10 2.1.2 Urethritis In the past, research has demonstrated that inflammation of the urethra occurs in 1-18% of patients who catheterise. However, catheter techniques and catheter materials have improved greatly since then. These research findings are, therefore, no longer valid, and new studies on children have not yet been conducted. 2.1.3 Epididymitis Epididymitis is not commonly seen but can occur in cases of poor compliance. It can be the result of an infection of the urethra and UTI with reflux of infected urine in the genital tract. Treatment with antibiotics for at least two weeks is indicated. In adults, the short-term incidence is 3-12%, and the long-term incidence is more than 40%.12 However, the incidence in children is not known. 2.2 Trauma 2.2.1 False passage A false passage is the formation of a false route, often in the region of the bladder neck or the prostate, which prevents the catheter from being inserted into the bladder. Treatment consists of leaving an indwelling catheter in situ for several weeks and administering antibiotics if necessary. Following this, intermittent catheterisation can be continued once more. If this is unsuccessful, a surgical investigation may be required. Adequate training of health professionals can help reduce the formation of false passages by up to 78%.13 For persistent catheterization problems due to false passages, construction of a catheterise stoma may be needed in selected cases. … Recommendation LE GR A false passage should be treated by placement of an indwelling catheter and with antibiotics if necessary 4 C Healthcare professionals should be well-trained (according to protocol, and competent means qualified) as well in performing catheterisation, as in passing on the responsibility of catheterisation to the healthcare user, as in recognising complications 4 B Children and healthcare users learning CIC/CISC should be adequately instructed according to these guidelines 4 B 2.2.2 Urethral stricture A urethral stricture as a complication of catheterisation is uncommon (5%) and seen only in men. The risk can be reduced by using hydrophilic catheters. 14 2.2.3 Urethral bleeding Urethral bleeding is seen more in boys than in girls. Persistent bleeding can be an indication of a UTI. 2.3 Other 2.3.1 Bladder stones The risk of developing bladder stones is known to be higher in patients who are long-term users of catheters via a Mitrofanoff stoma, those who have undergone ileocystoplasty, or those who do not completely empty their bladder when catheterising. Catheterisation via a stoma is not included in these guidelines. However, it is recognised that there is a risk of developing bladder stones in patients who have undergone ileocystoplasty and who catheterise via the urethra. 15,16 This is due to the mucous produced by the patch of bowel inserted into the bladder. It is important, therefore, that mucous is regularly removed to minimise the risk of stone formation. Wash out the bladder with a saline solution, which can be either readymade or cooled boiled water with salt added. If mucous is particularly problematic, acetylcysteine or chondroitin sulfate installations may be used to help break down the
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