Managing urinary retention for a young man

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1 Hollister Continence Care Case Report Managing urinary retention for a young man Jaclyn Lee, Clinical Nurse Specialist for Urology Whipps Cross Hospital, Leytonstone, England AIM: OBJECTIVES: Managing urinary retention can be very difficult in young men. This case study demonstrates the importance of choosing the appropriate product to obtain a successful outcome when teaching the principles of clean intermittent self-catheterisation (CISC). Aid incomplete bladder emptying Reduce the risk of bacterial or environmental contamination Protect upper urinary tract Promote bladder health and bladder function SETTING: Urology Urodynamics Unit at Whipps Cross Hospital PATIENT OVERVIEW: 20 year old male (exhibited behavior suggestive of a teenager), whose parents were present throughout the consultation, and did all the talking answering the questions regarding his medical history. Mr. P was admitted to accident and emergency (A&E) with strange presentation of diarrhea and vomiting. He described a three-week history of waking up with a puffy face, which subsided as the day progressed. He also had two days of difficulty emptying his bladder, experiencing three episodes of incontinence in one day. Over the past two months he had a feeling of incomplete bladder emptying, experiencing difficulties with the stopping/starting of his urine flow. He denied having abdominal pain, but complained of suprapubic tenderness. Past medical history: His mother explained that as a toddler, Mr. P was obsessed with cleanliness, especially refusing to micturate in public places; he felt that public toilets were dirty. He continues to have issues with voiding in public; therefore, he waits long periods between voiding. Investigations: Blood results identified an elevated creatinine level CT abdomen revealed a thickened bladder wall, but no other abnormalities USS KUB identified a distended bladder with 1400 mls urine, and a mild bilateral hydronephrosis

2 Managing urinary retention for a young man (continued) INTERVENTION(S): He was catheterised with an indwelling catheter and was treated with intravenous fluids until his renal function improved. He was discharged with the indwelling catheter and a catheter valve in place. He was educated in catheter valve management and was advised to open the valve every 4 hours during the day, with continuous drainage at night. At this stage, clean intermittent self-catheterisation (CISC), was discussed with him and his parents as a preferable way to empty his bladder. At his next visit he underwent a trial without catheter (TWOC), which proved rather successful. He voided a large volume of 650 mls, and 550 mls comfortably, with a demonstrated residual urine volume of 300 mls. It was determined that he be recommended for CISC, which was explained to both Mr. P and his parents. As a result, he was taught how to undertake CISC using a VaPro intermittent catheter, size 12 Ch, catheterizing twice a day. In light of his obsession with cleanliness, the VaPro catheter was the choice. Because of the unique features that offer a no-touch technique (plastic sleeve and a sterile protective tip) the catheter is protected from bacterial and environmental contamination and won t push bacteria from the distal urethra further into the urinary tract. He was advised on the importance of adequate fluid intake and to attempt to micturate at regular intervals (e.g., every 4 hours) if he has no sensation of a full bladder. He was requested to maintain a record of his fluid intake and urine output, as well as his residual volumes. MAIN OUTCOME: He was reviewed in clinic regularly over the next few weeks. After initial problems with his technique, he developed confidence and competence. He commenced spontaneous voiding, with volumes ranging between mls, with post void residuals of mls, adhering to a twice-a-day CISC regimen. He has had no signs or symptoms of a urinary tract infection, and now has no difficulty with catheter insertion. CONCLUSION: CISC is a successful intervention for bladder emptying and may be used to promote improved bladder function in immature young men. To train and support people carrying out CISC, it is important to explore and address their psychological and emotional, as well as practical needs. 1 Choosing the appropriate catheter, such as the VaPro intermittent catheter with its unique features, may help patients gain confidence, promote compliance, and may minimize the risk of introducing bacteria onto the catheter. It is important for catheter insertion to be as simple as possible with minimal discomfort in order to gain trust, motivation, and compliance to the catheterisation regimen. References 1. Logan K, Shaw C, Webber I, Samuel S, Broome L 2007, Patients experiences of learning clean intermittent selfcatheterization: a qualitative study. Journal of Advanced Nursing, 62(1), Hollister and logo, Hollister, and VaPro are trademarks of Hollister Incorporated Hollister Incorporated Company Name Address City, Country, Code

3 Hollister Continence Care Case Report Improve catheter insertion into a mitrofanoff stoma for a patient with limited dexterity Margaret Monaghan, Urology Nurse Specialist Glasgow Royal Hospital, Glasgow City, United Kingdom AIM: OBJECTIVES: To improve catheter insertion into a mitrofanoff stoma for a patient who has limited movement and strength in her hands. Help the patient continue activities of daily living with as little disruption as possible, and consequently improve her quality of life. Improve concordance with planned regime due to easier catheter insertion Attempt to reduce symptoms of urinary tract infections SETTING: Urology Outpatient Department, Glasgow Royal Hospital PATIENT OVERVIEW: 72 year old lady Peripheral neuropathy and osteoarthritis, with decreased dexterity in her hands Ureterostomy, mitrofanoff Recurrent UTIs, cystitis Mrs. B has trialed many catheter products, but due to limited movement or strength in her hands, has found it difficult to find a catheter she is able to manipulate easily. She found one long-term catheter that suited her needs; however it was cost prohibitive for long-term use. Since commencing intermittent catheterisation she has experienced symptoms of urinary tract infections. Although published studies show high acceptance and preference of intermittent catheterisation by patients who are receiving a mitrofanoff stoma, 1 successful outcomes depend on the patient being motivated, able and reliable with respect to performing intermittent catheterisation consistently, regularly, and with the appropriate device.

4 Improve catheter insertion into a mitrofanoff (continued) INTERVENTION(S): It was determined that ISC would be trialed, introducing Mrs. B to the VaPro 40 cm intermittent catheter, size 12 Ch. She was advised to perform ISC 4-6 times a day. MAIN OUTCOME: Mrs. B found the VaPro intermittent catheter easy to use and manage despite her decreased hand dexterity. The flexibility of the catheter enables insertion into the mitrofanoff pouch. She also manages to insert the protective tip into the stoma easily. The fact that the catheter remains sterile during handling (due to the protective sleeve), has given her more confidence in using this technique and helping to reduce the risk of bacterial and environmental contamination. She is happier to be more independent and less reliant on hospital visits and nursing interventions. She has not experienced a urinary tract infection since she commenced IC using the VaPro intermittent catheter. CONCLUSION: In the clinical decision-making process, major considerations should be given to patient choice, ease of use, lifestyle considerations, and any underlying medical issues such as bladder problems. Taking into account all of these factors may result in cost reduction, but most certainly using an easy-to-use catheter that provides users the assurance of features to support their well-being can affect patient compliance. References 1. Horowitz M, Kuhr CS, Mitchell ME The Mitrofanoff catheterizable channel: patient acceptance. Journal of Urology; 153: Hollister and logo, Hollister, and VaPro are trademarks of Hollister Incorporated Hollister Incorporated Company Name Address City, Country, Code

5 Hollister Continence Care Case Report To teach a blind man the principles of intermittent self-catheterisation Penny Hoines Stoke Mandeville Hospital, Buckinghamshire Hospitals NHS Trust AIM: To teach a blind man the principles of intermittent self-catheterisation (ISC). OBJECTIVES: SETTING: Ensure a safe technique Ensure full bladder emptying To catheterise confidently and competently, encouraging compliance with the advised regimen Spinal unit rehabilitation ward PATIENT OVERVIEW: Mr. R has been totally blind since the age of 22 due to bilateral retinal detachments. He recently sustained an incomplete spinal injury due to falling out a second floor bedroom. Therefore he suffers from neurogenic bladder with associated bladder emptying problems. He has experienced upper urinary tract infections since he was a child. INTERVENTION(S): He was taught the technique of undertaking intermittent self-catheterisation (ISC) using VaPro intermittent catheters whilst attending the unit for rehabilitation. He was advised to undertake the procedure 4-6 times a day. He also underwent a series of investigations to attempt to identify the reason for his long-term, upper urinary tract infections.

6 To teach a blind man the principles of intermittent self-catheterisation (continued) MAIN OUTCOME: He mastered the ISC technique despite his visual problems, managing to manipulate the catheter with ease and insert the protective tip by blind touch. He said, the protective sleeve gave him confidence, that with the no-touch technique he was protected from contaminating the catheter when undertaking the procedure. During the time he was performing ISC he did not complain of any signs or symptoms of urinary tract infection. CONCLUSION: Despite mastering the principles of ISC quite quickly, and articulating increased confidence in undertaking the procedure, he was forced to discontinue ISC when he required surgery for malformation of the right kidney. Post surgery, the consultant decided that Mr. R required the insertion of an indwelling catheter to hopefully reduce the extent of the kidney damage, resulting in the placement of a suprapubic catheter. Mr. R has voiced interest in reestablishing intermittent catheterisation in future, when his kidney function improves. This case study offers implications for clinical practice as it highlights the patient s perspective that the VaPro intermittent catheter offers the assurance of safety and ease of use. It also references that VaPro intermittent catheters offer an intuitive technique, so that even a blind man can catheterise successfully and safely. Hollister and logo, Hollister, and VaPro are trademarks of Hollister Incorporated Hollister Incorporated Company Name Address City, Country, Code

7 Hollister Continence Care Case Report Assess Bladder Function through Trial Without Catheter Georgina Boon, Urology Nurse Practitioner (UNP) Royal Glamorgan Hospital, Talbot Green, Rhondda Cynon Taf, Wales AIM: To assess the patient s bladder function by undertaking a trial without catheter. OBJECTIVES: Successful trial without an indwelling urinary catheter Avoid further surgery If required, teach the principles of intermittent self catheterisation (ISC) Improve his quality of life SETTING: The patient was admitted to the urology ward at Royal Glamorgan Hospital for one day to undergo a formal trial without catheter. PATIENT OVERVIEW: Mr. G had been diagnosed with bowel cancer and had undergone an abdominal-perineal resection 18 months earlier. A catheter is often inserted during major surgery; however, it should be removed within a predetermined time frame. Post surgery, Mr. G failed the trial without catheter on repeated occasions whilst an inpatient. As a result of this failure, he was discharged home with an indwelling urinary catheter in place. Mr. G was diagnosed with benign prostatic hyperplasia of the prostate and was prescribed Tamsulosin and Dutasteride. He was recommended for a transurethral resection of the prostate; however, he was totally against further surgery, preferring long-term bladder management instead. He agreed to undergo a further trial without catheter and, if necessary, agreed to be taught the principles of intermittent self-catheterisation (ISC) by the UNP.

8 Assess Bladder Function through Trial Without Catheter (continued) INTERVENTION(S): The trial without catheter proved unsuccessful. He did not void over a long period of time. As a result he was shown various intermittent catheters and informed of the possible associated risks of undertaking ISC. Since Mr. G has a bowel stoma and had already experienced a number of urinary tract infections, he chose to trial the VaPro intermittent catheter because the catheter has a protective tip and sleeve. He was instructed to perform ISC 4-6 times a day. MAIN OUTCOME: Mr. G was very pleased to be without the indwelling catheter and the associated equipment such as the leg drainage bag. He articulated his delight in feeling more comfortable and less restricted. He managed to insert the VaPro intermittent catheter with ease and minimal discomfort. He manipulated the protective tip and sleeve without any problems, with the confidence of knowing that the no-touch features could lessen the risk of introducing bacteria onto the catheter surface or pushed further into the urinary tract. 1 The UNP offered weekly follow-up by telephone liaison to monitor his progress and offer support. He said he has continued to adhere to the advised plan and has experienced no problems at all. Importantly he indicated he has experienced no urinary tract infections since commencing ISC, and continues to be happy and confident in using the VaPro product. Additionally, Mr. G has remarked about how easy the catheter is to handle. CONCLUSION: For patients who worry about cross contamination and the potential risk of urinary infection, a catheter with a protective sleeve and tip can make it easier to overcome their fear of undertaking intermittent self-catheterisation, and therefore achieve concordance with the planned regimen. References 1. Murahata R.I, Hudson E, 2005, The no touch method of intermittent urinary catheter insertion: can it reduce the risk of bacteria entering the bladder? Spinal Cord, Hollister and logo, Hollister, and VaPro are trademarks of Hollister Incorporated Hollister Incorporated Company Name Address City, Country, Code

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