Intermittent catheterization in the management of post spinal cord injury (SCI) neurogenic bladder using new hydrophilic, with lubrication in close circuit devices--our own preliminary results

Abstract

This article is a review of the related approaches in the field-- including the newest ones associated with a specific retrospective study on in-patients from our Clinic Division (preliminary results).

Study design: To objectively assess whether there are significant differences regarding some specific key biological and psychometric parameters related to the use of hydrophilic catheters vs. non-hydrophilic ones.

Materials and methods: We have evaluated the outcomes of long term IC using by comparatively using the afore-mentioned two different types of catheters, on two lots (totally 45 patients with mainly retention type of neurogenic bladder): 30 post SCI patients, using exclusively hydrophilic catheters and respectively, 10 same kinds of patients that used exclusively non-hydrophilic catheters. Additionally, there were 5 patients included in both lots as they have started IC with non-hydrophilic catheters and since 2008 they have switched on using hydrophilic ones. The methods used were primary data acquisition based on a unitary questionnaire and statistical analyses.

Results and discussion: Mainly: the patients that used exclusively hydrophilic type of catheters (median: "None") vs. those using exclusively non-hydrophilic type of catheters (median: "One every 4 months") presented: a significantly lower number of inflammatory episodes at scrotal level (p-value: 0.0001 WT), a significantly lower number of post/intra/inter catheterization bleeding episodes (p-value: 0.0001 WT), a very slightly lower number of UTI activations and expressed a significant higher satisfaction level (p-value <0.0001 WT). However, speculating a conceptual relation with the lower number of inflammatory episodes at scrotal level, it is to be thought that bigger lots of patients could provide, in this respect, significant results too. This study is to be continued, in order to further validate these preliminary, quite promising results, on bigger lots through the complex/ rigorous assessment methodology already used.

Keywords: hydrophilic catheters; intermittent catheterization; neurogenic bladder; spinal cord injury.

Fig. 1

Hydrophilic catheter with lubrication in close-circuit without supplementary facilitations, this catheter being one of the two types found in Romania; their cost are fully supported by the National Assurance House for 4 catheters/day

Fig. 2

Hydrophilic catheter with lubrication in close-circuit without supplementary facilitations (different producer)

Fig. 3

Hydrophilic catheter with lubrication in close-circuit with the facility of having a region impregnated with adhesive in order to fix it on an available surface (including a door or a wall) – very necessary, especially in self-catheterization

Fig. 4

Hydrophilic catheter with lubrication in close-circuit: device with a collector bag incorporated

Fig. 5

Number of catheterization/day

Fig. 6

Time elapsed since the onset of IC

Fig. 7

Oldness of neurogenic bladder (mainly retention type)

Fig. 8

Number of inflammatory episodes at scrotal level

Fig. 9

Number of post/inter catheterization-bleeding episodes

Fig. 10

Subjective evaluation of the satisfaction level

Fig. 11

Subjective evaluation of the satisfaction level concerning procedure

Fig. 12

Number of urinary infection aggravation