1
|
Sartori AM, Kessler TM, Castro-Díaz DM, de Keijzer P, Del Popolo G, Ecclestone H, Frings D, Groen J, Hamid R, Karsenty G, Musco S, Padilla-Fernández B, Pannek J, Schouten N, van der Vorm A, Blok BFM. Summary of the 2024 Update of the European Association of Urology Guidelines on Neurourology. Eur Urol 2024; 85:543-555. [PMID: 38594103 DOI: 10.1016/j.eururo.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND AND OBJECTIVE Most patients with neurourological disorders require lifelong medical care. The European Association of Urology (EAU) regularly updates guidelines for diagnosis and treatment of these patients. The objective of this review is to provide a summary of the 2024 updated EAU guidelines on neurourology. METHODS A structured literature review covering the timeframe 2021-2023 was conducted for the guideline update. A level of evidence and a strength rating were assigned for each recommendation on the basis of the literature data. KEY FINDINGS AND LIMITATIONS Neurological conditions significantly affect urinary, sexual, and bowel function, and lifelong management is required for neurourological patients to maintain their quality of life and prevent urinary tract deterioration. Early diagnosis and effective treatment are key, and comprehensive clinical assessments, including urodynamics, are crucial. Management should be customised to individual needs and should involve a multidisciplinary approach and address sexuality and fertility. Lifelong monitoring and follow-up highlight the importance of continuous care for neurourological patients. CONCLUSIONS AND CLINICAL IMPLICATIONS The 2024 EAU guidelines on neurourology provide an up-to-date overview of available evidence on diagnosis, treatment, and follow-up for neurourological patients. PATIENT SUMMARY Neurological disorders very frequently affect the lower urinary tract and sexual and bowel function and patients need lifelong management. We summarise the updated European Association of Urology guidelines on neurourology to provide patients and caregivers with the latest insights for optimal health care support.
Collapse
Affiliation(s)
- Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David M Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Peter de Keijzer
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Giulio Del Popolo
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | | | - Dennis Frings
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Stefania Musco
- Department of Neuro-urology, Careggi University Hospital, Florence, Italy
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Jürgen Pannek
- Neuro-Urology Department, Swiss Paraplegic Center, Nottwil, Switzerland; Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | | | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
2
|
Zacharia SS, Thomas R, George J. Adherence of spinal cord injury patients in the community to self-clean intermittent catheterization (CIC) within 12 months of discharge following rehabilitation: A telephone survey. J Spinal Cord Med 2024:1-7. [PMID: 38819985 DOI: 10.1080/10790268.2024.2352931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Abstract
CONTEXT Spinal cord injury often results in neurogenic bladder affecting storage or emptying functions of the bladder. Clean intermittent catheterization (CIC) is considered the gold standard for patients with neurogenic bladder dysfunction. Our study aims to assess the adherence of patients to CIC following discharge from rehabilitation. OBJECTIVE PRIMARY: To assess the adherence of patients with spinal cord injury in the community to self-CIC within 12 months of discharge. SECONDARY: To study the reasons and analyze the factors associated with discontinuation of CIC and to assess the perception of patients regarding CIC. METHODS Prospective follow-up of a retrospective cohort in 121 individuals with paraplegia who were trained to do CIC for bladder management. After obtaining telephonic consent, a questionnaire-based interview was conducted. RESULTS Out of 121 patients, 97 (80.2%) were males and 24 (19.8%) were females. The mean age was 35.8 ± 11.6 years. About 89 (73.6%) patients were continuing CIC as the primary mode of bladder management after discharge. However, only 18 (15%) patients were fully compliant with the CIC technique, 71 (59%) were partially compliant and 32 (26%) patients discontinued CIC. Reasons for the discontinuation of CIC included medical complications (78%), including leaks, recurrent UTI, hematuria, ulcers, back pain, and spasticity, and other factors like difficulty in following the timing of CIC (12.5%), issues with positioning (3.1%), and difficulty in restricting fluid intake (6.3%). CONCLUSION This study highlights the need for regular follow-up as well as education of patients regarding CIC technique, complications, care, and hygiene while doing CIC which can result in improved adherence to CIC.
Collapse
Affiliation(s)
- Saumya Susan Zacharia
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Raji Thomas
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| | - Jacob George
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, India
| |
Collapse
|
3
|
Wong V, Ippolito GM, Crescenze I. Integrating Patient Preferences with Guideline-Based Care in Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury. Urol Clin North Am 2024; 51:277-284. [PMID: 38609199 DOI: 10.1016/j.ucl.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Individual and social factors are important for clinical decision-making in patients with neurogenic bladder secondary to spinal cord injury (SCI). These factors include the availability of caregivers, social infrastructure, and personal preferences, which all can drive bladder management decisions. These elements can be overlooked in clinical decision-making; therefore, there is a need to elicit and prioritize patient preferences and values into neurogenic bladder care to facilitate personalized bladder management choices. For the purposes of this article, we review the role of guideline-based care and shared decision-making in the SCI population with neurogenic lower urinary tract dysfunction.
Collapse
Affiliation(s)
- Vivian Wong
- Department of Urology, Ohio State University, 915 Olentangy River Road, Suite 3100, Room 3105, Columbus, OH 43212, USA.
| | - Giulia M Ippolito
- Department of Urology, University of Michigan, 1733 Monterey Court, Ann Arbor, MI 48108, USA
| | - Irene Crescenze
- Department of Urology, Ohio State University, 915 Olentangy River Road, 2nd Floor Suite 2000, Columbus, OH 43212, USA
| |
Collapse
|
4
|
Myers JB, Kurtzman JT. Bladder-Related Quality of Life After Spinal Cord Injury: Findings from the Neurogenic Bladder Research Group Spinal Cord Injury Registry. Urol Clin North Am 2024; 51:163-176. [PMID: 38609189 DOI: 10.1016/j.ucl.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
The Neurogenic Bladder Research Group (NBRG) was formed with the mission to optimize quality of life (QoL), surgical outcomes, and clinical care of patients with neurogenic lower urinary tract dysfunction. One of the original priorities of the organization was to support creation of the NBRG Spinal Cord Injury (SCI) Registry. The aim of this Registry was to establish a prospective database, in order to study bladder-related QoL after SCI. The study enrolled close to 1500 participants from across North America over an 18 month time-period (January 2016-July 2017).
Collapse
Affiliation(s)
- Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA.
| | - Jane T Kurtzman
- Division of Urology, Department of Surgery, University of Utah, 50 N Medical Drive, Salt Lake City, UT, 84103, USA
| |
Collapse
|
5
|
Elliott CS, Seufert C, Zlatev D, Kreydin E, Crew J, Shem K. Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury? J Spinal Cord Med 2024; 47:239-245. [PMID: 34792429 PMCID: PMC10885770 DOI: 10.1080/10790268.2021.1999715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION One of the most important predictors of clean intermittent catheterization (CIC) adoption after spinal cord injury (SCI) is upper extremity (UE) motor function at discharge from rehabilitation. It is not clear however if post-discharge improvements in UE motor function affect future bladder management decisions. METHODS We assessed persons with cervical SCI in the National Spinal Cord Injury Dataset for the years 2000-2016 who underwent motor examination at discharge from rehabilitation and again at 1-year follow-up. Individuals were stratified based on a previously described algorithm which categorizes the ability to independently perform CIC based upon UE motor scores. Improvements in the predicted ability to self-catheterize over the first year after rehabilitation discharge were evaluated in relation to bladder management. RESULTS Despite 15% of our SCI cohort improving from "less than able to independently catheterize" to "able to independently catheterize", more patients in the overall cohort dropped out of CIC (175/643 = 27.2%) than adopted CIC (68/548 = 12.4%) (P < .001). We found that in those initially categorized as "less than able to independently catheterize" at the time of rehabilitation discharge, CIC adoption was not significantly different at 1-year follow-up whether or not there was motor improvement to "able to independently catheterize" (12.7% vs 9.2% respectively, P = 0.665). Between these two groups, CIC dropout was also equivalent (34.3% vs 30.0% respectively, P = 0.559). CONCLUSIONS In the first year after rehabilitation, more overall SCI patients transition away from CIC than convert to CIC. Significant improvements in UE motor function during the first year after rehabilitation discharge do not appear to affect bladder management decisions.
Collapse
Affiliation(s)
- Christopher S. Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Caleb Seufert
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Dimitar Zlatev
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Evgeniy Kreydin
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - James Crew
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
| |
Collapse
|
6
|
MacDiarmid S, Glazier DB, McCrery RJ, Kennelly MJ, Nelson M, Ifantides KB, McCammon KA. Efficacy and safety of an alternative onabotulinumtoxinA injection paradigm for refractory overactive bladder. Neurourol Urodyn 2024; 43:31-43. [PMID: 37746881 DOI: 10.1002/nau.25290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/05/2023] [Accepted: 09/13/2023] [Indexed: 09/26/2023]
Abstract
AIMS In studies utilizing a 20-injection-site paradigm of onabotulinumtoxinA treatment for overactive bladder (OAB), some patients performed clean intermittent catheterization (CIC). An alternative injection paradigm of fewer injections targeting the lower bladder may reduce the need for CIC by maintaining upper bladder function. This study evaluated the efficacy and safety of an unapproved alternative 10-injection-site paradigm targeting the lower bladder. METHODS In this phase 4, double-blind, parallel-group study, patients with OAB and urinary incontinence (UI) for ≥6 months with ≥3 episodes of urinary urgency incontinence (no more than 1 UI-free day) and ≥8 micturitions per day over 3 days during screening were randomized 2:1 to onabotulinumtoxinA 100 U or placebo injected at 10 sites in the lower bladder. RESULTS Of 120 patients, 78 in the onabotulinumtoxinA group and 39 in the placebo group had efficacy assessments. In the double-blind phase, mean change from baseline at week 12 in daily frequency of UI episodes was greater with onabotulinumtoxinA (-2.9) versus placebo (-0.3) (least squares mean difference [LSMD]: -2.99, p < 0.0001). Achievement of 100% (odds ratio [OR]: 6.15 [95% confidence interval, CI: 0.75-50.37]), ≥75% (OR: 7.25 [2.00-26.29]), and ≥50% improvement (OR: 4.79 [1.87-12.28]) from baseline in UI episodes was greater with onabotulinumtoxinA versus placebo. Reductions from baseline in the daily average number of micturitions (LSMD: -2.24, p < 0.0001), nocturia (LSMD: -0.71, p = 0.0004), and urgency (LSMD: -2.56, p < 0.0001) were greater with onabotulinumtoxinA than with placebo. Treatment benefit was improved or greatly improved in the onabotulinumtoxinA group (74.0% of patients) versus placebo (17.6%) (OR: 13.03 [95% CI: 3.23-52.57]). Mean change from baseline in Incontinence Quality of Life score was greater with onabotulinumtoxinA versus placebo (LSMD: 24.2, p = 0.0012). Two of 78 (2.6%) patients in the onabotulinumtoxinA group used CIC during the double-blind period; no females used CIC during the double-blind period. Commonly reported adverse events (≥5%) were urinary tract infection (UTI), dysuria, and productive cough for both groups; rate of UTI was higher with onabotulinumtoxinA versus placebo. CONCLUSION In patients treated with onabotulinumtoxinA for OAB with UI, an unapproved alternative injection paradigm targeting the lower bladder demonstrated efficacy over placebo, with a low incidence of CIC.
Collapse
Affiliation(s)
| | | | - Rebecca J McCrery
- Adult and Pediatric Urology and Urogynecology, Omaha, Nebraska, USA
- Virginia Urology, Richmond, Virginia, USA
| | | | | | | | | |
Collapse
|
7
|
Averbeck MA, Kennelly M, Thiruchelvam N, Konstantinidis C, Chartier-Kastler E, Krassioukov A, Landauro M, Jacobsen L, Vaabengaard R, Islamoska S. Risk factors for urinary tract infections associated with lower quality of life among intermittent catheter users. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S8-S16. [PMID: 37830866 DOI: 10.12968/bjon.2023.32.18.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Evidence shows that intermittent catheterisation (IC) for bladder emptying is linked to urinary tract infections (UTIs) and poor quality of life (QoL). AIM To investigate the association between UTI risk factors and QoL and patient-reported UTIs respectively. METHODS A survey was distributed to IC users from 13 countries. FINDINGS Among 3464 respondents, a significantly poorer QoL was observed when experiencing blood in the urine, residual urine, bowel dysfunction, recurrent UTIs, being female, and applying withdrawal techniques. A lower UTI risk was found when blood was not apparent in urine (RR: 0.63; 95% CI: 0.55-0.71), the bladder was perceived empty (RR: 0.83; 95% CI: 0.72-0.96), not having bowel dysfunction (RR: 0.86; 95% CI: 0.76-0.98), and being male (RR: 0.70; 95% CI: 0.62-0.79). CONCLUSION This study underlines the importance of risk factors and their link to QoL and UTIs, highlighting the need for addressing symptoms before UTIs become problematic.
Collapse
Affiliation(s)
| | - Michael Kennelly
- Professor and Director, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Emmanuel Chartier-Kastler
- Professor and Head of Urology, Sorbonne Université, Academic hospital Pitié Salpétrière, Paris, France
| | - Andrei Krassioukov
- Principal Investigator, Professor and Associate Director, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, The University of British Columbia; GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority; Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Malene Landauro
- Senior Medical Writer, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Lotte Jacobsen
- Principal Biostatistician, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Rikke Vaabengaard
- Lead Medical Specialist, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
| | - Sabrina Islamoska
- Senior Evidence Manager, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
| |
Collapse
|
8
|
Santos-Pérez de la Blanca R, Medina-Polo J, González-Padilla D, Cano-Galán MM, Arrébola-Pajares A, Hernández-Arroyo M, Rodríguez-Antolín A. Evaluation of Quality of Life and Self-reported Complications in Patients With Clean Intermittent Catheterization: An Observational Study. J Wound Ostomy Continence Nurs 2023; 50:400-405. [PMID: 37713351 DOI: 10.1097/won.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE This study sought to determine health-related quality of life and self-reported complications associated with clean intermittent catheterization (CIC). DESIGN Observational, cross-sectional study. SUBJECTS AND SETTING The target population was patients cared for by the urology department at Hospital 12 de Octubre in Madrid, Spain, undergoing CIC for chronic urinary retention of any etiology (neurogenic bladder dysfunction, neobladder, and other). The sample comprised 50 respondents with a mean age of 49 years; a majority (66%, n = 33) were female. Participants performed an average of 4 CICs. METHODS All participants completed the ISC-Q (Intermittent Self-Catheterization Questionnaire) and a questionnaire about CIC-associated complications. Data were collected in February 2019. RESULTS A vast majority of respondents (98%, n = 49) indicated preparation for catheterization was simple, and 76% (n = 38) indicated the catheter was easy to insert. One in 5 (20%, n = 10) considered carrying catheters and supplies inconvenient, though 58% (n = 29) indicated it was easy to dispose of the catheters outside the home. Most respondents (98%, n = 49) indicated they felt self-conscious about their need to self-catheterize, and 16% (n = 8) felt that CIC created limitations when visiting friends and family. The most frequent complication was symptomatic urinary tract infections (UTIs); participants reported an average of 1.7 UTIs in the last year. Additional complications, such as epididymo-orchitis, urethral stenosis, and urethral bleeding, were reported by less than 5% (n = 2) of participants. CONCLUSIONS Participants managed by CIC for chronic urinary retention of any cause reported acceptable levels of satisfaction with the procedure. The reported incidence of complications was low, except for UTIs.
Collapse
Affiliation(s)
- Rocío Santos-Pérez de la Blanca
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - José Medina-Polo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Daniel González-Padilla
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - María Mercedes Cano-Galán
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Ana Arrébola-Pajares
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Mario Hernández-Arroyo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Alfredo Rodríguez-Antolín
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| |
Collapse
|
9
|
Takahashi R, Sekido N, Matsuoka M, Sengoku A, Nomi M, Matsuyama F, Murata T, Kitta T, Mitsui T. Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan. Low Urin Tract Symptoms 2023; 15:165-172. [PMID: 37300392 DOI: 10.1111/luts.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI). METHODS We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI. RESULTS Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI. CONCLUSIONS There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.
Collapse
Affiliation(s)
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital, Osaka, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | | | | | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Yamanashi, Japan
| |
Collapse
|
10
|
Landauro MH, Jacobsen L, Tentor F, Pedersen T, Rovsing C, Feix do Nascimento O, Kennelly M. New Intermittent Urinary Micro-Hole Zone Catheter Shows Enhanced Performance in Emptying the Bladder: A Randomised, Controlled Crossover Study. J Clin Med 2023; 12:5266. [PMID: 37629309 PMCID: PMC10455232 DOI: 10.3390/jcm12165266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Urinary tract infections (UTIs) are common and troublesome complications of clean intermittent catheterisation (CIC) in individuals suffering from incomplete bladder emptying, which may exacerbate the underlying disease and lead to hospitalisation. Aside from the design of the intermittent catheter and its handling, a recent review highlighted residual urine as one of several UTI risk factors. A new urinary intermittent catheter with multiple micro-holes has been developed for improved bladder emptying. In a controlled crossover study, adult male CIC users were randomised for a health care professional-led catheterisation with the new micro-hole zone catheter (MHZC) and a conventional eyelet catheter (CEC) in two individual test visits to compare the number of flow-stops and the residual urine at the first flow-stop as co-primary endpoints. In 42 male CIC users, the MHZC resulted in significantly fewer flow-stop episodes compared to the CEC (mean 0.17, 95% CI [0.06, 0.45] vs. mean 1.09, 95% CI [0.75, 1.6], respectively; p < 0.001) and significantly less residual urine at the first flow-stop (mean 5.10 mL, SE [1.14] vs. mean 39.40 mL, SE [9.65], respectively; p < 0.001). No adverse events were observed in this study. The results confirm the enhanced performance of the MHZC compared to a CEC, ensuring an uninterrupted free urine flow with no need to reposition the catheter until the bladder is thoroughly empty.
Collapse
Affiliation(s)
| | - Lotte Jacobsen
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | - Fabio Tentor
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | - Troels Pedersen
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | | | | | - Michael Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, NC 28207, USA;
| |
Collapse
|
11
|
Lauridsen SV, Averbeck MA, Krassioukov A, Vaabengaard R, Athanasiadou S. UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management. BMC Nurs 2022; 21:272. [PMID: 36199133 PMCID: PMC9535847 DOI: 10.1186/s12912-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user. METHODS The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs. RESULTS The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section. CONCLUSIONS The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.
Collapse
Affiliation(s)
- S V Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark. .,WHO-CC, Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
| | | | - A Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Endowment Lands, Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | | | | |
Collapse
|
12
|
Liu J, Bi Y, Liu Y, Tang L, Wang A. Value of sufficient clean intermittent catheterization in urinary tract infection and upper urinary tract protection in children with neurogenic bladder. J Pediatr Urol 2022; 18:499.e1-499.e6. [PMID: 35527206 DOI: 10.1016/j.jpurol.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is a mainstay in the management of neurogenic bladder. OBJECTIVE To assess the effect of CIC on urinary tract infection and upper renal tract function in pediatric patients with neurogenic bladder, and the influence of duration of CIC on these variables. STUDY DESIGN A retrospective study was performed in 67 pediatric patients with neurogenic bladder who started CIC between 2014 and 2019 at our institution. The febrile urinary tract infection (fUTI) rate, renal pelvis diameter (measured by antero-posterior renal pelvis diameter, APPD), bladder wall thickness (BWT) on ultrasound, and creatinine level at 6 months and 12 months of CIC were compared with baseline in all patients. The grade of vesicoureteral reflux (VUR) at 12 months of CIC were also compared with baseline. RESULTS There were no significant differences compared with baseline after 6 months of CIC in the rate of fUTI, APPD, and BWT (p > 0.05); however, all of these parameters significantly improved after 12 months of CIC (p < 0.05). The VUR grade was significantly reduced after 12 months of CIC(p = 0.03). There was no significant change in serum creatinine level with any duration of CIC (both p > 0.05). DISCUSSION Continuing CIC for more than 6 months had a beneficial influence on protecting the upper urinary tract. Complications of CIC, such as recurrent fUTI and lower urinary tract trauma, are more likely to occur in the early stage of CIC due to poor technique by the caregivers and poor patient compliance underscoring the importance of caregiver education. Study limitations include the retrospective nature and small sample size. CONCLUSION CIC for less than 6 months may have limited influence on renal protection; however, a longer duration of CIC (12 months) resulted in significant improvement in outcomes. This study demonstrates the importance of proper caregiver education to establish standardized CIC techniques and to improve CIC quality.
Collapse
Affiliation(s)
- Jialin Liu
- Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Yunli Bi
- Department of Urology, Children's Hospital of Soochow University, 92# Zhongnan Street, SIP, Suzhou, 215025, China.
| | - Ying Liu
- Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Liangfeng Tang
- Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| | - Anle Wang
- Department of Urology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, China.
| |
Collapse
|
13
|
Recovering Voiding and Sex Function in a Patient with Chronic Complete Spinal Cord Injury by Olfactory Ensheathing Cell Transplantation. Case Rep Neurol Med 2022; 2022:9496652. [PMID: 35846867 PMCID: PMC9279098 DOI: 10.1155/2022/9496652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/08/2022] [Accepted: 06/18/2022] [Indexed: 11/21/2022] Open
Abstract
Spinal cord injury (SCI) is life-altering damage for patients, their family, and society. Transplantation of olfactory ensheathing cells has demonstrated neurorestoration effects for many neurological conditions, including SCI. But voiding and sex dysfunction in patients with chronic complete SCI is still a major issue even though neurorestorative therapies can restore their partial neurological functions. Here we report a case with traumatic complete SCI at the level of C6-C7 one year ago, who received OEC transplantation with intensive neurorehabilitation. The patient started to show clinical improvements within a few days after cell treatment. Six-year follow-up demonstrated his American Spinal Injury Association (ASIA)-Impairment Scale change from ASIA A to become ASIA C. The scores of International Association of Neurorestoratology Spinal Cord Injury Functional Rating Scale changed from 14 (prior to cell therapy) to 31 + 3 (six years after cell therapy). His main improvements in activity of daily life included eating, dressing and writing by himself, standing and walking, and urine control or voiding. His sex function recovered to be normal. He married and had a son through natural sex life. His improving functions and activities of daily life stayed stable in subsequent phone call follow-up. This was one individual case report. In the future, the deep mechanisms of why he got positive results, but other patients with similar condition did not get so much benefits from OEC transplantation should be explored.
Collapse
|
14
|
Elliott SP. EDITORIAL COMMENT. Urology 2022; 165:79. [PMID: 35843700 DOI: 10.1016/j.urology.2022.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN
| |
Collapse
|
15
|
Hentzen C, Haddad R, Turmel N, Biardeau X, Bey E, Amarenco G, Denys P, Gamé X, Phé V, Peyronnet B, Perrouin-Verbe MA, Joussain C. [Prioritization of risk situations in neuro-urology: Guidelines based on the Delphi method from Association française d'urologie (AFU), Association francophone internationale des groupes d'animation de la paraplégie (AFIGAP), Groupe de neuro-urologie de langue française (GENULF), Société française de médecine physique et de réadaptation (SOFMER) and Société interdisciplinaire francophone d'urodynamique et de pelvi-périnéologie (SIFUD-PP)]. Prog Urol 2022; 32:635-655. [PMID: 35659166 DOI: 10.1016/j.purol.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE During the COVID-19 pandemic, a care reorganization was mandatory, and affected patients in different areas, including management of neurogenic lower urinary tract dysfunction. This work aims to provide validated schedule concerning the assessment and management of patients in neuro-urology. METHODS Based on a literature review and their own expertise, a steering committee composed of urologists and physical medicine and rehabilitation practitioners generated a comprehensive risk-situation list and built a risk scale. A panel of French-speaking experts in neuro-urology was asked to define the timing for each clinical situation and validated these new recommendations through a Delphi process approach. RESULTS The 49 experts included in the rating group validated 163 propositions among the 206 initial items. The propositions were divided into four domains - diagnosis and assessment, treatment, follow-up, and complications - and two sub-domains - general (applicable for all neurological conditions) and condition-specific (varying according to the neurological condition (spinal cord injury, multiple sclerosis, brain injury, Parkinsonism, spinal dysraphism, lower motor neuron lesions)). CONCLUSIONS This multidisciplinary collaborative work generates recommendations based on expert opinion, providing a validated timing for assessment and management of patients in neuro-urology which may help clinicians to reorganize their patients' list with a personalized medicine approach, in a context of health crisis or not.
Collapse
Affiliation(s)
- C Hentzen
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France.
| | - R Haddad
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - N Turmel
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France; Département de médecine physique et de réadaptation, hôpital Danièle-Casanova, 93205 Saint-Denis, France
| | - X Biardeau
- Département d'urologie, université de Lille, CHU de Lille, hôpital Claude-Huriez, 59000 Lille, France
| | - E Bey
- Département d'urologie et d'andrologie, CHU de Nîmes, université de Montpellier, Nîmes, France
| | - G Amarenco
- GRC 01, GREEN (groupe de recherche clinique en neuro-urologie), Sorbonne université, hôpital Tenon, AP-HP, 75020 Paris, France
| | - P Denys
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
| | - X Gamé
- Département d'urologie, transplanttion rénale et andrologie, CHU de Rangueil, TSA 50032, 31059 Toulouse, France
| | - V Phé
- Département d'urologie, Sorbonne Université, hôpital Tenon, AP-HP, Paris, France
| | - B Peyronnet
- Département d'urologie, université de Rennes, Rennes, France
| | - M A Perrouin-Verbe
- Département d'urologie, University of Nantes, hôtel Dieu Hospital, Nantes, France
| | - C Joussain
- Inserm, département de neuro-urologie et d'andrologie, service de médecine physique et de réadaptation, université Paris-Saclay, UMR 1179, hôpital Raymond-Poincaré, AP-HP, Paris, France
| |
Collapse
|
16
|
Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG, Callender L, Holderbaum L, King T, Jackson A, Tran T, Lin G, Smith AL. Results of the patient report of intermittent catheterization experience (PRICE) study. Neurourol Urodyn 2021; 40:2008-2019. [PMID: 34516673 DOI: 10.1002/nau.24786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients' actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC. METHODS This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). RESULTS Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a "blocking sensation" during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported. DISCUSSION/CONCLUSION Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.
Collapse
Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rita G Hamilton
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Leah Holderbaum
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Tamara King
- Shepherd Multispecialty Clinic, Shepherd Center, Inc., Atlanta, Georgia, USA
| | - Angela Jackson
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Thanh Tran
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - George Lin
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
17
|
Moghalu O, Stoffel JT, Elliott S, Welk B, Lenherr S, Herrick J, Presson A, Myers J. Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury. Spinal Cord 2021; 59:987-996. [PMID: 33495582 PMCID: PMC8483561 DOI: 10.1038/s41393-020-00609-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
STUDY DESIGN Prospective, multi-centered, observational. OBJECTIVES To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING Multi-institutional sites in the United States, cohort drawn from North America. METHODS We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p < 0.001; NBSS-satisfaction 0.6, p < 0.001; SCI-QoL Difficulties 2.4, p < 0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS -2.3, p = 0.03; NBSS-satisfaction -0.4, p < 0.001) and upper tertile SCI-QoL Positive Affect (NBSS -2.8, p < 0.001; NBSS-satisfaction -0.7, p < 0.001; SCI-QoL Difficulties -0.7, p < 0.001). CONCLUSIONS In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.
Collapse
Affiliation(s)
- Odinachi Moghalu
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Blayne Welk
- Department of Urology, Western University, London, ON, Canada
| | - Sara Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Jennifer Herrick
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
18
|
Maeda K, Hotta Y, Ieda N, Kataoka T, Nakagawa H, Kimura K. Control of rat bladder neck relaxation with NORD-1, a red light-reactive nitric oxide releaser: In vitro study. J Pharmacol Sci 2021; 146:226-232. [PMID: 34116736 DOI: 10.1016/j.jphs.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 01/06/2023] Open
Abstract
We aimed to control the relaxation of rat bladder neck specimens by using NORD-1, a red light-reactive nitric oxide (NO) releaser. Female and male 10-11-week-old Wistar/ST rats were divided into three groups: NORD-1, vehicle, and NORD-1+[1,2,4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ; a soluble guanylyl cyclase inhibitor). We infused 10-4 M NORD-1 into the bladders of NORD-1 and NORD-1+ODQ group rats and the vehicle into those of vehicle group rats. Isometric tension was analyzed using circular bladder neck specimens with 10-5 M NG-nitro-l-arginine methyl ester, an NO synthase inhibitor. Moreover, 10-5 M ODQ was added into the NORD-1+ODQ group bath. After precontraction with 10-5 M carbachol, the specimens were irradiated with red light and their relaxation responses were measured. We evaluated NORD-1 tissue permeability by observing the sliced bladder neck specimens. The NORD-1 group specimens relaxed during red light irradiation; the relaxation response increased with the increase in light intensity. The vehicle and NORD-1+ODQ group specimens did not respond to irradiation. Sex-related differences in responsiveness were not noted. NORD-1 permeated into the urothelium of NORD-1 group specimens. Rat bladder neck relaxation was controlled by NORD-1 and light irradiation in vitro. NORD-1 might be a novel therapeutic agent for voiding dysfunction.
Collapse
Affiliation(s)
- Kotomi Maeda
- Department of Hospital Pharmacy, Nagoya City University, Graduate School of Pharmaceutical Sciences, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8603, Japan.
| | - Yuji Hotta
- Department of Hospital Pharmacy, Nagoya City University, Graduate School of Pharmaceutical Sciences, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8603, Japan.
| | - Naoya Ieda
- Department of Organic and Medicinal Chemistry, Nagoya City University, Graduate School of Pharmaceutical Sciences, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8603, Japan.
| | - Tomoya Kataoka
- Department of Clinical Pharmaceutics, Nagoya City University, Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8601, Japan.
| | - Hidehiko Nakagawa
- Department of Organic and Medicinal Chemistry, Nagoya City University, Graduate School of Pharmaceutical Sciences, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8603, Japan.
| | - Kazunori Kimura
- Department of Hospital Pharmacy, Nagoya City University, Graduate School of Pharmaceutical Sciences, 3-1 Tanabe-dori, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8603, Japan; Department of Clinical Pharmaceutics, Nagoya City University, Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya-shi, Aichi-ken 467-8601, Japan.
| |
Collapse
|
19
|
Slocum C, Halloran M, Unser C. A Primary Care Provider's Guide to Clinical Needs of Women With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:166-171. [PMID: 33192043 DOI: 10.46292/sci2603-166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Women are a growing proportion of individuals with SCI and have distinctive health needs spanning the life course that demand deliberate consideration and clinical expertise. Practitioners caring for women with SCI must incorporate broad medical knowledge of SCI physiology and health promotion for women, including differences in complication rates following SCI, and work collaboratively with rehabilitation, medical, and surgical specialists to optimize function and health for women with SCI. Clinical researchers must continue to perform population-based studies to best characterize the evolving needs of women with SCI and evaluate treatment efficacy and care delivery models to best serve this population.
Collapse
Affiliation(s)
| | - Molly Halloran
- Thomas Jefferson University Department of Medicine, Philadelphia, Pennsylvania
| | - Cody Unser
- Cody Unser First Step Foundation, Albuquerque, New Mexico
| |
Collapse
|
20
|
Establishment of animal model manifested as bladder neurogenic changes generated by bilateral pelvic nerve injury in male rats. Int Urol Nephrol 2020; 53:421-429. [PMID: 33025408 DOI: 10.1007/s11255-020-02668-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/25/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE To establish a male rat model of neurogenic bladder after bilateral pelvic nerve injury (BPNI) and investigate the factors associated with onset of neurogenic bladder. METHODS Twenty-four 8-week-old male Sprague-Dawley rats were randomly divided into three groups (n = 8 rats per group). Rats in 4-week and 8-week nerve injury group underwent BPNI, while rats in the sham group underwent a sham operation. Bladder functional analysis were performed and then bladders tissues were harvested for morphological examination and investigating the mRNA expression levels of target genes in all rats. RESULTS The bladder weight significantly increased in rats following BPNI. Functional analysis revealed non-voiding contractions and decreased detrusor contractility following BPNI, manifested as elevated post-void residual and bladder capacity while reduced maximum voiding pressure and voiding efficiency. The collagen area in bladder tissue and mRNA expression levels of target genes significantly increased at 4 or 8 weeks post-BPNI except Smad3. At 4 weeks post-BPNI, expression levels of vesicular acetylcholine transporter were reduced, then returned to baseline at 8 weeks. Expression levels of tyrosine hydroxylase were reduced at both 4 and 8 weeks post-BPNI. CONCLUSIONS A neurogenic bladder animal model was successfully established by performing BPNI in male rats, characterized by impaired voiding function, bladder detrusor fibrosis, and reduced neurotransmitter release.
Collapse
|
21
|
Sekido N, Takaoka EI, Nishiyama H, Ochi H, Satoh T. Impact of clean intermittent catheterization on quality of life of patients with neurogenic lower urinary tract dysfunction due to radical hysterectomy: A cross-sectional study. Low Urin Tract Symptoms 2020; 13:168-176. [PMID: 32929880 DOI: 10.1111/luts.12350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/10/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023]
Abstract
AIMS We investigated the quality of life (QOL) of a homogenous group of ambulant patients with neurogenic lower urinary tract dysfunction without significant comorbidities to elucidate the impact of clean intermittent catheterization (CIC) on QOL. METHODS The subjects were 71 female patients who underwent radical hysterectomy (RH) without recurrent disease. QOL was cross-sectionally measured with the Short-Form 36-Item Health Survey (SF-36) and King's Health Questionnaire (KHQ). We divided urinary management into spontaneous voiding (SV) and CIC as well as postoperative elapsed time into the entire period, less than 24 months (<24 months) and 24 months or more (≥24 months). RESULTS Patients with CIC showed significantly poorer QOL than patients with SV in some subscale/domain scores on SF-36 and KHQ for the entire period as well as <24 months after RH. In contrast, significant differences were not revealed between scores on both measures of patients with CIC and SV ≥24 months after RH. Moreover, in patients with CIC ≥24 months, some subscale/domain scores on both measures were significantly better than in those with <24 months. Norm-based scoring of SF-36 revealed that all subscales of patients with CIC <24 months were below the average score of healthy Japanese people, while only four subscales of those ≥24 months remained below the average. CONCLUSIONS QOL in patients with CIC was worse than in patients with SV in the short term, but similar in the long term, which suggests that QOL probably might improve with time in patients with CIC.
Collapse
Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Tsukuba University Hospital, Ibaraki, Japan.,Department of Urology, School of Medicine, Faculty of Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Ei-Ichiro Takaoka
- Department of Renal and Urological Surgery, School of Medicine, Faculty of Medicine, International University of Health and Welfare, Chiba, Japan
| | - Hiroyuki Nishiyama
- Department of Urology and Andrology, Majors of Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan
| | - Hiroyuki Ochi
- Departments of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Toyomi Satoh
- Departments of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| |
Collapse
|
22
|
RISI O, DE PALMA L, ANDRETTA E. The role of clean intermittent catheterization in rehabilitation setting: a survey of healthcare operators' perception in Italy. Eur J Phys Rehabil Med 2020; 56:525-528. [DOI: 10.23736/s1973-9087.20.06171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
23
|
Birkhäuser V, Liechti MD, Anderson CE, Bachmann LM, Baumann S, Baumberger M, Birder LA, Botter SM, Büeler S, Cruz CD, David G, Freund P, Friedl S, Gross O, Hund-Georgiadis M, Husmann K, Jordan X, Koschorke M, Leitner L, Luca E, Mehnert U, Möhr S, Mohammadzada F, Monastyrskaya K, Pfender N, Pohl D, Sadri H, Sartori AM, Schubert M, Sprengel K, Stalder SA, Stoyanov J, Stress C, Tatu A, Tawadros C, van der Lely S, Wöllner J, Zubler V, Curt A, Pannek J, Brinkhof MWG, Kessler TM. TASCI-transcutaneous tibial nerve stimulation in patients with acute spinal cord injury to prevent neurogenic detrusor overactivity: protocol for a nationwide, randomised, sham-controlled, double-blind clinical trial. BMJ Open 2020; 10:e039164. [PMID: 32792454 PMCID: PMC7430472 DOI: 10.1136/bmjopen-2020-039164] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD), including neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia, is one of the most frequent and devastating sequelae of spinal cord injury (SCI), as it can lead to urinary incontinence and secondary damage such as renal failure. Transcutaneous tibial nerve stimulation (TTNS) is a promising, non-invasive neuromodulatory intervention that may prevent the emergence of the C-fibre evoked bladder reflexes that are thought to cause NDO. This paper presents the protocol for TTNS in acute SCI (TASCI), which will evaluate the efficacy of TTNS in preventing NDO. Furthermore, TASCI will provide insight into the mechanisms underlying TTNS, and the course of NLUTD development after SCI. METHODS AND ANALYSIS TASCI is a nationwide, randomised, sham-controlled, double-blind clinical trial, conducted at all four SCI centres in Switzerland. The longitudinal design includes a baseline assessment period 5-39 days after acute SCI and follow-up assessments occurring 3, 6 and 12 months after SCI. A planned 114 participants will be randomised into verum or sham TTNS groups (1:1 ratio), stratified on study centre and lower extremity motor score. TTNS is performed for 30 min/day, 5 days/week, for 6-9 weeks starting within 40 days after SCI. The primary outcome is the occurrence of NDO jeopardising the upper urinary tract at 1 year after SCI, assessed by urodynamic investigation. Secondary outcome measures assess bladder and bowel function and symptoms, sexual function, neurological structure and function, functional independence, quality of life, as well as changes in biomarkers in the urine, blood, stool and bladder tissue. Safety of TTNS is the tertiary outcome. ETHICS AND DISSEMINATION TASCI is approved by the Swiss Ethics Committee for Northwest/Central Switzerland, the Swiss Ethics Committee Vaud and the Swiss Ethics Committee Zürich (#2019-00074). Findings will be disseminated through peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT03965299.
Collapse
Affiliation(s)
- Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Collene E Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | | | - Sarah Baumann
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Michael Baumberger
- Spinal Cord and Rehabilitation Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Lori A Birder
- Neuro-Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Sander M Botter
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Silvan Büeler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Célia D Cruz
- Instituto de Investigação e Inovação em Saúde, Translational Neuro-urology Group, Universidade do Porto, Porto, Portugal
- Faculdade de Medicina, Departemento de Biomedicina, Unidade de Biologia Experimental, Universidade do Porto, Porto, Portugal
| | - Gergely David
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Susanne Friedl
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Oliver Gross
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Knut Husmann
- Swiss Center for Musculoskeletal Biobanking, Balgrist Campus AG, Zürich, Switzerland
| | - Xavier Jordan
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Miriam Koschorke
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Eugenia Luca
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Sandra Möhr
- Clinic of Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
| | - Freschta Mohammadzada
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Nikolai Pfender
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Daniel Pohl
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Helen Sadri
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Andrea M Sartori
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
- Institute for Regenerative Medicine, University of Zürich, Zürich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zürich, Zürich, Switzerland
| | - Stephanie A Stalder
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Cornelia Stress
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Aurora Tatu
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Cécile Tawadros
- Spinal Cord Injury Department, Clinique romande de réadaptation, Sion, Switzerland
| | - Stéphanie van der Lely
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jens Wöllner
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Veronika Zubler
- Department of Radiology, Balgrist University Hospital, Zürich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Department of Urology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| |
Collapse
|
24
|
Theisen KM, Mann R, Roth JD, Pariser JJ, Stoffel JT, Lenherr SM, Myers JB, Welk B, Elliott SP. Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study. Spinal Cord 2020; 58:1274-1281. [PMID: 32409777 DOI: 10.1038/s41393-020-0481-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. OBJECTIVES To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). SETTING Multiple United States hospitals. METHODS 1479 participants with SCI were asked about neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI. PRUTI frequency over the last year was classified as 0, 1-3, 4-6, or >6. Four UTI QOL domains were assessed: (1) UTIs limited daily activities, (2) UTIs caused increased muscle spasms, (3) UTIs would not go away, and (4) UTIs made me avoid going out. Multivariable regression identified variables associated with poor QOL. RESULTS PRUTI frequency was 0 in 388 patients (26%), 1-3 in 677 (46%), 4-6 in 223 (15%), and more than 6 in 190 (13%). Increasing PRUTI rate was independently associated with worse QOL for all four questions. Compared with those with 0 PRUTIs, participants reporting >6 were more likely to limit daily activities (OR 9.0 [95% CI 8.1-21.2] p < 0.0001), experience increased muscle spasms (OR 12.4 [95% CI 7.5-20.6] p < 0.0001), perceive a UTI would not go away (OR 30.1 [95% CI 15.0-60.4] p < 0.0001), and avoid going out because of UTIs (OR 7.2 [95% CI 4.2-12.4] p < 0.0001). CONCLUSIONS An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.
Collapse
Affiliation(s)
| | - Rachel Mann
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - John T Stoffel
- University of Michigan, Ann Arbor, MI, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
| | - Sara M Lenherr
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Blayne Welk
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,Western University, London, ON, Canada
| | - Sean P Elliott
- University of Minnesota, Minneapolis, MN, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
| |
Collapse
|
25
|
Patel DP, Herrick JS, Stoffel JT, Elliott SP, Lenherr SM, Presson AP, Welk B, Jha A, Myers JB. Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourol Urodyn 2019; 39:211-219. [PMID: 31578784 DOI: 10.1002/nau.24172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. METHODS The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. RESULTS There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). CONCLUSIONS Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.
Collapse
Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jennifer S Herrick
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | | |
Collapse
|