Thursday, 26 January 2017

#ClinicSpeak: are you a ISCer?

If you are an ISCer choose your catheter wisely, that's assuming you are given a choice. #ClinicSpeak #ThinkHand

ISCer = somebody who intermittently self-catheterises 

Bladder problems in pwMS are almost the norm. Why? The neuronal system that supplies innervation to the bladder is long, has little functional reserve and is quite complicated in how it functions. This all makes bladder dysfunction in MS very common and in my experience a poor prognostic sign. PwMS with early bladder problems tended to do badly. Please note that I am using the past tense as we need to update our prognostic information with what happens to pwMS in the DMT era. I predict the prognosis will have improved substantially even if you do have bladder problems and are your MS is being treated actively and effectively. 

The systematic review below looks at outcomes of based on different approaches to ISC (intermittent self-catheterisation). The authors' found advantages to the use of so called hydrophilic-coated catheters in decreasing the incidence of UTI (urinary tract infections) and urethral trauma as well as improving ISCer satisfaction. The review also found that prelubricated catheters to be superior to conventional older catheters. As always with systematic reviews it concluded that randomised controlled trials are needed to assess the cost-effectiveness of hydrophilic and prelubricated catheters to see if they justify their price. 

From a personal perspective finding the right catheter makes an enormous difference to ISCers and cost is usually not the major issue. Preventing UTIs and the associated extra visits to the doctors and hospital admissions that result from UTIs will almost certianly justify the extra costs.  I would be interested to hear your thoughts on this issue. I am sure many of you have your own catheter nightmare and catheter bliss stories to tell. 

On reflection wouldn't it be nice if we could prevent bladder dysfunction in pwMS in the first place?

One last point I wanted to make is that the ability to self-catheterise is one of upper limb, or hand, functions that was highlighted over and over again by many of you as part of our #ThinkHand campaign. Maintaining the ability to self-catheterise is something we need to incorporate into our new ABILHAND PROM for pwMS. 

Shamout et al. Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord. 2017 Jan 24. doi: 10.1038/sc.2016.192.

STUDY DESIGN: Systematic review (Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA);

OBJECTIVES: Different types of catheters and techniques have been described in the past three decades to identify the best self-intermittent catheterization method. Our aim is to review systematically the literature on the most appropriate material and technique to perform self-intermittent catheterization in the adult neurogenic population.

METHODS: A systematic review search was performed through PubMed/Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases to study all types of self-intermittent catheters, and analyzing their impact on urinary tract infections (UTIs), urethral trauma, cost-effectiveness, quality of life and patient's satisfaction. We used the following keywords: 'intermittent catheterization/catheterisation', 'neurogenic', 'urinary catheters for intermittent use' and 'urethral catheterization/catheterisation' published by November 2015.

RESULTS: After screening 3768 articles, 31 were included in the final synthesis (level of evidence 1b to 2b). The 2188 trial participants were mainly spinal cord injury adults and women with multiple sclerosis. Hydrophilic-coated catheters tended to decrease the incidence of UTI as well as urethral trauma and improve patient's satisfaction when compared with non-hydrophilic-coated catheters. Similarly, prelubricated catheters were associated with better results in terms of patient satisfaction. Sterile technique seemed to decrease the incidence of recurrent UTI; however, these results are counter-balanced by significantly increasing cost compared with clean catheterization.

CONCLUSIONS: The present review demonstrated advantages of hydrophilic-coated catheters in decreasing risk of UTI and urethral trauma as well as improving patient's satisfaction. Prelubricated catheters has been shown to be superior to conventional polyvinyl chloride catheters. Randomized controlled trials comparing hydrophilic and prelubricated catheters must be conducted to assess possible superiority and cost-effectiveness.Spinal Cord advance online publication, 24 January 2017; doi:10.1038/sc.2016.192.

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