At the last urological congresses, in many speeches, the question was raised that it is necessary to change the established order – to establish cystostomy for all patients with the inability to urinate independently.
CYSTOMA is a method of urine diversion in the absence of spontaneous urination in the patient, or failure of this urination, when residual urine remains.
Previously, for all patients with such problems, a catheter was inserted through a small hole in the abdominal wall, which was there permanently, to drain urine. (You can read more about this in the article Urinary catheters).
This method is easier in terms of operation, replacement is performed on average once a month, or as needed. But it has a very significant disadvantage associated with the risk of infection.
Currently, the safest method of urine diversion is considered to be intermittent intermittent catheterization or self-casing of patients. The fundamental difference is that the catheter is not inside, it is inserted only at the time of urine removal, and then discarded. This is done 4-6 times a day. Disposable catheters are available as sterile, lubricated, male and female.
With a little training of patients or their relatives / caregivers using disposable catheters, there is no difficulty. The doctors of our center mainly face such situations when they visit a patient, and although this is not a very familiar scheme for Russia, we have more and more patients who switch to disposable catheters.
For people with disabilities, if the catheters are included in the individual rehabilitation program, and they are included in the list of technical means of rehabilitation, they are provided free of charge, or the funds spent on their purchase are returned.
Why we recommend switching to disposable catheters:
Cystostomy is a constant potential source of infection. Very often, patients fail to provide adequate care for her. Misconceptions persist that it is possible to flush the cystostomy, although this cannot be done, if it is removed, a replacement is needed. In this case, there is always a risk that the infection will go up to the kidneys.
If urine constantly flows through the catheter during a cystostomy, the walls of the bladder are affected. It needs to be trained by
pinching the catheter and filling the bladder, which requires additional manipulations that patients do not always perform regularly and correctly.
With a cystostomy, there is a high risk of stone formation, multiplication of infection on the walls of an indwelling catheter.
With intermittent catheterization with disposable catheters, bacteriuria is formed, that is, bacteria in the urine may be present, but exacerbations of lower urinary tract infections do not occur, since everything is sterile, disposable, the catheter is with the ureter for a short time and is removed.
Most often, patients are afraid of trauma to the ureter, but with modern activated (already coated with a special gel) disposable catheters this is almost impossible, they are slippery, flexible, thin, you can choose the right size.
At the congress, an example was given of the department of spinal trauma, where all patients were transferred to intermittent catheterization, which almost completely reduced the risk of urinary tract infections, outbreaks of generalized infection stopped, with a high rise in temperature and the development of pyelonephritis.
Disposable catheters are different:
Regular, which need to be lubricated with a special lubricant.
Already containing gel, but which need to be activated by taking it out of the package.
And the most comfortable, activated, which are already lubricated with a lubricant on all surfaces. Some manufacturers make these catheters with a continuous loop, meaning they already have a urine collection bag attached.
All things considered, your urologist should help you choose which system is right for you.