Table 11Summary of studies included in the clinical evidence review

StudyStudy typeUnderlying pathologyAge range (yrs)Follow up (range)Intervention detailsOutcomes reported
Cardenas 200432(N= 58)RCTSCINot specified, but adult5–6 monthsCounselling on IC technique and fluid management and discussion with the physician on UTI symptoms, the processes of seeking medical treatment for a symptomatic UTI and problems in accessing treatment. All information was backed up by a booklet.Episodes of symptomatic UTIs; Health beliefs; Locus of control; self efficacy
Hagglund 200533(N= 60)Non randomised trialSCINot specified, but probably adult6 months6 hour personal assistance services (PAS) training workshop. The workshop addressed prevention of common secondary conditions. It was chaired by a SCI physician, who provided information on preventing and treating pressure sores, UTIs, spasms, and autonomic dysreflexia. There was also information on bowel and bladder programs, general nutrition and weight loss strategies. Bladder management topics include types of catheters, proper insertion techniques, sterilisation and handling of reusable catheters, and signs of infection. UTI prevention was discussed alongside the use of an 8 minute video.Symptomatic UTIs in the past 6 months
Anderson 198334(n=75)Non randomised trialSCINot specified, but probably adult6 months post dischargeA training program of discussion periods followed by practical workshops. During the rehabilitation phase the patients attended 5 classes of 45 minutes each, on the topics of urinary tract care anatomy and physiology; bacteriology and UTI; monitoring the urinary tract, including danger signs and prevention; modes of urinary drainage, disinfection and appliance care; and trial of voiding and intermittent catheterisation. In addition, an instruction manual was developed for the patients and their families, who were also invited to join the teaching sessions. Patients were expected to follow the information and advice at home.Symptomatic UTIs in the past 6 months
Barber 199935
Prospective observational studySCINot specified, but probably adult6 months or longer (not specified)Intensive counselling by the clinic nurse with respect to proper clean intermittent catheterisation (CIC) technique, daily external condom catheter application and care, appropriate cleansing of supplies with dilute sodium hypochlorite solution and daily perineal hygiene. Sessions lasted 15–30 minutes. If the patient continued to exceed the threshold of 2 or more UTIs in the following 6 month period then they were either given further intensive counselling sessions, or placed on antibiotic therapy.<2 Symptomatic UTIs in a 6 month post intervention period signified a positive outcome.

From: 7, Information and Support

Cover of Urinary Incontinence in Neurological Disease
Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.
NICE Clinical Guidelines, No. 148.
National Clinical Guideline Centre (UK).
Copyright © 2012, National Clinical Guideline Centre.

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