Spina bifida and intermittent bladder catheterization in the context of rehabilitation

Abstract

For the majority of individuals with spina bifida (SB) is the intermittent bladder catheterization (IC) required. Identifying the factors involved in IC, especially selfcatheterization is fundamental in the development of effective training programs and public policies consistent with patient reality. This study sought to contribute to this end, describing and comparing the technical, bio-psycho-social and familial factors related to the use of IC. The study included 100 Brazilian individuals and 100 German individuals, of which 108 were female and 92 were male, with an age range of 0 to 55 years and a mean age of 14 years. Data were collected using questionnaires, printed (Brazil) and online (Germany), and analyzed using statistical tests, i.e. multivariate logistical regression and analysis of variance. Predictive factors for self-catheterization were defined, such as having six years of schooling or more, not having hydrocephalus, having a lower level of SB (sacral and lumbar), and differences related to country. The study also demonstrated that the non-application of IC was directly influenced by temporary interruptions of the procedure, the daily frequency of IC and the existence of technical difficulties. Also, it is important to note that continence, even partial, was achieved by 61.5% of the participants and that self-catheterization was responsible for increasing the likelihood of continence up to 3 times. The benefits of IC were statistically proven, such as reducing the number of UTIs (urinary tract infections), which were on average higher in Germans than in Brazilians. Interestingly, there was no difference in the number of UTIs among the Germans who performed disinfection (octenidine, polyhexanide), those who cleaned with soap and water and those who did not perform any cleaning before the introduction of the urethral catheter. The preparation of the transition to adulthood starts in childhood also for individuals with SB. Self-catheterization is part of the process of autonomy in self-care and social participation, and therefore deserves to be studied. Cooperative studies between different countries and cultures contribute to understanding the development and rehabilitation of people with SB.