Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided. This article aims to provide a multidisciplinary consensus view on this subject.
It is evident that every patient needs to be considered individually, bearing in mind the symptoms and investigations to be considered. We emphasise the importance of considering the term Bladder Voiding Efficiency (BVE). One group of patients who might find CISC helpful are those with a neurological disorder; these include spinal injury patients, multiple sclerosis, Parkinson's, and a condition called cauda equina. Sometimes bladder problems are treated with anticholinergics, and others may be treated with Botox. These may cause the bladder not to empty at all, which is good for leaks but needs self-catheterisation to empty the bladder. In the past, hospitals used a permanent catheter called an 'indwelling' or a 'suprapubic' catheter. These can have side effects, including infections, stones, and pain. For CISC, disposable catheters are the best option for patients as they come in different sizes and styles to provide individualised care. In conclusion, we would like hospitals to consider each patient separately and not use a general 'one-size-fits-all' bladder function for these patients.
Neurourology and urodynamics. 2023 Dec 11 [Epub ahead of print]
Christopher Chapple, Paul Abrams, Thomas Lam, Altaf Mangera, Mohammed Belal, Carmel Curtis, Jacqueline Emkes, Sarah Hillery, Karen Irwin, Karen Logan, Polly Weston, Ann Yates
Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., University of Bristol, Bristol, UK., Aberdeen Royal Infirmary - NHS Grampian, Aberdeen, UK., Spinal Injuries Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK., King's College Hospital NHS Foundation Trust, London, UK., National Bladder and Bowel Health Project NHS England and Excellence in Continence Care Board - Chair Patient and Carer forum, Manchester, UK., York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK., Bladder & Bowel UK, Manchester, UK., Aneurin Bevan University Health Board, Newport, UK., University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK., Cardiff & Vale University Health Board, Cardiff, UK.