People who are not able to empty their bladder themselves (having retention) are introduced to a bladder management method that suits their needs and capabilities. Below is a short description of some of the most common bladder management methods. The overall goal with bladder management is to make sure that the bladder gets emptied to ensure that the bladder stays healthy, and to obtain continence.

Intermittent catheterisation (IC)

An intermittent catheter is a plastic tube that is manually inserted into the bladder via the urethra. When the bladder is empty the tube is removed and discarded. The procedure is typically carried out 4-6 times a day (1).

European and American associations recommend IC as the golden standard for bladder emptying when suffering from a neurogenic lower urinary tract dysfunction. When comparing IC to other methods it is proven, that IC is associated with fewer urinary tract infections (UTIs), fewer bladder stones and fewer kidney stones (2-6).  IC provides a higher degree of independence (7), explained by no permanent presence of an indwelling catheter and no or reduced use of diapers, urisheaths and leg bags.

There are two goals when performing IC. The first goal is to keep a low bladder pressure. When the bladder pressure is low, the urine is less likely to flow black to the kidneys and less likely to cause overflow incontinence. To ensure a low bladder pressure the urine volume in the bladder should not exceed 500 ml. The second goal is to keep the bladder healthy and drained and thereby reduce the risk of the urine becoming stale and causing infections. That is done by adhering to the prescribed frequency of catheterisations and to empty the bladder completely each time (1).  

Indwelling catheter

An indwelling catheter is a tube that is inserted into the bladder through the urethra and then left there to drain the bladder on an ongoing basis (8).

These catheters are made by a soft material and often inserted using a guide wire. Indwelling catheters are inserted by a health care professional (8).

The catheter is held in place by inflating a balloon at the tip of the catheter with water. The catheter is connected to a drainage bag. The replacement of the indwelling catheter must be at intervals of weeks and is done by health care professionals. The drainage bag is emptied a couple of times a day (8).

The user carries the catheter and the drainage bag at all times (8).

Indwelling catheters are associated with a higher risk of urinary tract infections (2–6) compared to intermittent catheters.

 

Suprapubic catheter

A suprapubic catheter is an indwelling catheter inserted through the abdominal wall over the pubic area directly into the bladder (9). The procedure is carried out at the hospital by a surgeon. The function of the suprapubic catheter is the same as the indwelling catheter. A small balloon at the tip of the catheter is inflated with water to prevent it from falling out. The catheter is connected to a drainage bag. Alternatively, a valve can be connected to the catheter so it can be emptied at intervals. The replacement of the catheter is typically done at intervals of weeks and is done by health care professionals but can also be done at home (9).

The suprapubic catheter is associated with more autonomy for e.g. people in wheelchairs as they will need less help catheterising (3).

 

Mitrofanoff

The Mitrofanoff procedure is a surgical procedure where the appendix or a small section of the small intestine is separated and used to create a connection between the abdominal wall and the bladder (10). The catheter used for the Mitrofanoff is an intermittent catheter. The procedure makes it easier for the patient to self-catheterise, as it is not necessary to insert a catheter via the urethra, which can be difficult for some people (10).

 

 

 Intermittent  catheterization

 Indwelling catheter

 Suprapubic catheter

 Mitrofanoff

Independancy

Higher

Lower

Lower

Higher

Risk of UTI

Lower risk

Higher risk

Higher risk

Lower

Surgical procedure needed

No

No

Yes

Yes

 

 

Alternative voiding methods:

  • Credé stimulation: Is defined by manually applying pressure on the abdomen over the bladder to press urine out of the bladder (11)
  • Vasalva maneuver: Is defined by using the abdominal and diaphragm to increase the bladder pressure and force urine out of the bladder (11)
  • Tapping: Is defined by tapping the area over the bladder to trigger the detrusor contractions (12)