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Intermittent Catheterization and Urinary Tract Infection

A Comparative Study Between Germany and Brazil

Faleiros, Fabiana; de Oliveira Käppler, Christoph; Rosa, Talita; Gimenes, Fernanda Raphael Escobar

Journal of Wound Ostomy & Continence Nursing: November/December 2018 - Volume 45 - Issue 6 - p 521–526
doi: 10.1097/WON.0000000000000476
Continence Care

PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC).

DESIGN: A quantitative, descriptive, correlational study.

SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management.

METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC.

RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022).

CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.

Fabiana Faleiros, PhD, RN, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil.

Christoph de Oliveira Käppler, PhD, Faculty of Rehabilitation Sciences, University of Dortmund, Germany.

Talita Rosa, RN, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil.

Fernanda Raphael Escobar Gimenes, PhD, RN, University of São Paulo at Ribeirão Preto College of Nursing, São Paulo, Brazil.

Correspondence: Fabiana Faleiros, PhD, RN, University of São Paulo at Ribeirão Preto College of Nursing, Av. Bandeirantes, 3.900, Monte Alegre, Ribeirão Preto, São Paulo, CEP: 14.040-902, Brazil (fabifaleiros@eerp.usp.br).

This article is extracted from a Doctor's thesis entitled “Spina bifida and intermittent bladder catheterization in the context of rehabilitation: a comparative study of the technical and bio-psycho-social aspects in Brazil and Germany,” presented at the Dortmund University in Germany in 2012.

The authors declare no conflicts of interest.

© 2018 by the Wound, Ostomy and Continence Nurses Society.