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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>National Clinical Guideline Centre (UK). Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease. London: Royal College of Physicians (UK); 2012 Aug. (NICE Clinical Guidelines, No. 148.)</p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/nicecg148/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-nicecg148-lrg.png" alt="Cover of Urinary Incontinence in Neurological Disease" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>Urinary Incontinence in Neurological Disease: Management of Lower Urinary Tract Dysfunction in Neurological Disease.</h2><a data-jig="ncbitoggler" href="#__NBK132818_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK132818_dtls__"><div>NICE Clinical Guidelines, No. 148.</div><div>National Clinical Guideline Centre (UK).</div><div>London: <a href="https://www.rcp.ac.uk/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">Royal College of Physicians (UK)</a>; 2012 Aug.</div></div><div class="half_rhythm"><ul class="inline_list"><li style="margin-right:1em"><a class="bk_cntns" href="/books/n/nicecg148/">Contents</a></li></ul></div><div class="bk_noprnt"><form method="get" action="/books/n/nicecg148/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div><div class="icnblk_cntnt two_col"><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg148/ch10/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg148/ch12/" title="Next page in this title">Next ></a></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK132818_"><span class="label"> 11</span><span class="title" itemprop="name">Management with catheter valves</span></h1></div><div class="body-content whole_rhythm" itemprop="text"><div id="ch11.s1"><h2 id="_ch11_s1_">11.1. Catheter valves</h2><div id="ch11.s2"><h3>11.1.1. What is the safety and efficacy of the catheter valve compared with urinary drainage bags in neurological disease?</h3><div id="ch11.tu1" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK132818/table/ch11.tu1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch11.tu1_lrgtbl__"><table><thead><tr><th id="hd_h_ch11.tu1_1_1_1_1" colspan="2" rowspan="1" style="text-align:left;vertical-align:bottom;">Clinical Methodological Introduction</th></tr></thead><tbody><tr><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population:</td><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Incontinence due to <a class="def" href="/books/n/nicecg148/glossary.gl2/def-item/glossary.gl2-d47/">neurogenic</a> lower urinary tract dysfunction (NLUTD)</td></tr><tr><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d66/">Intervention</a>:</td><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Catheter valve</td></tr><tr><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Comparison:</td><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Urinary drainage bags</td></tr><tr><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Outcomes:</td><td headers="hd_h_ch11.tu1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">No. of incontinence episodes per week<br />Patient and carer perception of symptoms<br /><a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d101/">Quality of life</a><br />Kidney function (<a class="def" href="/books/n/nicecg148/glossary.gl2/def-item/glossary.gl2-d32/">hydronephrosis</a>)<br />Treatment adherence<br />Adverse events (UTI, catheter blockage)<br />Successful trial without a catheter</td></tr></tbody></table></div></div><p>We searched for RCTs and observational studies comparing the <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d40/">effectiveness</a> of catheter valves as interventions for improving outcomes for patients with neurological disease or injury. We looked for any RCTs or observational studies that compared the effectiveness of one or more of catheter valves with urinary drainage bags.</p><div id="ch11.s3"><h4>11.1.1.1. Clinical Evidence Review</h4><p>No RCTs or observational studies were identified comparing catheter valves with urinary drainage bags for improving outcomes in patients with incontinence due to NLUTD.</p></div><div id="ch11.s4"><h4>11.1.1.2. Economic evidence</h4><p>No relevant economic evaluations comparing catheter valves with urinary drainage bags were identified.</p><div id="ch11.s5"><h5>Unit costs</h5><p>In the absence of recent UK <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d29/">cost-effectiveness analysis</a>, relevant unit costs are provided below to aid consideration of cost-effectiveness.</p></div><div id="ch11.s6"><h5>Economic considerations</h5><p>Catheter valves and day use urinary drainage bags (<a class="figpopup" href="/books/NBK132818/table/ch11.t1/?report=objectonly" target="object" rid-figpopup="figch11t1" rid-ob="figobch11t1">Table 105</a>) are similar in cost and both are used in current practice. However, when considered at the cost per annum, urinary drainage bags, used on their own, are the marginally cheaper <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d66/">intervention</a>; this is due to the slight increase in cost associated with catheter valves. Extra costs for fitting the valves will have to be considered also, however this is not considered to be high and can be done by the patient or carer readily with minimal training.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figch11t1"><a href="/books/NBK132818/table/ch11.t1/?report=objectonly" target="object" title="Table 105" class="img_link icnblk_img figpopup" rid-figpopup="figch11t1" rid-ob="figobch11t1"><img class="small-thumb" src="/books/NBK132818/table/ch11.t1/?report=thumb" src-large="/books/NBK132818/table/ch11.t1/?report=previmg" alt="Table 105. Unit Cost of catheter valves and urinary drainage bags." /></a><div class="icnblk_cntnt"><h4 id="ch11.t1"><a href="/books/NBK132818/table/ch11.t1/?report=objectonly" target="object" rid-ob="figobch11t1">Table 105</a></h4><p class="float-caption no_bottom_margin">Unit Cost of catheter valves and urinary drainage bags. </p></div></div></div></div><div id="ch11.s7"><h4>11.1.1.3. Evidence statements</h4><div id="ch11.s8"><h5>Clinical Evidence statement</h5><p>No clinical <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d44/">evidence</a></p></div><div id="ch11.s9"><h5>Economic evidence statements</h5><p>The costs of the interventions are similar. However there is no <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d44/">evidence</a> of benefit of one <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d66/">intervention</a> over the other in terms of reducing incontinence. However, taken as a whole it is very likely that the costs associated with the interventions will easily be offset by the benefits of incontinence reduction and the reduction in cost of incontinence aids.</p><p>If one <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d66/">intervention</a> is shown to be associated with fewer infections, then it is likely that this intervention will be cost effective compared with the other.</p></div></div></div><div id="ch11.s10"><h3>11.1.2. Recommendations and links to evidence</h3><div id="ch11.tu2" class="table"><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK132818/table/ch11.tu2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__ch11.tu2_lrgtbl__"><table><thead><tr><th id="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Recommendations:</th><th id="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"><u>MANAGEMENT WITH CATHETER VALVES</u>
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<dl class="temp-labeled-list"><dt>47.</dt><dd><p class="no_top_margin">In people for whom it is appropriate a catheter valve may be used as an alternative to a drainage bag.</p><p>[This recommendation is from ‘Infection: prevention and control of healthcare-associated infections in primary and community care’ (NICE clinical guideline 139).]</p></dd><dt>48.</dt><dd><p class="no_top_margin">To ensure that a catheter valve is appropriate, take into consideration the person’s preference, family member and carer support, manual dexterity, cognitive ability, and lower urinary tract function when offering a catheter valve as an alternative to continuous drainage into a bag.</p></dd><dt>49.</dt><dd><p class="no_top_margin">Consider the need for continuing upper urinary tract surveillance in people who have impaired bladder storage (for example, due to reduced bladder compliance).</p></dd></dl></th></tr></thead><tbody><tr><td headers="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Relative value placed on the outcomes considered</td><td headers="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The GDG recognised the high value placed on <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d101/">quality of life</a>.</td></tr><tr><td headers="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Economic considerations</td><td headers="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The clinical review will inform which one should be used in which group of patients, and this is likely to lead to cost savings as clinicians will avoid recommending the wrong equipment for use and later switching to the other option. Using both options at the same time will also be avoided.<br />Based on a simple cost analysis based on unit costs and GDG assumptions on the quantity of resources needed, catheter valves and urinary drainage bags have similar costs.<br />As the clinical review has revealed that there is no difference in incontinence, the main issue to consider in terms of cost <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d40/">effectiveness</a> is the risk of urinary tract infections and adherence (patient comfort). If one <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d66/">intervention</a> is shown to be associated with fewer infections, then this will probably be cost effective, due to a reduction in longer term costs. The greater the comfort of the patient also will lead to better adherence and greater <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d40/">effectiveness</a> of the treatment A fairly simple analysis of cost allows us to see that while there is very little difference between catheter valve and bag usage, using drainage bags rather than non drainable bags is cheaper. Whether they are more cost effective is dependent on the prevalence of infection and patient comfort.</td></tr><tr><td headers="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality of <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d44/">evidence</a></td><td headers="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">There was no <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d44/">evidence</a> of harm or benefit available to the GDG as no relevant studies were identified in the literature review. Recommendations on the use of catheter valves were made on the basis of the clinical experience of the GDG members.</td></tr><tr><td headers="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Trade-off between clinical benefits and <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d52/">harms</a></td><td headers="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">In selected patients there may be significant <a class="def" href="/books/n/nicecg148/glossary.gl1/def-item/glossary.gl1-d101/">quality of life</a> benefits from the use of intermittent bladder drainage using a catheter valve rather than continuous drainage of urine into a bag but there is a risk of harm (in the form of incontinence, infection and renal damage) if catheter valves are used in patients whose bladders are not capable of storing urine at safe pressures.<br /><br />The GDG agreed that the recommendation from the Infection control guideline be incorporated.</td></tr><tr><td headers="hd_h_ch11.tu2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Other considerations</td><td headers="hd_h_ch11.tu2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">The GDG noted that the use of catheter valves was dependent on the patient’s cognitive ability, dexterity, or the availability of a carer to assist and these factors need to be considered when drawing up an individuals support plan. A valve may not be suitable for all patients, however the group agreed that a valve was often the option preferred by patients, because of convenience, the feeling of increased control over their bladder management and the relatively discreet nature of a valve as opposed to a leg bag.</td></tr></tbody></table></div></div></div></div><div id="bk_toc_contnr"></div></div></div>
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<div class="post-content"><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © 2012, National Clinical Guideline Centre.<p class="small">Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.</p><p class="small">The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.</p><p class="small">The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.</p></div><div class="small"><span class="label">Bookshelf ID: NBK132818</span></div><div style="margin-top:2em" class="bk_noprnt"><a class="bk_cntns" href="/books/n/nicecg148/">Contents</a><div class="pagination bk_noprnt"><a class="active page_link prev" href="/books/n/nicecg148/ch10/" title="Previous page in this title">< Prev</a><a class="active page_link next" href="/books/n/nicecg148/ch12/" title="Next page in this title">Next ></a></div></div></div></div>
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