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What is intermittent catheterization?

 What is intermittent catheterization?

Before answering this question, dear readers, it should be clear in our minds an axiom: All patients with traumatic or other damage to the spinal cord to the bladder is "neurogenic". It is this neurogenic bladder often not empty at all, or partially empty or worst of all empties developing high intravesical pressures. This last form is the worse for humans neurogenic bladder, precisely because this pressure is transmitted through regression to the kidney with disastrous results with the passage of time. Previously, we should mention that most common cause of death in patients with neurogenic bladder was renal failure which was exactly in this kidney damage from high pressure in the bladder.

The most important way of dealing with this mode is the emptying of the bladder once must, without letting urine to remain in it for a long time. This had understood and ancient Greeks who certainly not offering current probes used improvised catheters minutes reeds which anointed with honey to a lubricating effect. 

Who needs the intermittent catheterization?
Intermittent catheterization is not only needed by patients with traumatic spinal cord injury, and patients with neurogenic bladder due to multiple sclerosis, meningomyelocele, diabetes, stroke and other diseases. But it must be stressed that the neurogenic bladder patients with traumatic spinal cord injury is the most "unruly" type, and it is no exaggeration to say that it requires more attention from the patient and the treating urologist.

This group of people (with neurogenic bladder due to traumatic spinal cord) is exactly that which has the greatest need of intermittent catheterization compared with patients with neurogenic bladder by other cause.

How many catheterization per day?
Many of our patients ask, when we announce the number of catheterizations needed every day, why is there a difference in the this number among themselves and their friends or colleagues who have apparently the same disability? The answer lies in that although two people may suffer from the same disabilities apparently (e.g. Paraplegia), in fact the spinal cord injury is very dissimilar. This rule follows and nervous system bladder these patients (but with the explanation of the phenomenon and classification of neurogenic bladder will deal in a subsequent our articles).

The number of daily catheterization is necessary in a patient with neurogenic bladder is strictly personified and based on the results of urodynamic control.
In short, the number that urologist suggests to the patient in any case should not be random or a number of routine which is applied to a patient regardless of the problem he has but based on urodynamic testing.

Which are not suitable candidates for intermittent catheterization?
There are a number of people with neurogenic bladder who although requiring intermittent catheterization can not execute them. These patients were divided into categories according to the cause that makes it more difficult to perform the I.C.
Specifically:
a) Persons with disabilities of the upper limbs, such as friends quadriplegics who naturally can not perform fine movements with their hands, and who most often rely on assistant nurse, or people in their neighborhoods making catheterizations. Here of course the problem lies in people without access to these facilities and the problem clearly has a social basis.
b) Individuals who obese because their body volume can not correctly direct the catheter
c) People who do not have the mental capacity to understand the rationale for the use and technique of I.C.
d) Women because of their anatomy disability does not allow them to easily find out the orifice of the urethra
e) Subjects with urological problems such as urethral strictures, injuries of the urethra, or narrowing of the bladder neck. This category requires absolutely urological response before deciding that the patient should undergo DK

In a patient who was taught right the indication for intermittent catheterization, who is trained to perform them properly and who has regularly monitored the likelihood of complications is very small. Nevertheless, as with any treatment, and thus the intermittent catheterization is likely to occur some complications.

A)UTI
Finding germs in the urine of patients applying intermittent catheterization, is a common occurrence and should not cause particular concern and not to treat if not accompanied by any symptoms or signs. Whether to give or not treatment depends on if the patient has retained the sensation of bladder or not. If the damage to the nervous system allows total or partial sensation of bladder then the patient will have the classic symptoms of urinary tract infection such as frequent urination, burning during urination, dysuria, etc. But when it has lost the sensation which is the norm then the symptoms of a urinary tract infection can be many and varied, such as increased spasticity, hyperhidrosis or redness in the upper part of the trunk or face. In urine may occur turbidity, hematuria or strange odor. Whether intermittent catheterization cause infections, most studies show that the rate of infection is reduced, but there are some (few) showing that the rate increases, but admits that it is less harmful to the kidneys. Increased rate of infections especially in kidney exhibit patients with reflux of urine from the bladder to the kidney (VUR). Entering the self-lubricating catheter disposable Curan, dramatically reduced the rate of infection in these patients. The right way to further reduce infections are sufficient numbers catheterization during 24 hours, and the perfect bladder emptying after each catheterization. We must emphasize again that prophylactic administration of antibiotics, treatment of asymptomatic mikroviourias not necessary. UTIs accompanied by clinical signs should be treated with antibiotic treatment duration of 3 or 5 to 10 or 15 days. There are exceptions to this rule but this is a matter of the urologist to know and judge.
 
B)AGGRAVATED RENAL FUNCTION
Intermittent catheterization help perpetuity renal function. Here, fundamental position has Urodynamic control which will diagnose the type of neurologic bladder, and it can predict which patients are at increased risk for deterioration of the kidneys. The cysts exhibiting detrusor hyperreflexia with or not dysynergeia sfigktira- detrusor (simply put spasticity), compared with those who experience ypoantanaklastikotita detrusor muscle (simply put it loose flabby cysts) have increased chances, when the situation out of control, for kidney damage. Here, dear readers, you have understand that rarely these lesions, with rapid deterioration and damage to the kidneys settle very slowly and does not give points only in the latter stages.
So when a progressive deterioration of renal function is identified, must first urologist explore when the scheme of intermittent catheterization is appropriate for the patient's condition. Then depending on the severity of the condition may be resorted to escort drug therapy, or in difficult cases in magnifying cystoplasty.
Urethral Trauma.
 
C)The urethral catheterization is certainly not a normal phenomenon, and the entry of the catheter into the lumen can cause some irritation or damage. The spectrum of these lesions is broad and ranges from a simple inflammation by coagulation and perforation of the urethra. But the vast majority of injuries are mild and treated with antibiotics, anti-inflammatory drugs, and placing permanent catheter for a few days.
All these complications course have been minimized by the use of new technology self-lubricating low friction of catheters, such as Curan.
 
D)Gritty
Gritty of the bladder occurs in a small percentage of patients. This is usually due to the entrance with the catheter bristles from the region of the pubis in the bladder. Patients should be careful in this matter when intubated. The gritty bladder treated with endoscopic removal of stone.
 
E)Εpididymitis
The epididymitis is only occurs in men (only they have epididymis), and although it is also a form of urinary tract infection, the mention separately to emphasize the importance which it has for men undergoing intermittent catheterization to periodically check their testicles for unusual lumps.

CONCLUSION
The goal of intermittent catheterization is to ensure continence of urine, storage of urine in the bladder at low pressure between catheterizations, maintaining the patient's kidney in the best condition.

The best treatment is of no value if it does not apply ...

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