Intermittent self-catheterization training and effects on treatment adherence and infection

Background: Intermittent self-catheterization (CISC) is the preferred treatment for patients with bladder dysfunction due to spinal cord injuries or multiple sclerosis (MS). However, the learning phase plays a crucial role in the still frequent drop-out. Aim: To examine whether the timing of training affects the treatment compliance and the prevalence of urinary tract infections in patients with neurogenic urinary retention. Design: This is a non-randomized observational study. Setting: The study was carried out from January 2017 to December 2019 in outpatient settings at the Bari Polyclinic Unipolar Spinal Unit (Bari, Italy). Population: The study included adults with a CISC prescription for neurogenic urinary retention and learning the technique for the first time. Methods: One hundred patients were enrolled, 75 trained immediately after diagnosis and physician prescription, while 25 in the contest of a separate training visit, one or two days after physician prescription. After the training (T0), patient's data and number of prescribed daily catheterizations were recorded and compared with those collected after 6 and 12 months. Accuracy of the procedure and episodes of infections were assessed as well. Results: Adherence to prescribed CISC frequency and complications were not affected by the timing of training. However, patients adherent to the prescribe frequency of catheterization had less risk of infection than those who were not. Further post-hoc analysis confirmed that urodynamic findings and the pathology did not impact the overall occurrence of complications, but infections occurred more frequently in patients with MS (P<0.03). Conclusions: The timing of CISC education does not affect treatment adherence or the occurrence of complications. However, the adherence to the CISC prescription seems to reduce the risk of infection. Clinical rehabilitation impact: Patient training can be scheduled according to the organization of the centers, as patient compliance and the occurrence of complications are not affected.