The Manfred-Sauer-Foundation in cooperation with the European Association of Urology Nurses (EAUN) held the first ‘Uro Day last July 4. Approximately 120 participants from urology, nursing and the medical industry gathered in Lobbach, Germany, to discuss updates regarding intermittent catheterisation.
The guidelines, “Procedure and management of intermittent catheterisation in neurogenic bladder dysfunction”1 recently published by Deutsche Gesellschaft für Urologie (German Society for Urology) served as a basis for the lectures by five speakers from Germany and Switzerland.
“It is crucial to transfer knowledge and experience to the relevant hospitals,” said Dr. Ralf Böthig, Head of Neuro Urology in Hamburg-Boberg Hospital in Germany and co-author of the guidelines. “Equally important to us is informing professionals working in homecare and nursing so that a common standard can be created. ”
Improving the gold standard
Intermittent catheterisation (IC) was introduced in the 1940s by neurologist Sir Ludwig Guttmann and significantly reduced in those years the high number of patients with neurogenic bladder dysfunction dying from renal failure. Up to now the technique ensures a low pressure micturition and has been recognised internationally as “gold standard” in treating neurological problems. Catheters, condom urinals and other aids necessary for the intermittent catheterisation are subject to constant development and improvement.
However, there seems to be no common practice for the actual catheterisation procedure – not even among professionals: “Everyone have their own way to do it, and some are simply unable to cope with the variety we have today,” said Walter Holzschuh, Head of neuro-urological nursing at the Schweizer Paraplegiker-Zentrum in Nottwil, Switzerland. What’s missing is a common terminology and the means of re-examination and transparency. “We don’t want everyone doing the same thing; we want everyone achieving the same results.”
No out-of-the-box solutions
The first Uro Day offered a platform for a dynamic exchange and an overview of current recommendations in the management and execution of IC, as described, for example, in the new guidelines. The guidelines underscore that “IC never is a solution ‘out-of-the-box’ but remains an individual form of therapy for patients with neurological bladder dysfunction.” Principles which are generally accepted were highlighted in lectures focusing on indication/ contraindication, urinary tract infection and ‘Briefing the patient in IC.’
Urological therapy is interdisciplinary work
“We recognise a rethinking among professionals. Doctors, therapists, nurses and others understand that they must act as a team,” said Ellen Janhsen- Podien, Head of Training in urological therapy in the clinic Links der Weser in Bremen (DE). As “ambassador” for professional urological therapy she supports the current standards regarding applications.
Urological therapist Maike König of the Zentralklinikum Bad Berka (DE) stressed the interdisciplinary nature of catheterisation. According to König, the indiviudal posture during catheterisation, for instance, is a question that should be discussed with neurologists as well as orthopedic specialists.
Transfers must be supervised by physiotherapists and the adaptions of certain appliances by ergo therapists. Social workers and psychologists should be consulted when dealing with questions regarding the patient’s living environment and feelings of privacy. Common to all these discussions was the shared goal to provide individual treatment for patients to ensure the best possible security, independence and full participation in social life.
Böthig summed up the first Uro Day: “Neuro urology is a discipline with much potential. ” In the future, similar events might serve as a platform for interdisciplinary discourse as well as establishing a common quality standard.
1 Management und Durchführung des Intermittierenden Katheterismus (IK) bei Neurogenen Blasenfunktionsstörungen. [German]. DGU Guideline. Arbeitskreis Neuro-Urologie und den Arbeitskreis Pflege der Deutschsprachigen Medizinischen Gesellschaft für Paraplegie (DMGP). AWMF Online; May 2014:1-22. AWMF-Register Nr. 043/048 Klasse: S2k.http://www.awmf.org/uploads/tx_szleitlinien/043-048l_S2k_Management_IK_Neurogene_Blasenfunktionsstörungen_2014-05.pdf
By Nikola Hahn & Tanja Konrad,
Manfred-Sauer-Foundation, Lobbach, Germany