ate/severe urinary incontinence in men over 20 years old as. 4.5%, increasing ... strated that 69% in their sample preferred sheaths to their previous absorbent ...
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Assessing and treating urinary incontinence in men Mary Wilson Retired Nurse Practitioner for Bladder and Bowel Health, Humber NHS Foundation Trust
Assessment, treatment, and containment A continence assessment should always be carried out to identify the type(s) of UI, enabling a treatment plan to be created. This article focuses on aids for safe, problem-free management of male UI. While both men and women are able to use disposable pads or washable absorbent underwear, men have the option of disposable or reusable ‘pouches’, urinary sheaths, and appliances.
Penile sheaths These are soft, flexible sleeves fitting over the penis, culminating in an outlet for attachment to any standard urinary drainage system. However, they will not relieve urinary retention and are inappropriate for use when the penile skin is broken; use may be problematic for men with dementia, penile retraction, or a larger glans/narrower shaft. Most sheaths are manufactured from clear, breathable, 100% silicone (latex sheaths may cause allergies) and are in one piece (with the adhesion incorporated rather than as a separate fixation tape) (Smart 2014). In their study, Chartier‐Kastler et al (2011) demonstrated that 69% in their sample preferred sheaths to their previous absorbent products. Sheaths come in various widths and lengths. Manufacturers provide measuring devices (for use on a flaccid penis) to select the correct width. A length of 5 cm is preferable; measuring when the man is seated ensures that retraction does not then occur when he sits down (Smart, 2014). Using too long a
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sheath can result in the excess rolling back, discomfort, and premature removal. Pubic hair should be trimmed; some manufacturers provide guards to protect pubic hair from the adhesive (Woodward, 2015). If patients have adhesive-related skin irritation or the adhesion is not sufficiently strong, wipes, such as Coloplast’s Conveen Prep Wipes, can protect the skin and aid adhesion. Some sheaths include applicators to assist fitting, for instance, Conveen Optima by Coloplast. Most manufacturers advise that sheaths be changed every 24 hours.
Alternatives to penile sheaths: BioDerm and urinary appliances Some men, although eager to use a sheath, are unable to do so because of allergy or retraction. An alternative to the use of a sheath is CliniMed’s Bioderm; this product is also appropriate for men experiencing frequent erections (Woodward, 2015). Manufactured from hydrocolloid and latex free, it can remain in place for 3 days; one size fits all and it connects to the urine drainage bag. Bioderm is appropriate for both circumcised and uncircumcised men, providing the foreskin will retract.The device consists of a drainage tube culminating in a faceplate of seven radiating hydrocolloid adhesive ‘petals’. It is positioned so that the slit in the faceplate centre lines up with the urethral orifice. The ‘petals’ are smoothed onto the glans and secured by an adhesive strip of hydrocolloid; the foreskin is then replaced (CliniMed, 2014). Also available are body-worn urinals (e.g. those from JadeEuro-Med Ltd and SG&P Payne Ltd). Pubic pressure urinals are fitted when the patient has a retracted penis; the application of pubic pressure, exerted by a flange held firmly over the pubic area by groin and waist straps, extends the penile length (Billington, 2007). The appliance may have its own urine-collecting cone, or allow attachment of a non-adherent sheath. Alternatively, the patient may then be enabled to wear a penile sheath. Nightingale Nurses (Great Bear Healthcare), Script-Easy (Bard-Rochester), and Jade-Euro-Med provide fitting, advice, and aftercare by specially trained nurses. In the author’s experience, some men wear an appliance only for going out and then do not have to remove an adhesive sheath on returning home.
Clean intermittent catheterization CISC is used when the bladder cannot be voided adequately; it is considered to be the gold standard for urine drainage
British Journal of Community Nursing June 2015 Vol 20, No 6
© 2015 MA Healthcare Ltd
U
rinary incontinence (UI) is defined by the International Continence Society (ICS) as any involuntary loss of urine. However, they retained their earlier definition of ‘involuntary loss of urine that is a social or hygienic problem’ (Abrams et al, 2010:29). In a community-based study of participants over 60 years of age, Lagro-Janssen and colleagues (2008) identified that emotionally, men perceive more problems in living with UI than women, feeling significantly more frustration and shame and reporting more limitations in their social lives. Markland et al (2010) estimated the prevalence of moderate/severe urinary incontinence in men over 20 years old as 4.5%, increasing with age from 0.4% (20–34 years) to 16% (≥75 years). Moore and Gray (2004), in a review, identified that while UI was more prevalent in younger women than younger men, the difference narrowed with age.
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Increasing comfort for terminally ill patients
using a wraparound band, fastening the catheter to the strap. The Manfred Sauer p.grip has a self-adhesive tab that attaches to the catheter, which is then attached to a leg strap, over which a Velcro strip is positioned.The latter two devices have no hard edges that could inflict pressure. Woodward (2014) cited authors who warned against patients with diabetes, phlebitis, or poor circulation using strap devices, but notes that there is no supporting evidence.
Allow healing of category 3 or 4 pressure ulcers on the trunk, where other measures have been inadequate
Adhesive devices
Chronic urinary retention when intermittent or suprapubic catheterization is not an option or not agreed to by the patient Accurately monitoring urinary output in critically ill patients
Intractable UI – as the last resort Source: Wilson, 2011
and recommended in preference to indwelling catheterization.The procedure entails the in/out passage of a lubricated catheter. While usually carried out by the patient, it may be performed by health professionals or carers (Wilson, 2015).
Indwelling catheterization Indwelling catheters are self-retaining by means of a sterile water filled ≤10 ml balloon within the bladder, and are inserted either per urethra or supra-pubically (through the abdominal wall, above the pubic bone), and 30 ml balloons should be reserved for post-prostatectomy haemostasis (Wilson, 2012). Winder (2012) lists supra-pubic advantages/disadvantages, but it is usually regarded as preferable to urethral catheterization. The catheter is attached to a drainage bag or a catheter valve, allowing urine storage within the bladder.The indications for urethral indwelling catheterization are presented in Box 1.
Catheter securement As the balloon rests on the bladder neck, sudden traction can cause displacement or removal while more prolonged pressure can lead to pressure necrosis and erosion to the bladder neck, metal cleaving or damage to either end of a supra-pubic tract (Wilson, 2013; Woodward, 2014). To avoid these complications, catheters should be secured; Woodward (2014) categorises fixation devices into those involving straps or adhesion.
Straps These are non-slip, elasticated straps fastening round the leg. The Bard Comfasure catheter retainer strap secures the catheter within a clip, while Great Bear GB Fix-It grips the catheter
KEY POINTS
ww While urinary incontinence is more prevalent in younger women than younger men, the difference narrows with age ww For containment of urinary incontinence, men have the added option of using penile sheaths or appliances ww Fixation devices reduce the risk of any damage being caused by the presence of indwelling catheters ww Patients should be assisted in making an informed choice on their containment options
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The Bard StatLock stabilisation device consists of a clamp that secures the catheter but allows a swivelling movement; it is incorporated onto an anchor pad, which is attached using a strong adhesive onto a prepared area of thigh for up to 7 days. It is removed using alcohol wipes and a new pad is placed on the other thigh. CliniMed CliniFix adheres to the thigh skin using a skin-friendly hydrocolloid base; it can stay in situ for up to 7 days. The catheter is attached using a Velcro securing tape; for extra security, an adhesive area can be exposed onto which to fix the catheter.The skin adhesive is removed easily, using warm water or adhesive remover; bathing/showering may reduce the adhesive grip. Blue Box Ltd’s Grip-Lok is a hypoallergenic fabric-type strip available in two widths; it adheres to the skin, retaining the catheter in a foam channel using two wrap-overVelcro fabric tapes.The latter two devices have no hard edges.
Conclusion This article has looked at male UI, focusing on products available to assist patients toward trouble-free management of their UI. Patients should be assisted to make informed choices about these matters, in partnership with health professionals. BJCN Abrams P, Andersson KE, Birder L et al (2010) Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn 29(1): 213-40. doi:10.1002/nau.20870 Billington A (2007) Mainly men. In: Getliffe K, Dolman M. eds, Promoting Continence: A Clinical and Research Resource. 3rd edn. Elsevier Health Sciences, Philadelphia Chartier-Kastler E, Ballanger P, Petit J et al (2011). Randomized, crossover study evaluating patient preference and the impact on quality of life of urisheaths vs absorbent products in incontinent men. BJU Int 108(2): 241-7. doi:10.1111/j.1464-410X.2010.09736.x CliniMed (2014) BioDerm. bit.ly/1Ef3nDw (accessed 18 May 2015) Lagro-Janssen TA, Hilkens CJ, Klaasen RI,Teunissen D (2008) Greater emotional and social effect of urinary incontinence in men than women. J Am Geriatr Soc 56(9): 1779–81. doi:10.1111/j.1532-5415.2008.01842.x Markland AD, Goode PS, Redden DT, Borrud LG, Burgio KL (2010) Prevalence of urinary incontinence in men: results from the national health and nutrition examination survey. J Urol 184(3): 1022–7. doi:10.1016/j.juro.2010.05.025 Moore KN, Gray M (2004) Urinary incontinence in men: current status and future directions. Nurs Res 53(6 Suppl): S36–41 Smart C (2014) Male urinary incontinence and the urinary sheath. Br J Nurs 23(9): S20, S22–5 Wilson M (2011) Addressing the problems of long-term urethral catheterization: Part 1. Br J Nurs 20(22): 1418, 1420–4 Wilson M (2012) Addressing the problems of long-term urethral catheterization: Part 2. Br J Nurs 21(1): 16, 18-20, 22 passim Wilson M (2013) Catheter lubrication and fixation: interventions. Br J Nurs 22(10): 566, 568–9 Wilson M (2015). Clean intermittent self-catheterisation: working with patients. Br J Nurs 24(2): 76–85. doi:10.12968/bjon.2015.24.2.76 Winder A (2012) Good practice in catheter care. Journal of Community Nursing 26(6): 15–20 Woodward S (2014) Securing urethral catheters can help to reduce their complications. British Journal of Neuroscience Nursing 10(4): 162-5 Woodward S (2015) Selecting and fitting a penile sheath. Br J Nurs 24(5): 290–2. doi:10.12968/bjon.2015.24.5.290
British Journal of Community Nursing June 2015 Vol 20, No 6
© 2015 MA Healthcare Ltd
Box 1. Indications for long-term urethral catheterization
