Clinical background of patients treated with clean intermittent catheterization in Norway

Determining the variables associated to clean intermittent self-catheterization adherence rate: one-year follow-up study

PURPOSE

To determine adherence rate and variables associate with patients' adherence to Clean Intermittent Self Catheterization (CISC).

MATERIALS AND METHODS

Patients referred to CISC training program between July 2006 and May 2008, were prospectively evaluated with urodynamic, 3 days bladder diary (BD) and WHOQoL-brief questionnaire. After training to perform CISC, patients were evaluated at 2 weeks, monthly for 6 months and at 12 months with clinical visits and BD. Patients were considered adherent if they were performing at least 80% of the initial recommendation.

RESULTS

Sixty patients (50.4 ± 19.9 years old) were trained to perform CISC (21 female and 39 male). Out of them, 30 (50%) had neurogenic and 30 (50%) had a non-neurogenic voiding dysfunction. The adherence rate at 6 and 12 months was 61.7%, 58%, respectively. Patients < 40 years old had adherence rate of 86%. Women and neurogenic patients had higher adherence rate than their counterparts (p = 0.024 and p = 0.016, respectively). In the WHOQoL-brief, patients that adhere to the program had a significant higher score on psychological and social relationships domains. There was not difference in pre and post training WHOQoL-brief scores. Educational background, marriage status, detrusor leak point pressure, Bladder Capacity, number of leakage episodes did not play a role on the adherence rate.

CONCLUSION

Patients in CISC program present a reasonable adherence after one year. Women, neurogenic voiding dysfunction and patients under 40 years old were significantly more adherents. The psychological and social relationship status seems to positively interfere on adherence. CISC did not affect patient's QoL evaluated by WHOQoL-brief.

A Novel Product for Intermittent Catheterisation: Its Impact on Compliance with Daily Life—International Multicentre Study

OBJECTIVES

This study was undertaken to evaluate patient openness to changing and satisfaction with catheters used in intermittent catheterisation (IC) for urinary retention from neurogenic bladder dysfunction, and to compare patient response to conventional catheters and a novel packaged hydrophilic catheter: LoFric Primo.

PATIENTS AND METHODS

Of 409 patients recruited, 378 (283 males, 95 females; mean age: 43.5 yr) completed a 12-d trial of the novel catheter. The diagnoses were spinal cord lesion in 65.6%, multiple sclerosis in 9.6%, spina bifida in 2.3%, and other neurologic conditions in 22.5%; the mean duration of IC was 4.6 yr. Patients evaluated their current catheter at recruitment and the novel catheter after the 2-wk trial by questionnaire. Patient satisfaction was expressed on a Visual Analogue Scale for seven topics covering use and general satisfaction.

RESULTS

Of the 378 patients, 55.2% were happy to continue with the novel device, which was 74% of patients using standard polyvinyl chloride (PVC) catheters and 36% of those using prelubricated PVC (p=0.04). No individual patient factors were found to be significant in catheter choice. For the whole study population "ability to comply with daily life activities" was maintained with the novel product despite handling and general satisfaction being found more troublesome.

CONCLUSIONS

The main finding was that more than 50% of the patients wished to continue with the novel catheter and reported increased satisfaction regarding introduction of the catheter, handling, time spent, perception of IC, general satisfaction, and ability to cope with daily life.

Geriatric incontinence

Regardless of age, mobility, mentation, or institutionalization, incontinence is never normal. By attenuating physiologic reserve, aging increases the likelihood of becoming incontinent in the setting of additional physiologic, pharmacologic, or pathologic insults. Because many of these problems lie outside the urinary tract, so too must the diagnostic and therapeutic focus. Such a strategy, however, coupled with a multifactorial, creative, persistent, and optimistic approach, increases the chances of a successful outcome and generally rewards patient and physician alike.

Psychosocial Adjustment to Illness Scale (PAIS-SR) in a Norwegian material of patients with functional dyspepsia, duodenal ulcer, and urinary bladder dysfunction. Clinical validation of the instrument

BACKGROUND

There is an increasing interest in the psychosocial impact of a disease, but few instruments available to measure it.

METHODS

The internal consistency and construct validity of the Norwegian translation of the Psychosocial Adjustment to Illness Scale (PAIS-SR) was examined in a total of 557 patients.

RESULTS

The seven dimensions of the psychosocial adjustment to medical illness from the original test were represented in the Norwegian translation. Psychologic distress, social environment, and vocational environment explained most of the variance. The instrument had high internal consistency with Cronbach's alpha coefficients of > 0.75 on six of seven subscales. The PAIS-SR differentiated between groups of patients with urologic and upper gastrointestinal disease and seemed to give meaningful and useful clinical data. Patients with functional dyspepsia (n = 97) had higher score on psychologic distress than the other groups, whereas patients with duodenal ulcer (n = 97) were significantly less affected in their social life than the other patients.

CONCLUSIONS

The Norwegian translation of the PAIS-SR had high internal consistency, acceptable construct validity, and good discriminating validity.

Clean intermittent catheterisation-performing abilities, aversive experiences and distress

A total of 407 patients participated in a one year follow up study concerning their personal experiences and attitudes towards clean intermittent catheterisation (CIC). Most patients (90%) were able to perform CIC themselves, approximately 70% having no problems with the procedure. However, one third of the patients experienced CIC as aversive with significantly higher distress scores on the general health questionnaire (GHQ-28). Aversion and distress were more often reported by younger patients and females, and by patients with non neuropathic bladders. The patients' physical disabilities and their length of previous CIC experiences did not seem to influence the feelings of aversion. These findings demonstrate the importance of considering the psychological implications of CIC, and the emotional needs of these patients in order to improve compliance and quality of life.

Social functioning and general well-being in patients treated with clean intermittent catheterization

Social role function, health perceptions and general well-being were studied longitudinally over 1 yr in 149 males and 153 females performing clean intermittent catheterization (CIC). The evaluation included urological assessments and self-rating instruments (Revised Physical Battery, General Health Questionnaire--28 items, State Anxiety Inventory and CIC Pain and Discomfort Scale). Twenty-six percent reported major improvement in their overall quality of life, while 7% reported a wish to be dead and away from it all. Females with infranuclear lesions and detrusor myopathies scored higher on unpleasant health perceptions, state anxiety and physical discomfort by performing CIC than males. In males, the social role function 1 yr later was predicted by initial anxiety and urinary tract infections, whereas in females by initial anxiety only. Discomfort by CIC was predicted by initial infection in males, and by none or moderate medical comorbidity, initial depression and infection in females.

Risk factors for bacteriuria and clinical urinary tract infection in patients treated with clean intermittent catheterization

To study factors that may predict the occurrence of bacteriuria and clinical urinary tract infection, a total of 302 patients using clean intermittent catheterization was followed. Bacteriuria was found equally in men and women, while clinical urinary tract infection was significantly higher among women. Predictive factors of clinical urinary tract infection were low age and high mean catheterization volume in women. In men low age, neurogenic bladder dysfunction and nonself-catheterization were predictors in addition to urine leakage in patients with neurogenic dysfunction. Bacteriuria was a risk factor of future clinical infection and bacteriuria. No other risk factor of bacteriuria could be identified in the female population, while low frequency of catheterization, high age and nonself-catheterization were predictive in men. Patients using anti-infective agents had fewer episodes of bacteriuria but significantly more clinical urinary tract infections compared to nonusers.

Physical complications in patients treated with clean intermittent catheterization

To characterize and quantify complications related to clean intermittent catheterization (CIC) 302 out-patients were followed for a mean period of 13 months. The main problems were minor bleeding in connection with the procedure and infections. Except for two patients with recurrent strictures, no serious urethral complications were detected. One or more episodes of cystopyelitis were experienced by 5.6% of the patients. Long term major problems of infectious origin affected only 2.6% while 24.5% had no signs of clinical infection during the follow-up period. UTI was more frequent in young patients, women, and men with supranuclear affection. Eight patients suffered from bladder stones and 1 patient from epididymitis. No serious radiological changes were detected in the upper urinary tract. No association was found between reported problems and changes in the patients' general condition, physical disability and length of previous CIC experience.