1.1

Abbreviations

1.2

Introduction

Since the publication of Lapides et al. , clean intermittent self-catheterization (CISC) has been considered as the method of choice for the management of voiding dysfunction, typically the result of neurogenic pathology . CISC has contributed to a decrease in the morbidity and mortality of these patients and to an improvement in their quality of life .

As soon as the CISC technique has been learned and acquired, the question of the choice of the catheter is of primary importance, since it affects the patient’s comfort and satisfaction. These are part of the goals of care, influencing the patient’s compliance and long-term adherence to the technique .

In clinical practice, patients sometimes complain of difficulties in catheter handling (with hydrophilic catheters) or pain during catheterization, because of a sticking sensation in the urethra .

Until now, many different catheters have been used for CISC, with different properties in terms of handling and/or packaging and lubrication requirements of the catheter.

Although some authors have compared the tolerance and efficacy of various catheters, as well as patient satisfaction with pre-lubricated versus non-lubricated models , there is no simple, validated questionnaire evaluating patients’ satisfaction with the use of urinary catheters. However, various aspects of the catheterization process have been described: handling of the catheter package, ease of insertion and withdrawal of the catheter, evaluation of catheter lubrication, pain during catheterization .

A pilot study was carried out to design and validate a specific questionnaire, referred to as InCaSaQ, with the aim of evaluating patient satisfaction with intermittent catheterization.

1.3

Materials and methods

1.4

Results

1.5

Discussion

CISC is currently considered to be the most suitable treatment for reducing the risk of upper urinary tract alteration in patients with chronic urinary retention . Although, CISC is considered to improve quality of life , little is known about the individual patient’s satisfaction with his/her catheter.

InCaSaQ was well accepted by patients as seen by the very low rate of missing data. This can be attributed to easy comprehension, and the limited number of items. InCaSaQ is a simple and acceptable questionnaire, which is easy to understand and leads to reproducible results.

It has been validated in a neurological population, with both female and male patients. This sample population were representative of the first population to which CISC was indicated. CISC avoids urological complications in neurogenic bladder (particularly in spinal cord injury and multiple sclerosis) and improves quality of life .

The internal coherence was satisfactory, with a significant Cronbach’s alpha coefficient, reflecting a homogeneous scale.

At the time of our study, it did not exist more traditional or other validated instruments in the same field . Thus, the criterion validity of the questionnaire has not been evaluated.

The questionnaire demonstrated good reproducibility with intraclass correlation coefficient above 0.6 for 3 of the 4 categories. Nevertheless, significant changes in two categories observed between day 0 and day 15 may have resulted from different environment when completing the questionnaire (hospital and patient’s home) or from the impact of the medical visit. This has been observed with other instruments .

The sensibility of the scale to change over time was not evaluated because the small number of patients who changed their urinary catheter during the study was insufficient for statistical analysis.

In the past, various authors have tried to compare patient satisfaction with CISC, for two different sorts of catheter , using a non-validated questionnaire.

It is important to verify patient satisfaction with CISC. Indeed, various catheters can be proposed, some of which the patients may find considerably more comfortable than others. Various types of catheter can be used for CISC : coated (pre-lubricated), hydrophilic-coated or uncoated (separate lubricant). In addition, catheters have different lengths and are gender specific. Some catheters are more compact, and are found to be easier to use and store in a handbag .

The successful teaching of clean intermittent catheterization depends on the patient’s ability to learn, undertake and cope with the procedure. During teaching, the choice of equipment depends not only on the patient’s functional abilities, but also on his/her physical deficiencies or cognitive status. Indeed, general considerations such as ease of opening the package, catheter manipulation, package discretion and catheter gliding properties are often major selection criteria for the patient. Although the patient’s functional and cognitive ability to practice CISC can now be accurately predicted, using a recently described, reliable tool , cost-effectiveness is also an important criterion when choosing a catheter .

In the present study, the patients appeared to be generally satisfied in all of the 4 categories evaluated (“packaging”, “lubrication”, “catheter itself”, “after catheterization”), with high satisfaction scores ( Table 3 ). Maybe the scores would be lower with patients at the beginning of self-catheterization.

In the literature, Sutherland et al. , Stensballe et al. and Hedlund et al. suggested that hydrophilic catheters could be preferable to uncoated catheter, in terms of patient satisfaction. Hydrophilic catheters appear to be preferred by patients with a history of difficult catheterization .

Pascoe and Clovis evaluated two coated catheters in intermittent self-catheterization. These authors concluded that Speedicath ^® led to statistically favourable results, in terms of ease and speed of use, but no specific evaluation was made of patient satisfaction.

In 2008, Taskinen et al. evaluated the CISC experience of patients in a paediatric surgery ward, through the use of a questionnaire based on various aspects of the CISC process. They concluded that although the technical properties of hydrophilic catheters were quite similar, the patients had their own personal preferences. However, no psychometric validation was made of this questionnaire.

1.6

Conclusion

In conclusion, this study demonstrates that the InCaSaQ is a simple and valid test for the evaluation of patient satisfaction with the use of urinary catheters. The InCaSaQ can be useful when learning the CISC technique and in patient education. This questionnaire could be integrated into daily clinical practice, following CISC training, in order to adapt, sometimes after a long time of utilisation, the choice of catheter to that providing the best satisfaction for each patient. It could also provide a simple approach to the evaluation of a nurse’s training, and make it possible to provide advice to patients on their choice of catheter. It could also be use as an objective measure to compare for example catheters in trials or new products perhaps. Further studies will be necessary to verify the sensibility of the scale to change over time including patients at the beginning of self-catheterization, with modification in choice of catheters over the time.

Disclosure of interest

The authors declare that they have no conflicts of interest concerning this article.

Acknowledgements

The authors would like to thank the entire team of our neurourology center who included the patients.

2.1

Abréviations

2.2

Introduction

Depuis la publication princeps de Lapides et al. , l’autosondage (AS) est désormais considéré comme la méthode de choix dans le management des dysfonctions urinaires et particulièrement de la rétention d’urines notamment d’origine neurogénique .

L’AS a ainsi permis de contribuer à la diminution de la morbidité et de la mortalité de ces patients ainsi que d’une manière subséquente à l’amélioration de leur qualité de vie .

Dès l’instant où la technique de l’autosondage a été apprise et acquise par le patient, la question du choix du cathéter est d’une grande importance puisqu’elle affecte le confort général du patient et sa satisfaction.

Il y a plusieurs buts dans cet apprentissage et les différentes modalités peuvent influencer la compliance du patient et l’adhérence sur le long terme à la technique .

En pratique clinique, certains patients se plaignent parfois de difficultés à la manipulation du cathéter (tout particulièrement avec les sondes hydrophiles à faible friction) ou de douleurs pendant la cathétérisation en raison d’une sensation de striction douloureuse urétrale .

Différents types de cathéters ont pu être utilisés pour les AS, chaque cathéter ayant des propriétés, avantages et inconvénients spécifiques quant à leur manipulation et à leur environnement en termes de procédés de conservation ou de lubrification.

Alors que quelques travaux ont été effectués comparant la tolérance et l’efficacité des différents cathéters ainsi que la comparaison de la satisfaction du patient entre l’utilisation de cathéters prélubrifiés et non lubrifiés , il n’y a pas de questionnaire validé évaluant la satisfaction du patient lors de l’utilisation de leur propre cathéter.

Cependant, différents aspects du processus d’autosondages ont pu être décrits pouvant impacter la satisfaction comme la manipulation de l’enveloppe du cathéter, comme la facilité d’insertion ou pour retirer la sonde, comme la qualité de la lubrification du cathéter ou la douleur pouvant éventuellement survenir pendant cet autosondage .

Une étude pilote a ainsi été réalisée pour élaborer et valider un questionnaire spécifique nommé InCaSaQ dans le but d’évaluer la satisfaction du patient avec l’utilisation de son cathéter pour l’AS.

2.3

Matériels et méthodes

2.3.2

Questionnaire

Les items du questionnaire étaient issus d’une revue exhaustive de la littérature (PubMed de 1995 à 2012 utilisant les mots clés : Intermittent catheterization ; Hydrophilic-coated catheter ; Questionnaire ; Satisfaction ; Acceptance ; Compliance ; Lower urinary tract dysfunction ; Patients’ perception ; Quality of life ; Clinical evaluation ; Difficulties ), ainsi que par une analyse de l’expérience donnée par une équipe d’infirmières très spécialisées dans l’apprentissage des AS (plus de 400 apprentissages par an dans un centre de neuro-urologie spécialisé).

Une étude spécifique a été conduite intéressant six spécialistes de neuro-urologie et 11 infirmières en dehors de l’équipe initiale dans le but de vérifier l’exhaustivité des items qui avaient été préalablement listés et reportés par les patients.

Les huit items les plus fréquemment reportés ont été sélectionnés et ont été classés dans les quatre catégories suivantes :

• •
  

  enveloppe ( packaging ) :

  
  
  
  
  • ∘
    

    discrétion et solidité de l’enrobement,

    
    
  • ∘
    

    son hygiène et sa robustesse,

    
    
  • ∘
    

    les facilités d’ouverture et les possibilités de fixation du cathéter ;

  
  
  
  
• •
  

  lubrification : les modalités utilisées pour la lubrification (spontanée, gel, eau…) ;

  
  
• •
  

  le cathéter lui-même :

  
  
  
  
  • ∘
    

    la manière de le tenir, de l’introduire, de l’insérer à travers le méat urétral,

    
    
  • ∘
    

    la facilité de progression et le confort d’insertion,

    
    
  • ∘
    

    la facilité avec laquelle les urines pouvaient s’écouler ;

  
  
  
  
• •
  

  après la cathérisation : la facilité avec laquelle le cathéter pouvait être jeté.

Ces items ont été sélectionnés pour évaluer la satisfaction du patient avec le cathéter d’AS d’une manière qu’il puisse être simple et facilement compris par toutes les catégories de patients.

Les items spécifiques reliés à la discrétion, au caractère sécuritaire et hygiénique du cathéter, de l’ouverture de l’enrobement, les moyens de lubrification, la facilité d’insertion et pour retirer le cathéter, la facilité de la miction et la facilité de jeter le cathéter.

Les items définitifs et les catégories d’InCaSaQ sont listés dans le Tableau 1 .

Tableau 1

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