Complications of long term catheters:
- Recurrent UTIs
- Blockages with debris
- Calcification forming on catheter, bladder stones
- Long term increased risk of SCC from chronic inflammation (8 – 10 %)
- Urethral erosion
Risk of bacteriuria 3 – 10 % per day – all patients have bacteriuria by 20 days.
No conclusive evidence that SPC reduces rates of bacteriuria or infection cf. IDC but SPC benefits do include:
- Less epididymitis
- Less urethral stricture disease
- Retained sexual function
- No risk of urethral erosion
Downsides of SPC:
- Blockages due to debris or mucus or encrustations
- Urethral bypassing with spasms
Solutions for encrustation – citric acid solutions (UroTainer Suby G, renacidin) – dissolves struvite.
Goals of catheterisation in long term:
- Bladder drainage
- Provide low pressure storage
- Preserve continence
- Avoid renal function deterioration
- Minimise complications and maintain quality of life
Clean intermittent catheterisation is the most effective and practical means of being catheter free for people who cannot empty spontaneously
It requires:
- Co-operative, motivated patient
- Adequate hand function (or carer)
- Adequate urethral exposure
Typically performed every 4 – 6 hours to minimise bacterial dwell time and mimic physiological bladder capacities 300 – 500 mL.
12 – 16 Fr catheters, shorter catheters for females.
Hydrophilic coated catheters have lower rates of UTI and haematuria, and better patient satisfaction.
Silicone preferred over latex as less susceptible to encrustation, and high latex allergies in neurological population.
Long term catheters should be considered over ISC if:
- Anatomical, functional or caregiver limitations
- Persistent incontinence
- Small capacity bladder
- Autonomic dysreflexia