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Catheters-Incontinence

Καθετήρες - Ακράτεια

Urinary incontinence is a common medical problem. It is estimated that it affects more than 5% of the population regardless of age.

 

It consists of loss of control over the bladder, which is often associated with weakening of the pelvic floor muscles. Bladder problems are most prevalent among people over the age of 65, while women are more likely to be affected than men. The most common types of urinary incontinence are associated with activities which increase abdominal pressure such as coughing, sneezing, laughing or lifting weights (stress incontinence) and urge incontinence. Incontinence caused by overactive bladder is characterized by a sudden urgent need to urinate accompanied by immediate bladder contraction and involuntary loss of urine.

Catheters - Incontinence Treatment

Catheters

A catheter is a small, thin tube that is inserted into the bladder to drain urine, when the bladder cannot empty normally. A permanent catheter is one which remains in the bladder for hours, days or longer. A catheter that is inserted to drain urine and then is removed is called an intermittent or short-term catheter.

Permanent Catheter

A permanent catheter is a thin, sterile tube which is inserted into the bladder for urine drainage. An inflated cuff, which is filled with sterilized water, is used to hold the tube in place. Urine drains via the catheter tube to an external collection device: a urine collection bag. The procedure for the insertion of a catheter is called catheterization. A permanent catheter is used when no other method is effective or when the patient does not have the necessary ability or help to handle any other alternative technique. This type of catheter remains inside the bladder and it is changed at least once a month. 

External or Condom Catheters

Millions of men all over the world suffer from urinary incontinence. Incontinence is a health problem that presents both in older and younger people. Incontinence is -among other things- a social issue also. If it is treated properly, then the patient will have the same quality of life they had prior to this condition.

The adhesive external catheter is designed for treating male urinary incontinence.

Instructions: Application of the condom catheter

  1. Wash the penis with soft soap and water. Rinse and dry the penis carefully
  2. You may want to trim or shave the pubic hair
  3. Open the package at the perforated line.
  4. In order to remove the plastic, press the catheter at the top of the white cone and pull to release it.
  5. Unfold the adhesive catheter over the penis.

Intermittent Catheterization

Intermittent catheterization is considered a breakthrough in the treatment of neurogenic bladder disorders. Intermittent catheterization can be applied in most cases (but not all) and combine, in the best possible way, the strictly ‘medical’ as well as social-personal goals of each person. Intermittent catheterization can be done by the patient or a caregiver (preferably always the same person) after proper training. The selection of the proper catheter is sometimes crucial for the patient’s functional independence with regard to self-catheterization. Intermittent Catheterization (IC) is a technique used in conditions where the urinary catheter does not remain within the bladder. It is inserted for the period that is necessary to empty the bladder and then it is removed.

Indications for Intermittent Catheterization (IC)

Indications for IC are varied and include: Bladder emptying problems due to neurological disorders or injury, Neurogenic dysfunction of the bladder or Intravesicular obstruction with incomplete emptying of the bladder.

1. Neurogenic dysfunctions of the bladder

Neurogenic damages may cause a dysfunction of the bladder through a "communication” loss between the bladder and the diuresis centers in the brain. Patients with neurogenic dysfunctions might have a combination of urge incontinence and residual urine (detrusor-sphincter dysynergia) or partial or full retention of urine due to underactive or non-contracting detrusor. The extent and severity of urine retention depends on the site of the damage. Also, injuries or disorders of peripheral nerves near the bladder site or the sacrum may cause incomplete bladder emptying (1, 2, 3, 4, 5, 6, 7).

The following neurological conditions might cause bladder voiding problems, indicating a need for intermittent catheterization:

  • Spinal cord injury
  • Multiple sclerosis
  • Meningomyelocele
  • Spina bifida
  • Spinal cord tumor
  • Autonomic dysreflexia
  • Diabetes mellitus (incomplete emptying due to neuropathy)

There might be other neurogenic conditions that are not presented here, which might disturb the central or peripheral nervous system and thus affect bladder functions. Nowadays, in most of the Western world, intermittent catheterization is considered the 'gold standard’ for the treatment of neurologic bladder dysfunction.

2. Non-neurogenic dysfunctions of the bladder

Intermittent Catheterization (as opposed to the placement of a permanent catheter) allows easier monitoring of the volume of spontaneous diuresis following temporary urine retention or incomplete emptying of the bladder. Urethral stricture following internal urethrotomy is often treated with intermittent distension with single-use catheters. Briefly, intermittent catheterization is likely to be suitable in the following conditions with non-neurogenic dysfunctions of the bladder:

  • Idiopathic urine retention or incomplete emptying of bladder (1, 2)
  • Infravesicular obstruction
  • When the patient is scheduled for surgery such as TUR-P (transurethral resection of the prostate) (1,2,3)
  • When surgery is impossible or dangerous
  • Urethral stricture (for intermittent dilation) (2,3)
  •  Urinary tract infections with residual urine (1, 2)
  • Urinary incontinence with residual urine (Overflow incontinence)
  • Urinary incontinence in combination with another treatment
  • Post-operative urinary retention (8,10)
  • Urine retention after childbirth (11)
  • Urine sampling for diagnostic tests
  • Bladder instillation / irrigation

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