Abstract: From Time Dependent Intermittent Self-Catheterization to Volume Dependent Self-Catheterization in Multiple Sclerosis using the PCI 5000 BladderManager^®

D. De Ridder, H. Van Poppel, L. Baert, and J. Binard. "From time dependent intermittent self-catheterisation to volume dependent self-catheterisation in Multiple Sclerosis using the PCI 5000 BladderManager^®." Spinal Cord 35 (1997): 613-16.

Objectives:
* To assess the accuracy of the BladderManager^® PCI 5000, and the viability of replacing time-dependent self-catheterization programs for multiple sclerosis patients with a volume-dependent self-catheterization program using the PCI 5000.

Methods:
* Twenty-five multiple sclerosis patients participated in the study. All had previously been on an intermittent self-catheterization program. Before use of the BladderManager^® commenced, a record of voiding and catheterization time and volume, and periods of incontinence, was kept for 48 hours for each patient. Then, for a period of two weeks, the patients were allowed to use the BladderManager^®, after having been trained in a one to two hour session. Ultrasound measurements were performed by patients every hour during the day and every two hours during the night. A pre-set volume was calculated at which each patient should void, and when the BladderManager^® indicated that this volume had been reached, the patient was catheterized. After two weeks, ultrasound volumes and catheterized volume measurements were recorded on a voiding chart over a period of two days, and this chart was compared to the voiding chart made prior to the introduction of the BladderManager^®.
* The number of catheterizations, catheterized volume, and periods of incontinence were the variables used to assess the possible benefits of patient and volume controlled catheterization.

Results:
* Evaluation of ultrasound measurements showed an accuracy of 91.05%.
* After ultrasound measurement was introduced, the average catheterized volume for the study group increased from 260.8 cc ± 154.5 cc (median = 245 cc) to 297.5 cc ± 138.9 cc (median = 316 cc).
* The frequency of catheterization was diminished after the introduction of the BladderManager^®.
* The number of incontinent periods for the whole group, measured during 48 hours, was decreased from 69 to 39 (P < 0.05) under the volume-dependent program.
* Independence of bladder control increased in more than half of the patients with the use of the BladderManager^®.

Conclusions:
* "There is little doubt that the PCI 5000 BladderManager^® is accurate enough to be used in a clinical setting. The correlation between catheterized and measured volume as well as the accuracy are excellent for an ultrasound measurement."
* "This ultrasound unit can be used in a reliable way by patients or nurses without any ultrasound experience, after an initial training of less than two hours."
* With the PCI 5000, the number of incontinent episodes was reduced, which improved patients' quality of life and reduced the cost of care by decreasing the need for incontinence supplies.
* The PCI 5000 is of value as a feedback training device for multiple sclerosis patients. "Using the PCI 5000 BladderManager^® we were able to improve the urological status even in these patients [who were in advanced state of multiple sclerosis], proving that even in advanced stages biofeedback training techniques can be useful. This is very important from the rehabilitation point of view, since it improves the self esteem of the patient, decreases his incontinence and consequent social problems, without increasing the level of assistance needed, thus increasing the quality of life."

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