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Ali S, Khan OS, Youssef AM, Saba I, Alfedaih D. Hydrophilic catheters for intermittent catheterization and occurrence of urinary tract infections. A retrospective comparative study in patients with spinal cord Injury. BMC Urol 2024; 24:122. [PMID: 38867233 PMCID: PMC11167762 DOI: 10.1186/s12894-024-01510-y] [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: 04/17/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Neurogenic bladder dysfunction is a major problem for spinal cord injury (SCI) patients not only due to the risk of serious complications but also because of the impact on quality of life. The main aim of this study is to compare the rate of urinary tract infection (UTI) associated with hydrophilic-coated catheters versus uncoated polyvinyl chloride (PVC) catheters among SCI patients presenting with functional neurogenic bladder sphincter disorders. METHODOLOGY This was a retrospective cohort study from 2005 to 2020 including adult male or female patients who have an SCI at least more than 1 month ago with neurogenic bladder dysfunction and were using intermittent catheterization (single-use hydrophilic-coated or the standard-of-care polyvinyl chloride uncoated standard catheters) at least 3 times a day to maintain bladder emptying. RESULTS A total of 1000 patients were selected and recruited through a stratified random sampling technique with 467 (47.60%) patients in the uncoated catheter arm and 524 (52.60%) in the coated catheter groups. The three outcome measures, namely: symptomatic UTI, Bacteriuria, and pyuria were significantly higher in the group using uncoated polyvinyl chloride (PVC) catheters compared to hydrophilic-coated catheters at the rate of 79.60% vs.46.60%, 81.10% vs. 64.69, and 53.57% versus 41.79% respectively. Males, elder patients, longer duration, and severity of SCI were associated with increased risk of symptomatic UTI. CONCLUSIONS The results indicate a beneficial effect regarding clinical UTI when using hydrophilic-coated catheters in terms of fewer cases of symptomatic UTI. Bacteriuria is inevitable in patients with long-term catheterization, however, treatment should not be started unless the clinical symptoms exist. More attention should be given to the high-risk group for symptomatic UTIs.
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Affiliation(s)
- Sajjad Ali
- Infectious Diseases Department, Sultan bin Abdulaziz Humanitarian City, P.O.Box: 64399, Riyadh, 11536, Saudi Arabia.
| | - Omar Sufyan Khan
- Infectious Diseases Department, Sultan bin Abdulaziz Humanitarian City, P.O.Box: 64399, Riyadh, 11536, Saudi Arabia
| | - Amira M Youssef
- Research and Scientific Center, Sultan bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Iram Saba
- Research and Scientific Center, Sultan bin Abdulaziz Humanitarian City, Riyadh, Saudi Arabia
| | - Deem Alfedaih
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Yates A, Weston P. Product evaluation of the Luja Micro-hole Zone Technology in clean intermittent self-catheterisation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S10-S15. [PMID: 38722003 DOI: 10.12968/bjon.2024.33.9.s10] [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: 07/11/2024]
Abstract
Clean intermittent self-catheterisation is a common procedure undertaken by people with bladder dysfunction. However, it is not without its complications, the main one being urinary tract infection. The most common causes of urinary tract infections are poor hygiene, technique and adherence, excessive post-void residual urine and bladder trauma. A catheter with new Micro-hole Zone Technology has been developed, which can potentially improve bladder emptying and minimise these complications. A case study is used to illustrate its effects in practice.
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board, Cardiff
| | - Polly Weston
- Chair, Association for Continence Professionals, and Team Lead, Bay Wide Bladder and Bowel Service, University Hospitals of Morecambe Bay NHS Foundation Trust
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3
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Place J. Advances in clean intermittent self-catheterisation: impact on trauma and urinary tract infections. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S5-S7. [PMID: 38010969 DOI: 10.12968/bjon.2023.32.sup18.s5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Intermittent self-catheterisation with hydrophilic coated catheters carries the risk of trauma, bleeding and infection. However, evidence suggest that these risks can be minimised with a new generation of catheters that stay lubricated over time, allowing for comfortable and safe insertion and withdrawal.
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Affiliation(s)
- Janet Place
- Urology Sister, Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust
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4
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Plata M, Santander J, Zuluaga L, Torres-Sandoval C, Valencia S, Azuero J, Trujillo CG. Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections. World J Urol 2023; 41:491-499. [PMID: 36547679 DOI: 10.1007/s00345-022-04235-5] [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: 05/20/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. OBJECTIVE To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. METHODOLOGY A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. RESULTS Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60). CONCLUSION We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia.
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
- Universidad del Rosario, Bogotá D.C., Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Camilo Torres-Sandoval
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Sergio Valencia
- Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
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Zachariou A, Zachariou D, Kaltsas A, Giannakis I, Dimitriadis F, Douvli E, Champilomatis I, Kounavou C, Papatsoris A, Tsounapi P, Mamoulakis C, Takenaka A, Sofikitis N. Translation and Validation of the Intermittent Catheterization Difficulty Questionnaire (ICDQ) into Greek. J Multidiscip Healthc 2022; 15:2571-2577. [PMID: 36388624 PMCID: PMC9656416 DOI: 10.2147/jmdh.s387110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022] Open
Abstract
Purpose Clean intermittent self-catheterization (CISC) is a safe and effective alternative to managing incomplete bladder emptying in patients afflicted with neurogenic bladder conditions. The Intermittent Catheterisation Difficulty Questionnaire (ICDQ) is a validated questionnaire concerning the assessment of catheter use and patient difficulties during CISC. The present study aimed to translate and validate the ICDQ into the Greek language. A subsequent outcome was to substantiate the requirement of both urologist consultation with patients undergoing CISC and the detailed evaluation of various therapeutic options with the consultation of other specialist physicians. Material and Methods The study was undertaken between March 2022 and July 2022 and involved patients in an outpatient department of a Rehabilitation Centre. Sixty-two neurologic patients suffering from spinal cord injury (SCI), multiple sclerosis (MS), cauda equina (CE), and myelitis represented a convenience sample. To calculate test-retest reliability, patients filled out two consecutive questionnaires; an initial one and a second after one week. The socio and demographic circumstances of all participants were evaluated. Results The mean ICDQ total score at the test and retest was 5.96±1.28 (mean total score ± standard deviation) and 5.91±1.29, respectively. Evaluation of the data concerning alterations between men and women did not reveal statistically significant differences. Cronbach’s alpha coefficient was 0.94, which proves the inter-correlation between the different topics. An ICC of 0.97 indicated very high intra-rater reliability. Conclusion ICDQ, a valid and reliable self-administered screening tool for CISC difficulties faced by patients using this procedure regularly, was successfully translated and validated into Greek. A more detailed evaluation and understanding of these difficulties would enhance the quality of CISC and allow for more suitable treatment and the selection of catheter types used. These improved treatment strategies are possible as repeated use and constant comparison of ICDQ scores determine treatment impact, facilitating treatment regimen modification, should it be required.
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Affiliation(s)
- Athanasios Zachariou
- Department of Urology, University of Ioannina, Ioannina, Greece
- Physical Medicine and Rehabilitation Centre EU PRATTEIN, Volos, Greece
- Correspondence: Athanasios Zachariou, Urology Department, Ioannina University, Volos, 38221, Greece, Tel +302421026937, Email
| | - Dimitrios Zachariou
- Department of Urology, University of Ioannina, Ioannina, Greece
- Physical Medicine and Rehabilitation Centre EU PRATTEIN, Volos, Greece
| | - Aris Kaltsas
- Department of Urology, University of Ioannina, Ioannina, Greece
| | | | - Fotios Dimitriadis
- Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Erriketi Douvli
- Department of Urology, University of Ioannina, Ioannina, Greece
| | | | | | - Athanasios Papatsoris
- 2nd Department of Urology, Sismanogleion General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiota Tsounapi
- Department of Urology, Faculty of Medicine, Tottori University, Yonago, Japan
| | | | - Atsushi Takenaka
- Department of Urology, Faculty of Medicine, Tottori University, Yonago, Japan
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Barken KB, Vaabengaard R. A scoping review on the impact of hydrophilic versus non-hydrophilic intermittent catheters on UTI, QoL, satisfaction, preference, and other outcomes in neurogenic and non-neurogenic patients suffering from urinary retention. BMC Urol 2022; 22:153. [PMID: 36123663 PMCID: PMC9487088 DOI: 10.1186/s12894-022-01102-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background For patients suffering from urinary retention due to neurogenic [e.g., spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS)] or non-neurogenic [e.g., cancer, benign prostate hypertrophy (BPH)] causes, intermittent catheterization is the primary choice for bladder emptying. This scoping review compared hydrophilic-coated intermittent catheters (HCICs) with non-hydrophilic (uncoated) catheters in neurogenic and non-neurogenic patients with respect to satisfaction, preference, adverse events, urinary tract infection (UTI), quality of life (QoL), cost effectiveness, pain, and discomfort. Methods A systematic literature search was conducted using PubMed, Cochrane Library, Google Scholar, Embase, and available clinical practice guidelines and was limited to systematic reviews/meta-analysis and clinical studies (randomized trials, cohort and case–control studies) published in English between 2000 and 2020. A narrative synthesis was performed, comparing HCIC with non-hydrophilic catheters in each pathology. The articles where critically appraised and weighted according to their level of evidence based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence grading. Results Thirty seven original articles and 40 reviews were included. The comparison of HCICs versus non-hydrophilic catheters was well-documented in patients with mixed pathology, SCI, and to some extent SB. The available evidence predominantly indicates better outcomes with HCICs as reported by study authors, particularly, greater UTI reduction and improved satisfaction, cost-effectiveness, and QoL. However, SB studies in children did not report reduction in UTIs. Children complained about slippery catheters, indicating possible touching of the surface during insertion, which may compromise cleanliness of the procedure and affect outcomes such as UTI. Limited studies were available exclusively on BPH and none on MS; however, most studies performed on mixed pathologies, including BPH and MS, indicated strong preference for HCICs compared to non-hydrophilic catheters. Conclusions The findings generally support HCICs over non-hydrophilic catheters; however, most studies were fairly small, often used a mix of pathologies, and the conclusions were often based on studies with high drop-out rates that were therefore underpowered. Larger studies are needed to support the general finding that HCICs are the preferred choice in most populations. Additional training in children or redesigned catheters may be necessary for this age-group to fully benefit from the advantages of HCICs. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01102-8.
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7
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Prevalence of bacteriuria in cats with neurogenic bladder. Vet Res Commun 2022; 46:1075-1084. [PMID: 35835971 DOI: 10.1007/s11259-022-09973-w] [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: 02/22/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
Urinary tract infections are defined as the adherence, multiplication, and persistence of an infectious agent within the urogenital system, causing an associated inflammatory response and clinical signs; instead, the presence of bacteria in urine as determined by positive bacterial culture (PUC) from a properly collected urine specimen, in the absence of clinical signs, is defined subclinical bacteriuria. Limited information on the prevalence of PUC in spinal cord injury cats affected by neurogenic bladder (NB) is available. On contrary, in NB dogs and humans the prevalence of bacteriuria is well documented. Moreover, while in humans information about bacteriemia associated with NB is already available, this aspect has never been studied in NB cats. The aim of this prospective study was to determine the prevalence of PUC in cats with NB, compared to animals affected by chronic kidney disease (CKD) and healthy cats. Furthermore, the prevalence of bacteriemia in cats with NB was evaluated. Fifty-one cats met the inclusion criteria: 12 cats were affected by NB, 22 had CKD and 17 were healthy. The prevalence of PUC was 58.33% and 18% in NB and CKD cat populations, respectively. All blood cultures were negative. The incomplete bladder emptying and the decreased resistance in the bladder wall could be considered predisposing elements to PUC in the NB feline population. The results of this study highlight, for the first time, an high prevalence of PUC in cats affected by NB, which was not found to be associated with bacteriemia.
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8
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Hillery S. Reducing the risk of urinary tract infections in intermittent self-catheterisation users. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:620-622. [PMID: 35736851 DOI: 10.12968/bjon.2022.31.12.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Sarah Hillery
- Urology Advanced Nurse Practitioner, York Teaching Hospital NHS Foundation Trust
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9
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Berger A, Goldstine J, Hofstad C, Inglese GW, Kirschner-Hermanns R, MacLachlan S, Shah S, Vos-van der Hulst M, Weiss J. Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands. J Spinal Cord Med 2022; 45:461-471. [PMID: 33054606 PMCID: PMC9135430 DOI: 10.1080/10790268.2020.1829416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC).Design: Retrospective chart review.Setting: Two European SCI rehabilitation centers.Participants: Seventy-three consecutive patients with recent SCI who initiated IC.Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI . Rates were expressed in terms of numbers of UTIs per 100 patient-months (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions.Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring "mention of UTI"). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20-25 cases. Median time to UTI ranged from 42 days ("mention of UTI") to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm3).Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.
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Affiliation(s)
- Ariel Berger
- Real-World Evidence, Evidera Inc., Waltham, Massachusetts, USA,Correspondence to: Ariel Berger, Real-World Evidence, Evidera Inc., 500 Totten Pond Road, 5th Floor, Waltham, Massachusetts02451, USA.
| | - Jimena Goldstine
- Global Market Access, Hollister Inc., Libertyville, Illinois, USA
| | - Cheriel Hofstad
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Gary W. Inglese
- Global Market Access, Hollister Inc., Libertyville, Illinois, USA
| | - Ruth Kirschner-Hermanns
- Neuro-Urology, Neurological Rehabilitation Center Godeshoehe e.V., Bonn, Germany,Neuro-Urology/Clinic of Urology, University Clinic, Bonn, Germany
| | | | - Surbhi Shah
- Real-World Evidence, Evidera Inc., Waltham, Massachusetts, USA
| | - Marije Vos-van der Hulst
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands,Rehabilitation Spinal cord Injury, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Jerome Weiss
- Neuro-Urology, Neurological Rehabilitation Center Godeshoehe e.V., Bonn, Germany
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10
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Effects of hydrophilic coated catheters on urethral trauma, microtrauma and adverse events with intermittent catheterization in patients with bladder dysfunction: a systematic review and meta-analysis. Int Urol Nephrol 2022; 54:1461-1470. [PMID: 35449382 PMCID: PMC9184422 DOI: 10.1007/s11255-022-03172-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/08/2022] [Indexed: 02/08/2023]
Abstract
Background Hydrophilic coated catheters are recommended to reduce the side effects of intermittent catheterization (IC) in patients with bladder dysfunction. However, there is lack of Level one evidence to support the use of this intervention. Search methods Several electronic databases were systematically searched to evaluate complication incidences for hydrophilic coated (HC) and non-hydrophilic catheters (NHC). Results Twelve studies were eligible for inclusion in the review. The meta-analyses exploring microscopic hematuria frequencies (RR = 0.69; 95% CI 0.52–0.90) and urethral stricture frequencies (RR = 0.28; 95% CI 0.13–0.60) showed a lower risk ratio associated with HC in comparison to NHC, whereas gross hematuria was no statistically significant difference in two groups. Subgroup analyses of gross hematuria which was grouped according to "catheterization frequency", "single/multiple catheterization" and "self/other catheterization” were performed and the values of combined RR were also no statistically significant difference. Conclusions Compared with non-hydrophilic catheters, the hydrophilic coated catheters have positive significance in reducing the incidence of urethral microtrauma and the urethral stricture. However, more studies are warranted for evaluating effects of hydrophilic coated catheters on the incidence of gross hematuria. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03172-x.
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Clark C, Haslam C, Malde S, Panicker JN. Urinary catheter management: what neurologists need to know. Pract Neurol 2021; 21:504-514. [PMID: 34753810 DOI: 10.1136/practneurol-2020-002772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.
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Affiliation(s)
- Calum Clark
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK .,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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Prieto JA, Murphy CL, Stewart F, Fader M. Intermittent catheter techniques, strategies and designs for managing long-term bladder conditions. Cochrane Database Syst Rev 2021; 10:CD006008. [PMID: 34699062 PMCID: PMC8547544 DOI: 10.1002/14651858.cd006008.pub5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Intermittent catheterisation (IC) is a commonly recommended procedure for people with incomplete bladder emptying. Frequent complications are urinary tract infection (UTI), urethral trauma and discomfort during catheter use. Despite the many designs of intermittent catheter, including different lengths, materials and coatings, it is unclear which catheter techniques, strategies or designs affect the incidence of UTI and other complications, measures of satisfaction/quality of life and cost-effectiveness. This is an update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the clinical and cost-effectiveness of different catheterisation techniques, strategies and catheter designs, and their impact, on UTI and other complications, and measures of satisfaction/quality of life among adults and children whose long-term bladder condition is managed by intermittent catheterisation. SEARCH METHODS We searched the Cochrane Incontinence Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 12 April 2021), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheterisation techniques, strategies or catheter designs. DATA COLLECTION AND ANALYSIS As per standard Cochrane methodological procedures, two review authors independently extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE. Outcomes included the number of people with symptomatic urinary tract infections, complications such as urethral trauma/bleeding, comfort and ease of use of catheters, participant satisfaction and preference, quality of life measures and economic outcomes. MAIN RESULTS We included 23 trials (1339 randomised participants), including twelve RCTs and eleven cross-over trials. Most were small (fewer than 60 participants completed), although three trials had more than 100 participants. Length of follow-up ranged from one month to 12 months and there was considerable variation in definitions of UTI. Most of the data from cross-over trials were not presented in a useable form for this review. Risk of bias was unclear in many domains due to insufficient information in the trial reports and several trials were judged to have a high risk of performance bias due to lack of blinding and a high risk of attrition bias. The certainty of evidence was downgraded for risk of bias, and imprecision due to low numbers of participants. Aseptic versus clean technique We are uncertain if there is any difference between aseptic and clean techniques in the risk of symptomatic UTI because the evidence is low-certainty and the 95% confidence interval (CI) is consistent with possible benefit and possible harm (RR 1.20 95% CI 0.54 to 2.66; one study; 36 participants). We identified no data relating to the risk of adverse events comparing aseptic and clean techniques or participant satisfaction or preference. Single-use (sterile) catheter versus multiple-use (clean) We are uncertain if there is any difference between single-use and multiple-use catheters in terms of the risk of symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.98, 95% CI 0.55, 1.74; two studies; 97 participants). One study comparing single-use catheters to multiple-use catheters reported zero adverse events in either group; no other adverse event data were reported for this comparison. We identified no data for participant satisfaction or preference. Hydrophilic-coated catheters versus uncoated catheters We are uncertain if there is any difference between hydrophilic and uncoated catheters in terms of the number of people with symptomatic UTI because the certainty of evidence is low and the 95% CI is consistent with possible benefit and possible harm (RR 0.89, 95% CI 0.69 to 1.14; two studies; 98 participants). Uncoated catheters probably slightly reduce the risk of urethral trauma and bleeding compared to hydrophilic-coated catheters (RR 1.37, 95% CI 1.01 to 1.87; moderate-certainty evidence). The evidence is uncertain if hydrophilic-coated catheters compared with uncoated catheters has any effect on participant satisfaction measured on a 0-10 scale (MD 0.7 higher, 95% CI 0.19 to 1.21; very low-certainty evidence; one study; 114 participants). Due to the paucity of data, we could not assess the certainty of evidence relating to participant preference (one cross-over trial of 29 participants reported greater preference for a hydrophilic-coated catheter (19/29) compared to an uncoated catheter (10/29)). AUTHORS' CONCLUSIONS: Despite a total of 23 trials, the paucity of useable data and uncertainty of the evidence means that it remains unclear whether the incidence of UTI or other complications is affected by use of aseptic or clean technique, single (sterile) or multiple-use (clean) catheters, coated or uncoated catheters or different catheter lengths. The current research evidence is uncertain and design and reporting issues are significant. More well-designed trials are needed. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheterisation techniques and strategies, and catheter designs.
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Affiliation(s)
- Jacqui A Prieto
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | - Fiona Stewart
- c/o Cochrane Incontinence, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Mandy Fader
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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13
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Takahashi S, Arakawa S, Ishikawa K, Kamei J, Kobayashi K, Shigemura K, Takahashi S, Hiyama Y, Hamasuna R, Hayami H, Yazawa S, Yasuda M, Togo Y, Yamamoto S, Wada K, Watanabe T. Guidelines for Infection Control in the Urological Field, including Urinary Tract Management (revised second edition). Int J Urol 2021; 28:1198-1211. [PMID: 34480379 DOI: 10.1111/iju.14684] [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: 07/19/2021] [Accepted: 08/17/2021] [Indexed: 01/08/2023]
Abstract
The Committee for the Development of Guidelines for Infection Control in the Urological Field, including Urinary Tract Management of the Japanese Urological Association, together with its systematic review team and external reviewers, have prepared a set of practice guidelines, an abridged version of which is published herein. These guidelines cover the following topics: (i) foundations of infection control, standard precautions, route-specific precautions, and occupational infection control (including vaccines); (ii) the relationship between urologists and infection control; (iii) infection control in urological wards and outpatient clinics; (iv) response to hepatitis B virus reactivation; (v) infection control in urological procedures and examinations; (vi) prevention of infections occurring in conjunction with medical procedures and examinations; (vii) responses to urinary tract tuberculosis and bacillus Calmette-Guérin; (viii) aseptic handling, cleaning, disinfection, and sterilization of urinary tract endoscopes (principles of endoscope manipulation, endoscope lumen cleaning, and disinfection); (ix) infection control in the operating room (principles of hand washing, preoperative rubbing methods, etc.); (x) prevention of needlestick and blood/bodily fluid exposure and response to accidental exposure; (xi) urinary catheter-associated urinary tract infection and purple urinary bag syndrome; and (xii) urinary catheter-associated urinary tract infections in conjunction with home care. In addressing these topics, the relevant medical literature was searched to the extent possible, and content was prepared for the purpose of providing useful information for clinical practice.
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Affiliation(s)
- Satoshi Takahashi
- Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Soichi Arakawa
- Department of Urology, Sanda City Hospital, Sanda, Hyogo, Japan
| | - Kiyohito Ishikawa
- Department of Quality and Safety in Healthcare, Division of Infection Control and Prevention, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Kanao Kobayashi
- Department of Urology, Japan Organization of Occupational Health and Safety, Chugoku Rosai Hospital, Kure, Hiroshima, Japan
| | | | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Yoshiki Hiyama
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Ryoichi Hamasuna
- Department of Urology, Federation of National Public Service and Affiliated Personal Mutual Aid Association, Shin-Kokura Hospital, Kitakyushu, Fukuoka, Japan
| | - Hiroshi Hayami
- Blood Purification Center, Kagoshima University Hospital, Kagoshima, Japan
| | - Satoshi Yazawa
- Yazawa Clinic, Tokyo, Japan.,Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yasuda
- Center for Nutrition Support and Infection Control, Gifu University Hospital, Gifu, Japan
| | - Yoshikazu Togo
- Department of Urology, Kyowakai Medical Corporation Kyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Shingo Yamamoto
- Urology and Kidney Transplant Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichiro Wada
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
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Chuang L, Tambyah PA. Catheter-associated urinary tract infection. J Infect Chemother 2021; 27:1400-1406. [PMID: 34362659 DOI: 10.1016/j.jiac.2021.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.
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Affiliation(s)
- Leyland Chuang
- Raffles Internal Medicine Centre, Raffles Hospital, Singapore
| | - Paul Anantharajah Tambyah
- University Medicine Cluster, National University Health System, Singapore; Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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15
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Truzzi JC, de Almeida FG, Sacomani CA, Reis J, Rocha FET. Neurogenic bladder - concepts and treatment recommendations. Int Braz J Urol 2021; 48:220-243. [PMID: 34156189 PMCID: PMC8932021 DOI: 10.1590/s1677-5538.ibju.2021.0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/15/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction: Bladder and urinary sphincter malfunctioning that results from some change in the central and/or peripheral nervous system is defined as neurogenic bladder. The urinary tract symptoms that can be related to its filling, emptying, or both have a significant impact on the quality of life of individuals. The present review was based on the document prepared for the public health system in Brazil as a treatment guidelines proposal. Material and Methods: Survey questions were structured as per PICO (Population, Intervention, Control, and Outcome). Search strategies were defined and performed in the MEDLINE/Pubmed, Embase, Epistemonikos and Google Scholar databases. The selection of articles followed the evidence hierarchy concept; evidence body was identified, and the quantitative study data were extracted. The quality of evidence and grade of recommendation were qualitatively assessed according to GRADE (Grading of Recommendations, Assessment, Development and Evaluations). Results: A total of 2.707 articles were identified, with 49 of them being selected to compose the basis for this review. Neurogenic bladder treatments were classified according to their focus on filling or emptying symptoms and sub- classified in pharmacological and surgical treatments. Conclusion: Treatment guidelines are important tools for the public health system to promote the best practice when treating neurogenic bladder patients.
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Affiliation(s)
- José Carlos Truzzi
- Departamento de Assuntos Médicos, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brasil
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16
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Balhi S, Arfaouni RB, Mrabet A. Intermittent catheterisation: the common complications. Br J Community Nurs 2021; 26:272-277. [PMID: 34105361 DOI: 10.12968/bjcn.2021.26.6.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intermittent catheterisation (IC) has been in practice for more than 40 years and is considered the gold standard in the management of urinary retention in the neurological bladder. IC has many advantages over indwelling urethral or suprapubic catheterisation, including reducing the risk of infection, protecting the bladder and improving quality of life. However, complications can be caused by the practice of this technique, the most common of which is infection. This review discusses some of the common complications that can occur with the use of intermittent catheterisation, including urinary tract infection (UTIs) and urethral complications. It also highlights the role of the nurse in the management of its complications.
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Affiliation(s)
- Salma Balhi
- Doctor, Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Rym Baati Arfaouni
- Doctor, Urodynamics and Functional Exploration Unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ali Mrabet
- Doctor, Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis, Tunisia
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17
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Catheters for intermittent catheterization: a systematic review and network meta-analysis. Spinal Cord 2021; 59:587-595. [PMID: 33911191 DOI: 10.1038/s41393-021-00620-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 02/13/2021] [Accepted: 02/25/2021] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Systematic review and network meta-analysis. OBJECTIVES Intermittent catheterization (IC) is considered the standard treatment for neuro-urological patients who are unable to empty their bladders. The present study aimed to conduct a systematic evaluation and network meta-analysis of all available types of intermittent catheters, and determine which one is best suited for clinical use. METHODS We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify relevant studies. Only randomized clinical trials (RCTs) were included. Five types of catheters were identified based on the included studies. A Bayesian network meta-analysis was then performed. The surface under the cumulative ranking (SUCRA) curve was used to determine the best catheter for each outcome. RESULTS A total of 25 RCTs, involving 1233 participants, were included. The pooled odds ratios of symptomatic UTI were lower for two ready-to-use single-use catheters (gel-lubricated non-coated catheter, OR: 0.30, 95% CI 0.095-0.86; pre-activated hydrophilic-coated catheter, OR: 0.41, 95% CI 0.19-0.83) as compared to single-use non-coated catheter. In terms of patient satisfaction, the SUCRA results showed that the pre-activated hydrophilic-coated catheter may the preferred option (SUCRA = 82.8%). However, there were no significant differences in all outcome measures between traditional single-use non-coated catheters and clean non-coated catheters. CONCLUSION Ready-to-use single-use catheters are associated with lower rates of UTI compared to traditional catheters. Patients may be most satisfied with the pre-activated one. For traditional single-use non-coated catheters and clean non-coated catheters, there is still no convincing evidence as to which is better. Thus, more well-designed trials are needed.
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18
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Balhi S, Mrabet MK. Teaching patients clean intermittent self-catheterisation: key points. Br J Community Nurs 2020; 25:586-593. [PMID: 33275512 DOI: 10.12968/bjcn.2020.25.12.586] [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: 01/26/2023]
Abstract
Intermittent self-catheterisation (ISC) is recognised as the gold standard for the treatment of neurological bladders. ISC involves the introduction of a catheter by the patient into the bladder and its immediate removal when drainage stops. This process needs to be repeated four to six times a day. Therapeutic patient education (TPE) is commonly used nowadays to treat and care for patients with chronic disease. Community nurses can play an active role in introducing ISC to patients and teaching them to perform it. This review emphasises the important points to consider when teaching patients ISC.
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Affiliation(s)
- Salma Balhi
- Both at the Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunisia
| | - Mohamed Khalil Mrabet
- Both at the Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunisia
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19
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Santiago JE, Cameron AP, Navarrete RA. Addressing Sphincter Dysfunction in the Female with Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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A biomimetic urethral model to evaluate urinary catheter lubricity and epithelial micro-trauma. J Mech Behav Biomed Mater 2020; 108:103792. [DOI: 10.1016/j.jmbbm.2020.103792] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 11/21/2022]
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21
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Averbeck MA, Welk B. Editorial Comment: An Effective Evidence-Based Cleaning Method for the Safe Reuse of Intermittent Urinary Catheters: In Vitro Testing. Int Braz J Urol 2020; 46:843-844. [PMID: 32648424 PMCID: PMC7822374 DOI: 10.1590/s1677-5538.ibju.2020.05.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Marcio Augusto Averbeck
- Chefe de Neuro-Urologia, Unidade de Videourodinâmica, Hospital Moinhos de Vento. Porto Alegre, RS, Brasil
| | - Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London ON Canada
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22
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Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord 2020; 58:1291-1300. [PMID: 32457515 DOI: 10.1038/s41393-020-0487-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative survey. OBJECTIVES Examine clinicians' perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service. SETTING Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA). METHODS Clinicians reviewed an 'Evidence Matrix' summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach. RESULTS Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management. CONCLUSIONS Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.
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24
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Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, Takahashi R, Tanaka K, Namima T, Honda M, Mitsui T, Yamanishi T, Watanabe T. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int J Urol 2020; 27:276-288. [PMID: 32077161 DOI: 10.1111/iju.14186] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryosuke Takahashi
- Department of Urology, Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Katsuyuki Tanaka
- Department of Urology, Kanagawa Rehabilitation Hospital, Atsugi, Kanagawa, Japan
| | - Takashige Namima
- Department of Urology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masashi Honda
- Division of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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25
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Walter M, Krassioukov AV. Single-use Versus Multi-use Catheters: Pro Single-use Catheters. Eur Urol Focus 2019; 6:807-808. [PMID: 31628079 DOI: 10.1016/j.euf.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
Currently there is neither a regulatory foundation nor evidence-based medicine available to recommend reuse or multiple use of catheters for intermittent catheterization. High-level evidence from studies comparing the effect of reuse/multiple use versus single use on symptomatic urinary tract infection and urethral injury is still missing.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, Canada; G.F. Strong Rehabilitation Centre, Vancouver, Canada.
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26
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Goodes LM, King GK, Rea A, Murray K, Boan P, Watts A, Bardsley J, Hartshorn C, Thavaseelan J, Rawlins M, Brock JA, Dunlop SA. Early urinary tract infection after spinal cord injury: a retrospective inpatient cohort study. Spinal Cord 2019; 58:25-34. [PMID: 31388122 DOI: 10.1038/s41393-019-0337-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective audit. OBJECTIVES Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). SETTING Western Australian Hospitals managing SCI patients. METHODS Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. RESULTS Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5-1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0-1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1-2.3, p-value 0.009; and 3.9, 95%CI 2.6-5.9, p-value < 0.001 respectively). CONCLUSIONS Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. SPONSORSHIP None.
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Affiliation(s)
- Louise M Goodes
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Gabrielle K King
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, The University of Western Australia, Crawley, WA, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Peter Boan
- Departments of Microbiology and Infectious Diseases, Fiona Stanley Hospital and PathWest Laboratory Medicine, Murdoch, WA, Australia
| | - Anne Watts
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jen Bardsley
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | | | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - James A Brock
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | - Sarah A Dunlop
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia.
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27
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Koeter I, Stensröd G, Hunsbedt Nilsen A, Lund R, Haslam C, De Sèze M, Sriram R, Heesakkers J. User perception of a new hydrophilic-coated male urinary catheter for intermittent use. Nurs Open 2019; 6:116-125. [PMID: 30534401 PMCID: PMC6279713 DOI: 10.1002/nop2.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS This study investigated user perception and adherence related to a hydrophilic-coated urinary catheter (LoFric® Origo™), available for male patients who practice intermittent catheterization. DESIGN The study had a prospective observational design, including patients from 19 European hospitals. METHODS A total of 416 patients were eligible for the study; 179 experienced catheter users and 237 de novo. Two questionnaires were filled out, one describing background data and a second, 8 weeks later, evaluating catheter features. RESULTS The response rate for the second questionnaire was 88% (365 patients). Patients evaluating the new catheter showed a general satisfaction rate of 81% and 72% kept using it. The hygienic grip of the catheter was appreciated by 85% and the foldable feature by 67%. The results show that convenience, ease of use, and hygienic factors are patient-preferred features for a urinary catheter. These factors were confirmed for the evaluated hydrophilic-coated catheter.
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Affiliation(s)
| | - Gro Stensröd
- Urodynamisk laboratoriumSunnaas Sykehus HFNesoddtangenNorway
| | | | - Rigmor Lund
- Urologisk poliklinikkAkershus Universitetssykehus HFLørenskogNorway
| | - Colette Haslam
- National Hospital for Neurology and Neurosurgery, Queens SquareLondonUK
| | - Marianne De Sèze
- Cabinet de Neuro‐Urologie, Pelvipérinéologie et UrodynamiqueGroupe Urologique de la Clinique Saint AugustinBordeauxFrance
| | - Rajagopalan Sriram
- University Hospitals Coventry and Warwickshire NHS Trust, Walsgrave HospitalCoventryUK
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Cortese YJ, Wagner VE, Tierney M, Devine D, Fogarty A. Review of Catheter-Associated Urinary Tract Infections and In Vitro Urinary Tract Models. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:2986742. [PMID: 30405898 PMCID: PMC6204192 DOI: 10.1155/2018/2986742] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/01/2018] [Accepted: 07/03/2018] [Indexed: 12/22/2022]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are one of the most common nosocomial infections and can lead to numerous medical complications from the mild catheter encrustation and bladder stones to the severe septicaemia, endotoxic shock, and pyelonephritis. Catheters are one of the most commonly used medical devices in the world and can be characterised as either indwelling (ID) or intermittent catheters (IC). The primary challenges in the use of IDs are biofilm formation and encrustation. ICs are increasingly seen as a solution to the complications caused by IDs as ICs pose no risk of biofilm formation due to their short time in the body and a lower risk of bladder stone formation. Research on IDs has focused on the use of antimicrobial and antibiofilm compounds, while research on ICs has focused on preventing bacteria entering the urinary tract or coming into contact with the catheter. There is an urgent need for in vitro urinary tract models to facilitate faster research and development for CAUTI prevention. There are currently three urinary tract models that test IDs; however, there is only a single very limited model for testing ICs. There is currently no standardised urinary tract model to test the efficacies of ICs.
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Affiliation(s)
- Yvonne J. Cortese
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | | | | | - Declan Devine
- Materials Research Institute, Athlone Institute of Technology, Athlone, Ireland
| | - Andrew Fogarty
- Bioscience Research Institute, Athlone Institute of Technology, Athlone, Ireland
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Welk B, Isaranuwatchai W, Krassioukov A, Husted Torp L, Elterman D. Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective. J Med Econ 2018; 21:639-648. [PMID: 29458282 DOI: 10.1080/13696998.2018.1443112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
STUDY DESIGN A Markov model was used to analyze cost-effectiveness over a lifetime horizon. OBJECTIVE To investigate the cost-effectiveness of hydrophilic-coated intermittent catheters (HCICs) compared with uncoated catheters (UCs) among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury (SCI). SETTING A Canadian public payer perspective based on data from Ontario; including a scenario analysis from the societal perspective. METHODS A previously published Markov decision model was modified to compare the lifetime costs and quality-adjusted life years (QALYs) for the two interventions. Three renal function and three urinary tract infection (UTI) health states as well as other catheter-related events were included. Scenario analyses, including utility gain from compact catheter and phthalate free catheter use, were performed. Deterministic and probabilistic sensitivity analyses were conducted to evaluate the robustness of the model. RESULTS The model predicted that a 50-year-old patient with SCI would gain an additional 0.72 QALYs if HCICs were used instead of UCs at an incremental cost of $48,016, leading to an incremental cost-effectiveness ratio (ICER) of $66,634/QALY. Moreover, using HCICs could reduce the lifetime number of UTI events by 11%. From the societal perspective, HCICs cost less than UCs, while providing superior outcomes in terms of QALYs, life years gained (LYG), and UTIs. The cost per QALY further decreased when health-related quality-of-life (HRQoL) gains associated with compact HCICs or catheters not containing phthalates were included. CONCLUSION In general, ICERs in the range of CAD$50-100,000 could be considered cost-effective. The ICERs for the base case and sensitivity analyses suggest that HCICs could be cost-effective. From the societal perspective, HCICs were associated with potential cost savings in our model. The results suggest that reimbursement of HCICs should be considered in these settings.
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Affiliation(s)
- Blayne Welk
- a Department of Surgery and Epidemiology & Biostatistics , Western University , London , Ontario , Canada
- b St Joseph's Health Care , London , Ontario , Canada
| | - Wanrudee Isaranuwatchai
- c Center for Excellence in Economic Analysis Research (CLEAR), The HUB, Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada
- d Institute of Health Policy, Management and Evaluation, University of Toronto , Toronto , Ontario , Canada
- e Canadian Center for Applied Research in Cancer Control , Vancouver , British Columbia , Canada
| | - Andrei Krassioukov
- f ICORD, Spinal Cord Program, GF Strong Rehabilitation Center, University of British Columbia , Vancouver , British Columbia , Canada
| | | | - Dean Elterman
- h Toronto Western Hospital/Krembil Research Institute , Toronto , Ontario
- i Department of Surgery , University of Toronto , Toronto , Ontario
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Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, Gousse A, Kielb S, Kraus S, Mangera A, Reid S, Szell N, Cruz F, Chartier-Kastler E, Ginsberg DA. Surveillance and management of urologic complications after spinal cord injury. World J Urol 2018; 36:1545-1553. [PMID: 29845320 DOI: 10.1007/s00345-018-2345-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. METHODS This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). RESULTS At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. CONCLUSIONS There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.
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Affiliation(s)
- Evgeniy Kreydin
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA
| | - Blayne Welk
- Division of Urology, The University of Western Ontario, London, ON, Canada
| | - Doreen Chung
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Teresa Danforth
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Angelo Gousse
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | | | - Stephen Kraus
- University of Texas, San Antonio, San Antonio, TX, USA
| | - Altaf Mangera
- Department of Urology, Pitié-Salpêtrière, Paris, France
| | | | - Nicole Szell
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | - Francisco Cruz
- Department of Urology, Hospital de São João, Porto, Portugal
| | | | - David A Ginsberg
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA.
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Irwin NJ, McCoy CP, McCullough AR, Corbett DJ. Use of in vitro and haptic assessments in the characterisation of surface lubricity. Proc Inst Mech Eng H 2018; 233:84-90. [PMID: 29393009 DOI: 10.1177/0954411918756155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lubricity is a key property of hydrophilic-coated urinary catheter surfaces. In vitro tests are commonly employed for evaluation of surface properties in the development of novel catheter coating technologies; however, their value in predicting the more subjective feeling of lubricity requires validation. We herein perform a range of in vitro assessments and human organoleptic studies to characterise surface properties of developmental hydrophilic coating formulations, including water wettability, coefficient of friction, dry-out kinetics and lubricity. Significant reductions of up to 40% in the contact angles and coefficient of friction values of the novel coating formulations in comparison with the control poly(vinylpyrrolidone)-coated surfaces were demonstrated during quantitative laboratory assessments. In contrast, no significant differences in the more subjective feeling of lubricity between the novel formulations and the control-coated surfaces were observed when formulations were haptically assessed by the techniques described herein. This study, importantly, highlights the need for optimisation of in vitro and human haptic assessments to more reliably predict patient preferences.
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Affiliation(s)
- Nicola J Irwin
- 1 School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Colin P McCoy
- 1 School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - Amanda R McCullough
- 2 Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, Australia
| | - Dan J Corbett
- 3 China Medical University - The Queen's University of Belfast Joint College, Shenyang, China
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Truzzi JC, Teich V, Pepe C. Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries. Int Braz J Urol 2018; 44:121-131. [PMID: 28792195 PMCID: PMC5815542 DOI: 10.1590/s1677-5538.ibju.2017.0221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/17/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. OBJECTIVE To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. MATERIALS AND METHODS A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. RESULTS The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. CONCLUSIONS Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.
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Affiliation(s)
- José Carlos Truzzi
- Escola Paulista de Medicina, Universidade Federal de São Paulo, SP, Brasil
- Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brasil
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Chlorhexidine sustained-release varnishes for catheter coating - Dissolution kinetics and antibiofilm properties. Eur J Pharm Sci 2017; 112:1-7. [PMID: 29104066 DOI: 10.1016/j.ejps.2017.10.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022]
Abstract
Catheter-associated urinary tract infections are difficult to eradicate or prevent, due to their biofilm-related nature. Chlorhexidine, a widely used antiseptic, was previously found to be effective against catheter-related biofilms. For the present study, we developed sustained-release chlorhexidine varnishes for catheter coating and evaluated their antibiofilm properties and chlorhexidine-dissolution kinetics under various conditions. The varnishes were based on ethylcellulose or ammonio methacrylate copolymer type A (Eudragit® RL). Chlorhexidine was released by diffusion from a heterogeneous matrix in the case of the ethylcellulose-based formulation, and from a homogeneous matrix in the case of Eudragit® RL. This dictated the release pattern of chlorhexidine under testing conditions: from film specimens, and from coated catheters in a static or flow-through system. Momentary saturation was observed with the flow-through system in Eudragit® RL-based coatings, an effect that might be present in vivo with other formulations as well. The coatings were retained on the catheters for at least 2weeks, and showed prolonged activity in a biological medium, including an antibiofilm effect against Pseudomonas aeruginosa. The current study demonstrates the potential of catheter coatings with sustained release of chlorhexidine in the prevention of catheter-associated urinary tract infections.
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An unexpected delivery: pregnancy experience of a paraplegic lady. Spinal Cord Ser Cases 2017; 3:17002. [DOI: 10.1038/scsandc.2017.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 12/01/2016] [Accepted: 01/03/2017] [Indexed: 11/08/2022] Open
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Prieto J, Murphy CL, Moore KN, Fader M. WITHDRAWN: Intermittent catheterisation for long-term bladder management. Cochrane Database Syst Rev 2017; 8:CD006008. [PMID: 28796279 PMCID: PMC6483323 DOI: 10.1002/14651858.cd006008.pub4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Intermittent catheterisation is a commonly recommended procedure for people with incomplete bladder emptying. There are now several designs of intermittent catheter (e.g. different lengths, 'ready to use' presentation) with different materials (e.g. PVC-free) and coatings (e.g. hydrophilic). The most frequent complication of intermittent catheterisation is urinary tract infection (UTI), but satisfaction, preference and ease of use are also important to users. It is unclear which catheter designs, techniques or strategies affect the incidence of UTI, which are preferable to users and which are most cost effective. OBJECTIVES To compare one type of catheter design versus another, one type of catheter material versus another, aseptic catheterisation technique versus clean technique, single-use (sterile) catheters versus multiple-use (clean) catheters, self-catheterisation versus catheterisation by others and any other strategies designed to reduce UTI and other complications or improve user-reported outcomes (user satisfaction, preference, ease of use) and cost effectiveness in adults and children using intermittent catheterisation for incomplete bladder emptying. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE in process, and handsearching of journals and conference proceedings (searched 30 September 2013), the reference lists of relevant articles and conference proceedings, and we attempted to contact other investigators for unpublished data or for clarification. SELECTION CRITERIA Randomised controlled trials (RCTs) or randomised cross-over trials comparing at least two different catheter designs, catheterisation techniques or strategies. DATA COLLECTION AND ANALYSIS Two review authors assessed the methodological quality of trials and abstracted data. For dichotomous variables, risk ratios and 95% confidence intervals were derived for each outcome where possible. For continuous variables, mean differences and 95% confidence intervals were calculated for each outcome. Because of trial heterogeneity, it was not always possible to combine data to give an overall estimate of treatment effect. MAIN RESULTS Thirty-one trials met the inclusion criteria, including 13 RCTs and 18 cross-over trials. Most were small (less than 60 participants completed), although five trials had more than 100 participants. There was considerable variation in length of follow-up and definitions of UTI. Participant dropout was a problem for several trials, particularly where there was long-term follow-up to measure incidence of UTI. Fifteen trials were more than 10 years old and focused mainly on comparing different catheterisation techniques (e.g. single versus multiple-use) on clinical outcomes whereas, several more recent trials have focused on comparing different types of catheter designs or materials, especially coatings, and user preference. It was not possible to combine data from some trials owing to variations in the catheters tested and in particular the catheter coatings. Where there were data, confidence intervals around estimates were wide and hence clinically important differences in UTI and other outcomes could neither be identified nor reliably ruled out. No study assessed cost-effectiveness. AUTHORS' CONCLUSIONS Despite a total of 31 trials, there is still no convincing evidence that the incidence of UTI is affected by use of aseptic or clean technique, coated or uncoated catheters, single (sterile) or multiple-use (clean) catheters, self-catheterisation or catheterisation by others, or by any other strategy. Results from user-reported outcomes varied. The current research evidence is weak and design issues are significant. More well-designed trials are strongly recommended. Such trials should include analysis of cost-effectiveness because there are likely to be substantial differences associated with the use of different catheter designs, catheterisation techniques and strategies.
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Affiliation(s)
- Jacqui Prieto
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
| | - Catherine L Murphy
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
| | - Katherine N Moore
- University of AlbertaFaculty of Nursing3rd Floor, Clinical Sciences BuildingEdmontonCanadaT6G 2G7
| | - Mandy Fader
- University of SouthamptonFaculty of Health SciencesRoom AA80, South Academic Block (Mailpoint11)Southampton General HospitalSouthamptonUKSO16 6YD
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DeFoor W, Reddy P, Reed M, VanderBrink B, Jackson E, Zhang B, Denlinger J, Noh P, Minevich E, Sheldon C. Results of a prospective randomized control trial comparing hydrophilic to uncoated catheters in children with neurogenic bladder. J Pediatr Urol 2017; 13:373.e1-373.e5. [PMID: 28713004 DOI: 10.1016/j.jpurol.2017.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/09/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Children with neurogenic bladder (NGB) often require a lifetime of clean intermittent catheterization (CIC), typically using uncoated catheters (UCs). Hydrophilic catheters (HCs) have lower friction than UCs with reported less damage to the urethra. The purpose of this study is to compare outcomes between these catheters. METHODS An investigator-initiated, prospective, randomized clinical trial was conducted to compare HCs versus UCs. Children aged 2-17 years with NGB on CIC were enrolled for 1 year. Block randomization was used. Dexterity scores were obtained in those who perform self-catheterization. Outcomes were UTI, difficulty passing the catheter, urethral injury, and patient satisfaction. RESULTS Demographic data is presented in the Table. Seventy-eight patients were enrolled. Age and gender were similar between the groups. Fifteen patients in each group performed CIC via an abdominal wall stoma. Eight and 15 patients withdrew from the UC and HC groups, respectively. The HC group overall had more problems with the catheter, mainly difficulty with handling. There were no differences for passing the catheter, pain, hematuria, or urethral injuries. There were two urinary tract infections (UTIs) in two HC patients and 17 UTIs in seven UC patients (p = 0.003). Patients with UTIs in the HC group went from 16% in the previous year to 5% during the study. Three children in the HC group had three or more UTIs in the year before enrollment and none during the study. The patients that completed the study with HC were overall satisfied and many requested to continue with the HC. CONCLUSIONS HCs may decrease the risk of UTI in children with NGB. Urethral complications were low in both groups. Most HC patients were pleased but some found the slippery coating difficult to handle.
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Affiliation(s)
- William DeFoor
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Pramod Reddy
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Melissa Reed
- Office of Clinical and Translational Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Brian VanderBrink
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Elizabeth Jackson
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bin Zhang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Julie Denlinger
- Office of Clinical and Translational Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Paul Noh
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eugene Minevich
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Curtis Sheldon
- Division of Pediatric Urology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Meddings J, Saint S, Krein SL, Gaies E, Reichert H, Hickner A, McNamara S, Mann JD, Mody L. Systematic Review of Interventions to Reduce Urinary Tract Infection in Nursing Home Residents. J Hosp Med 2017; 12:356-368. [PMID: 28459908 PMCID: PMC5557395 DOI: 10.12788/jhm.2724] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) in nursing homes are common, costly, and morbid. PURPOSE Systematic literature review of strategies to reduce UTIs in nursing home residents. DATA SOURCES Ovid MEDLINE, Cochrane Library, CINAHL, Web of Science and Embase through June 22, 2015. STUDY SELECTION Interventional studies with a comparison group reporting at least 1 outcome for: catheter-associated UTI (CAUTI), UTIs not identified as catheter-associated, bacteriuria, or urinary catheter use. DATA EXTRACTION Two authors abstracted study design, participant and intervention details, outcomes, and quality measures. DATA SYNTHESIS Of 5794 records retrieved, 20 records describing 19 interventions were included: 8 randomized controlled trials, 10 pre-post nonrandomized interventions, and 1 nonrandomized intervention with concurrent controls. Quality (range, 8-25; median, 15) and outcome definitions varied greatly. Thirteen studies employed strategies to reduce catheter use or improve catheter care; 9 studies employed general infection prevention strategies (eg, improving hand hygiene, surveillance, contact precautions, reducing antibiotics). The 19 studies reported 12 UTI outcomes, 9 CAUTI outcomes, 4 bacteriuria outcomes, and 5 catheter use outcomes. Five studies showed CAUTI reduction (1 significantly); 9 studies showed UTI reduction (none significantly); 2 studies showed bacteriuria reduction (none significantly). Four studies showed reduced catheter use (1 significantly). LIMITATIONS Studies were often underpowered to assess statistical significance; none were pooled given variety of interventions and outcomes. CONCLUSIONS Several practices, often implemented in bundles, such as improving hand hygiene, reducing and improving catheter use, managing incontinence without catheters, and enhanced barrier precautions, appear to reduce UTI or CAUTI in nursing home residents. Journal of Hospital Medicine 2017;12:356-368.
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Affiliation(s)
- Jennifer Meddings
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- Department of Pediatrics and Communicable Diseases, Division of General
Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sanjay Saint
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sarah L. Krein
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | | | - Heidi Reichert
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Andrew Hickner
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- Cushing/Whitney Medical Library, Yale University, New Haven,
Connecticut
| | - Sara McNamara
- Department of Internal Medicine, Division of Geriatric and Palliative
Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason D. Mann
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Lona Mody
- Department of Internal Medicine, Division of General Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Geriatric and Palliative
Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Rognoni C, Tarricone R. Healthcare resource consumption for intermittent urinary catheterisation: cost-effectiveness of hydrophilic catheters and budget impact analyses. BMJ Open 2017; 7:e012360. [PMID: 28096251 PMCID: PMC5253566 DOI: 10.1136/bmjopen-2016-012360] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/05/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study presents a cost-effectiveness analysis comparing hydrophilic coated to uncoated catheters for patients performing urinary intermittent catheterisation. A national budget impact analysis is also included to evaluate the impact of intermittent catheterisation for management of bladder dysfunctions over a period of 5 years. DESIGN A Markov model (lifetime horizon, 1 year cycle length) was developed to project health outcomes (life years and quality-adjusted life years) and economic consequences related to patients using hydrophilic coated or uncoated catheters. The model was populated with catheter-related clinical efficacy data retrieved from randomised controlled trials and quality-of-life data (utility weights) from the literature. Cost data (EUR, 2015) were estimated on the basis of healthcare resource consumption derived from an e-survey addressed to key opinion leaders in the field. SETTING Italian Healthcare Service perspective. POPULATION Patients with spinal cord injury performing intermittent urinary catheterisation in the home setting. MAIN OUTCOME MEASURES Incremental cost-effectiveness and cost-utility ratios (ICER and ICUR) of hydrophilic coated versus uncoated catheters and associated healthcare budget impact. RESULTS The base-case ICER and ICUR associated with hydrophilic coated catheters were €20 761 and €24 405, respectively. This implies that hydrophilic coated catheters are likely to be cost-effective in comparison to uncoated ones, as proposed Italian threshold values range between €25 000 and €66 400. Considering a market share at year 5 of 89% hydrophilic catheters and 11% uncoated catheters, the additional cost for Italy is approximately €12 million in the next 5 years (current market share scenario for year 0: 80% hydrophilic catheters and 20% uncoated catheters). CONCLUSIONS Considered over a lifetime, hydrophilic coated catheters are potentially a cost-effective choice in comparison to uncoated ones. These findings can assist policymakers in evaluating intermittent catheterisation in patients with spinal cord injury.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
- Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy
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Rognoni C, Tarricone R. Intermittent catheterisation with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol 2017; 17:4. [PMID: 28073354 PMCID: PMC5225586 DOI: 10.1186/s12894-016-0191-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intermittent catheterisation is the method of choice for the management of bladder dysfunctions. Different urinary catheters are available, but there is conflicting evidence on which type of catheter is best. The present study provides an objective evaluation of the clinical effectiveness of different subsets of urinary catheters. Methods A systematic literature review was performed for published RCTs regarding hydrophilic coated and PVC (standard) catheters for intermittent catheterisation. Separate meta-analyses were conducted to combine data on frequencies of urinary tract infections (UTIs) and haematuria. Two separate analyses were performed, including or excluding reused standard catheters. Results Seven studies were eligible for inclusion in the review. The meta-analyses exploring UTI frequencies showed a lower risk ratio associated with hydrophilic catheters in comparison to standard ones (RR = 0.84; 95% CI, 0.75–0.94; p = 0.003). Results for the “reuse” scenario were consistent with the ones related to “single-use” scenario in terms of frequency of UTIs. The meta-analyses exploring haematuria were not able to demonstrate any statistically significant difference between hydrophilic catheters in comparison to standard ones. Conclusions The findings confirm previously reported benefits of hydrophilic catheters but a broader evaluation that takes into account also patient preferences, compliance of therapy, quality of life and costs would be needed to assess the economic sustainability of these advanced devices. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0191-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Via Roentgen 1, Milan, 20136, Italy
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Cornejo-Dávila V, Durán-Ortiz S, Pacheco-Gahbler C. Incidence of Urethral Stricture in Patients With Spinal Cord Injury Treated With Clean Intermittent Self-Catheterization. Urology 2016; 99:260-264. [PMID: 27566143 DOI: 10.1016/j.urology.2016.08.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To report the incidence of urethral stricture and its management in patients with spinal cord injury treated with clean intermittent self-catheterization (CIC). MATERIALS AND METHODS The clinical records of 333 patients with spinal cord injury treated with CIC since 2001 were identified, and those who developed a urethral stricture during their follow-up, including their treatment and results achieved, were analyzed. RESULTS The patients had a median age at the time of injury of 27 years, of which only 14 patients (4.2%) developed urethral stricture at a mean duration of self-catheterization of 9 years; 86% of them were treated with urethrotomy, without recurrence through a mean of 1-year follow-up. There are no previous reports of rates of urethral stricture in this type of patients in our institution; the rate found is considerably low, as is the recurrence after urethrotomy, which can be decreased by the continuous self-obturation achieved with catheterization. CONCLUSION Urethral stricture as a complication of CIC in patients with spinal cord injury has a low incidence and can be effectively treated in those who develop it.
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Affiliation(s)
| | - Sergio Durán-Ortiz
- Division of Urology, Hospital General "Dr. Manuel Gea González", Mexico City, Mexico
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Bardsley A. Intermittent catheterisation: an option for managing bladder dysfunction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S16-8. [PMID: 27172502 DOI: 10.12968/bjon.2016.25.9.s16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bardsley
- Senior Lecturer, Course Director for Non-Medical Prescribing, Coventry University discusses the role of intermittent catheterisation and considerations for health professionals and the individual concerned
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43
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Biardeau X, Corcos J. Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma. Ann Phys Rehabil Med 2016; 59:125-9. [DOI: 10.1016/j.rehab.2016.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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Lamin E, Newman DK. Clean intermittent catheterization revisited. Int Urol Nephrol 2016; 48:931-9. [DOI: 10.1007/s11255-016-1236-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/29/2016] [Indexed: 12/27/2022]
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Affiliation(s)
- Alison Bardsley
- Senior Lecturer and Course Director for Non-Medical Prescribing and BSc in Professional Practice, Coventry University
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Prieto JA, Murphy C, Moore KN, Fader MJ. Intermittent catheterisation for long-term bladder management (abridged cochrane review). Neurourol Urodyn 2015; 34:648-53. [DOI: 10.1002/nau.22792] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Jacqui A. Prieto
- University of Southampton-Faculty of Health Sciences; South Academic Block, Southampton General Hospital; Southampton United Kingdom
| | - Catherine Murphy
- University of Southampton-Faculty of Health Sciences; South Academic Block, Southampton General Hospital; Southampton United Kingdom
| | | | - Mandy J. Fader
- University of Southampton-Faculty of Health Sciences; South Academic Block, Southampton General Hospital; Southampton United Kingdom
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Abstract
Approximately 450 000 people use long-term urinary catheters in the UK. Permanent catheters are used by 3% of the community population and occupy an estimated 4% of a district nurse's caseload in the UK. Catheterisation is defined as 'drainage or aspiration of the bladder or urinary reservoir' and can be intermittent or indwelling. Long-term indwelling catheterisation can be transurethral or suprapubic via the anterior abdominal wall. This article will discuss the safe and effective use of different forms of catheterisation for patients in the community setting.
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Affiliation(s)
- Alison Bardsley
- Senior Lecturer (Adult Nursing), Course Director in Non-medical Prescribing, Nursing, Midwifery and Healthcare Practice, Coventry University
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49
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Logan K. The male experience of ISC with a silicone catheter. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2015; 24:S30, S32-4. [PMID: 25978472 DOI: 10.12968/bjon.2015.24.sup9.s30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Since its introduction in the 1970s, intermittent self-catheterisation (ISC) has become more common and should be considered the method of choice for draining retained urine. The realisation for male patients that they require catheterisation can be associated with a significant physical and psychological burden (Shaw and Logan, 2013). This article describes a UK multi-centre patient satisfaction survey evaluating the features of a male ISC silicone catheter. The survey was aimed at determining patient preferences and perceptions of learning ISC with the intermittent catheter to evaluate if a silicone catheter is acceptable and user friendly. This information is intended to be used to expand the knowledge base around catheter selection and help guide nurses who offer a choice of catheters when teaching ISC to patients.
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Affiliation(s)
- Karen Logan
- Consultant Nurse and Director of Continence Services, Aneurin Bevan Health Board, Llanfrechfa Grange Hospital, Wales
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