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Research Article

Effects of Different Urinary Catheterization Practices on Urinary Complications and Quality of Life


1 Department of Fundemantal of Nursing, Istanbul University-Cerrahpaşa, Florence Nightingale Nursing Faculty, İstanbul, Türkiye
2 Department of Urology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, Türkiye


DOI : 10.33719/nju1614575
New J Urol. 2025;20(1):32-39.
Abstract

Abstract

Objective: This study investigates the effects of different urinary catheterization methods—transurethral catheterization (TC), suprapubic catheterization (SC), and clean intermittent catheterization (CIC)—on urinary complications and quality of life. 

Material and Methods: This research conducted as a descriptive design with 91 patients at a urology clinic in Istanbul between November 2023 and September 2024, the research evaluates catheterization-related complications and their impact on patients’ emotional, social, and physical well-being over a six-month period. Data collection utilized the Patient Information Form and the King’s Quality of Life Questionnaire.

Results: Indicate that while all methods present complications such as urinary tract infections (UTIs), urgency, and hematuria, CIC and SC showed significant reductions in UTI rates over time (p=0.001 and p=0.042, respectively). CIC also resulted in fewer cases of hematuria compared to other methods (p=0.039). In terms of quality of life, SC demonstrated improvements in emotional and social domains over six months, whereas CIC offered enhanced autonomy and better physical health outcomes. Transurethral catheterization, despite its widespread use, was associated with higher complication rates, particularly UTIs.

Conclusion: The findings underscore the importance of individualized catheterization decisions as based on multidisciplinary team approach and emphasize the critical role of nursing in following patient outcomes. Comprehensive patient education and adherence to hygiene protocols were instrumental in reducing complications and enhancing quality of life. Future studies should explore the long-term implications of these catheterization methods and further assess the role of nursing interventions in improving patient care.

Keywords: clean intermittent catheterization, transuretral catheterization, suprapubic cystostomy, complications, quality of life

Abstract

Objective: This study investigates the effects of different urinary catheterization methods—transurethral catheterization (TC), suprapubic catheterization (SC), and clean intermittent catheterization (CIC)—on urinary complications and quality of life. 

Material and Methods: This research conducted as a descriptive design with 91 patients at a urology clinic in Istanbul between November 2023 and September 2024, the research evaluates catheterization-related complications and their impact on patients’ emotional, social, and physical well-being over a six-month period. Data collection utilized the Patient Information Form and the King’s Quality of Life Questionnaire.

Results: Indicate that while all methods present complications such as urinary tract infections (UTIs), urgency, and hematuria, CIC and SC showed significant reductions in UTI rates over time (p=0.001 and p=0.042, respectively). CIC also resulted in fewer cases of hematuria compared to other methods (p=0.039). In terms of quality of life, SC demonstrated improvements in emotional and social domains over six months, whereas CIC offered enhanced autonomy and better physical health outcomes. Transurethral catheterization, despite its widespread use, was associated with higher complication rates, particularly UTIs.

Conclusion: The findings underscore the importance of individualized catheterization decisions as based on multidisciplinary team approach and emphasize the critical role of nursing in following patient outcomes. Comprehensive patient education and adherence to hygiene protocols were instrumental in reducing complications and enhancing quality of life. Future studies should explore the long-term implications of these catheterization methods and further assess the role of nursing interventions in improving patient care.

Keywords: clean intermittent catheterization, transuretral catheterization, suprapubic cystostomy, complications, quality of life

INTRODUCTION

INTRODUCTION

Urinary catheterization is the process of draining urine stored in the bladder using a catheter (1). Urinary catheterization is performed in two different ways, transurethral permanent catheterization and clean intermittent catheterization, depending on the purpose of use and the needs of the patient (2). Transurethral indwelling catheterization is one of the most frequently performed procedures in hospitals, as it is performed in approximately 25% of hospitalized patients (3). Clean intermittent catheterization (CIC) is a preferred method for emptying the bladder instead of long-term indwelling catheterization in patients who develop bladder dysfunction due to various reasons (1, 4) 

Indwelling catheterization is applied to the bladder via the urethral or suprapubic route. The application of the catheter to the bladder via the urethral route is called urinary catheterization (bladder catheterization). Suprapubic catheterization is usually preferred after bladder, urethral surgery, pelvic surgery or genitourinary trauma. Suprapubic catheterization has some advantages over urinary catheterization, such as increasing the individual’s independence, facilitating participation in sexual activities, and reducing the risk of some complications such as epididymitis (5, 6). (CIC) is considered a safe and effective catheterization method that supports the independence of the individual’s bladder function, reduces the negative impact on daily life activities, and results in improvements in the individual’s body image, self-confidence, and quality of life (5, 7). While the decision to apply or remove a urinary catheter is made by the physician, clinical nurses are responsible for the application, removal and routine care of the catheter (8). In CIC practices, nurses have an important role in teaching and providing the patient/caregiver with catheterization skills during the hospital/home care process (4, 7).

Correct catheter application, care and catheterization training play a fundamental role in eliminating these problems that negatively affect the patient’s quality of life and motivation to comply with treatment (5). When the literature was reviewed, no study was found that examined the effects of different urinary catheterization practices on urinary complications and quality of life. This study was conducted to examine the effects of different urinary catheterization practices on urinary complications and quality of life.

INTRODUCTION

Urinary catheterization is the process of draining urine stored in the bladder using a catheter (1). Urinary catheterization is performed in two different ways, transurethral permanent catheterization and clean intermittent catheterization, depending on the purpose of use and the needs of the patient (2). Transurethral indwelling catheterization is one of the most frequently performed procedures in hospitals, as it is performed in approximately 25% of hospitalized patients (3). Clean intermittent catheterization (CIC) is a preferred method for emptying the bladder instead of long-term indwelling catheterization in patients who develop bladder dysfunction due to various reasons (1, 4) 

Indwelling catheterization is applied to the bladder via the urethral or suprapubic route. The application of the catheter to the bladder via the urethral route is called urinary catheterization (bladder catheterization). Suprapubic catheterization is usually preferred after bladder, urethral surgery, pelvic surgery or genitourinary trauma. Suprapubic catheterization has some advantages over urinary catheterization, such as increasing the individual’s independence, facilitating participation in sexual activities, and reducing the risk of some complications such as epididymitis (5, 6). (CIC) is considered a safe and effective catheterization method that supports the independence of the individual’s bladder function, reduces the negative impact on daily life activities, and results in improvements in the individual’s body image, self-confidence, and quality of life (5, 7). While the decision to apply or remove a urinary catheter is made by the physician, clinical nurses are responsible for the application, removal and routine care of the catheter (8). In CIC practices, nurses have an important role in teaching and providing the patient/caregiver with catheterization skills during the hospital/home care process (4, 7).

Correct catheter application, care and catheterization training play a fundamental role in eliminating these problems that negatively affect the patient’s quality of life and motivation to comply with treatment (5). When the literature was reviewed, no study was found that examined the effects of different urinary catheterization practices on urinary complications and quality of life. This study was conducted to examine the effects of different urinary catheterization practices on urinary complications and quality of life.

MATERIALS AND METHODS

MATERIALS AND METHODS

Design of Study
This study was conducted as a descriptive and correlational research to investigate the effects of different urinary catheterization practices on urinary complications and quality of life.

The study was conducted with 91 patients who applied to the urology clinic of a city hospital in Istanbul between November 2023 and September 2024, who were applied transurethral catheter or suprapubic catheter and applied clean intermittent catheterization. The study was approved by the ethics committee (258/2023). Written informed consent was obtained from each patient and the study was designed in accordance with the Declaration of Helsinki.

The study included patients aged 18 years and over, who were applied indwelling transurethral catheter or suprapubic catheterization for the first time due to urinary retention, and who had just started clean intermittent catheterization. Patients who were hospitalized for other reasons and who had upper extremity coordination disorders that would prevent them from performing CIC were not included in the study.

Data Collection Forms
Data were collected using the Patient Information Form and the King’s Quality of Life Questionnaire.

Patient Information Form: This form was prepared by the researcher in light of the literature to determine the factors affecting the patients’ catheterization-related problems (4). The Patient Information Form consisted of two sections including questions aimed at determining individual characteristics and characteristics that may affect the application. The first section included questions aimed at determining the patient’s age, gender, education level, marital status and chronic disease status, and the second section included questions aimed at determining the type of catheterization applied, the number of times CIC will be applied per day, the type of catheter used, the need for assistance from others in daily life and complications associated with catheterization.

King’s Quality of Life Questionnaire: The adaptation study of the questionnaire developed in 1997 at the King’s College Hospital (London) (9) to the Turkish society was carried out by Akkoç et al. (10). It consists of 21 questions and 8 sections that question general health perception, the effect of urination complaints on the patient’s life, daily life activities, social and private life restrictions, mood, sleep patterns and behaviors related to urinary incontinence. However, there is also a section that questions the patient’s symptoms related to urinary voiding. With this question, the effect and severity of bladder problems on the patients are questioned under subheadings. These are; pollakiuria, nocturia, sudden urge, sudden urge incontinence, stress incontinence, nocturnal enuresis, incontinence during sexual intercourse, frequent urinary tract infection and pain in the bladder. All questions are evaluated out of 4 points. The lowest score that can be obtained from the questionnaire is 0; the highest score is 100. A high score indicates a level of complaints that leads to greater deterioration in quality of life.

Implementation of the Research
Patients who underwent transurethral catheterization were monitored by the research physician by periodically changing the 16-18 Fr Foley catheter (20-30 days interval). CIC training was given to patients who started clean intermittent catheterization in a urodynamics room where CIC could be performed and where patient privacy was appropriate. The training lasted approximately 20 minutes and was given by the research physician and nurse, along with the verbal training included in routine practice and video-supported CIC training. The video prepared by the research nurse in accordance with the European Association of Urology Nurses (EAUN) Society of Urologic Nurses and Associates (SUNA) CIC practice guidelines was used. 

Suprapubic cystostomy was performed under local anesthesia, under ultrasound guidance, using a percutaneous cystostomy catheter kit, with a catheter placement of 14-16fr at the time the bladder was optimally full (mean 300 ml). The suprapubic catheter was changed under local anesthesia at 20-30 days.

After the information, patients were asked to answer the Patient Information Form and King’s Quality of Life Questionnaire. In the clinical routine, patients were asked to answer the Patient Information Form and King’s Quality of Life Questionnaire at the 1st, 3rd and 6th month follow-ups when they came to the outpatient clinic for routine follow-up.

Statistical Analysis
All data were analyzed using SPSS 21.0 statistical software for Windows (SPSS, Chicago, IL, USA). Results are reported as mean ± SD. All continuous variables were checked with Kolmogorov-Smirnov normality test to show normality of distributions. Comparisons between groups were evaluated with independent sample t-test, Mann-Whitney U test, ANOVA test and chi-square test. Statistical significance was accepted as p<0.05.

For the sample analysis of the study, it was planned to include at least 29 patients in each group with 80% reliability and 5% margin of error, taking the satisfaction scores in the study conducted by Lavelle et al. as an example (11).

MATERIALS AND METHODS

Design of Study
This study was conducted as a descriptive and correlational research to investigate the effects of different urinary catheterization practices on urinary complications and quality of life.

The study was conducted with 91 patients who applied to the urology clinic of a city hospital in Istanbul between November 2023 and September 2024, who were applied transurethral catheter or suprapubic catheter and applied clean intermittent catheterization. The study was approved by the ethics committee (258/2023). Written informed consent was obtained from each patient and the study was designed in accordance with the Declaration of Helsinki.

The study included patients aged 18 years and over, who were applied indwelling transurethral catheter or suprapubic catheterization for the first time due to urinary retention, and who had just started clean intermittent catheterization. Patients who were hospitalized for other reasons and who had upper extremity coordination disorders that would prevent them from performing CIC were not included in the study.

Data Collection Forms
Data were collected using the Patient Information Form and the King’s Quality of Life Questionnaire.

Patient Information Form: This form was prepared by the researcher in light of the literature to determine the factors affecting the patients’ catheterization-related problems (4). The Patient Information Form consisted of two sections including questions aimed at determining individual characteristics and characteristics that may affect the application. The first section included questions aimed at determining the patient’s age, gender, education level, marital status and chronic disease status, and the second section included questions aimed at determining the type of catheterization applied, the number of times CIC will be applied per day, the type of catheter used, the need for assistance from others in daily life and complications associated with catheterization.

King’s Quality of Life Questionnaire: The adaptation study of the questionnaire developed in 1997 at the King’s College Hospital (London) (9) to the Turkish society was carried out by Akkoç et al. (10). It consists of 21 questions and 8 sections that question general health perception, the effect of urination complaints on the patient’s life, daily life activities, social and private life restrictions, mood, sleep patterns and behaviors related to urinary incontinence. However, there is also a section that questions the patient’s symptoms related to urinary voiding. With this question, the effect and severity of bladder problems on the patients are questioned under subheadings. These are; pollakiuria, nocturia, sudden urge, sudden urge incontinence, stress incontinence, nocturnal enuresis, incontinence during sexual intercourse, frequent urinary tract infection and pain in the bladder. All questions are evaluated out of 4 points. The lowest score that can be obtained from the questionnaire is 0; the highest score is 100. A high score indicates a level of complaints that leads to greater deterioration in quality of life.

Implementation of the Research
Patients who underwent transurethral catheterization were monitored by the research physician by periodically changing the 16-18 Fr Foley catheter (20-30 days interval). CIC training was given to patients who started clean intermittent catheterization in a urodynamics room where CIC could be performed and where patient privacy was appropriate. The training lasted approximately 20 minutes and was given by the research physician and nurse, along with the verbal training included in routine practice and video-supported CIC training. The video prepared by the research nurse in accordance with the European Association of Urology Nurses (EAUN) Society of Urologic Nurses and Associates (SUNA) CIC practice guidelines was used. 

Suprapubic cystostomy was performed under local anesthesia, under ultrasound guidance, using a percutaneous cystostomy catheter kit, with a catheter placement of 14-16fr at the time the bladder was optimally full (mean 300 ml). The suprapubic catheter was changed under local anesthesia at 20-30 days.

After the information, patients were asked to answer the Patient Information Form and King’s Quality of Life Questionnaire. In the clinical routine, patients were asked to answer the Patient Information Form and King’s Quality of Life Questionnaire at the 1st, 3rd and 6th month follow-ups when they came to the outpatient clinic for routine follow-up.

Statistical Analysis
All data were analyzed using SPSS 21.0 statistical software for Windows (SPSS, Chicago, IL, USA). Results are reported as mean ± SD. All continuous variables were checked with Kolmogorov-Smirnov normality test to show normality of distributions. Comparisons between groups were evaluated with independent sample t-test, Mann-Whitney U test, ANOVA test and chi-square test. Statistical significance was accepted as p<0.05.

For the sample analysis of the study, it was planned to include at least 29 patients in each group with 80% reliability and 5% margin of error, taking the satisfaction scores in the study conducted by Lavelle et al. as an example (11).

RESULTS

RESULTS

The research was conducted with 91 patients who applied to the Urology Clinic of a City Hospital. Of the patients included in the study, 30 had been applied transurethral catheterization (TC), 31 been applied suprapubic cystostomy (SC), and 30 applied when the characteristics of the patients included in the study were examined, the mean age was 53.14±9.80 years, 54.9% were male, the mean BMI was 25.01±4.65, 70.3% were married, 52.7% did not have a chronic disease and 67% did not need anyone’s help in performing their daily living activities. No significant difference was found between the groups in terms of individual characteristics (p>0.05) (Table-1).

In the first month of follow-up, 31 patients had UTI, 22 had urgency, 29 had incontinence, 33 had hematuria, and 16 had urethral stricture. Of these complications, the frequency of UTI, urgency, incontinence, and hematuria decreased over time, while the frequency of urethral stricture increased. When the catheter-related complications of the patients were examined, it was found that the rate of urinary system infection in the sixth month in patients who underwent suprapubic catheterization and clean intermittent catheterization decreased statistically significantly compared to the first and third months (p=0.042 for SC and p=0.001 for CIC). On the other hand, the rate of hematuria in the third month was significantly lower in patients who underwent clean intermittent catheterization compared to the patients in the other group (p=0.039). No significant difference was observed between the groups in terms of other complications (p>0.05) (Table-2). 

When the quality of life of the patients was compared, in the within-group evaluation of patients who underwent suprapubic catheterization, the mean KHQ-Emotional status sub-dimension scores at the 6th month were significantly lower compared to the first and third months (1st month=35.84±13.67, 3rd month=39.43±13.10, 6th month=31.54±11.86; p=0.005) (Table-3). 

The mean KHQ symptom severity sub-dimension scores were significantly lower in patients who underwent transurethral catheterization compared to the patients in the other group at the sixth month (TC=42.00±8.95, SC=47.96±10.81, CIC=44.69±10.35; p=0.041) (Table-3).

RESULTS

The research was conducted with 91 patients who applied to the Urology Clinic of a City Hospital. Of the patients included in the study, 30 had been applied transurethral catheterization (TC), 31 been applied suprapubic cystostomy (SC), and 30 applied when the characteristics of the patients included in the study were examined, the mean age was 53.14±9.80 years, 54.9% were male, the mean BMI was 25.01±4.65, 70.3% were married, 52.7% did not have a chronic disease and 67% did not need anyone’s help in performing their daily living activities. No significant difference was found between the groups in terms of individual characteristics (p>0.05) (Table-1).

In the first month of follow-up, 31 patients had UTI, 22 had urgency, 29 had incontinence, 33 had hematuria, and 16 had urethral stricture. Of these complications, the frequency of UTI, urgency, incontinence, and hematuria decreased over time, while the frequency of urethral stricture increased. When the catheter-related complications of the patients were examined, it was found that the rate of urinary system infection in the sixth month in patients who underwent suprapubic catheterization and clean intermittent catheterization decreased statistically significantly compared to the first and third months (p=0.042 for SC and p=0.001 for CIC). On the other hand, the rate of hematuria in the third month was significantly lower in patients who underwent clean intermittent catheterization compared to the patients in the other group (p=0.039). No significant difference was observed between the groups in terms of other complications (p>0.05) (Table-2). 

When the quality of life of the patients was compared, in the within-group evaluation of patients who underwent suprapubic catheterization, the mean KHQ-Emotional status sub-dimension scores at the 6th month were significantly lower compared to the first and third months (1st month=35.84±13.67, 3rd month=39.43±13.10, 6th month=31.54±11.86; p=0.005) (Table-3). 

The mean KHQ symptom severity sub-dimension scores were significantly lower in patients who underwent transurethral catheterization compared to the patients in the other group at the sixth month (TC=42.00±8.95, SC=47.96±10.81, CIC=44.69±10.35; p=0.041) (Table-3).

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DISCUSSION

DISCUSSION

This study explores how different urinary catheterization practices influence the incidence of urinary complications and their subsequent impact on patients’ quality of life. At the end of the study, when the catheterization preferences of patients who needed urinary catheterization due to urinary retention were compared, it was seen that patients who used CIC and suprapubic cystostomy had less UTI and hematuria decreased over time in patients who used CIC. In addition, when their quality of life was compared, it was observed that the social and emotional quality of life of patients who used suprapubic cystostomy improved as the time of use progressed.

The choice of urinary catheterization method—transurethral catheterization (TC), suprapubic cystostomy (SC), or clean intermittent catheterization (CIC)—can significantly impact both urinary complications and the quality of life of patients (12). Each method presents unique advantages and disadvantages, influencing patient outcomes and experiences (13, 14). 

Transurethral catheterization, while commonly used, has been associated with a range of complications, including urinary tract infections (UTIs), urgency, incontinence, and hematuria. According to a study, patients who underwent TC reported a higher incidence of UTIs and irritative urinary symptoms when compared to those using other catheterization methods (15). However, a systematic review suggest that while TC may initially present challenges, it may provide better symptom management over time for some patients, indicating a need for individualized assessments for catheter selection (16).
Suprapubic cystostomy has been demonstrated to decrease UTI rates significantly. A study by Krebs et al. (17) reported that patients with SC showed lower UTI rates and fewer complications compared to TC. Nonetheless, despite these benefits, emotional status scores were reported to decline for patients with SC, highlighting the necessity for comprehensive management strategies to address the psychological impact of this procedure (11, 18). This emphasizes the importance of emotional support and education about living with a suprapubic catheter in improving overall patient experience. In our study, it was determined that patients using SC and CIC had fewer UTIs over time. This situation is thought to be related to both the learning of SC catheter care under the supervision of a specialist nurse. In addition, SC is easy to use and, especially, it leads to improvements in quality of life because it is in a position that allows sexual intercourse.

Clean intermittent catheterization has emerged as a favorable option, particularly regarding reducing hematuria and UTI rates (16, 19). A study by Fumincelli et al. found that patients using CIC reported lower complication rates and better quality of life outcomes, especially in emotional and physical health domains (14). As indicated by a systematic review by Kinnear et al., CIC allows for greater autonomy and control over bladder management, which correlates with enhanced patient satisfaction and overall well-being (16). The results of our study showed that patients using CIC experienced fewer complications over time (especially UTI and hematuria). The decrease in complications can be explained by following the correct application steps under the supervision of a specialist nurse and paying attention to hygiene. The use of informational materials such as videos and brochures that aim to review the application steps for CIC use reduces complications related to CIC (4).

The role of nursing in urinary catheter management is critical to optimizing patient outcomes. According to a qualitative study, nurses are vital in educating patients about the different catheterization methods, their associated risks, and the importance of proper catheterization techniques (20). Nursing assessments and interventions play a significant role in monitoring for signs of infection or complications, providing timely interventions, and ensuring emotional support. By fostering a therapeutic relationship, nurses can help patients overcome the challenges of catheterization and improve their quality of life (21).

Moreover, nursing interventions can significantly influence the quality of life for patients undergoing catheterization. Regular assessments and patient education on hygiene practices can mitigate the psychological burden associated with urinary complications (22). Nurses facilitate communication between patients and healthcare providers, ensuring that concerns are promptly addressed, which can further enhance satisfaction and quality of life.

There are some limitations to the study. The first of these is that the follow-up period was limited to six months. Longer follow-ups are needed to better evaluate the effects of catheterization methods on quality of life. Catheterization preferences were left to the patients’ preference and not every patient tried all catheterization methods. Another limitation is that the applied catheter thickness was thicker in the TC group.

DISCUSSION

This study explores how different urinary catheterization practices influence the incidence of urinary complications and their subsequent impact on patients’ quality of life. At the end of the study, when the catheterization preferences of patients who needed urinary catheterization due to urinary retention were compared, it was seen that patients who used CIC and suprapubic cystostomy had less UTI and hematuria decreased over time in patients who used CIC. In addition, when their quality of life was compared, it was observed that the social and emotional quality of life of patients who used suprapubic cystostomy improved as the time of use progressed.

The choice of urinary catheterization method—transurethral catheterization (TC), suprapubic cystostomy (SC), or clean intermittent catheterization (CIC)—can significantly impact both urinary complications and the quality of life of patients (12). Each method presents unique advantages and disadvantages, influencing patient outcomes and experiences (13, 14). 

Transurethral catheterization, while commonly used, has been associated with a range of complications, including urinary tract infections (UTIs), urgency, incontinence, and hematuria. According to a study, patients who underwent TC reported a higher incidence of UTIs and irritative urinary symptoms when compared to those using other catheterization methods (15). However, a systematic review suggest that while TC may initially present challenges, it may provide better symptom management over time for some patients, indicating a need for individualized assessments for catheter selection (16).
Suprapubic cystostomy has been demonstrated to decrease UTI rates significantly. A study by Krebs et al. (17) reported that patients with SC showed lower UTI rates and fewer complications compared to TC. Nonetheless, despite these benefits, emotional status scores were reported to decline for patients with SC, highlighting the necessity for comprehensive management strategies to address the psychological impact of this procedure (11, 18). This emphasizes the importance of emotional support and education about living with a suprapubic catheter in improving overall patient experience. In our study, it was determined that patients using SC and CIC had fewer UTIs over time. This situation is thought to be related to both the learning of SC catheter care under the supervision of a specialist nurse. In addition, SC is easy to use and, especially, it leads to improvements in quality of life because it is in a position that allows sexual intercourse.

Clean intermittent catheterization has emerged as a favorable option, particularly regarding reducing hematuria and UTI rates (16, 19). A study by Fumincelli et al. found that patients using CIC reported lower complication rates and better quality of life outcomes, especially in emotional and physical health domains (14). As indicated by a systematic review by Kinnear et al., CIC allows for greater autonomy and control over bladder management, which correlates with enhanced patient satisfaction and overall well-being (16). The results of our study showed that patients using CIC experienced fewer complications over time (especially UTI and hematuria). The decrease in complications can be explained by following the correct application steps under the supervision of a specialist nurse and paying attention to hygiene. The use of informational materials such as videos and brochures that aim to review the application steps for CIC use reduces complications related to CIC (4).

The role of nursing in urinary catheter management is critical to optimizing patient outcomes. According to a qualitative study, nurses are vital in educating patients about the different catheterization methods, their associated risks, and the importance of proper catheterization techniques (20). Nursing assessments and interventions play a significant role in monitoring for signs of infection or complications, providing timely interventions, and ensuring emotional support. By fostering a therapeutic relationship, nurses can help patients overcome the challenges of catheterization and improve their quality of life (21).

Moreover, nursing interventions can significantly influence the quality of life for patients undergoing catheterization. Regular assessments and patient education on hygiene practices can mitigate the psychological burden associated with urinary complications (22). Nurses facilitate communication between patients and healthcare providers, ensuring that concerns are promptly addressed, which can further enhance satisfaction and quality of life.

There are some limitations to the study. The first of these is that the follow-up period was limited to six months. Longer follow-ups are needed to better evaluate the effects of catheterization methods on quality of life. Catheterization preferences were left to the patients’ preference and not every patient tried all catheterization methods. Another limitation is that the applied catheter thickness was thicker in the TC group.

CONCLUSION

CONCLUSION

In conclusion, the choice of urinary catheterization method profoundly impacts urinary complications and patient quality of life. While TC, SC, and CIC each offer advantages and challenges, CIC appears to provide the best long-term outcomes regarding symptom management and patient autonomy. The nursing role is integral in this context, as effective nursing care has been shown to significantly reduce complications and enhance overall quality of life for patients. Continued research is essential to explore the long-term effects of these catheterization methods and the evolving role of nursing in improving patient outcomes.

CONCLUSION

In conclusion, the choice of urinary catheterization method profoundly impacts urinary complications and patient quality of life. While TC, SC, and CIC each offer advantages and challenges, CIC appears to provide the best long-term outcomes regarding symptom management and patient autonomy. The nursing role is integral in this context, as effective nursing care has been shown to significantly reduce complications and enhance overall quality of life for patients. Continued research is essential to explore the long-term effects of these catheterization methods and the evolving role of nursing in improving patient outcomes.

Acknowledgement

Acknowledgement

Conflict of Interest: None.

Funding: None.

Ethics Committee Report: Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital was reviewed by the Clinical Research Ethics Committee at its meeting dated 06.11.2023 and found to be ethically appropriate according to decision number 258.

Authors’ Contributions: Concept – YC; Design – FB; Supervision – FB; Materials – MGC; Data Collection and/or Processing – YC, MGC; Analysis and/or Interpretation –MGC; Literature Review –YC; Writing –YC, MGC; Critical Review -FB.

Acknowledgement

Conflict of Interest: None.

Funding: None.

Ethics Committee Report: Istanbul Prof. Dr. Cemil Taşcıoğlu City Hospital was reviewed by the Clinical Research Ethics Committee at its meeting dated 06.11.2023 and found to be ethically appropriate according to decision number 258.

Authors’ Contributions: Concept – YC; Design – FB; Supervision – FB; Materials – MGC; Data Collection and/or Processing – YC, MGC; Analysis and/or Interpretation –MGC; Literature Review –YC; Writing –YC, MGC; Critical Review -FB.

REFERENCES

REFERENCES

1.    Lauridsen, S., et al., European Association of Urology Nurses Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral intermittent in adults Dilatation, urethral intermittent in adults Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral intermittent in adults Dilatation, urethral intermittent in adults. 2013.
2.    Niël-Weise BS, van den Broek PJ, da Silva EM, Silva LA. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev. 2012;(8):CD004201. Published 2012 Aug 15. https://doi.org/10.1002/14651858.CD004201.pub3
3.    Bhatt NR, Davis NF, Thorman H, Brierly R, Scopes J. Knowledge, skills, and confidence among healthcare staff in urinary catheterization. Can Urol Assoc J. 2021;15(9):E488-E494. https://doi.org/10.5489/cuaj.6986
4.    Culha Y, Acaroglu R. The Effect of Video-Assisted Clean Intermittent Catheterization Training on Patients’ Practical Skills and Self-Confidence. Int Neurourol J. 2022;26(4):331-341. https://doi.org/10.5213/inj.2244166.083
5.    Newman DK, New PW, Heriseanu R, et al. Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. 2020;52(8):1443-1451. https://doi.org/10.1007/s11255-020-02435-9
6.    Campeau L, Shamout S, Baverstock RJ, et al. Canadian Urological Association Best Practice Report: Catheter use. Can Urol Assoc J. 2020;14(7):E281-E289. https://doi.org/10.5489/cuaj.6697
7.    Silva DRA, Mazzo A, Jorge BM, Souza Júnior VD, Fumincelli L, Almeida RGS. Intermittent Urinary Catheterization: The Impact of Training on a Low-Fidelity Simulator on the Self-Confidence of Patients and Caregivers. Rehabil Nurs. 2017;42(2):97-103. https://doi.org/10.1002/rnj.226
8.    Büyükyilmaz F, Culha Y, Zümreler H, Özer M, Culha MG, Ötünçtemur A. The effects of bladder training on bladder functions after transurethral resection of prostate. J Clin Nurs. 2020;29(11-12):1913-1919. https://doi.org/10.1111/jocn.14939
9.    Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104(12):1374-1379. https://doi.org/10.1111/j.1471-0528.1997.tb11006.x
10.    Akkoc Y, Karapolat H, Eyigor S, Yesil H, Yüceyar N. Quality of life in multiple sclerosis patients with urinary disorders: reliability and validity of the Turkish version of King’s Health Questionnaire. Neurol Sci. 2011;32(3):417-421. https://doi.org/10.1007/s10072-011-0484-9
11.    Lavelle RS, Coskun B, Bacsu CD, Gliga LA, Christie AL, Lemack GE. Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions. Neurourol Urodyn. 2016;35(7):831-835. https://doi.org/10.1002/nau.22812
12.    Fumincelli L, Mazzo A, Martins JCA, Henriques FMD, Cardoso D, Rodrigues MA. Quality of Life of Intermittent Urinary Catheterization Users and Their Caregivers: A Scoping Review. Worldviews Evid Based Nurs. 2017;14(4):324-333. https://doi.org/10.1111/wvn.12231
13.    Nast KJ, Chiang G, Marietti S. Vesicostomy button: how is it placed, in whom, and how is quality of life affected?. Int Braz J Urol. 2019;45(4):807-814. https://doi.org/10.1590/S1677-5538.IBJU.2018.0686
14.    Fumincelli L, Mazzo A, Martins JCA, Henriques FMD, Orlandin L. Quality of life of patients using intermittent urinary catheterization. Rev Lat Am Enfermagem. 2017;25:e2906. Published 2017 Jul 10. https://doi.org/10.1590/1518-8345.1816.2906
15.    Schiøtz HA, Malme PA, Tanbo TG. Urinary tract infections and asymptomatic bacteriuria after vaginal plastic surgery. A comparison of suprapubic and transurethral catheters. Acta Obstet Gynecol Scand. 1989;68(5):453-455. https://doi.org/10.3109/00016348909021020
16.    Kinnear N, Barnett D, O’Callaghan M, Horsell K, Gani J, Hennessey D. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 2020;39(2):854-862. https://doi.org/10.1002/nau.24253
17.    Krebs J, Wöllner J, Pannek J. Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord. 2016;54(9):682-686. https://doi.org/10.1038/sc.2015.214
18.    Hennessey DB, Kinnear N, MacLellan L, Byrne CE, Gani J, Nunn AK. The effect of appropriate bladder management on urinary tract infection rate in patients with a new spinal cord injury: a prospective observational study. World J Urol. 2019;37(10):2183-2188. https://doi.org/10.1007/s00345-018-02620-7
19.    Katsumi HK, Kalisvaart JF, Ronningen LD, Hovey RM. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 2010;48(4):325-329. https://doi.org/10.1038/sc.2009.134
20.    Alex J, Ferguson C, Ramjan LM, Fishburn ML, Montayre J, Salamonson Y. Development and evaluation of a spaced eLearning intervention for nurses in enhancing urinary catheter management - A co-design study in partnership with research end-users. Nurse Educ Today. 2025;144:106448. https://doi.org/10.1016/j.nedt.2024.106448
21. Seyhan Ak E, Özbaş A. The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. J Clin Nurs. 2018;27(5-6):e1078-e1088. https://doi.org/10.1111/jocn.14160
22. Oswald F, Young E, Denison F, Allen RJ, Perry M. Staff and patient perceptions of a community urinary catheter service. Int J Urol Nurs. 2020;14(2):83-91. https://doi.org/10.1111/ijun.12230 

REFERENCES

1.    Lauridsen, S., et al., European Association of Urology Nurses Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral intermittent in adults Dilatation, urethral intermittent in adults Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Urethral intermittent in adults Dilatation, urethral intermittent in adults. 2013.
2.    Niël-Weise BS, van den Broek PJ, da Silva EM, Silva LA. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev. 2012;(8):CD004201. Published 2012 Aug 15. https://doi.org/10.1002/14651858.CD004201.pub3
3.    Bhatt NR, Davis NF, Thorman H, Brierly R, Scopes J. Knowledge, skills, and confidence among healthcare staff in urinary catheterization. Can Urol Assoc J. 2021;15(9):E488-E494. https://doi.org/10.5489/cuaj.6986
4.    Culha Y, Acaroglu R. The Effect of Video-Assisted Clean Intermittent Catheterization Training on Patients’ Practical Skills and Self-Confidence. Int Neurourol J. 2022;26(4):331-341. https://doi.org/10.5213/inj.2244166.083
5.    Newman DK, New PW, Heriseanu R, et al. Intermittent catheterization with single- or multiple-reuse catheters: clinical study on safety and impact on quality of life. Int Urol Nephrol. 2020;52(8):1443-1451. https://doi.org/10.1007/s11255-020-02435-9
6.    Campeau L, Shamout S, Baverstock RJ, et al. Canadian Urological Association Best Practice Report: Catheter use. Can Urol Assoc J. 2020;14(7):E281-E289. https://doi.org/10.5489/cuaj.6697
7.    Silva DRA, Mazzo A, Jorge BM, Souza Júnior VD, Fumincelli L, Almeida RGS. Intermittent Urinary Catheterization: The Impact of Training on a Low-Fidelity Simulator on the Self-Confidence of Patients and Caregivers. Rehabil Nurs. 2017;42(2):97-103. https://doi.org/10.1002/rnj.226
8.    Büyükyilmaz F, Culha Y, Zümreler H, Özer M, Culha MG, Ötünçtemur A. The effects of bladder training on bladder functions after transurethral resection of prostate. J Clin Nurs. 2020;29(11-12):1913-1919. https://doi.org/10.1111/jocn.14939
9.    Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol. 1997;104(12):1374-1379. https://doi.org/10.1111/j.1471-0528.1997.tb11006.x
10.    Akkoc Y, Karapolat H, Eyigor S, Yesil H, Yüceyar N. Quality of life in multiple sclerosis patients with urinary disorders: reliability and validity of the Turkish version of King’s Health Questionnaire. Neurol Sci. 2011;32(3):417-421. https://doi.org/10.1007/s10072-011-0484-9
11.    Lavelle RS, Coskun B, Bacsu CD, Gliga LA, Christie AL, Lemack GE. Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions. Neurourol Urodyn. 2016;35(7):831-835. https://doi.org/10.1002/nau.22812
12.    Fumincelli L, Mazzo A, Martins JCA, Henriques FMD, Cardoso D, Rodrigues MA. Quality of Life of Intermittent Urinary Catheterization Users and Their Caregivers: A Scoping Review. Worldviews Evid Based Nurs. 2017;14(4):324-333. https://doi.org/10.1111/wvn.12231
13.    Nast KJ, Chiang G, Marietti S. Vesicostomy button: how is it placed, in whom, and how is quality of life affected?. Int Braz J Urol. 2019;45(4):807-814. https://doi.org/10.1590/S1677-5538.IBJU.2018.0686
14.    Fumincelli L, Mazzo A, Martins JCA, Henriques FMD, Orlandin L. Quality of life of patients using intermittent urinary catheterization. Rev Lat Am Enfermagem. 2017;25:e2906. Published 2017 Jul 10. https://doi.org/10.1590/1518-8345.1816.2906
15.    Schiøtz HA, Malme PA, Tanbo TG. Urinary tract infections and asymptomatic bacteriuria after vaginal plastic surgery. A comparison of suprapubic and transurethral catheters. Acta Obstet Gynecol Scand. 1989;68(5):453-455. https://doi.org/10.3109/00016348909021020
16.    Kinnear N, Barnett D, O’Callaghan M, Horsell K, Gani J, Hennessey D. The impact of catheter-based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn. 2020;39(2):854-862. https://doi.org/10.1002/nau.24253
17.    Krebs J, Wöllner J, Pannek J. Risk factors for symptomatic urinary tract infections in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord. 2016;54(9):682-686. https://doi.org/10.1038/sc.2015.214
18.    Hennessey DB, Kinnear N, MacLellan L, Byrne CE, Gani J, Nunn AK. The effect of appropriate bladder management on urinary tract infection rate in patients with a new spinal cord injury: a prospective observational study. World J Urol. 2019;37(10):2183-2188. https://doi.org/10.1007/s00345-018-02620-7
19.    Katsumi HK, Kalisvaart JF, Ronningen LD, Hovey RM. Urethral versus suprapubic catheter: choosing the best bladder management for male spinal cord injury patients with indwelling catheters. Spinal Cord. 2010;48(4):325-329. https://doi.org/10.1038/sc.2009.134
20.    Alex J, Ferguson C, Ramjan LM, Fishburn ML, Montayre J, Salamonson Y. Development and evaluation of a spaced eLearning intervention for nurses in enhancing urinary catheter management - A co-design study in partnership with research end-users. Nurse Educ Today. 2025;144:106448. https://doi.org/10.1016/j.nedt.2024.106448
21. Seyhan Ak E, Özbaş A. The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. J Clin Nurs. 2018;27(5-6):e1078-e1088. https://doi.org/10.1111/jocn.14160
22. Oswald F, Young E, Denison F, Allen RJ, Perry M. Staff and patient perceptions of a community urinary catheter service. Int J Urol Nurs. 2020;14(2):83-91. https://doi.org/10.1111/ijun.12230 

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