1. INTRODUCTION

The European Association of Urology Nurses (EAUN) was created in April 2000 to represent European urology nurses. The EAUN’s underlying goal is to foster the highest standards of urological nursing care throughout Europe. With administrative, financial, and advisory support from the European Association of Urology (EAU), the EAUN also encourages research and continued nursing education (through European Urology – Accredited Continuing Nursing Education; EU-ACNE) and aspires to develop European standards for education of urology nurses.

We believe that excellent health care goes beyond geographical boundaries. Improving current standards of urological nursing care has been top of our agenda, with the aim of directly helping our members develop or update their expertise. To fulfil this essential goal, we are publishing an update of one of our Evidence-based Guidelines for Best Practice in Urological Health Care booklets; a comprehensive compilation of theoretical knowledge and practical guidelines on intermittent catheterisation (IC). IC is defined as the best evidence-based practice for bladder management in individuals with difficulty in voiding due to neurogenic or non-neurogenic lower urinary tract dysfunction. [1] Advances in care have significantly increased survival in patients with, for example, spinal cord injury/disease (SCI/D), and proper bladder management is an important element in SCI rehabilitation. Problems with bladder regulation are one of the most important health issues, and urinary tract infections are reported as the leading cause of re-hospitalisation after SCI/D. SCDs now account for 50% of the patients with spinal cord dysfunction; for example, due to spinal cord infarction, metastasis and infection.

The goal is to maintain continence, prevent urological complications, preserve upper and lower urinary tract function, and make bladder management compatible with the person’s lifestyle and environment to maintain physical health and quality of life (QoL). [2, 3]

The evidence presented in these guidelines are based on studies with different patient populations. The inclusion criteria were adults with bladder dysfunction who needed to perform IC regardless of whether bladder dysfunction was caused by: urinary incontinence (leaking urine or inability to control micturition); urinary retention; surgery on the prostate or genitalia; or the need to catheterise once or long-term.

The EAUN Guidelines Working Group (further referred to as “Working Group” in this document) believes there is a need to provide guidelines with recommendations that clearly state the level of evidence of each procedure, with the aim of improving current practices and delivering a standard and reliable protocol. In this booklet, we include clear illustrations, extensive references, and annotated procedures to help nurses identify potential problem areas and carry out effective patient care. The Working Group decided to include topics such as indications and contraindications, equipment, nursing principles, and interventions in catheter-related care, as well as education for patients and caregivers, and urethral dilatation. We also highlight the psychological and social aspects unique to the experience of patients performing IC that have a profound influence on QoL.

With our emphasis on delivering these guidelines based on evidence and expert opinion, we intend to support nurses and practitioners who are already assessed as competent in IC procedures. Although these guidelines aim to be comprehensive, effective practice can only be achieved if the nurse or practitioner has a clear and thorough knowledge of the anatomy and physiology under discussion, and the necessary understanding of basic nursing principles.

This publication focuses on urethral IC and intermittent urethral dilatation. These guidelines are intended to complement, or provide support to, established clinical practice and should be used within the context of local policies and existing protocols and with recognition of the individual situation of the patient.

This text is made available to all individual EAUN members. The full text can be accessed on the EAUN website (www.eaun.org).