First Report

U.S. Patient and Clinician Experiences With the inFlow™ Urinary Prosthesis for Permanent Urinary Retention in Women

Leanne Schimke, MSN, FNP-C, CRNP, CUNP; Kevin M. Connolly


Urol Nurs. 2020;40(2):61-73. 

In This Article

Current Medical Treatment Options

Permanent urinary retention in women is most often of neurologic origin; therefore, it is generally incurable, and according to Aldamanhori and colleagues (2018), there are few clinical treatment options. For the vast majority of women with PUR, their only choice has been essentially to choose which type of urinary catheter they wish to use for bladder drainage: either clean intermittent catheterization (CIC), which requires inserting a tube into the bladder 4 to 6 or more times daily, or indwelling catheterization, which requires a tube connected to a urine bag to remain in the bladder at all times. Although a 2013 Cochrane systematic review (Jamison et al., 2013) found that due to the absence of methodologically strong trials, it was not possible to reach any conclusions regarding preferred use of different types of catheters in managing neurogenic bladder, CIC is considered the standard of care because it is thought to have a lower rate of infection than indwelling catheters and is recommended by the most current guidelines from the Infectious Diseases Society of America (Hooten et al., 2010). A recent systematic review (Kinnear et al., 2019) found low level of evidence regarding CIC being associated with lower rates of urinary tract infection (UTI) than an indwelling urethral catheter in women with spinal cord injuries.

Clean intermittent catheterization must be performed as often as 200 times per month; thus, this option is largely restricted for women who are able to perform self-catheterization – something not all women with PUR can do. Many women with PUR have a disabling primary medical condition that hinders their ability to perform CIC and may lack the necessary hand dexterity, visual acuity, or ability to position themselves appropriately. In addition, as Crescenze and colleagues (2019) relate, some women perceive the CIC procedure as embarrassing and even shameful, likely because it requires repeated touching of the genital area in an unfamiliar fashion. Among this group are older women and those with certain cultural beliefs.

Currently, the only alternative for women who cannot (or will not) use CIC is an indwelling catheter. This is despite that for some time, reducing the use of indwelling catheters has been a major health care priority by the U.S. Department of Health and Human Services (DHHS) (2009) and the Centers for Medicare and Medicaid Services (CMS) (2008) due to the exceedingly high rate of infection associated with indwelling catheterization. In an unfortunate sequela, multiple infections in a medically compromised population, such as women with PUR, increase the likelihood of sepsis. Paoli and colleagues (2018) noted that hospital sepsis costs rose to $24 billion per year based on 2015–2018 data, which means that at an average cost of $70,000 per case, sepsis is the most expensive condition treated in U.S. hospitals.