Before CIC operation training, the patients should be comprehensively evaluated, the existing problems should be dealt with, and the treatment scheme suitable for the patients' condition should be formulated. For example, drug and behavior training can help the bladder to store urine, so as to determine the safe bladder capacity (that is, the bladder pressure does not exceed 40cmH2O when storing urine). Patients should be fully aware that bladder overfilling may cause damage to the upper urinary tract, especially if the pressure in the bladder exceeds 40cm2O for a long time. Only in this way can patients understand the importance of regular catheterization every day. Generally, urethral catheterization is needed 4~6 times a day to avoid bladder overfilling.
The most commonly used catheters in CIC are F 14~F 16 transparent plastic catheters, and female patients can use short catheters specially designed for CIC. The materials of the catheter are plastic, rubber and silica gel. Transparent catheter can see whether urine flows out as soon as possible, which is helpful for patients to judge the insertion depth of catheter, reduce the pain caused by catheterization and facilitate the cleaning of catheter.
The principle of cleaning is that the used catheter should be cleaned with soapy water and dried. Prepare 6 clean urinary catheters every day and put them in clean and dry pockets for outdoor and night use. Male patients should know how they feel when the catheter passes through the membranous sphincter and prostate, as well as the resistance of their hands to prevent urethral injury caused by forced insertion. Wash your hands before catheterization. After applying some paraffin oil to the top of the catheter, insert the urethra into the bladder by hand. When urine flows out, insert 1~2cm deep, and slowly pull out the catheter after the urine is exhausted, so that the urine accumulated at the bottom of the bladder can be easily discharged.
The key to female patients' training is to know the anatomical position of urethra, and the exact position of urethral orifice can be known through mirror or hand touch. Knowing the anatomical position of the urethral orifice, the patient can sit or step on the toilet, separate his legs, touch the urethral orifice with one hand and insert the tip of the catheter into the urethra with the other. Slowly pull out the catheter after the urine is exhausted.
If CIC is difficult due to anatomical factors, further examination is needed, especially to relieve lower urinary tract obstruction such as urethral stricture. CIC is not recommended for patients who have difficulty in moving their hands, although there are some devices that can help such patients with catheterization. Small doses of antibiotics can be taken to prevent infection 2~4 weeks before CIC, and it is not necessary to use antibiotics for a long time. Regular monthly follow-up of patients with urine routine and urine culture.
Complications and follow-up of clean intermittent catheterization
CIC has few local complications. Occasionally there is urethral bleeding or gross hematuria, and many of them can heal themselves. Occasionally, bladder stones occur. Urethral injury can lead to urethral stricture and make CIC difficult. The above situation is relatively simple and rarely happens in urology.
Urinary tract infection is the most common complication of CIC. Asymptomatic bacteriuria is often found in CIC patients, for example, patients have no signs of serious urinary tract infection such as fever, hematuria, turbid urine, urine odor and lower abdominal pain, and no special treatment is needed [14]. Urinary tract infection with clinical symptoms generally needs anti-infection treatment. Because of sensory disturbance, the symptoms and signs of urinary tract infection in patients with spinal cord injury are different, such as aggravated muscle spasm, hyperreflexia of autonomic nerve, high fever, hematuria, foul urine and turbid urine. Because the patients with spinal cord injury have obviously decreased their self-consciousness, it is necessary to observe whether there is urinary tract infection from the signs. Urinary tract infection with clinical symptoms or signs generally occurs, which requires short-term anti-infection treatment. A 10-year clinical follow-up study with CIC as adjuvant therapy showed that the incidence of asymptomatic bacteriuria was about 74%, while patients with high fever or pyelonephritis were rare [15]. Long-term use of low-dose antibiotics may be helpful for some recurrent urinary tract infections.
The existence of vesicoureteral reflux can significantly increase the risk of upper urinary tract infection caused by CIC. For example, there is enough bladder safety capacity through urodynamic evaluation before CIC starts, and the amount of CIC catheterization is also limited by bladder safety capacity, so acquired vesicoureteral reflux rarely occurs. But with the passage of time, the compliance of neurogenic bladder will gradually decrease. Therefore, patients with neurogenic bladder should be evaluated regularly every year to find out whether it is suitable for CIC adjuvant therapy. If CIC, urinary tract infection or hydronephrosis recur for a long time in the near future, the existence of vesicoureteral reflux and the functional status of vesicoureteral should be re-evaluated. For patients with mild vesicoureteral reflux and mild recurrent infection, long-term use of low-dose antibiotics may be helpful. For patients with obvious vesicoureteral reflux and severe recurrent urinary tract infection, bladder dilatation (self-expanding or enterovesical dilatation) and reflux ureterostomy are generally accompanied by low bladder compliance, and CIC catheterization can effectively protect the upper urinary tract function after operation.
Patients receiving CIC usually need to be followed up regularly every year after their condition is stable. The contents of the review include urine analysis, urine culture and drug sensitivity test, the number of times of catheterization every day, the amount of catheterization each time, renal function and renal ultrasound. If hydronephrosis occurs, intravenous pyelography, vesicoureteral reflux radiography and urodynamic examination (or video urodynamic examination) should be performed. If hematuria occurs, cystoscopy should be performed to exclude bladder stones and even bladder tumors.
In a word, clean intermittent self-catheterization has become the most basic treatment for bladder emptying. CIC is used to treat urinary incontinence and some complications of bladder emptying disorder after urinary incontinence treatment. Long-term clinical observation has confirmed that CIC has good safety, effectiveness and tolerance. Moreover, CIC is easily mastered by patients or their families. With proper follow-up, the popularization of CIC technology will obviously improve the survival time and quality of life of patients with bladder and urethra dysfunction and urinary incontinence.