Time Burden of Bladder Management in Individuals With Spinal Cord Injury

Analysis of facilitators and barriers to early urinary catheter removal in postoperative patients by spine surgery nurses: a qualitative study based on the COM-B model in China

BACKGROUND

The high utilization rate of indwelling urinary catheters in patients after spine surgery poses an increased risk for a range of associated complications. Evidence-based recommendations suggest that urinary catheters should be removed early, yet spine surgery nurses are not positive about the behavior of removing catheters early after the surgery.

OBJECTIVES

The aim of this study was to explore the facilitators and barriers to early catheter removal by spine surgery nurses in postoperative patients, guided by the COM-B model.

METHODS

This study employed a qualitative study with a descriptive research design. In-depth and semi-structured interviews were carried out to explore facilitators and barriers to early catheter removal in postoperative patients by 18 spine surgery nurses in China. Data were analyzed using traditional content analysis methods.

RESULTS

We identified 10 barriers and facilitators from capability, opportunity, and motivation based on the COM-B model. (1) capability: lack of knowledge, Lack of standardized protocols, Changes in workload; (2) opportunity: Increase in the demand for human and material resources, Lack of effective communication, Lack of prioritization of early catheter removal; and (3) motivation: Promote patients' early recovery, Conflicting emotions.

CONCLUSIONS

Nurses encountered barriers from capability, opportunity, and motivation, which were not isolated but interrelated. Future interventions need to incorporate facilitators and barriers to address the issue of early indwelling urinary catheter removal in patients after spine surgery by taking a holistic approach at multiple levels, including nurses, doctors, patients, and health systems.

Bladder Emptying Strategies, Active Follow-up Adherence and Barriers in Post-Discharge Spinal Cord Injury individuals: A Multiple Center Cross-Sectional Study

Background

Adherence plays a crucial role in the long-term management of chronic conditions, including neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury (SCI). Poor adherence can lead to complications, reduced quality of life, and increased healthcare costs.

Purpose

This study aimed to evaluate the post-discharge bladder-emptying practices and adherence to follow-up in SCI individuals with NLUTD, identifying key factors influencing adherence to improve long-term care strategies.

Methods

A cross-sectional survey was conducted in Southwest China from May 1 to September 30, 2023. Online questionnaires were employed to collect data on sociodemographic characteristics, bladder emptying methods, active follow-up adherence and related barriers.

Results

Out of 412 fully completed questionnaires, as for bladder-emptying method, 70.15% of respondents opted for clean intermittent catheterization (CIC) as their primary or preferred mode. CIC usage was more prevalent among participants with thoracic and lumbar SCI, while those with cervical SCI demonstrated a higher reliance on indwelling catheterization (IDC) and cystostomy. A significant 63.55% did not engage in regular hospital follow-ups participants with thoracic SCI had the lowest adherence rate (49.79%), followed by lumbar (72.62%) and cervical (77.59%) groups. Preferences for medical consultation were highest for rehabilitation physicians at 65.68%, with neurourologists following at 33.83%. Key barriers to follow-up adherence were identified as the more severity of SCI, lack of disease knowledge, increasing age, and reliance on adult children for care. In contrast, positive predictors of follow-up adherence were ample financial support and previous medical consultation experiences.

Conclusion

This study revealed insufficient follow-up adherence among SCI individuals with NLUTD, with CIC emerging as the preferred method for bladder emptying strategy. Age and injury level significantly influenced adherence. To improve long-term management of NLUTD, future initiatives should focus on enhancing health education accessibility, optimizing healthcare services, and providing comprehensive financial support to high-risk groups.

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.

Integrating Patient Preferences with Guideline-Based Care in Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury

Individual and social factors are important for clinical decision-making in patients with neurogenic bladder secondary to spinal cord injury (SCI). These factors include the availability of caregivers, social infrastructure, and personal preferences, which all can drive bladder management decisions. These elements can be overlooked in clinical decision-making; therefore, there is a need to elicit and prioritize patient preferences and values into neurogenic bladder care to facilitate personalized bladder management choices. For the purposes of this article, we review the role of guideline-based care and shared decision-making in the SCI population with neurogenic lower urinary tract dysfunction.

Urinary Catheters: Materials, Coatings, and Recommendations for Selection

Urinary catheters have been used for more than 3000 years, although materials have changed from wood to silver to rubber. Research continues to try and find the optimal catheter materials, which improve safety and quality of life. Advantages when comparing newer catheter materials are not always obvious but catheters coated with a hydrophilic layer may reduce urethral trauma and the incidence of urinary tract infections. However, extrapolation of the data is limited by lack of end-point standardization and heterogenous populations.

The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction

It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.

Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury?

INTRODUCTION

One of the most important predictors of clean intermittent catheterization (CIC) adoption after spinal cord injury (SCI) is upper extremity (UE) motor function at discharge from rehabilitation. It is not clear however if post-discharge improvements in UE motor function affect future bladder management decisions.

METHODS

We assessed persons with cervical SCI in the National Spinal Cord Injury Dataset for the years 2000-2016 who underwent motor examination at discharge from rehabilitation and again at 1-year follow-up. Individuals were stratified based on a previously described algorithm which categorizes the ability to independently perform CIC based upon UE motor scores. Improvements in the predicted ability to self-catheterize over the first year after rehabilitation discharge were evaluated in relation to bladder management.

RESULTS

Despite 15% of our SCI cohort improving from "less than able to independently catheterize" to "able to independently catheterize", more patients in the overall cohort dropped out of CIC (175/643 = 27.2%) than adopted CIC (68/548 = 12.4%) (P < .001). We found that in those initially categorized as "less than able to independently catheterize" at the time of rehabilitation discharge, CIC adoption was not significantly different at 1-year follow-up whether or not there was motor improvement to "able to independently catheterize" (12.7% vs 9.2% respectively, P = 0.665). Between these two groups, CIC dropout was also equivalent (34.3% vs 30.0% respectively, P = 0.559).

CONCLUSIONS

In the first year after rehabilitation, more overall SCI patients transition away from CIC than convert to CIC. Significant improvements in UE motor function during the first year after rehabilitation discharge do not appear to affect bladder management decisions.

Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan

OBJECTIVES

To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI).

METHODS

We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI.

RESULTS

Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI.

CONCLUSIONS

There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.

Internal and External Barriers to Bladder Management in Persons with Neurologic Disease Performing Intermittent Catheterization

People living with neurogenic lower urinary tract dysfunction (NLUTD) often have to use clean intermittent catheters (CIC) to manage their bladder function. The use of catheters presents multiple unique challenges, based on both the person's inherent characteristics and on the external limitations imposed by public toilets. We review the impact of age, sex, upper limb function, caregiver assistance, time required to perform CIC, and urinary incontinence on CIC in NLUTD, with special reference to their interaction with societal and public health factors. Public toilet limitations, such as lack of availability, adequate space and special accommodation for CIC, cleanliness, and catheter design are also reviewed. These potential barriers play a significant role in the perception and performance of bladder care in people living with NLUTD.

Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury

Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients' allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields.

Variation in Provider Practice Patterns and the Perceived Need for a Shared Decision-making Tool for Neurogenic Lower Urinary Tract Dysfunction

OBJECTIVE

To evaluate neurogenic lower urinary tract dysfunction (NLUTD) care providers' current practice patterns, their perceived need for a shared decision-making tool for NLUTD management.

METHODS

We developed an electronic survey to assess multiple factors surrounding NLUTD management including practice patterns, perceived need for a decision aid and willingness to use it. Prior to survey dissemination, a panel of expert NLUTD care providers reviewed and provided a critique of the survey. It was delivered via email to the members of the Genitourinary Reconstructive Surgeons, and the Society of Urodynamics, female pelvic medicine and urogenital reconstruction between March and May 2022.

RESULTS

A total of 117 NLUTD care providers from 11 countries participated in this survey. Most participants were urologists (n: 109, 93%) working at academic teaching hospitals (n: 82, 70%). The most common treatments the providers had provided for stress urinary incontinence and detrusor overactivity were sling procedures (n: 76, 65%) and anticholinergics (n: 111, 95%). Participants believed that NLUTD management can be highly patient-specific and extensively vary from one individual to another. Most participants believed that patients performing clean intermittent catheterization have better QoL compared to those utilizing indwelling urinary catheters (n: 81, 69%). Participants believed there is a need for a NLUTD decision aid, and they expressed their willingness to use one if available.

CONCLUSION

We found discordances between guideline recommendations, provider practice patterns, and patient-reported outcome measures and essential attributes that indicated the need for a decision aid to improve patient-provider communication and shared decision-making in NLUTD management.