Therapeutic education and intermittent self-catheterization. A Cohort study to assess success and failure rate as the outcome of the initial session and after one year
Mr Thibaud HONOREa, Dr Alexia EVEN SCHNEIDERa, Prof Pierre DENYSa
a CHU Raymond Poincaré
Introduction : Intermittent self-catheterization (ISC) is currently the gold standard for the management of retentionist neurologic bladders. There is no in the literature any randomized studies of strong or weak power enlightening the efficacity of therapeutic education (TE) in the acceptance, compliance and realization of SIC.
Material: A cohort of 87 patients who got a therapeutic education for ISC in our unity of neuro-urology was studied. The following data were collected: disease, age, gender, voiding method before TE, presence or absence at inclusion of overactive bladder syndrome, urge urinary incontinence, stress urinary incontinence, dysuria, also detrusor overactivity and bladder compliance at cystometry at inclusion. Failure or success of performing the ISC as the outcome of initial TE and after 1 year was studied, as well as their cause.
Results: Success of ISC as the outcome of the initial TE was 79%, and immediate failure was 21%. In 1/3 cases, the reason was anatomy. The other main causes were psychology, skill, or due to motor function or dexterity impairment.
One year after TE, the rate of patients who aren’t undertaking anymore the ISC and who are coming back to their previous voiding method or a new one is 1/3. Half of patients were still undertaking ISC and 15% lost to follow-up.
Main failures causes at 1 year were: initial failure (37%), return to a voiding method by spontaneous voiding (17%), dissatisfaction of ISC (10%), combination of ISC and spontaneous voiding (10%), and for 13% a modification of voiding method (sacral neuromodulation, Bricker, cystectomy).
Among the patients lost to follow-up and not answering to the phone, 3 failed the ISC initially while 10 succeeded.
There was no statistical correlation between the different data collected initially and the success or failure of ISC one year after the TE.
Discussion: 1/3 of patients who got therapeutic education for intermittent self-catheterization don’t use this voiding method after one year of follow-up. The important number of patients lost to follow-up (15%) call into question the follow-up of patients after therapeutic education and also the significance of follow-up and reinforcement sessions.
Keywords : therapeutic education, intermittent selft-catheterization, compliance, follow-up