Diane Newman: Welcome. I'm Diane Newman. I'm an Adult Nurse Practitioner, an Adjunct Professor of Urology in Surgery at the Perelman School of Medicine, University of Pennsylvania, Philadelphia.

I'm going to present information on the new embedded technology that we're seeing now in hydrophilic catheters that we use for intermittent catheterizations that we're teaching our patients. I'm hopeful that this is going to provide you with new information about where we are currently in this field of technology in catheters.

We'll start here with a catheter technology timeline. And basically innovations have been occurring for many, many hundreds of years. We started with the red rubber which was really the greatest invention because it gave us the capability of having a catheter we could pass easily and use intermittently, but it's really evolved since then. And you see in the 1980s we really started with hydrophilic coating. And that has really revolutionized catheterization for patients who do it intermittently because it really is a user friendly coating and it really makes catheterization much easier for most patients and really decreases a lot of the adverse events that we see in individuals, especially men, who are catheterizing long-term. And that population is really growing.

Now, the material has changed. And basically we started out with that red rubber, but I don't know what you're finding where you're practicing and your patient population, but I'm seeing more and more latex allergy of concern where many health systems are actually becoming 100% latex free of all products, not just catheters, because of acquired latex allergies. And actually, in healthcare professionals practicing in hospitals. And we went to PVC which was a better type of catheter, but somewhat more stiff, but now we have improvements in plastic material with different types of materials such as PEBA and silicone. Silicone is a little bit more difficult. It tends to be so flexible it's sometimes difficult to insert. But when you go down to the hydrophilic catheters, we have now new material, PVP and polyurethane, which is really where the hydrophilic coating is basically chemically adhered to the surface of these catheters. You see that evolution in the material of intermittent catheters.

Now, the material though is adhered, as I said, to the surface of the catheter and it can dry out. I just want to share with you that this can cause problems. As that catheter is withdrawn, if it's drying, it can cause pain, bleeding or trauma, it can maybe cause some openings of the epithelial lining of the internal urethra. And you and I know that overtime that lining can start to inflame and develop strictures. If it opens up, it can cause introduction of bacteria. It can cause catheter associated urinary tract infections. There can be problems with the concept of that coating kind of really coming off that catheter and really as it's being withdrawn from the urethra.

Problems. It does remain fully hydrated. That coating remains wet and lubricious so it's a smoother passage, but it's for a short time, five to 20 minutes. As hydration falls below 75%, that coating loses its lubricious properties and it becomes adhesive. And that can stick to the urethra mucosa. And actually in 2013, the EAUN, that's the nursing group of the European Association of Urology, actually has a guideline out and I use this quite a bit in my teaching and when I talk to patients is that they noted that patients who may take a long time to catheterize, they're reporting discomfort during withdrawal. And that's because the drying of the hydrophilic surface.

This is just a little schematic as far as what happens with that mechanism as that coating dries out. And basically you see on the left an uncoated catheter. You see the hydrophilic coated catheter, that second picture there, and the chains of the PVP, polyvinyl alcohol, and the fully hydrated coating. But as it starts to dry out, look what happens. That coating is less hydrated and exposing those polymer chains. And that's where we see issues with tackiness that can happen when you're withdrawing the catheter.

And actually this article is way back in 2005 but they actually discussed how hydrophilic catheters can reduce urethra trauma because lubricious but they did talk about how you test as it withdraws and what type of adherence that can occur with drying out of the catheter. A good thing to remember too is as that catheter dries out, is that patient pulling it, forcing that removal? That would be of concern to me as a clinician.

What we have now in 2022 is embedded technology. What is embedded technology? Well, it's not on the surface, it's embedded to that surface layer of the catheter. That's what's important with embedded technology. And the GentleCath Glide actually has that hydrophilic coating that is embedded into the catheter surface.

GentleCath does not use PVP coating or any type of coating. That's what's really important. It uses a type of molecule called a surfactant. The hydrophilic head is arranged on the surface of their catheters and that tail that I showed you about remains embedded within the polymer. You're not going to see it sticking out to irritate the internal urethral surface. That's what's important about the embedded technology.

Embedded is integrating that hydrophilic properties into the material of the catheter. And what that means is when water is applied to the outside of a FeelClean catheter, it's attracted to the surface where the hydrophilic additive is embedded, and it instantly creates a slippery surface. And that's kind of what this picture is showing. And it retains those hydrophilic properties during insertion and removal. And I think that's what's key with the embedded technology.

It's uniform throughout and you don't have to worry about the PVP coating or lubrication because it doesn't use PVP. It becomes lubricious when hydrated but not sticky when drying because that material is embedded. What you have and what's tested is the friction. The low friction when you insert. Low friction means less trauma and friction with the urethral mucosa. And it makes it easier for insertion and removal.

When this technology was developed, they did some testing and analyzed intermittent catheters with reference to the wettability, they call it, and lubricity of the catheter surface. And how much microtrauma, which is the small trauma to that uroepithelial cell layers of the urethra, the internal layers of the urethra.

What is wettability? That's a new term for me too. I'm sure it is for you. The wettability of the catheter surface is determined by its contact angle. It measures a spread of a water droplet on a solid surface, which would be the catheter surface. And you want that water droplet to remain rounded on that hydrophobic surface with a high contact angle. If it has a low contact angle, it'll flatten out. Really it's the ability of a material to bind water and that results in a more lubricious surface. And remember, we want a lubricious surface because that's a smoother insertion and removal.

And this just shows you a picture of that, GentleCath is on your right, and how you see that water droplet as far as the dome of it. It's really spread on that surface as opposed to an uncoated catheter or a PVP material catheter that's coated.

They also tested this embedded FeelClean technology with a GentleCath Glide. And they actually looked at the withdrawal force. Remember I showed you that picture before, measuring as they withdrawal the catheter, which they've done in a lab. And basically there was less force. What they're saying is this technology is less traumatic. You don't need to have that force as far as removal. And they compared it to other PVP coated catheters. You see the evolution in testing of this new technologies on catheterization.

I hope this is some new material for you. I'm always excited because I use all the catheters out there that we have available because not one catheter fits every patient. They're very individualized and I'm sure you listening individualize your care when you assess that patient when initiating intermittent catheterization. And I think we now see that the design, especially in the hydrophilic coatings and the hydrophilic embedded technology, is really evolving. FeelClean is the newest hydrophilic catheter that we now have on the market. It has embedded catheter surface technology. And we're hopeful that we're going to see research on the fact that it can reduce urethral trauma during removal. And I think we're going to see some good outcomes here as we advance this technology.

Thank you very much for listening.