Clean intermittent catheterization (CIC) is one of the core elements of neurogenic bladder management in the patients with spinal cord injury and is effective and safe to maintain low intra-bladder pressure and achieve urinary continence. Until now, the most notable development in urinary catheter products for CIC is the introduction of hydrophilic coating. Fortunately, in Korea, the national medical insurance has recently covered the cost for urinary catheters in this patient group. The purpose of this review is to summarize the history of CIC and the recent development of urinary catheter products. From our review, we would like to suggest a way of thinking that is the way forward for the future to improve the implementation of CIC with minimal morbidity.
Humans ; Insurance ; Intermittent Urethral Catheterization ; Korea ; Spinal Cord Injuries ; Spinal Cord ; Thinking ; Urinary Bladder, Neurogenic ; Urinary Catheters

PURPOSE: In recent years, the importance of patient satisfaction and quality of life—referred to as patient-related outcomes— has been emphasized, in addition to the evaluation of symptoms and severity through questionnaires. However, the questionnaires that can be applied to Korean patients with neurogenic bladder are limited. Therefore, the current study linguistically validated the Intermittent Self-Catheterization Questionnaire (ISC-Q) as an instrument to evaluate the quality of life of Korean patients with neurogenic bladder who regularly perform clean intermittent catheterization (CIC). METHODS: The validation process included permission for translation, forward translations, reconciliation, backward translation, cognitive debriefing, and proofreading. Two bilingual translators independently translated the original version of the ISC-Q into Korean and then combined the initial translations. A third bilingual translator performed a backward translation of the reconciled version into English. Five Korean-speaking patients with neurogenic bladder carried out the cognitive debriefing. RESULTS: During the forward translation process, the 24 questions of the ISC-Q were translated into 2 Korean versions. The terms used in each version were adjusted from the original version to use more conceptually equivalent expressions in Korean. During the backward translation process, several changes were involving substitutions of meaning. In the cognitive debriefing process, 5 patients were asked to complete the questionnaire. All patients agreed that the questionnaire explained their situation well. CONCLUSIONS: This study presents a successful linguistic validation of the Korean version of the ISC-Q, which could be a useful tool for evaluating treatment satisfaction in patients with neurogenic bladder performing CIC regularly.
Catheterization ; Catheters ; Humans ; Intermittent Urethral Catheterization ; Linguistics ; Patient Satisfaction ; Quality of Life ; Translations ; Urinary Bladder, Neurogenic ; Urination

PURPOSE: We retrospectively evaluated the efficacy of botulinum neurotoxin A (BoNT-A) on vesicoureteral reflux (VUR), continence status, and urodynamic parameters in children with myelodysplasia who were not responsive to standard conservative therapy.METHODS: The study included 31 children (13 boys, 18 girls) with a mean age of 9.2±2.3 years (range, 5–14 years) with myelodysplasia, retrospectively. All children were fully compatible with clean intermittent catheterization (CIC) and did not respond to the maximum tolerable anticholinergic dose. All children received an intradetrusor injection of 10 U/kg (maximum, 300 U) of BoNT-A into an infection-free bladder. All patients had VUR (22 unilateral, 9 bilateral) preoperatively. The grade of reflux was mild (grades 1, 2), intermediate (grade 3), and severe (grades 4, 5) in 25, 7, and 8 ureters, respectively.RESULTS: The mean maximum bladder capacity increased from 152.9±76.9 mL to 243.7±103 mL (P<0.001), and the maximum detrusor pressure decreased from 57±29.4 cm H₂O to 29.6±13.9 cm H₂O (P<0.001). After BoNT-A treatment, 16 refluxing ureters (40%) completely resolved, 17 (42.5%) improved, 5 (12.5%) remained unchanged, and 2 (5%) became worse. Of the 31 children with urinary leakage between CICs, 22 (71%) became completely dry, 6 (19%) improved, and 3 (10%) experienced partial improvement.CONCLUSIONS: In children with myelodysplasia, we were able to increase bladder capacity, enhance continence, and prevent VUR by using intradetrusor BoNT-A injections. Although our results are promising, a larger group of long-term prospective studies are warranted to investigate this method of treatment.
Botulinum Toxins, Type A ; Child ; Humans ; Intermittent Urethral Catheterization ; Methods ; Prospective Studies ; Retrospective Studies ; Ureter ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urodynamics ; Vesico-Ureteral Reflux

PURPOSE: The main goal of this retrospective study is to explore the predictors of success in learning clean intermittent self-catheterization (CISC) in patients over 65 years of age. The secondary goal is to assess whether in this population, the risk of failure to perform CISC is greater, compared with patients under 65 with similar pathologies. METHODS: All patients older than 65 consulting between January 2011 and January 2016 for learning CISC were included. A control population younger than 65 matching with sex, body mass index, and pathology was selected. RESULTS: One hundred sixty-nine of the 202 patients (83.7%) over 65 succeeded in learning CISC. Obesity (P < 0.05), low pencil and paper test (PP test) (P < 0.01) and low functional independence measure (FIM) (P < 0.01) scores were risk factors of failure. No significant differences were found with sex or pathology. In multivariate analysis, low PP test perineum access (odds ratio [95% confidence interval], 2.30 [1.32–4.42]), low FIM motor (1.04 [1.01–1.08]), and FIM cognition (1.18 [1.03–1.37]) scores were independent factors of learning failure. Compared to control group, age over 65 was not predictive of failure (P=0.15). CONCLUSIONS: Our study shows that success in learning CISC does not depend on age but on difficulties in mobility, access to perineum and probably cognitive disorders.
Adult* ; Body Mass Index ; Cognition ; Humans ; Intermittent Urethral Catheterization ; Learning* ; Multivariate Analysis ; Obesity ; Pathology ; Perineum ; Retrospective Studies ; Risk Factors ; Urinary Bladder Diseases ; Urinary Retention

PURPOSE: To evaluate adherence to anticholinergic therapy (AT) and clean intermittent self-catheterization (CISC) in patients with multiple sclerosis (MS) and to identify factors associated with poor adherence. METHODS: This single-center study prospectively included 49 patients suffering from MS who had been prescribed AT and/or CISC. Adherence was evaluated using a self-report questionnaire. The Expanded Disability Status Scale (EDSS), Patient Global Impression of Improvement, Mini-Mental State Examination, Urinary Symptom Profile, and Hospital Anxiety and Depression (HAD) instruments were administered, and the number of daily anticholinergic pills and/or catheterizations was noted. Whether patients were receiving concomitant intradetrusor botulinum toxin injections was assessed, as were barriers to treatment, side effects, number of spontaneous micturitions, reasons for the prescription, satisfaction, and difficulties. RESULTS: Only 38% of patients were adherent to AT. Experiencing side effects was related to nonadherence (P=0.02). Only 29% of patients were adherent to CISC. More intense voiding dysfunction (P<0.001), a higher frequency of CISC (P=0.03), and a higher EDSS score (P=0.02) were associated with better adherence. Conversely, the HAD score (P<0.001), depression (P<0.001), the persistence of spontaneous micturition (P<0.001), a blocking sensation during catheterization (P=0.04), and the need to adapt one's posture or gesture to perform catheterization (P=0.04) were associated with poorer adherence. CONCLUSIONS: Adherence to AT and CISC was poor in patients with MS suffering from bladder dysfunction. Several factors related to nonadherence were identified in this study, and addressing these factors might help to improve treatment adherence.
Anxiety ; Botulinum Toxins ; Catheterization ; Catheters ; Cholinergic Antagonists ; Compliance ; Depression ; Gestures ; Humans ; Intermittent Urethral Catheterization ; Multiple Sclerosis* ; Posture ; Prescriptions ; Prospective Studies ; Sensation ; Urinary Bladder ; Urination

PURPOSE: The purpose of this study is to investigate adherence to the clean intermittent catheterization (CIC) and influencing factors on the adherence following a customized intensive education program (CIEP). METHODS: This work is a retrospective descriptive study. The subjects were 226 emptying failure patients who learned in a CIEP from January 2012 to July 2014. The program developed in 2011 and consisted of 1) customized theoretical education; based on the results of urologic tests, underlying disease, or surgery of the patients, 2) hands-on practice until the trainees were able to master the techniques, 3) questions about the process of catheterization and what he/she needs to know. 4) at follow-up, the survey about adherence and barrier to CIC. Clinical characteristics; the level of satisfaction, understanding, and self-confidence; the barrier in medical records were reviewed. RESULTS: The short-term adherence rate (median 22 days) is 87.6% and the long-term adherence rate (median 112 days) is 50.4%. The biggest obstacle is time management. The levels of satisfaction, understanding, and self-confidence are very high. The variable of Income is the only factor that has influence on adherence. CONCLUSION: Despite the CIEP, the adherence rate is relatively low. In addition to the education, emotional and psychological supports and regular follow-up are needed to improve long-term adherence.
Catheterization ; Catheters ; Education ; Follow-Up Studies ; Humans ; Intermittent Urethral Catheterization ; Medical Records ; Patient Compliance ; Retrospective Studies ; Time Management

PURPOSE: Augmentation enterocystoplasty (AE) has been shown to improve clinical symptoms in patients with end-stage bladder disease (ESBD). Herein, we report the long-term outcomes of a series of patients with different etiologies of ESBD who received AE. METHODS: We retrospectively reviewed 102 patients with ESBD who received AE at the Hualien Tzu Chi General Hospital from 1992 to 2014. ESBD in this study was defined as including neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or myelomeningocele, inflammatory bladder disease (IBD), ESBD occurring after pelvic cancer surgery, and other etiologies. Complications including active lower urinary tract problems and urinary tract infection (UTI), as well as patients’ self-reported satisfaction with the procedure, were evaluated. RESULTS: A total of 102 patients were included in the study. A majority of patients received AE for NLUTD (n=43), followed by IBD (n=38), ESBD after pelvic cancer surgery (n=15), and the other etiologies (n=6). Patients had a mean age of 39.4±18.7 years and were followed for a mean of 78 months. All patients had significantly increased cystometric bladder capacity and compliance at the time of follow-up. Fifty-four patients (52.9%) reported moderate to excellent satisfaction with the outcome, and there were no significant differences among the groups (P=0.430). The most common reason for dissatisfaction was the need for clean intermittent catheterization (CIC; 41.7%), followed by urinary incontinence (25.0%) and recurrent UTI (16.7%). CONCLUSIONS: AE is a safe and effective procedure for patients with ESBD. Postoperative urinary incontinence and UTI as well as the need for CIC may affect quality of life and decrease patient satisfaction.
Compliance ; Cystitis ; Follow-Up Studies ; Hospitals, General ; Humans ; Intermittent Urethral Catheterization ; Lower Urinary Tract Symptoms ; Meningomyelocele ; Patient Satisfaction ; Pelvic Neoplasms ; Quality of Life ; Retrospective Studies ; Spinal Cord Injuries ; Urinary Bladder Diseases* ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urinary Tract ; Urinary Tract Infections

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization* ; Quality of Life* ; Urethra ; Urinary Bladder, Neurogenic* ; Urinary Diversion

PURPOSE: To evaluate changes in quality of life (QoL) in patients with neurogenic bladder treated with clean intermittent catheterization (CIC), who changed from a multiple use catheter (MUC) to single use catheter (SUC). METHODS: The Modified Intermittent Self-Catheterization Questionnaire (mISC-Q) was used to determine potential changes in patients'QoL as a result of switching from MUC to SUC. The mISC-Q consists of questions within four categories: ease of use, convenience, discreetness, and symptomatic benefit. Answers were graded as Strongly agree (+2), Agree (+1), Not sure (0), Disagree (−1), and Strongly disagree (−2). Overall patient QoL, as well as by sex, disease (presence of augmentation cystoplasty), and catheterization route (via urethra or urinary diversion), were analyzed. RESULTS: Thirty-eight patients (21M:17F; mean age: 21.7±5.3 y) submitted questionnaires. For ease of use, SUC was significantly better than MUC (score: 0.364, P=0.002) in all patients. Patients with catheterization via the urethra showed significant favor for SUC in ease of use (score: 0.512, P<0.001) and convenience (score: 0.714, P=0.011), but patients with catheterization via the abdominal stoma of urinary diversion gave negative scores in all categories, though no categories were significant. CONCLUSION: This study suggested that changing from MUC to SUC may lead to improvements in QoL, especially regarding ease of use. This benefit was clearly found in patients with catheterization via urethra rather than abdominal stoma of urinary diversion.
Catheterization ; Catheters* ; Humans ; Intermittent Urethral Catheterization* ; Quality of Life* ; Urethra ; Urinary Bladder, Neurogenic* ; Urinary Diversion

PURPOSE: Clean intermittent self-catheterization (CISC) is now considered the gold standard for the management of urinary retention. In the literature, several articles on patients’ perspectives on CISC and adherence to this technique have been published. No studies have yet explored the points of view of professional caregivers, such as nurses and doctors. The aim of this study was to explore the opinions of urologists about CISC and to evaluate the need for dedicated nurses specialized in CISC through a self-administered questionnaire. METHODS: A questionnaire was developed to explore the opinions of professional caregivers about self-catheterization and to evaluate the need to provide nurses with specialized education in CISC. Questionnaires were sent to 244 urologists through email. We received 101 completed questionnaires. The response rate was 41.4%. RESULTS: Hand function, the presence or absence of tremor, and visual acuity were rated as the most important determinants for proposing CISC to a patient. Twenty-five percent of the urologists reported that financial remuneration would give them a greater incentive to propose CISC. The lack of dedicated nurses was reported by half of the urologists as a factor preventing them from proposing CISC. A meaningful number of urologists thought that patients perceive CISC as invasive and unpleasant. Although most urologists would choose CISC as a treatment option for themselves, almost 1 urologist out of 5 would prefer a permanent catheter. CONCLUSIONS: This questionnaire gave valuable insights into urologists’ perceptions of CISC, and could serve as the basis for a subsequent broader international study. Further research should also focus on the opinions of nurses and other caregivers involved in incontinence management. Apart from financial remuneration, it is also clear that ensuring sufficient expertise and time for high-quality CISC care is important. This could be a potential role for dedicated nurses.
Caregivers ; Catheters ; Education ; Electronic Mail ; Hand ; Humans ; Intermittent Urethral Catheterization ; Motivation ; Remuneration ; Tremor ; Urinary Catheterization ; Urinary Retention* ; Visual Acuity