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

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

History continued….. Latex rubber became available on 1930s- and in 1935 Dr Frederic Foley introduced the latex balloon catheter Latex rubber became available on 1930s- and in 1935 Dr Frederic Foley introduced the latex balloon catheter Charriere’s French scale was used to describe the external diameter of a catheter. Charriere’s French scale was used to describe the external diameter of a catheter. After WW2 Sir Ludwig Guttman introduced the concept of sterile intermittent catheterisation After WW2 Sir Ludwig Guttman introduced the concept of sterile intermittent catheterisation

What is catheterisation? 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 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 Royal Marsden Clinical Guidelines 2002 Royal Marsden Clinical Guidelines 2002

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

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

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

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

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

Atonic/ Neurogenic bladder- causes Central nervous system (CNS): Central nervous system (CNS): –Cerebrovascular event. Cerebrovascular eventCerebrovascular event –Spinal injury. Peripheral nervous system (PNS): Peripheral nervous system (PNS): –Diabetes. –AIDS. AIDS –Alcohol. –Vitamin B12 deficiency neuropathies. Vitamin B12 deficiencyVitamin B12 deficiency –Herniated disc. Herniated discHerniated disc –Damage due to pelvic surgery. Mixed CNS and PNS: Mixed CNS and PNS: –Parkinson's disease. Parkinson's diseaseParkinson's disease –Multiple sclerosis. Multiple sclerosisMultiple sclerosis –Syphilis. Syphilis –Tumours.

Incontinence and catheterisation It is not appropriate to catheterise a person who is incontinent without first trying to identify the cause of the incontinence. It is not appropriate to catheterise a person who is incontinent without first trying to identify the cause of the incontinence. Catheters can: Catheters can: Cause infections Cause infections Cause trauma Cause trauma Decrease the person’s bladder functions Decrease the person’s bladder functions The decision to catheterise should be discussed with the multi disciplinary team and the person if appropriate. 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: 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 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 incontinence is affecting a person’s ability to participate in rehabilitation If the person’s skin is becoming damaged as a result of incontinence If the person’s skin is becoming damaged as a result of incontinence

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