Intermittent catheterisation: simple, safe, and effective but underused.

Abstract

Twenty five years ago Lapides and coworkers showed that intermittent catheterisation was a safe and effective way of managing patients with urinary retention or incontinence due to neuropathic or hypotonic bladder.1 2 This technique has transformed the lives of people rendered housebound by bladder problems and has preserved the kidneys of children with spina bifida3 4 5 6 7 8 9 10 and of adults with spinal cord injury.11 12 13 14 15 Intermittent catheterisation is a clean but not sterile technique. It entails inserting a catheter into the bladder, emptying out all the urine, and then removing the catheter. This is performed several times a day by the patient or carer. It puts the patient in control of emptying the bladder and safeguards the kidneys by providing drainage. #### Summary points Incomplete emptying of bladder—A bladder that retains a large volume of residual urine soon fills to capacity, causing frequency, urgency, nocturia, or incontinence. Urinary stasis leads to urinary tract infections and calculi. By eliminating residual urine, intermittent catheterisation enables the bladder to function more effectively as a reservoir, relieves symptoms, and reduces the incidence of symptomatic urinary infections.3 9 16 22 25 28 Obstructive uropathy—Many patients with a neuropathic bladder have an overactive sphincter, causing obstruction of the bladder outlet and dilatation of the upper urinary tracts. A combination of a contracting urethral sphincter with hyperreflexic bladder contractions (detrusor-sphincter dyssynergia) accelerates the damage. If the obstruction of the bladder outlet is overcome by intermittent catheterisation then dilatation of the upper urinary tracts is reduced and renal function improved.6 22 Reflux nephropathy—Vesicoureteric reflux associated with neuropathic bladder often causes renal damage. The risk is increased by obstruction of the bladder outlet, high intravesical pressure, or urinary infection. Intermittent catheterisation can reduce or eliminate …