What are the tips for safe and convenient self-intermittent catheterization (IC) in female patients with spastic paraplegia?

Self-Intermittent Catheterization in Female Patients with Spastic Paraplegia

Female patients with spastic paraplegia should perform clean intermittent self-catheterization every 4-6 hours using single-use hydrophilic-coated catheters, with proper hand hygiene and perineal preparation before each catheterization. 1

Catheterization Frequency and Volume Management

• Catheterize every 4-6 hours to maintain bladder volumes below 500 mL per collection, as this prevents detrusor muscle damage and reduces complications 1, 2
• If volumes consistently exceed 500 mL at scheduled intervals, increase catheterization frequency rather than accepting bladder overdistension 1, 2
• Avoid catheterizing more frequently than every 4 hours unless volumes exceed 500 mL, as excessive frequency increases infection risk without benefit 2

Catheter Selection

• Use hydrophilic-coated catheters as the preferred option, as they are associated with fewer UTIs, less urethral trauma, and improved patient satisfaction compared to non-coated catheters 1, 3
• If hydrophilic catheters are unavailable, gel reservoir (prelubricated) catheters are an acceptable alternative 4
• Always use single-use catheters only once, as reusing catheters significantly increases UTI frequency 1

Proper Technique for Female Patients

• Perform hand hygiene with antibacterial soap or alcohol-based cleaners before and after each catheterization 1, 2
• Clean the perineal area before catheterization 1
• Maintain daily perineal hygiene with soap and water 5
• Use clean technique (not sterile) for intermittent catheterization in the community setting 1, 6

Addressing Spasticity-Related Challenges

• Female patients with spastic paraplegia may face additional challenges including intention tremor, spinal deformity, and difficulty with positioning 7
• Despite severe disability, patients in wheelchairs with paraplegia and spinal deformity have successfully mastered the technique with proper instruction 7
• Consider positioning aids or mirrors to improve visualization of the urethral meatus in patients with limited mobility or spasticity 7

Infection Prevention

• Do not treat asymptomatic bacteriuria, as this leads to antimicrobial resistance without clinical benefit 1
• Collect urine for culture only when the patient has symptoms potentially indicating UTI (fever, increased spasticity, autonomic dysreflexia, suprapubic pain, or change in urine character with symptoms) 5
• Maintain adequate hydration of 2-3 L per day unless contraindicated to decrease UTI risk 2

Common Pitfalls to Avoid

• Never allow bladder volumes to exceed 500 mL, as this causes detrusor muscle damage and prolonged retention 2
• Do not use indwelling catheters when intermittent catheterization is feasible, as indwelling catheters carry significantly higher infection risk, bladder stone formation, and poorer quality of life 1, 8
• Avoid inadequate catheterization frequency (less than every 6 hours), as this results in bladder overdistension and increased complications 1
• Do not reuse single-use catheters, even if washed, as this significantly increases UTI frequency 1

When Self-Catheterization Is Not Feasible

• If the patient cannot perform self-catheterization due to physical limitations (severe spasticity preventing hand function), cognitive impairment, or lack of caregiver support, and an indwelling catheter is unavoidable, then suprapubic catheterization should be used over an indwelling urethral catheter 1
• Consider referral for evaluation of sacral anterior root stimulator implantation in patients with recurrent symptomatic UTIs and incontinence despite intermittent catheterization 8

Long-Term Monitoring

• Monitor for urethral trauma, particularly in patients with spasticity who may have difficulty with catheter insertion 3
• Assess continence status, as incontinence despite anticholinergic therapy is a common reason for discontinuation of intermittent catheterization in female patients with spinal cord injury 8
• Evaluate upper urinary tract periodically, though deterioration is rare with proper intermittent catheterization technique 6, 8