A patient's scream: seeking support for a 21st century catheter

Abstract

In 1969 at Stoke Mandeville, I was recovering from a C5/6 complete spinal lesion. A chat with a nurse led him to say that, in his 20 years experience of catheters, the only thing that such a device guaranteed was a urine infection. Heeding his advice, I lasted 35 years before the stress of trying to save my business from bankruptcy caused my bladder sphincter to shut completely in daylight hours. So, for the last 8 years, I have enjoyed all the glorious side-effects of a urethral catheter. Actually, to be fair, all went well until a 9-month period of particularly inadequate care that caused pressure damage to the urethra on several occasions and culminated in a 12-hour blockage, which caused mayhem to the whole area of the urology speciality. For 2 years, I produced sediments that either partially or completely blocked the catheter. Complete blockages result in emergency call out of community nurses; partial blockages put back pressure on my kidneys, usually for several days – slowly reducing my life expectancy. May I describe the amazing impact a more efficacious device could have on spinally injured people – and many others no doubt. Like many spinally injured complications. Up to 50% of long-term catheter users will experience blockages or leakages of urine around the catheter. As Peter states, the catheter user should be able to control his or her bladder drainage with a remotely controlled device. The normal healthy bladder is drained 6–10 times a day and on each occasion it is emptied completely so that any bacteria are washed out regularly. The Foley catheter is retained in the bladder by an inflatable balloon which prevents the bladder from emptying completely so that bacteria not only remain but multiply in the residual urine. The drainage eyes are situated in the protuberant tip of the catheter which removes the protective coating of mucin covering the urothelial cells lining the bladder. As a result, bacteria can more readily invade the bladder wall and blood stream. Catheter design needs to be brought into the 21st century, to reduce the high incidence of catheter-associated urinary tract infections which account for a formidable burden on health services worldwide. New device developments in this sadly neglected field of health care are long overdue and would develop greater momentum if lead by a strong lobby of catheter users, highlighting their concerns and needs as Peter has outlined. With that vital support, I have no doubt that we professionals can bring pressure on the skilled specialists who can revolutionise this field of health care. BJN