Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry

Abstract

Introduction: Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation.Methods: The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL.Results: There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). Conclusions: Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL. K E Y W O R D S catheters, indwelling, intermittent urethral catheterization, patient-reported outcome measures, quality of life, spinal cord injuries, urinary bladder

Impact of clean intermittent catheterization on quality of life of patients with neurogenic lower urinary tract dysfunction due to radical hysterectomy: A cross‐sectional study

“…Since the response shift can be helpful or unhelpful depending on the context, it is noteworthy that encouraging patients to focus on areas of their life that are positive, and to set goals in areas that are highly valued and progressing well would be helpful 21 . Performing CIC in women poses increased complexity compared with performing CIC in men because access to the urethra is more challenging for women, and women can perceive CIC as intrusive, embarrassing, and aversive 11 . Patients who are not able to establish a reasonable routine, due to a lack of social support or logistical means to allow for timely CIC, are more likely to abandon it 11 .…”

“…Performing CIC in women poses increased complexity compared with performing CIC in men because access to the urethra is more challenging for women, and women can perceive CIC as intrusive, embarrassing, and aversive 11 . Patients who are not able to establish a reasonable routine, due to a lack of social support or logistical means to allow for timely CIC, are more likely to abandon it 11 . Thus, unsurprisingly, patients who remain on CIC in the long term become well adjusted and are less likely to be dissatisfied with CIC 11 .…”

“…Patients who are not able to establish a reasonable routine, due to a lack of social support or logistical means to allow for timely CIC, are more likely to abandon it 11 . Thus, unsurprisingly, patients who remain on CIC in the long term become well adjusted and are less likely to be dissatisfied with CIC 11 . Until recently, we have seen patients with CIC monthly because of a restriction on reimbursement for catheters for CIC by the Japanese healthcare system.…”

“…Clean intermittent catheterization (CIC) is a standard procedure for patients with neurogenic lower urinary tract dysfunction (NLUTD) who are unable to void spontaneously 1,2 . While the efficacy and safety of CIC have been frequently reported, 3,4 there have been few reports regarding differences in quality of life (QOL) between CIC and spontaneous voiding (SV) in patients with NLUTD, except patients with spinal cord injury (SCI) 5‐11 . Patients' QOL after SCI is profoundly affected not only by urinary management but also by disability due to the injury itself 7‐10 .…”

Cost‐effectiveness of hydrophilic‐coated urinary catheters for individuals with spinal cord injury: A systematic review

“…Our findings are relevant, particularly among the spinal cord injury population, who are often injured when they are young, and are expected to use intermittent catheters for decades 1 . Financial support of hydrophilic‐coated catheters may improve the quality of life and reduce urinary infections, and thus reduce the significant number of patients that switch to indwelling catheters, a medically inferior bladder management method 29 …”