Teaching of intermittent self-catheterisation through dedicated nurse-led TOV clinic for patients with uncomplicated acute urinary retention: How useful is it in practice?

Abstract

Objectives: Acute urinary retention (AUR) is a common urological emergency. Our institution has established an outpatient pathway for managing patients with uncomplicated AUR on discharge from A&E: with catheter education and alpha-blocker therapy. They are followed up in a nurse-led clinic where intermittent self-catheterisation (ISC) can be taught if required. The aim of this study is to investigate the outcomes of our nurse-led trial of void (TOV) clinic and specifically the merit of teaching ISC. Methods: Data was prospectively collected and analysed for all patients with AUR who were followed up in the nurse-led TOV clinic between October 2012 and December 2014. Results: Over 26 months, 120 men with AUR attended the TOV clinic with an average age of 71 years (range 28–94 years). Forty-nine of 120 (41%) patients had an identifiable cause for AUR (UTI=13, constipation=13, alcohol=11, anti-cholinergics=7, post-operative=4 and post-brachytherapy=1). Sixty-four men passed and 50 failed TOV. Six were excluded from this analysis as they did not proceed to TOV in clinic (three requested LTC and three were not appropriate for outpatient clinic). All 50 patients who failed TOV were offered ISC. Thirty-two of 50 patients (64%) learnt ISC. Ten declined and eight were unable to perform ISC. Only seven of 50 patients (14%) went on to have a TURP, four of whom had declined to learn ISC. Of the remaining 43 patients, 24 (56%) had return of spontaneous voiding. Conclusion: In our experience, a pathway for reviewing AUR patients in a nurse-led TOV clinic where expertise for ISC tuition is available is extremely useful. In our series, only 14% of patients who failed TOV required TURP. Bladder function often returns to normal over time but ISC offers patients an autonomous management option if satisfactory to themselves whilst avoiding the complications of LTC.