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Catheters and catheterisation

For those who cannot empty their bladder the normal way, intermittent catheterisation is the therapy of choice to maintain urethral health. Complications are common but when hydrophilic single-use catheters entered the market, the risks of UTI dropped significantly. Low friction seemed to be key to maintain urethral health. Today, there is only one hydrophilic catheter that is scientifically proven to reduce complications also after long-term use.

Catheterisation with a urinary catheter is necessary when there is urine left in the bladder that cannot be emptied through normal voiding, i.e. urinary retention. If not treated, urinary retention may cause infection, incontinence, nocturia and discomfort but also more severe complications such as renal failure and septicaemia. Hence catheterisation is a life-saving therapy. Urinary retention can be caused by neurogenic bladder dysfunction, secondary to a lesion to the central and/or peripheral nervous system. Common diagnoses related to neurogenic bladder dysfunction are spinal cord injury, myelomeningocele (spina bifida), Multiple Sclerosis, Parkinson’s disease, diabetes and stroke. Non-neurogenic factors such as from benign prostatic hyperplasia can also cause urinary retention that necessitates catheterisation.

The most common complication of all types of catheterisations is urinary tract infection (UTI). The bladder is generally considered a sterile environment but this has recently been challenged.1 The urinary microbiota seems linked to urinary health1 and the introduction of a catheter increases the risk of new bacterial contamination and an imbalance. However, it has been known for a long time that keeping the urine inside the body is far more dangerous than using a catheter to get it out.2

Intermittent catheterisation

Catheterisation can either be done using an indwelling catheter or by practicing intermittent catheterisation. Intermittent catheterisation means ‘on demand’ emptying of the bladder using a catheter that is removed after each use. An indwelling catheter remains in the bladder with a balloon or other retention mechanism, and is either placed through the abdominal wall (suprapubic indwelling) or through the urethra (transurethral indwelling). While intermittent catheterisation is a continence management method that allows normal bladder dynamics similar to normal voiding, an indwelling catheter involves more invasive placement and has a constant in and out flow leaving a static bladder unless a system is used to control emptying of the bladder, for example a flip flo valve. Complications are more frequently seen with the use of indwelling catheters, and include infections, bladder stones and catheter blockage. This is why intermittent catheterisation is the first choice therapy today, both for short- and long-term.3 4 5 6 7 8 Suprapubic catheters are only recommended for short-term use and transurethral indwelling catheters should always be avoided and/or their use minimized.3 4 5 8 9 Apart from maintaining good urinary tract health, successful intermittent catheterisation means many advantages for the patient. These include improved self-confidence and self-esteem, improved quality of life with less incontinence/urgency, better sleep, making physical activities possible, ability to be sexually active, less pain and discomfort.e.g. 10 11 12 13

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