Self catheterization has revolutionized the treatment of neurogenic bladders. It is a safe , time tested and effective way of managing urinary retention or urge incontinence .It has transformed the lives people crippled with neurogenic bladders or obstructive uropathies.
This involves catheterization by a suitable catheter by the patient himself/herself at regular intervals so as to empty the bladder.
Few indications for the self catheterization are:
1) Neurogenic /hypotonic bladder causing chronic urinary retention.This could be due to diabetes, multiple sclerosis,sacral cord pathology,spinal cord injuries etc.
2) High pressure retention : which can result in reflux nephropathy and renal damage .
3)Obstructive retention: In patients who are wheel chair bound and too frail to undergo surgery and suffering from prostatomegaly and retention ; intermittent self catheterization is a better modality of treatment. In patient who are infirm and debilitated and don't have carer to do the intermittent catheterization we usually keep indwelling supra-pubic catheter.
4) in patients with stricture urethra : follow up cases to prevent recurrence of the stricture.
How to do the self catheterization : tips from Ramayya Pramila:
We use Nelaton 14 Fr catheter for the urinary emptying.
We demonstrate the methodology to the patient or the carer fro effective implementation.
The Nelaton should be amply lubricated with xylocaine jelly.
In females: a trained female nurse demonstrates the self catheterization to the female patient encouraging the use of mirror to visualize the urethral; meatus properly
We have trained male and female nurses who exclusively do teaching , demonstrating the correct way and following up the patients doing the CISC.
The major drawback of CISC is if done incorrectly ; it can lead to trauma or infections( incomplete emptying leads to stagnation and infection).The bleeding( pain) and infection can result in patient dropping out from the CISC regimen. This can have very serious repercussions.
The patients are evaluated fully clinically( Focal Neurological Assessment- for dermatomes and their sensitivity, anal tone etc), urodynamic test( to know the chances of upper tract damage due to high pressure bladder), urine culture and imaging studies etc. If needed we prefer to supplement anticholinergic medication to keep the reflex bladder contractions low.
This involves catheterization by a suitable catheter by the patient himself/herself at regular intervals so as to empty the bladder.
Few indications for the self catheterization are:
1) Neurogenic /hypotonic bladder causing chronic urinary retention.This could be due to diabetes, multiple sclerosis,sacral cord pathology,spinal cord injuries etc.
2) High pressure retention : which can result in reflux nephropathy and renal damage .
3)Obstructive retention: In patients who are wheel chair bound and too frail to undergo surgery and suffering from prostatomegaly and retention ; intermittent self catheterization is a better modality of treatment. In patient who are infirm and debilitated and don't have carer to do the intermittent catheterization we usually keep indwelling supra-pubic catheter.
4) in patients with stricture urethra : follow up cases to prevent recurrence of the stricture.
How to do the self catheterization : tips from Ramayya Pramila:
We use Nelaton 14 Fr catheter for the urinary emptying.
We demonstrate the methodology to the patient or the carer fro effective implementation.
The Nelaton should be amply lubricated with xylocaine jelly.
In females: a trained female nurse demonstrates the self catheterization to the female patient encouraging the use of mirror to visualize the urethral; meatus properly
We have trained male and female nurses who exclusively do teaching , demonstrating the correct way and following up the patients doing the CISC.
The major drawback of CISC is if done incorrectly ; it can lead to trauma or infections( incomplete emptying leads to stagnation and infection).The bleeding( pain) and infection can result in patient dropping out from the CISC regimen. This can have very serious repercussions.
The patients are evaluated fully clinically( Focal Neurological Assessment- for dermatomes and their sensitivity, anal tone etc), urodynamic test( to know the chances of upper tract damage due to high pressure bladder), urine culture and imaging studies etc. If needed we prefer to supplement anticholinergic medication to keep the reflex bladder contractions low.
Just imagine what a difference this would have made for people in the old days before such wonderful modern inventions were available to them. We are indeed a very privileged generation with access to everything at our very fingertips. You can even buy self catheter supplies online now without even leaving the house. It's a great time to be alive for sure.
ReplyDeleteThanks for sharing the information about the intermittent self caricaturisation .But people have need to take care about that if they do it himself.
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