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Stoffel JT, Yu L. Urinary Catheters: Materials, Coatings, and Recommendations for Selection. Urol Clin North Am 2024; 51:253-262. [PMID: 38609197 DOI: 10.1016/j.ucl.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Urinary catheters have been used for more than 3000 years, although materials have changed from wood to silver to rubber. Research continues to try and find the optimal catheter materials, which improve safety and quality of life. Advantages when comparing newer catheter materials are not always obvious but catheters coated with a hydrophilic layer may reduce urethral trauma and the incidence of urinary tract infections. However, extrapolation of the data is limited by lack of end-point standardization and heterogenous populations.
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Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Lisa Yu
- Neurourology/Incontinence/Reconstruction, University of Michigan/Michigan Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Dean NL, Gras J, Lantz EE, Patterson JP, Inglese G, Goldstine JV, Medina-Rivera M, Bionda N, Strickland AD, Sileika TS. Microbial Transfer by Intermittent Catheters: An In Vitro Evaluation of Microbial Transfer in Catheter With Variable Protective Features. J Wound Ostomy Continence Nurs 2024; 51:66-73. [PMID: 38215300 DOI: 10.1097/won.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate the effects of various protective features (eg, catheter cap, introducer tip, and catheter sleeve) of hydrophilic intermittent catheters against contamination with urinary tract infection-associated microorganisms using an in vitro model. DESIGN An in vitro study of microbial transfer. MATERIALS AND METHODS Gloves were contaminated with uropathogenic microorganisms and used to simulate intermittent catheterization of male anatomical models with and without the protective features present in 5 commercially available hydrophilic catheters. Using this contaminated touch transfer method, both the meatus of the sterile male anatomical models and sterile surgical gloves of an operator were inoculated with a high level of microorganisms (107 and 109 colony-forming units [CFU], respectively). The operator then performed catheterization of the anatomical model. The most relevant segments of the catheter were sampled, and the level of microbial transfer and catheter contamination was quantified. Results from experimental and sample replicates from the 3 microbial species and 5 catheters (sleeved and unsleeved) were analyzed by pair-wise t tests and analysis of variance. RESULTS Of the 5 commercially available sleeved intermittent catheters evaluated in this study, use of catheters with multiple protective components (ring cap, introducer tip, and catheter sleeve) resulted in significant improvement in protection against contamination with a 25- to 2500-fold lower level of microbial contamination (C1 segment) across all species as compared to catheters protected with only sleeves or un-sleeved catheters. CONCLUSIONS The combination of a ring cap, protective introducer tip, and protective sleeve provides additional protection when compared to sleeve alone from transferring microbial contamination from the meatus to the advancing catheter. Additional research is needed to determine whether these design features result in fewer urinary tract infections among intermittent catheter users.
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Affiliation(s)
- Nicole L Dean
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - James Gras
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Ellen E Lantz
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jillian P Patterson
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Gary Inglese
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Jimena V Goldstine
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Mariely Medina-Rivera
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Nina Bionda
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Aaron D Strickland
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
| | - Tadas S Sileika
- Nicole L. Dean, BS, Hollister Inc, Libertyville, Illinois
- James Gras, AS, iFyber LLC, Ithaca, New York
- Ellen E. Lantz, PhD, iFyber LLC, Ithaca, New York
- Jillian P. Patterson, BS, iFyber LLC, Ithaca, New York
- Gary Inglese, RN, MBA, Hollister Inc, Libertyville, Illinois
- Jimena V. Goldstine, PhD, Hollister Inc, Libertyville, Illinois
- Mariely Medina, PhD, iFyber LLC, Ithaca, New York
- Nina Bionda, PhD, iFyber LLC, Ithaca, New York
- Aaron D. Strickland, PhD, iFyber LLC, Ithaca, New York
- Tadas S. Sileika, PhD, PMP, Hollister Inc, Libertyville, Illinois
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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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Forster CS, Kowalewski NN, Atienza M, Reines K, Ross S. Defining Urinary Tract Infections in Children With Spina Bifida: A Systematic Review. Hosp Pediatr 2021; 11:1280-1287. [PMID: 34697071 DOI: 10.1542/hpeds.2021-005934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CONTEXT Children with spina bifida are at high risk for urinary tract infections (UTI). However, there is no standardized definition of UTI in this population, leading to variability in both clinical management and research. This was highlighted in the 2013 systematic review on the same topic. OBJECTIVE Evaluate the frequency with which researchers are defining UTI in their studies of children with spina bifida and to determine what parameters are used. DATA SOURCES We searched Medline and Scopus databases for articles that included pediatric patients with spina bifida and used UTI as an outcome. STUDY SELECTION Exclusion criteria included publication before October 1, 2012, non-English language, and nonprimary research articles. DATA EXTRACTION Two independent reviewers each extracted data. RESULTS A total of 39 studies were included; 74% of these analyzed included an explicit definition of UTI. The most commonly used definition included a combination of symptoms and culture results (34.5%), whereas 31% used a combination of symptoms, culture results, and urinalysis data. Only 3.4% of articles used a urine culture alone to define UTI. CONCLUSIONS More articles that focus on children with spina bifida included a definition of UTI. However, significant variability persists in the definition of UTI in this patient population.
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Affiliation(s)
- Catherine S Forster
- Children's National Hospital, Washington, District of Columbia .,The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | | | - Matthew Atienza
- The George Washington School of Medicine and Health Sciences, The George Washington University, Washington, DC
| | - Katy Reines
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Sherry Ross
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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5
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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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Sager C, Barroso U, Bastos JM, Retamal G, Ormaechea E. Management of neurogenic bladder dysfunction in children update and recommendations on medical treatment. Int Braz J Urol 2021; 48:31-51. [PMID: 33861059 PMCID: PMC8691255 DOI: 10.1590/s1677-5538.ibju.2020.0989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Defective closure of the neural tube affects different systems and generates sequelae, such as neurogenic bladder (NB). Myelomeningocele (MMC) represents the most frequent and most severe cause of NB in children. Damage of the renal parenchyma in children with NB acquired in postnatal stages is preventable given adequate evaluation, follow-up and proactive management. The aim of this document is to update issues on medical management of neurogenic bladder in children. MATERIALS AND METHODS Five Pediatric Urologists joined a group of experts and reviewed all important issues on "Spina Bifida, Neurogenic Bladder in Children" and elaborated a draft of the document. All the members of the group focused on the same system of classification of the levels of evidence (GRADE system) in order to assess the literature and the recommendations. During the year 2020 the panel of experts has met virtually to review, discuss and write a consensus document. RESULTS AND DISCUSSION The panel addressed recommendations on up to date choice of diagnosis evaluation and therapies. Clean intermittent catheterization (CIC) should be implemented during the first days of life, and antimuscarinic drugs should be indicated upon results of urodynamic studies. When the patient becomes refractory to first-line therapy, receptor-selective pharmacotherapy is available nowadays, which leads to a reduction in reconstructive procedures, such as augmentation cystoplasty.
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Affiliation(s)
- Cristian Sager
- Service of Urology, National Hospital of Pediatrics Prof. Dr. P. J. Garrahan, Buenos Aires, Argentina
| | - Ubirajara Barroso
- Departamento de Urologia, Universidade Federal da Bahia - UFBA, Salvador, BA, Brasil.,Escola Bahiana de Medicina (BAHIANA), Salvador, BA, Brasil
| | - José Murillo Bastos
- Universidade Federal de Juiz de Fora - UFJF, Juiz de Fora, MG, Brasil.,Hospital e Maternidade Therezinha de Jesus da Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (HMTJ-SUPREMA), Juiz de Fora, MG, Brasil
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Moussa M, Chakra MA, Papatsoris AG, Dellis A, Dabboucy B, Fares Y. Bladder irrigation with povidone-iodine prevent recurrent urinary tract infections in neurogenic bladder patients on clean intermittent catheterization. Neurourol Urodyn 2021; 40:672-679. [PMID: 33476092 DOI: 10.1002/nau.24607] [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] [Received: 09/07/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022]
Abstract
AIMS To determine if daily povidone-iodine (PI) bladder irrigation in neurogenic lower urinary tract dysfunction (NLUTD) patients doing clean intermittent catheterization (CIC) can reduce the rate of symptomatic urinary tract infections (UTIs), emergency department (ED) visit for UTIs, and hospitalization for UTIs. METHODS We prospectively reviewed the records of patients with NLUTD on CIC who had recurrent symptomatic UTIs and who were placed on daily intravesical instillations of PI. This trial was conducted from January 2014 to January 2020 on 119 patients. RESULTS After using daily PI bladder irrigation, the rate of symptomatic UTIs was reduced by 99.2% (incidence rate ratio [IRR]: 0.008, 95% confidence interval [CI]: 0.001-0.059; p < .001), the rate of ED visits was reduced by 99.2%% (IRR: 0.008, 95% CI: 0.001-0.059; p < .001), and the rate of inpatient hospitalizations for UTI was reduced by 99.9% (IRR: 0.0008, 95% CI: 0.0002-0.0035; p < .001). There was also a significant decrease in multidrug resistance in UTI organisms with the use of PI bladder instillation. CONCLUSIONS Daily intravesical PI instillation is a well-tolerated approach to prevent UTIs and related ED visits and hospitalizations in NLUTD patients doing CIC.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Lebanese Univeristy, Beirut, Lebanon
| | - Mohamed Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Athanasios G Papatsoris
- Second Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Dellis
- Department of Urology and General Surgery, Areteion Hospital, Athens, Greece
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
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Gamé X, Phé V, Castel-Lacanal E, Forin V, de Sèze M, Lam O, Chartier-Kastler E, Keppenne V, Corcos J, Denys P, Caremel R, Loche CM, Scheiber-Nogueira MC, Karsenty G, Even A. Intermittent catheterization: Clinical practice guidelines from Association Française d'Urologie (AFU), Groupe de Neuro-urologie de Langue Française (GENULF), Société Française de Médecine Physique et de Réadaptation (SOFMER) and Société Interdisciplinaire Francophone d'UroDynamique et de Pelvi-Périnéologie (SIFUD-PP). Prog Urol 2020; 30:232-251. [PMID: 32220571 DOI: 10.1016/j.purol.2020.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/02/2020] [Accepted: 02/13/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Our objective was to provide guidelines covering all aspects of intermittent catheterisation (intermittent self-catheterisation and third-party intermittent catheterisation). MATERIALS AND METHODS A systematic review of the literature based on Pubmed, Embase, Google scholar was initiated in December 2014 and updated in April 2019. Given the lack of robust data and the numerous unresolved controversial issues, guidelines were established based on the formal consensus of experts from steering, scoring and review panels. RESULTS This allowed the formulation of 78 guidelines, extending from guidelines on indications for intermittent catheterisation, modalities for training and implementation, choice of equipment, management of bacteriuria and urinary tract infections, to the implementation of intermittent catheterisation in paediatric, geriatric populations, benign prostatic hyperplasia patients and continent urinary diversion patients with a cutaneous reservoir as well as other complications. These guidelines are pertinent to both intermittent self-catheterisation and third-party intermittent catheterisation. CONCLUSION These are the first comprehensive guidelines specifically aimed at intermittent catheterisation and extend to all aspects of intermittent catheterisation. They assist in the clinical decision-making process, specifically in relation to indications and modalities of intermittent catheterisation options. These guidelines are intended for urologists, gynaecologists, geriatricians, paediatricians, neurologists, physical and rehabilitation physicians, general practitioners and other health professionals including nurses, carers….
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Affiliation(s)
- X Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Université Paul Sabatier, Toulouse, France.
| | - V Phé
- Sorbonne Université, Service d'Urologie, AP-HP, hôpital Pitié-Salpetrière, Paris, France
| | - E Castel-Lacanal
- CHU Toulouse, service de Médecine Physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - V Forin
- Médecine Physique et de Réadaptation pédiatrique, Hôpital Armand Trousseau AP-HP, Sorbonne Université, Paris, France
| | - M de Sèze
- Cabinet de neuroUrologie et Pelviperinéologie, Clinique Saint Augustin, Bordeaux, France
| | - O Lam
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - E Chartier-Kastler
- Sorbonne Université, Service d'Urologie, AP-HP, hôpital Pitié-Salpetrière, Paris, France
| | - V Keppenne
- Service d'urologie, CHU Liège, Liège, Belgium
| | - J Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - P Denys
- Université de Versailles Saint Quentin. Service de Neuro Urologie, AP-HP, Hopital Raymond Poincaré, Garches, France
| | - R Caremel
- Clinique du Cèdre, Bois-Guillaume, France
| | - C-M Loche
- Service de Rééducation Neurolocomotrice, AP-HP, HU Henri Mondor, Créteil, France
| | | | - G Karsenty
- Aix-Marseille Université, Urologie et Transplantation Rénale, Hôpital La Conception, APHM, Marseille, France
| | - A Even
- Service de Neuro Urologie, AP-HP, Hôpital Raymond Poincaré, Garches, France
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Sam CJ, Jagadeesan CT, Sen S, Arunachalam P, Appalaraju B, Das PT. Urinary Tract Infection in Pediatric Patients on Clean Intermittent Catheterization via a Mitrofanoff port with Reused Catheters - Any Association with Catheter Sterility? J Indian Assoc Pediatr Surg 2020; 25:91-95. [PMID: 32139987 PMCID: PMC7020673 DOI: 10.4103/jiaps.jiaps_10_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/25/2019] [Accepted: 06/28/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of this study is to find out whether the reused catheters for clean intermittent catheterization (CIC) are colonized before insertion and its association with urinary tract infection (UTI). Materials and Methods: This is a study conducted on 28 pediatric surgery patients who are on CIC via a Mitrofanoff port and who were reusing catheters, in a tertiary care private medical college hospital for 6-month period. Catheters to be used for the next catheterization were sent for culture along with urine culture. A questionnaire was utilized to assess CIC practice and UTI. Results: Diseases of patients were: neurogenic bladder and exstrophy–epispadias and posterior urethral valve. Twenty-one of them had an augmented bladder. Hydronephrosis was present in ten and vesicoureteral reflux (VUR) in five. Their mean duration of CIC was 5.3 years. Of 28 catheter tip samples, 16 catheters were colonized with organism. Of the 28 urine culture samples, 17 cultures were positive and all were asymptomatic except one. Of the 16 positive catheter samples, only 9 had positive urine culture; four of them had grown different organisms and five of them had the same organism, and even in these five, single organism was seen only in three. Urine culture grew Gram-negative organism in 85%, but catheter grew Gram-positive organism in 46%. No difference was found in the variables between both groups such as hydronephrosis, VUR, and augmented bladder. Conclusion: Reused catheters were colonized in 57% of the study patients, but reused catheter may not be the cause of culture positivity or UTI in the study population.
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Affiliation(s)
- Cenita James Sam
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Cindrel T Jagadeesan
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Sudipta Sen
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Pavai Arunachalam
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - B Appalaraju
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Praseetha T Das
- Department of Paediatric Surgery, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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Stein R, Bogaert G, Dogan HS, Hoen L, Kocvara R, Nijman RJM, Quadackers JSLT, Rawashdeh YF, Silay MS, Tekgul S, Radmayr C. EAU/ESPU guidelines on the management of neurogenic bladder in children and adolescent part I diagnostics and conservative treatment. Neurourol Urodyn 2019; 39:45-57. [PMID: 31724222 DOI: 10.1002/nau.24211] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/22/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND In childhood, the most common reason for a neurogenic bladder is related to spinal dysraphism, mostly myelodysplasia. AIMS Herein, we present the EAU/ESPU guidelines in respect to the diagnostics, timetable for investigations and conservative management including clean intermittent catheterization (CIC). MATERIAL AND METHODS After a systematic literature review covering the period 2000 to 2017, the ESPU/EUAU guideline for neurogenic bladder underwent an update. RESULTS The EAU/ESPU guideline panel advocates a proactive approach. In newborns with spina bifida, CIC should be started as soon as possible after birth. In those with intrauterine closure of the defect, urodynamic studies are recommended be performed before the patient leaves the hospital. In those with closure after birth urodynamics should be done within the next 3 months. Anticholinergic medication (oxybutynin is the only well-investigated drug in this age group-dosage 0.2-0.4 mg/kg weight per day) should be applied, if the urodynamic study confirmed detrusor overactivity. Close follow-up including ultrasound, bladder diary, urinalysis, and urodynamics are necessary within the first 6 years and after that the time intervals can be prolonged, depending on the individual risk and clinical course. In all other children with the suspicion of a neurogenic bladder due to various reasons as tethered cord, inflammation, tumors, trauma, or other reasons as well as those with anorectal malformations, urodynamics-preferable video-urodynamics, should be carried out as soon as there is a suspicion of a neurogenic bladder and conservative treatment should be started soon after confirmation of the diagnosis of neurogenic bladder. With conservative treatment the upper urinary tract is preserved in up to 90%, urinary tract infections are common, but not severe, complications of CIC are quite rare and continence can be achieved at adolescence in up to 80% without further treatment. DISCUSSION AND CONCLUSIONS The transition into adulthood is a complicated time for both patients, their caregivers and doctors, as the patient wants to become independent from caregivers and treatment compliance is reduced. Also, transition to adult clinics for patients with neurogenic bladders is often not well-established.
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Affiliation(s)
- Raimund Stein
- Department of Pediatric, Adolescent and Reconstructive Urology, Medical Faculty Mannheim, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Guy Bogaert
- Department of Urology, University of Leuven, Belgium
| | - Hasan S Dogan
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
| | - Lisette Hoen
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Radim Kocvara
- Department of Urology, 1st Faculty of Medicine in Praha, General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Rien J M Nijman
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | - Josine S L T Quadackers
- Department of Urology and Pediatric Urology, University Medical Centre Groningen, Rijks Universiteit Groningen, Groningen, The Netherlands
| | | | - Mesrur S Silay
- Division of Pediatric Urology, Department of Urology, Istanbul Medeniyet University, Istanbul, Turkey
| | - Serdar Tekgul
- Division of Pediatric Urology, Department of Urology, Hacettepe University, Ankara, Turkey
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Lucas E. Medical Management of Neurogenic Bladder for Children and Adults: A Review. Top Spinal Cord Inj Rehabil 2019; 25:195-204. [PMID: 31548786 DOI: 10.1310/sci2503-195] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Neurogenic bladder is a chronic condition affecting patients of all ages with significant medical and quality of life implications. Goals of treatment consist of protection of the upper urinary tract and promotion of reliable urinary continence. Successful management involves medications and most often bladder drainage via clean intermittent catheterization. This article reviews current literature on medical management to achieve goals of treatment.
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12
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Preece J, Haynes A, Gupta S, Becknell B, Ching C. Implications of Bacteriuria in Myelomeningocele Patients at Time of Urodynamic Testing. Top Spinal Cord Inj Rehabil 2019; 25:241-247. [PMID: 31548791 DOI: 10.1310/sci2503-241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To identify those myelomeningocele (MMC) patients at risk for post-urodynamic study (UDS) complications. We hypothesized that patients who manage their bladder with clean intermittent catheterization (CIC) would have a greater risk of post-instrumentation complications due to higher rates of bacteriuria compared to those who freely void (FV). Design/Methods: Urine was collected from patients with MMC without augmentation cystoplasty undergoing routine renal ultrasound or urodynamic study (UDS). Samples were divided into those with bacteriuria (urine culture ≥10,000 colony-forming units) and those without. Post-UDS complications were evaluated and compared between CIC and FV patients. Results: A total of 91 urine samples from 82 total MMC patients were included for evaluation. Significantly more patients on CIC than those who FV had bacteriuria (67% vs 33%, p = .0457). From these urine samples, 54 were obtained at time of UDS of which 45 were from patients on CIC and 9 from FV patients. More patients on CIC had bacteriuria at the time of UDS than those who FV (60% vs 33%, respectively), but this did not reach significance (p = .1416). No patient with bacteriuria on CIC had a complication after UDS while one FV patient with bacteriuria developed post-UDS pyelonephritis. Conclusion: MMC patients with bacteriuria on CIC did not have post-UDS complications. Patients with bacteriuria who FV may be at particular risk for post-instrumentation UTI, providing guidance as to which MMC patients should undergo urine testing prior to UDS in order to prevent post-instrumentation pyelonephritis.
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Affiliation(s)
- Janae Preece
- Department of Urology, Children's Hospital of Michigan, Detroit, Michigan
| | - Andria Haynes
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sudipti Gupta
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
| | - Brian Becknell
- Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio.,Division of Nephrology, Nationwide Children's Hospital, Columbus, Ohio
| | - Christina Ching
- Division of Urology, Nationwide Children's Hospital, Columbus, Ohio.,Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, Ohio
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Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections. Adv Urol 2019; 2019:2757862. [PMID: 31065264 PMCID: PMC6466920 DOI: 10.1155/2019/2757862] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 01/11/2023] Open
Abstract
A risk factor model for urinary tract infections in patients with adult neurogenic lower urinary tract dysfunction performing clean intermittent catheterisation was developed; it consists of four domains, namely, (1) general (systemic) conditions in the patient, (2) individual urinary tract conditions in the patient, (3) routine aspects related to the patient, and (4) factors related to intermittent catheters per se. The conceptual model primarily concerns patients with spinal cord injury, spina bifida, multiple sclerosis, or cauda equina where intermittent catheterisation is a normal part of the bladder management. On basis of several literature searches and author consensus in case of lacking evidence, the model intends to provide an overview of the risk factors involved in urinary tract infections, with specific emphasis to describe those that in daily practice can be handled and modified by the clinician and so come to the benefit of the individual catheter user in terms of fewer urinary tract infections.
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Castle AC, Park A, Mitchell AJ, Bliss DZ, Gelfand JA, De EJB. Neurogenic Bladder: Recurrent Urinary Tract Infections—Beyond Antibiotics. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0481-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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15
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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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