Clean intermittent catheterization--physical and psychological complications.
During a 6 months period in 1988, 407 patients (206 men and 201 women) with a mean age of 51.7 years, treated with clean intermittent catheterization (CIC), were included in a one-year prospective follow-up study regarding physical and psychological complications and complaints related to the treatment. According to diagnoses and examinations, the patients were divided in 5 groups: supranuclear affections (106 patients), infranuclear affections (141), detrusor myopathy (136), infravesical obstruction (19) and suprapontine affections (5). Significant bacteriuria was found in 50.6% of all urine samples analyzed, with E. Coli as the dominant species. In urine samples from patients not using antiinfective agents, bacteriuria was found in 57.5% while the corresponding figures in patients using methenamine hippurate and antibiotics were 42.5% and 37.5% respectively. Bacteriuria was found equally in both sexes. The distribution of species was equal in CIC-treated patients and in other outpatients studied. Only minor differences were found regarding the drug resistance pattern. The prevalence of symptomatic urinary tract infections varied from 11.9% to 17.4% with a higher frequency in females and patients using antibiotics. During the observation period of one year 24.5% had no clinical UTI at all, 58.6% had minor symptoms, 14.3% had more comprehensive or frequent symptoms while 2.6% claimed major symptoms. Women had a higher clinical infection rate than men (p < 0.01). Bleeding in connection with the catheterization procedure varied from 10.7% to 13.6%. Traces of blood were detected in 22.8% of all urine samples analyzed with no differences between patients who claimed observing blood and those denying. No other major physical complications were detected in significant values or seriousness. Predictive factors of clinical UTI were low age and high mean catheterization volume in female patients. In male patients low age, neurogenic bladder dysfunction and non-self-catheterization were predictors in addition to urine leakage in those with neurogenic dysfunction. Bacteriuria was a risk factor of future clinical infection and bacteriuria. No other risk factor of bacteriuria could be identified in the female population, while low frequency of catheterization, high age and non-self-catheterization were found predictive in males.(ABSTRACT TRUNCATED AT 400 WORDS)
Bakke
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Department of Surgery, Haukeland University Hospital, Bergen, Norway.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001437:Bacteriuria / Q000209:etiology; D003430:Cross-Sectional Studies; D004927:Escherichia coli Infections / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D011581:Psychological Tests; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D001750:Urinary Bladder, Neurogenic / Q000628:therapy; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000379:methods / Q000523:psychology; D014552:Urinary Tract Infections / Q000209:etiology