adjusted odds ratio of 0.773 (95% confidence interval 0.609-0.982). Conclusions: People with spinal cord injury have many challenging issues in the regulation of bladder function at their level inclusive of procedural difficulties, environmental barriers and medical complications, and understanding of which will help to establish a comprehensive and a holistic program to provide remote/community care.

Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single‐use catheters

“…Especially, optimizing ISC away from home is a major challenge. Joshi et al 17 reported that 63.41% of patients with SCI had difficulty in carrying out CIC away from home, and the reason for difficulty of the majority of the patients was toilet facilities, followed by time regulation and dependence. If ISC is difficult to perform when away from home, the use of i‐IDC may be considered in Japan.…”

Diagnosis and treatment of neurogenic bladder secondary to aortic dissection: A 8‐year retrospective study at a single center

“…Although seems simple and straightforward, assisted bladder emptying, including Credé or Valsalva maneuver, is not suggested due to the considerations of safety and effectiveness. Nowadays, CIC is considered as the “gold standard for bladder emptying.” 26 …”

“…Nowadays, CIC is considered as the "gold standard for bladder emptying." 26 Maintaining low pressure during bladder retention is important. Antimuscarinic drugs, botulinum toxin injection, electrical stimulation, and bladder augmentation are all effective strategies.…”

Rehabilitation care of patients with neurogenic bladder after spinal cord injury: A literature review

“…The acute stage of spinal cord injury patients is the stage of spinal cord shock[ 16 ]. The bladder loses spinal cord innervation, resulting in complete paralysis of the detrusor muscle of the bladder, loss of contraction and relaxation functions, and reduced tension of the urethral sphincter.…”