What are the complications of clean intermittent catheterization (CIC) in the treatment of bladder dysfunction?

Updated: Jan 04, 2019
  • Author: Gregory T Carter, MD, MS; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

Encourage fluid restriction to limit bladder volumes to less than 600 mL. Schedule catheterization 3-6 times per day.

Problems with this technique include urethral trauma and predisposition to bacteriuria or urinary tract infections. To prevent latex allergy, use nonlatex catheters for long-term CIC. Lubrication with 2% lidocaine helps limit pain and trauma. At times, use of a curved tip (coudé) catheter may be necessary if introduction of a standard catheter proves difficult.

Men with spinal cord lesions higher than C7 who are unable to perform self-catheterization are the most likely to benefit from the use of external condom catheters. If outlet obstruction is present, a sphincterotomy is necessary. The patient must have reflex bladder contractions. Skin breakdown can occur, especially in patients with poor hygiene. Urinary tract infections can occur.

Indwelling catheters, either suprapubic or urethral, may be employed. Patients frequently choose this option for convenience and as a last resort when all other measures have failed. It is also an option for persons who are unable to catheterize themselves and who prefer not to have the caregiver perform CIC.

Catheter care includes monthly catheter changes, sterilization of collection bags, and irrigation. Urinary colonization and infections are common. Long-term users should undergo routine cystoscopy to rule out bladder cancer. Pediatric and geriatric patients with adequate bladder emptying may use diapers or incontinence pads.

A retrospective study by Chaudhry et al indicated that in patients undergoing CIC for neurogenic bladder secondary to spina bifida or tethered cord, the risk of frequent urinary tract infection is greater in younger patients, with the odds of such infection decreasing by 7% per year. [21]


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