Catheterisation History and indications for Ellie Stewart CNS

Catheterisation History and indications for…. Ellie Stewart CNS Urogynaecology Guys and St Thomas NHS Foundation Trust

History of catheterisation…. n The word ‘catheter’ comes from Greek meaning to ‘let or send down’ n They were used as early as 3000 BC to relieve urinary retention n Catheters at that time were made of rolled up palm leaves, hollow tops of onions, gold, silver, copper and brass

History continued…. . n Latex rubber became available on 1930 sand in 1935 Dr Frederic Foley introduced the latex balloon catheter n Charriere’s French scale was used to describe the external diameter of a catheter. n After WW 2 Sir Ludwig Guttman introduced the concept of sterile intermittent catheterisation

What is catheterisation? n Urinary catheterisation is the process by which a tube (catheter) is inserted into the bladder for the purposes of draining urine, instilling irrigating fluids or drugs, or for urodynamic investigations n Royal Marsden Clinical Guidelines 2002

Indications for catheterisation n Urinary retention: – Acute- painful – Chronic – – – Caused by obstruction: Bladder outlet obstruction Stricture First trimester pregnancy Chronic constipation Prolapse/ procidentia

Acute monitioring n Surgery: To monitor accurate urine output post op n To monitor output in acute conditions n Urology surgery- TURP, TURBT, etc n Urogynaecology surgery- TVT, prolpase repair n Empty bladder during labour

Instillations n BCG n Mitomycin- chemotherapy n Bladder irrigation post TURP, TURBT, haematuria n Drug therapy for interstitial cystitis etc

Investigations n Urodynamics n Obtain an uncontaminated urine specimen n Monitor a post void residual in absence of bladder scanner n X-ray investigations

Atonic bladder n Atonic -no tone, unable to contract n Neurogenic -damage to nervous system making it under active or overactive n Inability to empty bladder n Symptoms- overflow incontinence, recurrent UTIs n Treatments: anticholinergics, ISC, bladder augmentation

Atonic/ Neurogenic bladder- causes n Central nervous system (CNS): n Peripheral nervous system (PNS): n Mixed CNS and PNS: – Cerebrovascular event. – Spinal injury. – – – Diabetes. AIDS. Alcohol. Vitamin B 12 deficiency neuropathies. Herniated disc. Damage due to pelvic surgery. – – Parkinson's disease. Multiple sclerosis. Syphilis. Tumours.

Incontinence and catheterisation n n It is not appropriate to catheterise a person who is incontinent without first trying to identify the cause of the incontinence. Catheters can: Cause infections Cause trauma Decrease the person’s bladder functions The decision to catheterise should be discussed with the multi disciplinary team and the person if appropriate. There are occasions when catheterisation is the correct course of action, for example: If all other options have been explored and incontinence remains a problem If the incontinence is affecting a person’s ability to participate in rehabilitation If the person’s skin is becoming damaged as a result of incontinence

Contraindications……. n Caution with bladder and prostate cancers, strictures or very large prostates n Incontinence- before pt has been investigated and treated, if appropriate consider SP catheterisation/ ISC n Convenience!!!