Clean intermittent self-catheterization
Neal DE., Lawson AL., Webb RJ., Robertson AS.
The introduction of clean intermittent self-catheterization (CISC) as a method of management for patients with impaired bladder emptying has been a major advance in clinical urology. It requires commitment and enthusiasm from the staff involved and motivation from the patient to be successful, but has assumed increasing importance because of the advent of bladder reconstruction procedures. Selection of patients by the urologist, based on motivation, dexterity and urodynamic factors, is an important determinant in the final symptomatic outcome, but in view of the low morbidity of CISC, patients should be given the benefit of the doubt. Most patients can be taught the technique, but it can be difficult for the wheelchair-bound female with poor dexterity. A high proportion of patients with impaired bladder emptying will do well, but adverse urodynamic factors include a relatively small residual urine, a small bladder capacity, low bladder compliance, detrusor hyperreflexia and a weak sphincter mechanism. Major complications directly caused by the technique are rare, particularly in women. Minor problems include hematuria and discomfort on catheterization, but these can be diminished by careful technique. CISC is an easily learned technique that is safe and acceptable to patients and one which places few extra burdens on hospital or community resources. © 1993 The International Urogynecology Journal.