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A Narrative Review of Micro-hole Zone Technology: An innovation in clean intermittent self-catheterisation

Clean intermittent self-catheterisation (CISC) is a very common and largely well-tolerated intervention for people with neurological and urological voiding dysfunction; however, catheter-associated urinary tract infections (CAUTIs) are a troublesome and potentially major complication. The main risk factors predisposing to CAUTI associated with CISC are poor patient compliance, failure to achieve complete bladder emptying resulting in residual urine, and microtrauma during catheterisation, potentially weakening the bladder’s defences against UTI. An innovative development in the design of CISC catheters is Micro-hole Zone Technology (MHZT) used in the novel Luja™ CISC catheter, which aims to overcome some of the problems associated with conventional CISC catheters. Through a narrative review of the literature undertaken by a multi-disciplinary panel of experts, specialists and patient advocate, who reviewed all major factors contributing to CAUTI and the potential benefits of MHZT catheters over conventional two-eyelet CISC catheters (CECs). MHZT catheters potentially confer the following advantages over CECs in male and female patients: (1) more effective bladder drainage in one continuous flow; (2) reduced risk of blockages by preventing the occlusion of the catheter end-eyelets by bladder mucosa; (3) reduced risk of bladder mucosal microtrauma; and (4) reduced intra-catheter pressure if any flow stop occurs, hence minimising the unpleasant dragging sensation. These benefits are likely to improve the patient’s comfort, quality of life and compliance. However, the panel acknowledged the lack of robust clinical data as to whether MHZT catheters reduced the incidence of CAUTI. Hence, comparative studies between MHZT and CECs are needed before definitive conclusions can be drawn.

Thomas B.L. Lama,b, Altaf Mangerac, Paul Abramsd,e,f, Mohammed Belalg,h, Carmel Curtisi, Jacqueline Emkesj,k, Jonathan Charles Goddard,l, Sarah Hillerym,n, Karen Irwino, Karen Loganp, Nikesh Thiruchelvamq, Polly Westonr,s, Ann Yatest, Christopher Chappleu,v,w

  1. Aberdeen Royal Infirmary, Aberdeen, UK
  2. Academic Urology Unit, University of Aberdeen, Aberdeen, UK
  3. Spinal Injuries Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  4. University of Bristol, Bristol, UK
  5. Bristol Urological Institute, Southmead Hospital, Bristol, UK
  6. Bristol Health Research Charity, Bristol, UK
  7. University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  8. The British Association of Urological Surgeons, London, UK
  9. King’s College Hospital NHS Foundation Trust, London, UK
  10. National Bladder and Bowel Health Project NHS England and Excellence in Continence Care Board – Chair Patient and Carer forum, Manchester, UK
  11. Bladder Health UK, Birmingham, UK
  12. Leicester General Hospital, Leicester, UK
  13. York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
  14. The British Association of Urological Nurses, Bathgate, UK
  15. Bladder & Bowel UK, Manchester, UK
  16. Aneurin Bevan University Health Board, Newport, UK
  17. Addenbrooke’s Hospital, Cambridge, UK
  18. University Hospitals of Morecambe Bay NHS Foundation Trust, Kendal, UK
  19. Association for Continence Professionals, Bathgate, UK
  20. Cardiff & Vale University Health Board, Cardiff, UK
  21. Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  22. University of Sheffield, Sheffield, UK
  23. Sheffield Hallam University, Sheffield, UK
Source: Thomas B.L. Lam, Altaf Mangera, Paul Abrams, Mohammed Belal, Carmel Curtis, Jacqueline Emkes, Jonathan Charles Goddard, Sarah Hillery, Karen Irwin, Karen Logan, Nikesh Thiruchelvam, Polly Weston, Ann Yates, Christopher Chapple, A Narrative Review of Micro-hole Zone Technology: An innovation in clean intermittent self-catheterisation, Continence, Volume 11, 2024, 101332, ISSN 2772-9737, https://doi.org/10.1016/j.cont.2024.101332.

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI.

Cross-cultural adaptation and psychometric properties of the Chinese version of the Intermittent Self-Catheterization Questionnaire (ISC-Q).

The intermittent self-catheterization questionnaire (ISC-Q) is a valid and reliable tool to assess the quality of life (QOL) in patients with neurogenic lower urinary tract dysfunction (NLUTD) who engage in ISC.

Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process

Study objective: To assess the duration needed for regaining normal bladder voiding function in patients with postoperative bladder dysfunction requiring intermittent self-catheterization after deep endometriosis surgery and identify risk factors that might affect the recovery process.

Design: Retrospective study based on data recorded in a large prospective database.

Setting: Endometriosis referral center.

Patients: From September 2018 to June 2022, 1900 patients underwent excision of deep endometriosis in our center; 61 patients were discharged with recommendation for intermittent self-catheterization and were thus included in the study.

Interventions: Intermittent self-catheterization after endometriosis surgery.

Measurements and main results: A total of 43 patients (70.5%) stopped self-catheterization during the follow-up period. Median follow-up was 25 weeks (range, 7-223 wk). Surgery was performed laparoscopically in 48 patients (78.7%) and robotically in 13 (21.3%); 47 patients (77%) had nodules involving the digestive tract, 11 (18%) had urinary tract involvement, 29 had parametrial nodules (47.5%), and 13 (21.3%) had sacral plexus involvement. The probability of bladder voiding function recovery and arrest of self-catheterization was 24.5%, 54%, 59%, 72%, and 77% at 4, 8, 12, 52, and 78 weeks, respectively. Cox's multivariate model identified preoperative bladder dysfunction as the only statistically significant independent predictor for arrest of self-catheterization (hazard ratio, 0.36; 95% confidence interval, 0.15-0.83).

Conclusion: Patients requiring intermittent self-catheterization for bladder dysfunction after deep endometriosis excision may spontaneously recover bladder function in 77% of cases. Symptoms suggesting preoperative bladder voiding dysfunction should be reviewed before planning surgery, and patients should be informed of the higher postoperative risk of long-term bladder voiding dysfunction.

Sari Boulus,1 Benjamin Merlot,2 Isabella Chanavaz-Lacheray,1 Sophia Braund,3 Sandesh Kade,4 Thomas Dennis,1 Horace Roman5

  1. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France.
  2. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates.
  3. Expert Center in Multidisciplinary Endometriosis Management (Dr. Braund), Rouen University Hospital, Rouen, France.
  4. Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates.
  5. Franco-European Multidisciplinary Endometriosis Institute, Clinique Tivoli-Ducos (Drs. Boulus, Merlot, Chanavaz-Lacheray, Dennis, and Roman), Bordeaux, France; Franco-European Multidisciplinary Endometriosis Institute Middle East Clinic (Drs. Merlot, Kade, and Roman), Burjeel Medical City, Abu Dhabi, United Arab Emirates; Department of Gynecology and Obstetrics (Dr. Roman), Aarhus University Hospital, Denmark. Electronic address: .
Source: Boulus S., Merlot B., Chanavaz-Lacheray I. et al. Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process. J Minim Invasive Gynecol. 2024 Apr;31(4):341-349. doi: 10.1016/j.jmig.2024.01.014.

Evaluating the impact of a new clean intermittent self-catheterisation device: experiences of male patients.

Urinary incontinence is common and has many causes. A main one is urinary retention, and clean intermittent self-catheterisation is the gold standard for managing it. There are, however, complications associated with performing this, which affect patient experience, quality of life and compliance with the procedure.

The bacterial displacement test: an in vitro microbiological test for the evaluation of intermittent catheters and urinary tract infection.

Intermittent catheters (ICs) are commonly used in bladder management but catheter-associated urinary tract infections (CAUTIs) remain challenging. Insertion tips may reduce the risk of CAUTIs by minimizing bacterial transfer along the urinary tract.

Evaluating the effectiveness of early urethral catheter removal combined with intermittent catheterization for promoting early recovery of bladder function after laparoscopic radical hysterectomy: a study protocol for a randomized controlled trial.

Bladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life.

Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device.

To evaluate the efficacy of the Aurie System, a preclinical prototype allowing for standardized intermittent catheter (IC) reuse of novel reusable no-touch ICs. Individuals with neurogenic bladder often require single-use ICs to urinate, but urinary tract infection (UTI) is a common cause of morbidity for IC users.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI‐RS 2023

Aims: The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol.

Methods: The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC.

Results: There is no consensus on the threshold value of PVR that is considered “elevated” or “significant.” There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol.

Conclusions: There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for “elevated” or “significant” PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Sachin Malde,1 Mo Belal,2 Rayan Mohamed‐Ahmed,3 William Gibson,4 Barbara Padilla‐Fernandez,5 Angela Rantell,3 Caroline Selai,6 Eskinder Solomon,1 Paul Abrams7

  1. Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  2. Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
  3. Department of Urogynaecology, King's College Hospital, London, UK
  4. Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
  5. Department of Urology, Hospital Universitario de Canarias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
  6. Department of Uro‐Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
  7. Bristol Urological Institute, Bristol, UK
Source: Malde S, Belal M, Mohamed‐Ahmed R, et al. Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI‐RS 2023. Neurourol Urodyn. 2024;43: 1353‐1362. doi:10.1002/nau.25324.

Intermittent Catheterization Continuity Care on Bladder Function Recovery and Quality of Life in Patients After Radical Hysterectomy for Cervical Cancer: A Quasi-Experimental Study.

Bladder dysfunction is a common complication following radical hysterectomy, affecting patients' QOL. Exploring interventions, particularly IC continuity care, is crucial for identifying strategies to enhance postoperative outcomes.

Reduction in lower urinary tract mucosal microtrauma as an effect of reducing eyelet sizes of intermittent urinary catheters.

Intermittent catheterization (IC) utilizing conventional eyelets catheters (CECs) for bladder drainage has long been the standard of care. However, when the tissue of the lower urinary tract comes in close proximity to the eyelets, mucosal suction often occurs, resulting in microtrauma.

Analysis of the urine flow characteristics inside catheters for intermittent catheter selection.

In this study, we conducted a numerical analysis on catheter sizes using computational fluid dynamics to assess urinary flow rates during intermittent catheterization (IC). The results revealed that the fluid (urine) movement within a catheter is driven by intravesical pressure, with friction against the catheter walls being the main hindrance to fluid movement.

Comparing an Integrated Amphiphilic Surfactant to Traditional Hydrophilic Coatings for the Reduction of Catheter-Associated Urethral Microtrauma.

Hydrophilic-coated intermittent catheters have improved the experience of intermittent urinary catheterization for patients compared to conventional gel-lubricated uncoated catheters. However, the incorporation of polyvinylpyrrolidone (PVP) within hydrophilic coatings can lead to significant issues with coating dry-out.

Perspectives on technology: Single-use catheters – evidence and environmental impact

Objective: To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration.

Methods: A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single- and multi-use catheters were included in our review. All studies that reported on primary data were narratively summarised.

Results: A total of 11 studies were identified that reported on primary data comparing single- and multi-use catheters. There was no appreciable evidence suggesting reusable multi-use catheters were inferior to single-use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single-use catheters is significant.

Conclusions: The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single-use over multi-use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed.

Calvin C. Zhao,1 Craig V. Comiter,1 Christopher S. Elliott1,2

  1. Department of Urology, Stanford University School of Medicine, Stanford, CA, USA
  2. Division of Urology, Santa Clara Valley Medical Center, San Jose, CA, USA
Source: Calvin C. Zhao, Craig V. Comiter, Christopher S. Elliott. Perspectives on technology: Single-use catheters – evidence and environmental impact. BJU International. 2024.  https://doi.org/10.1111/bju.16313.

Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study

Background: Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure.

Aim: The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI.

Design: This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data.

Methods: A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis.

Results: Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'.

Conclusion: It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.

Yacoub Abuzied,1 Rasmieh Al-Amer,2 Mohammad Y N Saleh,3 Shreemathie Somduth,4 Mohammed AlBashtawy,5 Amira Mohammed Ali6

  1. Department of Nursing, Spinal Cord Injury, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
  2. Faculty of Nursing, Yarmouk University, Irbid, Jordan.
  3. Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan.
  4. Nursing Administration, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia.
  5. Nursing Community Health, Princess Salma Faculty of Nursing, Al Al-Bayt University, Al-Mafraq, Jordan.
  6. Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt.

Source: Abuzied Y., Al-Amer R., Saleh M. et al. Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study. Int J Nurs Pract. 2024 May 26:e13268. doi: 10.1111/ijn.13268.

Product evaluation of the Luja Micro-hole Zone Technology in clean intermittent self-catheterisation.

Clean intermittent self-catheterisation is a common procedure undertaken by people with bladder dysfunction. However, it is not without its complications, the main one being urinary tract infection.

Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single-use catheters.

To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC).

Intermittent self-catheterisation: the community nurse's role in identifying and overcoming the barriers.

With their expertise and ability to leverage the therapeutic relationship, community nurses are well-placed to manage the complications and challenges associated with intermittent self-catheterisation.

Intermittent self-catheterisation: the gold standard for individuals with bladder dysfunction.

Intermittent self-catheterisation (ISC) has long been identified as the 'gold standard' for drainage of the bladder for individuals with bladder dysfunction. This article will outline identification of appropriate individuals, the types of intermittent self-catheters available, outline how it can improve quality of life for sufferers of bladder dysfunction, outline the complications that may occur and finally, suggest why it should be recommended as the 'gold standard' if it is taught and done correctly.

Single-use catheters: evidence and environmental impact.

To explore the data comparing single- vs multi-use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single-use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration.

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