Rethink the use of the urinary catheter and consider other treatment options 2

Rethink the use of the urinary catheter and consider other treatment options

The indication for a bladder catheter is often thoughtless. Alternative treatments are often not taken into account. Once laid, drainage usually accompanies patients until the end of their life.

the Installation of a bladder catheter Geriatric patients are often classified more as a temporary breastfeeding measure than as a medical procedure with serious consequences. Andreas Wiedemann, Witten Evangelical Hospital and his colleagues. For various reasons, drainage is then generally, although originally considered a transitional solution, as follows: measure definitively considered and not removed. For patients, the insertion of a catheter represents a radical step with many consequences for the quality of life.

Among the best known impairment losses By supra-pubic or transurethral catheter, we mean the cutaneous problems of the fistula or the skin area under the urine bag, infections, obstruction of the urethra, paralysis of the urethra , odor, reduced mobility through the drainage system, hematuria and recessive dependent caregivers, which makes the change,

Less is known geriatric complications of long-term bladder drainageexplain the urologists. Thus, the combination of bacterial colonization of the bladder and mechanical irritation through drainage can lead to overactive bladder symptoms. Tenesmus is painful for patients and makes them worried. In addition, especially in patients with cognitive limitations, the tendency to auto-discover increases, resulting in injury in the worst case.

Injuries often already when the catheter is attached

In addition, studies show that Increase the risk of fallingt. On the one hand, urologists attribute this to tenants, who primarily encourage dementia patients to overheat (often nocturnal) toilets and the drainage system itself, which can disrupt circulation and coordination. We must also remember risk of injury in the context of the catheter system. For suprapubic catheters, the incidence of complications can go up to 12% and the mortality rate is 2.4%. Transurethral catheterization is associated with a risk of trauma of 6.7 to 1000 deposits.

In this context, the recommendation "Urinary Incontinence in Geriatric Patients" explicitly states before deciding on a long-term urinary drainage as part of a structured procedure. weigh all other treatment optionsThese include primarily behavioral interventions with fixed or individual emptying times as well as bladder formation.

Lower anticholinergic exposure

Is one Bladder disorders According to the authors, it is important to distinguish between acute and chronic urinary retention and classic urinary incontinence, especially with regard to the potential for rehabilitation. Here, however, there is often unclear symptomatology in the elderly, so urological clarification would be helpful.

Especially in case of acute urinary retention, an alphablocker-assisted catheter output test with reduction of anticholinergic load by drug therapy is recommended. It should be noted that not only conventional anticholinergics induce detrusor hypoactivity, but also tricyclic antidepressants, morphine, furosemide or phenprocoumon.

Source: Wiedemann A et al. Urologist 2019; 58: 389-397