Urology & Continence Care Today | September 2021

Welcome to Urology and Continence Care Today Journal

This new digital journal has been developed to help you to excel in your job at a time when the demands made of you have never been greater. 

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Viewpoints

Urology & Continence Care Today

Welcome to Urology Awareness Month 2021

It is easy to say you are holding an awareness month, but let’s consider the why, what and how.

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Urology & Continence Care Today

Managing bladder and bowel conditions in educational settings

This article examines the guidance available for school leaders, proprietors, governors, staff and practitioners to help them better support children and young people with bladder and bowel issues as they return to school.

Continence care

Urology & Continence Care Today

Managing male urinary incontinence with sheaths, body worn urinals and penile compression clamps

Urinary incontinence is prevalent in men, with 61% of the general population of men experiencing lower urinary tract symptoms. These symptoms present as problems with voiding, storage or post-micturition of urine. Even after assessment and treatment, some men are still left with urinary incontinence, which is normally managed or contained by either pad products or urinary catheters (if clinically indicated). However, there is a vast range of alternative devices for containment. This article reviews some of the alternative devices that are available, namely sheaths, body worn urinals and penile compression clamps. It discusses the merits and disadvantages of each device and advises when they should or should not be used.

Viewpoints

Urology & Continence Care Today

Improving the lives of children/teenagers with continence challenges

It is estimated that one in 12 children and young people in the UK suffer with a wetting or soiling problem, which can have a devastating impact on their family life, social life and self-esteem. Left untreated, bladder and bowel problems can cause serious health complications, but with the right treatment and support most children can overcome their problem or learn to manage it. This article outlines what ERIC, The Children’s Bowel & Bladder Charity, can do to help.

Viewpoints

Urology & Continence Care Today

URApp: smartphone app to aid bladder training in young people

‘Urinary incontinence is among the most common paediatric problems and it is commonly assumed to resolve with age. Consequently, parents and clinicians often adopt a ‘wait and see’ approach. A significant proportion of children, however, continue to suffer from persistent urinary incontinence into adolescence. This article describes the development of a smartphone app to aid adherence to bladder training in young people with urinary incontinence.

Continence care

Urology & Continence Care Today

Trial without catheter: what is best practice?

Indwelling urinary catheters are still one of the most commonly used invasive devices in health care, with recognised significant risk factors, including catheter-associated urinary tract infection (CaUTI) and sepsis. Timely and successful removal of the catheter often falls to the responsibility of community nurses. There has been much debate about the optimum timing and circumstances for a successful trial without catheter (TWOC). This article looks at best practice guidelines and relevant clinical evidence to support healthcare professionals in making choices around TWOC procedures.

Viewpoint

Urology & Continence Care Today

World Continence Week 2021

World Continence Week (WCW), taking place from 21–27 June, is an annual health campaign run by the World Federation for Incontinence and Pelvic Problems (WFIPP). The campaign highlights the impact that urinary incontinence can have on people’s lives and encourages sufferers to seek help to improve their quality of life.

Editorial

Urology & Continence Care Today

Assessing continence issues during the Covid-19 pandemic

Current Covid restrictions have forced many healthcare professionals to embrace technology and work in very different ways. Indeed, the traditional telephone has allowed the Newcastle continence service to provide a service to patients referred with all types of urinary incontinence. But, is it even possible to assess someone’s continence and devise a treatment plan over the telephone?

Continence care

Urology & Continence Care Today

Skin pH and barrier function

The maintenance of skin pH is essential if it is to provide a barrier to the outside world. This article examines how skin pH is maintained normally, what can disrupt it and the consequences of change. Finally, best practice guidance on restoring and maintaining a healthy skin pH and barrier function is provided.  
 

Product of the month

Urology & Continence Care Today

GentleCath™ Glide

As a clinician, it is important that you are aware of the latest products and innovations that have the potential to improve outcomes for you and your patients. Each month, UCCT will highlight a product that is new, improved or innovative in order to keep you up to date.
 
Here, we present GentleCath™ Glide, a hydrophilic urinary catheter that uses FeelClean™ Technology to facilitate smooth, fast and convenient intermittent catheterisation.

Product of the month

Urology & Continence Care Today

PROSHIELD Skin Care

As a clinician, it is important that you are aware of the latest products and innovations that have the potential to improve outcomes for you and your patients. Each month, UCCT will highlight a product that is new, improved or innovative in order to keep you up to date.

Here, we present PROSHIELD Skin Care, which is formulated for the prevention and management of Incontinence-associated dermatitis on both intact and injured skin.

Continence care

Urology & Continence Care Today

Understanding long-term catheterisation for effective bladder drainage

Patients in the community often have a long-term catheter in place and so their management inevitably becomes the responsibility of community nurses. As urinary incontinence can cause patients discomfort and have a negative impact on their day-to-day life, it is important that healthcare professionals understand the reasons for catheterisation and are aware of the different treatment options available, such as urethral and suprapubic, in order to provide patients with the most suitable device according to their needs and lifestyle. This paper explores the issues involved with indwelling catheterisation and looks at one new product range that aims to promote patient comfort and reduce associated risks.

Review

Urology & Continence Care Today

Pelvic floor exercises for treating stress urinary incontinence

Here, Sharon Holroyd, lead CNS, Calderdale Bladder and Bowel Service; chairperson, Yorkshire ACA, defines stress urinary incontinence and the treatment options available, and reviews the evidence to support pelvic floor exercises as an effective rehabilitation for patients with symptoms of stress urinary incontinence.

Continence care

Urology & Continence Care Today

Effective assessment and management of nocturia in the older person

Nocturia is a common lower urinary tract symptom that mainly affects older people. Nocturia causes excess urination at night and, because of associated night-time rising, can also result in falls and fractures. Nocturia has a range of presentations, therefore it is vital that nurses understand how to assess the condition accurately to provide appropriate treatment. This article examines the effective assessment of nocturia, as well as detailing the various lifestyle treatment options that can be used, such as a targeted reduction of fluid intake, weight loss and altered medication profiles. Medication and surgical options should only be used following a trial of lifestyle interventions.

Continence care

Urology & Continence Care Today

Indwelling urinary catheterisation: evidence-based practice

Indwelling urinary catheters remain one of the most commonly used clinically invasive devices across the NHS and social care in the UK. The problems associated with the prolonged use of catheters are widely referenced. Healthcare-acquired infections (HCAIs) currently result in 5,000 preventable deaths a year, with 20% of all HCAIs associated with the urinary tract. Many staff have learned catheterisation techniques in their early careers, with no need for a formal review of skills and knowledge. This has perhaps contributed to some historical and now outdated tasks still being performed. The evidence for best practice when managing indwelling catheters is reflected in national and international guidelines, which have recently undergone a complete overhaul. This article explores common practices and best practice evidence to assist with safe and effective management of these essential but often risky devices.

Continence care

Urology & Continence Care Today

Catheter valves: retraining the bladder to avoid prolonged catheter use

Catheterisation is an invasive procedure that can have a negative impact on a patient’s life. This paper looks at raising awareness of catheter valves, as a cost-effective and alternative drainage system to leg bags, following holistic assessment and working in partnership with patients. A catheter valve is a small tap-like device inserted into the end of an indwelling catheter, which, if suitable, can help empower patients, retrain their bladders, promote comfort and improve quality of life. The article explores the importance of patient education, meeting expectations and forward planning to help reduce short-term catheters becoming long term. It also identifies guidance supporting appropriate catheterisation and how nurses can empower patients with self-management.

Continence care

Urology & Continence Care Today

Reducing the incidence of inappropriate indwelling urinary catheterisation

There are a variety of reasons as to why a patient may require an indwelling catheter, however, these are seldom documented or communicated across healthcare services (Codd, 2013). Thus, shortterm catheters are at risk of becoming long-term catheters in the absence of clear documentation and forward planning. The risk of infection increases the longer a urinary catheter remains in situ. This article explores the guidance available to support appropriate urinary catheter use, catheter management, documentation, forward planning and patient education for effective catheter care. How this can be implemented to support appropriate removal of urinary catheters or ongoing care for long-term urinary catheter use for patients across the primary and secondary care services is also discussed.

Continence care

Urology & Continence Care Today

Treatment interventions for bowel dysfunction: constipation - part two

This two-part article aims to help healthcare professionals understand constipation; the possible causes, and the anatomical and functional problems. In the first part, the author explained anatomy and physiology of the lower gastrointestinal tract, what are normal bowel motions, frequency and variation, which includes the Bristol Stool Chart to view the types of bowel motions sufferers may often experience. Here, the focus is on conservative treatment interventions for constipation, exploring the four ‘Fs’ acronym (Rex, 2013): fibre (in diet); fluids (those best for health reasons); fitness (‘if you do not move, it will not move’); and finally feet, which relates to the best sitting position to help achieve bowel evacuation successfully.

Continence care

Urology & Continence Care Today

Treatment interventions for bowel dysfunction: constipation - part one

Bowel dysfunction is a common problem for adults and children, and yet many people do not seek help and when they do it is not up to standard. Unmanaged symptoms impact on the health of the patient, both physically and mentally, and add extra cost to the NHS. This article, by a clinical nurse specialist working with people suffering from bladder and bowel dysfunctions, will help healthcare professionals understand the possible causes of anatomical and functional bowel problems, especially constipation, and the conservative treatment interventions. This First article in a two-part series, explains anatomy and physiology of the lower gastrointestinal tract, what constitutes a normal bowel habit, frequency and variation. The second will focus on the causes of constipation, which are often misunderstood and misdiagnosed, and how they can be assessed and managed, as well as treatment options available.

Product of the month

Urology & Continence Care Today

MoliCare® Premium Elastic

As a clinician, it is important that you are aware of the latest products and innovations that have the potential to improve outcomes for you and your patients. Each month, UCCT will highlight a product that is new, improved or innovative in order to keep you up to date.

Here, we present MoliCare® Premium Elastic, a new generation slip which is designed to ease application while offering comfort and security for the wearer.

Continence care

Urology & Continence Care Today

Secret Life of Catheters: an educational programme

The National Catheter Education Programme is a Health Education England-funded initiative to improve the care of patients with catheters. Part of this initiative is the Secret Life of Catheters programme. This article highlights the need for improvement in catheter care and explains the development of this project, which aims to drive improvements across primary and secondary settings through the large-scale delivery of a multiprofessional educational programme in catheter care. The programme explores key dilemmas that district nurses, community nurses, healthcare assistants and doctors can encounter with catheters, and provides approaches to address them. By standardising the teaching of clinical concepts and practice strategies, it is hoped that variations in practice and pockets of misunderstanding can be eliminated.

Continence care

Urology & Continence Care Today

Latest developments in transanal irrigation therapy

Transanal irrigation has been acknowledged as a minimally invasive technique with proven clinical evidence of ebenefit, perticulary in patients with neurogenic bowel disorders. The severity of impairment in patients with neurogenic bowel disorders will depend on the level of spinal cord damage and may lead to a loss of the sense of needing to defecate, loss of control of the external sphincter, loss of muscle tone and contractility of the bowel / rectum, and disrupted transit time. Any transanal irrigation system chosen will require careful assessment of the patient's needs and preferences before treatment is initiated. There is also a need for ongoing support from a suitably experienced healthcare professional to ensure compliance and efficacy. Although the initially cost of transanal irrigation systems may seem expensive, when compared to the long-term cost of other treatments, repeated tests and hospital admissions, they represent a more cost-effective long-term option.

Continence care

Urology & Continence Care Today

Ketamine bladders: what community nurses should know

The effect of drugs on mental and physical health are well documented. However, these consequences do not necessarily prevent people using them either recreationally or more regularly, with some becoming addicted to their drug or drugs of choice. It is estimated that in 2016/17, around one in 12 (8.5%) adults aged 16 to 59 in England and Wales had taken an illicit drug in the last year (NHS Digital, 2018). Ketamine has become increasingly popular, especially among younger users, as it is cheap and mistakenly seen as a ‘safe’, non-addictive drug. However, the reality is that even recreational use may have serious consequences. The effect on the urinary system can be devastating, with users experiencing anything from frequency and cystitis-like symptoms, to extreme debilitating pain from the inflamed and shrunken bladder, resulting in cystectomy and urinary diversion, and, if the kidneys are affected, renal failure and dialysis.

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Urology & Continence Care Today

Respiratory conditions and urinary incontinence

Urinary incontinence (UI) has been associated with chronic respiratory symptoms, which impact on patient quality of life (da Silva Paes et al, 2016). Chronic respiratory symptoms, such as coughing, wheezing, and dyspnoea, and patients with chronic chest conditions, such as asthma, bronchitis or chronic obstructive pulmonary disease (COPD), are associated with increased occurrence of UI. Women with respiratory symptoms have more severe symptoms and are more likely to have stress urinary leakage than those without. This paper provides an overview of asthma, and highlights the importance of community nurses not only addressing issues associated with respiratory diseases, such as ensuring that there is a personalised asthma action plan (PAAP) in place for those with asthma, but also assessing urinary incontinence to evaluate occurrence and decide upon measures that can be taken to prevent or lessen any leakage.

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Urology & Continence Care Today

Resources to protect your mental health and wellbeing at work during the Covid-19 outbreak

Kate Upton, registered adult nurse and fellow of the Higher Education Academy; representative for Nursing Professions on the Crisis, Disaster and Trauma Psychology Section of the British Psychological Society; independent nursing/medical tutor and medical writer; PhD student at the University of Birmingham

Product of the month

Urology & Continence Care Today

Prosys® SensaCath®

As a clinician, it is important that you are aware of the latest products and innovations that have the potential to improve outcomes for you and your patients. Each month, UCCT will highlight a product that is new, improved or innovative in order to keep you up to date. 
 
Here, we present the Prosys® SensaCath® intermittent catheter range, which has been developed to enhance the patient experience during intermittent self-catheterisation.
 

In focus

Urology & Continence Care Today

Psychosocial issues and self-catheterisation

Catheterisation has improved continence and reduced associated urinary tract problems. Intermittent catheterisation has been shown to be acceptable for all ages, including the elderly. The role of the nurse is important in teaching and supporting patients using clean intermittent catheterisation (CIC) to ensure confidence and adherence with the procedure. Some patients with indwelling catheters may experience poor body image and negative sexual self-esteem.

Cost

Urology & Continence Care Today

An overview of the cost and complications of catheterisation

Urinary tract infection (UTI) is an important cause of morbidity and mortality in the healthcare setting, accounting for 19% of all nosocomial infections (Loveday et al, 2014).

It is estimated that 43–56% of these are catheter-associated urinary tract infections (CAUTI) (Loveday et al, 2014).

If inadequately treated, CAUTI may progress to bacteraemia and consequent urosepsis syndrome, multiplying the risk of mortality and extending hospital stay (Centers for Disease Control and Prevention, 2009).

At a glance

Urology & Continence Care Today

Patient perspective

Belinda Campbell started using a single-use urinary catheter in 2011. Although she did not have a proper diagnosis, she was told that her bladder and sphincter muscles did not work and that the connection between the brain and the bladder was not as it should be. Here, we ask Belinda about her journey and the support she has received in learning how to self-catheterise and coming to terms with a lifelong condition.

Comment

Urology & Continence Care Today

Compassion fatigue

Kate Upton describes compassion fatigue, an increasingly reported form of stress associated with the demands of nursing in the current NHS, and questions what can be done to overcome it.

In focus

Urology & Continence Care Today

Best practice in the use of indwelling catheterisation

Over one million indwelling urinary catheters are inserted every year in the UK; this equates to between 12 and 24% of hospital patients having an indwelling catheter at some point during their inpatient stay (Feneley et al, 2015).

The use of indwelling urinary catheters in the care sector can be higher (Royal College of Physicians, 2004; Loveday et al, 2015).

Nurses should be familiar with best practice and understand the advantages and disadvantages of using indwelling urinary catheters in the urethral and suprapubic sites.

At a glance

Urology & Continence Care Today

Overview of the urinary tract

Passing urine is something most of us do not give a thought about, as it is part of everyday lives. However, it is a more complex process than is apparent, as all elements of the urinary tract need to be functioning and working together, and the three micturition centres in the body, which control filling and emptying of the bladder via the autonomic and somatic nervous systems, also need to work in harmony to urinate successfully. Here, Rachel Leaver, lecturer practitioner, urological nursing, UCLH and London South Bank University, UCLH NHS Foundation Trust, provides an overview of the male and female urinary tracts.

In focus

Urology & Continence Care Today

Minimum standards of care: an overview

Continence is an important and common problem and so nurses have a responsibility to be able to screen for and perform a basic assessment of incontinence.

Resolution of continence issues is possible for many with the right care and advice.

Primary care nurses need the education and training to be able to offer advice and treatment to help meet people's continence needs and to know when to refer on to specialist services.

In focus

Urology & Continence Care Today

Intermittent self-catheterisation

If a patient cannot empty their bladder completely, intermittent self-catheterisation (ISC) may be an acceptable treatment option.

Learning ISC can be daunting for patients and unless taught properly and the patient is given time to learn at their own pace, compliance may be a problem (Logan et al, 2008).

There are a huge variety of catheters available for ISC and each patient should be assessed individually to find out which option best suits their needs.

Profile

Urology & Continence Care Today

The ACA - enabling healthcare organisations to flourish and grow

Patricia McDermott explains how the ACA is setting the standard for excellence and innovation in continence care today.

Profile

Urology & Continence Care Today

BAUN - helping to improve urological patient care

Jane Brocksom explains how BAUN has developed into the vibrant organisation it is today and the opportunities it offers to the profession.

Series

Urology & Continence Care Today

Writing for publication

Writing for publication is now unavoidable for healthcare professionals who want to progress their career. However, it can feel like a daunting process on top of the demands of the day job and home life. This first part of our writing for publication series, provides guidance on what you need to do before you even begin to write.

Continence care

Urology & Continence Care Today

Is it time to take a fresh look at catheter care and could we do better?

Catheters have been around for thousands of years, but the basic principles have not changed, so here we ask - Is it time to take a fresh look at catheter care and could we do better?