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BPR: Catheter use

on daily activities; promotes patient independence; and day using visual analogue scales to assess pain and interfer-
improves sleep, social functioning, and overall QOL. 42-44 ence with daily activities, and the Medical Outcomes Study
The success of IC requires that it is acceptable to the SF-12 to evaluate QOL. The majority of patients found IC
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patient upfront, and that the patient is satisfied with treat- to be easy or very easy (72/92, 78.3%), and reported little
ment and compliant with it long-term. That, in turn, requires or no interference with work or other daily activities (76/92,
appropriate and skilled education, support, and long-term 82.6%); moreover, nearly 90% (80/92) reported no or mini-
followup by the healthcare team. 41,43 Initial uptake and suc- mal pain with IC. QOL was improved in 60% (56/92) based
cess may be further impacted by patient factors, such as on questionnaire used. While this study is limited by a hybrid
gender, body habitus, and manual dexterity, and by external population, positive selection bias, use of a non-validated
factors, such as caregiver support and access to materials. questionnaire, and lack of baseline data, it confirms that IC
Long-term compliance is ensured when the goals listed is a worthwhile strategy that is well-accepted long-term and
above are met, when interference with daily activities is can improve patients’ QOL.
minimized, and when complications and adverse effects of
IC are avoided, including pain, urethral trauma, stricture Impact of catheter type and material on patient perspective
formation, and UTIs. If these criteria are met, patient sat-
isfaction is ensured, resulting in improved QOL and per- Hydrophilic vs. uncoated catheters
45
ceived quality of care. Unfortunately, such ideal circum-
stances are not always realized, and many patients describe Two comparative studies in children with spina bifida dem-
IC having a negative impact on QOL owing to social and onstrated a preference for single-use HC vs. standard reusable
psychological disturbance and UTIs. 43,46 One small, cross- PVC catheters. 51,52 Qualitative research confirms this prefer-
sectional survey of 44 patients reported that only half were ence in community-dwelling adults; however, some patients
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completely satisfied with IC. In the NLUTD population, express concern about the economic and environmental
53
patients may revert to indwelling catheters, particularly impact of single-use catheters. In the review by Shamout et
17
those with greater disability requiring external support, al, the following observations were made regarding studies
younger patients, and those with persistent incontinence evaluating patient satisfaction and preferences:
between catheterization (especially women who cannot 1. Seven of nine RCTs comparing HC vs. non-HC cath-
use external collection devices). 44 eters reported significantly higher satisfaction and/or
Examining the impact of IC on QOL is challenging, given preference for HC catheters;
the heterogeneous population of patients employing it and 2. Two of two RCTs demonstrated patient preference for
the multiple factors that impact QOL in these patients beyond prelubricated vs. non-prelubricated catheters;
just their use of IC. As an example, patients with SCI gener- 3. HC catheters may be favored over prelubricated cath-
ally report their QOL to be worse than age- and sex-matched eters; however, only one study with only 29 patients
controls. Gender differences may further impact outcomes: compared them;
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females have a more difficult time accessing the urethra, 4. Preferences may exist between various brands of HC
while men have a more difficult time with passage into the catheters; and,
42
bladder. A validated patient-reported outcome (PRO) mea- 5. In the only study using a validated QOL question-
sure has been developed to examine the impact of IC on naire, compact catheters were preferred over non-
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QOL, however, it has been used in only one study. Other compact catheters by 63% of 125 NLUTD patients.
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authors have adapted or modified various existing question- Four other RCTs showed no significant difference.
naires and/or incorporated simple measures, such as visual
analog scales, or employed a qualitative approach for the Impact of catheterization technique on patient perspective
assessment. 42,43,50 The important improvements that impact
QOL in patients undertaking IC appear to be those related While many studies have compared catheterization tech-
to urinary symptoms, independence, self-confidence, social niques and materials, robust QOL data is lacking in the
50
relationships, and access to work activities. In qualitative majority of these. Clean IC is less time-consuming and
analysis, QOL was influenced by gender, lifestyle, frequency less costly compared to aseptic IC, and it improves patient
55
and duration of IC, technical difficulties, type of catheter QOL. There is no data comparing QOL in patients reusing
used, comorbidities, and individual predispositions. 43 catheters vs. single-use PVC catheters.
High patient satisfaction and improved QOL has also
been confirmed in established IC cohorts. Kessler et al Summary
studied a mixed neurogenic and non-neurogenic popula-
tion of patients who had been performing IC for a mean IC reduces or removes the risks associated with indwell-
of five years with an average frequency of three times per ing catheters and enhances independence and social and

CUAJ • July 2020 • Volume 14, Issue 7 E285