An overview of catheters and collection devices in urology

Corne de Boer

Stomatherapist, Department of Urology, Steve Biko Academic Hospital, Pretoria

Correspondence to: C de Boer (deboer@lantic.net)

Definition of incontinence

Incontinence can be defined as the involuntary loss of urine and faeces. Usually the time and place for urination or defecation cannot be controlled, and the person is forced to pass urine or stool.

Collection devices

Urinary sheaths/condom catheters

• We are moving away from sheaths/catheters containing latex to sheaths or catheters containing 100% silicone.

• Urinary sheaths are attached to the outside of the penis shaft and can be self-adhesive or contain a uriliner for attachment to the penis shaft.

• Sheaths differ in size from 25 mm to 40 mm.

• The patient needs to be evaluated thoroughly for penis size because if the condom/sheath fits too tightly it will cause ulcers on the penis shaft or if it fits to loosely it will fall off.

• When ulceration occurs, the patient needs to stop using the urinary sheath and an alternative option should be considered for managing the urinary incontinence.

Penile clamps

• These are very effective for very active male patients.

• When evaluating the patient for a penile clamp, the manufacturing instructions should be followed carefully to prevent restriction of blood flow to the penis as well as ulceration.

Absorbent products

• Absorbent products are manufactured for urinary and faecal incontinence and contain super-absorbent material (SAM).

• There is a wide variety available comprising pads, diapers and pull-up pants.

• Different sizes are available and patients need to be evaluated for amount of urine requirements and appropriate size.

• Evaluate patients for ulceration of the healthy skin and consider referring for barrier cream or film.

Underwear

It is important for underwear to:

• Be easy to remove and contain fasteners

• Contain the smell

• Absorb small amounts of urine.

Protective linen

Protective linen includes absorbent linen savers and washable mattress protectors.

Urinary catheters

• Urinary catheters should be considered as the last option for managing urinary incontinence.

• For long-term catheterisation consider a 100% silicone catheter with the correct balloon size.

• Catheters should be changed regularly by competent personnel.

• Catheters should always be stabilised and if long-term catheterisation is considered; refer the patient to a urologist for a suprapubic catheter.

• Patients should be evaluated after catheterisation for the correct collection bag, e.g. a night bag for large volumes of urine during the night, and a leg bag for during the day, which is enclosed underneath clothing.

Self-intermittent catheterisation

Patients are usually referred for self-intermittent catheterisation to control the leakage of urine in overflow incontinence when the bladder residual is more than 80 ml. Another reason would be to teach a patient with a urethral stricture to catheterise him/herself to keep the stricture open and to prevent urinary retention. It may also be necessary for any post-urology or gynaecological procedures.

High bowel washouts or retrograde colonic lavage technique (RCLT) for faecal incontinence

The principles of RCLT include:

• An empty colon cannot soil.

• The colon is a capable reservoir.

• It only needs to be emptied at long regular intervals, e.g. every 24 hours.

• The colon can be programmed to empty itself at a set time, with or without assistance.

• A natural gastrocolonic reflex aids programming of the colon.

Bowel irrigation offers the following advantages:

• More freedom and security.

• Time and place of bowel movement can be determined.

• Method is easy to learn and can be performed without mess or discomfort.

• It is cost-effective as there is no need for suppositories, enemas and added medication.

• There are no haemorrhoids or trauma to the rectum as a result of damage to blood vessels while ‘gloving’.

Requirements for bowel irrigation include:

• The patient must be well motivated and understand the advantages.

• The patient must be able to ‘transfer’ to the commode or toilet for the procedure.

• Dedicated caregivers are needed for quadriplegics and tetraplegics.

The following are contra-indications for bowel irrigation:

• Diseases of the bowel or existing irritable bowel

• Senility or mental deficiency

• Inability to reach the anus and hold the cone in place, e.g. obesity.

References available at www.cmej.org.za