2015 Volume 18 Issue 4 Pages 340-347
We developed a care protocol for voluntary voiding and assessed its clinical utility in cerebrovascular disease patients with voiding dysfunction after indwelling urinary catheter removal. We studied cerebrovascular disease patients admitted to a cerebrovascular specialty hospital, in whom a urinary catheter had been placed for more than 7 days. The protocol comprised three phases: 1st: risk assessment of voiding dysfunction and decision-making for catheter removal; 2nd: removal of the catheter and care on the removal day; and 3rd: care for voluntary voiding. Voiding dysfunction was assessed using a portable ultrasound scanning device for bladder volume measurement, and the volumes of voiding, incontinence and residual urine, and voiding time and frequency were monitored. The primary outcome measures were the period of voiding dysfunction due to voiding approach, urinary retention and difficulty in voiding at discharge, which were assessed at the day of catheter removal, 1 week and 4 weeks later, and at the time of voluntary voiding. Intervention was conducted according to the protocol in collaboration with multidisciplinary staff, including the investigator, ward nurses, primary physician, specialty physician and rehabilitation staff. The subjects were 11 males and 6 females（mean age: 68.3 ± 13.5）. The period of catheter indwelling was 25.7 ± 15.9 days. Using the protocol, 13 of the 17 patients achieved voluntary voiding, and four needed an indwelling catheter again. Of the 13 patients who achieved voluntary voiding, seven achieved voiding in a toilet or urinary apparatus, and six experienced incontinence in diapers. These results suggest a certain benefit of the protocol.
