It is required to manage urinary tract dysfunction cases in various diseases at acute care unit in general hospital. Indwelling urinary catheters (IUCs) initially placed in acute care frequently in local hospitals in Japan.  Inappropriate use of IUCs or continued overuse of IUCs in acute care leads to both infectious and non-infectious complications, and prevents self-supporting life of patients. On another front, many of the patients in acute care have increasing post voiding residual bladder volume (PVR). even among those without IUCs.  If abnormal PVR increasing is missed, that may lead to complications for upper urinary tract.  It is important to detect and manage cases with voiding dysfunction appropriately in early period of hospital stay. This study aimed to evaluate the population of urinary dysfunction in each unit of acute care and interventions underwent after removal of catheter.

We started team approach for urinary dysfunction cases since January 2017 by continence care team formed by urologists, nurses, physiotherapists and occupational therapists. The continence care team made rounds in all unit of our institution (550 beds) . The team prompted the medical staffs to remove IUCs in early period, and provided suggestions how to evaluate and manage cases with voiding dysfunction. We prepared ultrasonic bladder scanner in each ward for evaluation of post voiding residual bladder volume (PVR). Medical staffs evaluate patients with frequency-volume chart and measurement of PVR. The continence care team also recommended clean intermittent catheterization  (CIC) by nurses for patients with increasing PVR, and enforced rehabilitation for improvement of activity of daily living including toilet activity. We searched the patient variables obtained from the charts; age, sex,admitting diagnosis and catheterization status at discharge.

We performed team approach for 721 patients between January 2017 and December 2018. Of these patients, 416(58.4%) were male and 296(41.6%) were female, the mean age was 74.6(range 15 to 102 years old) . 416(58.4%) patients were 75 years of age and older, 206(49.5%) were male and 210(50.5%) were female. 431(60.5%) patients had IUCs during the hospital stay. Increasing PVR requiring drainage was confirmed in 610(85.7%) and of these patients 354(58.0%) had IUCs. The admitting diagnosis of the cases with increasing PVR including urological and non-urological, neurogenic and non-neurogenic, various categories (Table). Drug intervention was performed for 216(30.3%) by urologist. Nurses managed the patients with increasing PVR by CIC until the PVR decrease below 100-ml. Rehabilitation staffs of the continence care team distribute the information to nurses how to train patient toilet activity in each ward. 312(43.8%) patients were discharged to home, 289(40.6%) to another hospitals for rehabilitation, 50(0.7%) to nursing home and 61(8.6%) were died. Of all patients 477(67.0%) were discharged without any catheterization, 57(8.0%) were trained to perform clean intermittent self-catheterization (CISC) and 30(4.2%) had indwelling catheter at discharge (including 14 dead cases).

We found that patients with various diagnosis have urinary dysfunction in acute care unit whether they are affected with neurogenic diseases or not. This study also shows many patients without indwelling catheter have increasing PVR requiring drainage. It is important for medical staffs in all department to acquire screening skills how to evaluate and manage voiding dysfunction in each patient with any diseases or catheterization status. Early intervention, not only pharmaceutical therapy but also proper CIC management and training of toilet activity for patients with voiding dysfunction lead them to independence from unnecessary use of indwelling catheter and self-support of continence.

It is important for medical staffs working in any unit in acute care, whether they are involved in neurological disease or not, to have adequate knowledge and skills to assess and manage appropriately the urinary tract problems of patients. We should provide information about prevalence of voiding dysfunction in various diseases to assigned medical staffs  regularly.