Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
University of Sheffield, Sheffield, UK.
Neurourol Urodyn. 2024 Feb;43(2):459-463. doi: 10.1002/nau.25353. Epub 2023 Dec 11.
Clean intermittent self-catheterisation (CISC or ISC) is used by patients/carers to empty the bladder if needed. Sometimes the urethral lumen leading out of the bladder is blocked; sometimes, the bladder (detrusor) muscle itself or the autonomic motor nerves innervating the bladder are damaged, resulting in a failure of the detrusor muscle to work, leading to a failure of the bladder being able to empty adequately. Prior consensus as to the indications and timing of CISC has yet to be provided. This article aims to provide a multidisciplinary consensus view on this subject.
It is evident that every patient needs to be considered individually, bearing in mind the symptoms and investigations to be considered. We emphasise the importance of considering the term Bladder Voiding Efficiency (BVE). One group of patients who might find CISC helpful are those with a neurological disorder; these include spinal injury patients, multiple sclerosis, Parkinson's, and a condition called cauda equina. Sometimes bladder problems are treated with anticholinergics, and others may be treated with Botox. These may cause the bladder not to empty at all, which is good for leaks but needs self-catheterisation to empty the bladder. In the past, hospitals used a permanent catheter called an 'indwelling' or a 'suprapubic' catheter. These can have side effects, including infections, stones, and pain. For CISC, disposable catheters are the best option for patients as they come in different sizes and styles to provide individualised care. In conclusion, we would like hospitals to consider each patient separately and not use a general 'one-size-fits-all' bladder function for these patients.
清洁间歇性自我导尿（CISC 或 ISC）用于患者/护理人员在需要时排空膀胱。有时，通向膀胱的尿道腔道受阻；有时，膀胱（逼尿肌）本身或支配膀胱的自主运动神经受损，导致逼尿肌无法正常工作，导致膀胱无法充分排空。目前尚未就 CISC 的适应证和时机达成共识。本文旨在就这一主题提供多学科共识意见。
显然，每位患者都需要单独考虑，同时考虑要考虑的症状和检查。我们强调考虑膀胱排空效率（BVE）这一术语的重要性。一组可能发现 CISC 有帮助的患者是患有神经疾病的患者；这些包括脊髓损伤患者、多发性硬化症、帕金森病和马尾综合征。有时，膀胱问题可以用抗胆碱能药物治疗，而其他问题可能可以用肉毒杆菌素治疗。这些可能导致膀胱完全无法排空，这对于漏尿是好的，但需要自我导尿来排空膀胱。过去，医院使用一种称为“留置”或“耻骨上”的永久性导管。这些可能会有副作用，包括感染、结石和疼痛。对于 CISC，一次性导管是患者的最佳选择，因为它们有不同的尺寸和样式，可以提供个性化的护理。总之，我们希望医院能够单独考虑每位患者，而不是对这些患者使用一般的“一刀切”膀胱功能。
