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Chancellor M. Underactive Bladder According to the European Association of Urology Guidelines. Eur Urol 2024; 86:221-222. [PMID: 38744630 DOI: 10.1016/j.eururo.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Michael Chancellor
- Department of Urology, William Beaumont University Hospital, Corewell Health, Royal Oak, MI, USA.
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Chancellor M, Bartolone S. A legacy of excellence: celebrating 40 years of the Diokno-Lapides essay contest. Int Urol Nephrol 2024; 56:1235-1241. [PMID: 38082094 PMCID: PMC10923967 DOI: 10.1007/s11255-023-03886-6] [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: 09/22/2023] [Accepted: 11/09/2023] [Indexed: 03/09/2024]
Abstract
The Diokno-Lapides Essay Contest was originally established in 1984 as the Jack Lapides Essay Contest on Urodynamic and Neurourology Research. Developed by Ananias Diokno to honor his mentor, Jack Lapides at the University of Michigan, it was funded by a grant from Marion Laboratories. The contest recognizes individuals doing outstanding work in neurourology and has been awarded yearly since 1985. Renamed the Diokno-Lapides Essay Contest in 2014, it has generated significant papers and discoveries in neurourology. Spanning 40 years, winners and other participants have attested to the contest's influence on their careers and its opportunities for networking and mentorship across the global urology community.
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Affiliation(s)
- Michael Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Corewell Health William Beaumont University Hospital, 3811 W 13 Mile Rd, Suite 504, Royal Oak, MI, USA.
| | - Sarah Bartolone
- Department of Urology, Oakland University William Beaumont School of Medicine, Corewell Health William Beaumont University Hospital, 3811 W 13 Mile Rd, Suite 504, Royal Oak, MI, USA
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Baradaran N, Peng J, Palettas M, Chen Y, DeVivo MJ, Schwab JM. Bladder Management With Chronic Indwelling Catheter is Associated with Elevated Mortality in Patients with Spinal Cord Injury. Urology 2022; 165:72-80. [PMID: 35263641 DOI: 10.1016/j.urology.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database. METHODS Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened. Patients who died within 1 year of injury and had 2 or more changes in method of bladder management, or reported normal volitional void were excluded. Outcome of interest was death from nonpulmonary, nonwound related sepsis (NPNWS). Left truncation cox regression method using age as the time-scale was used to calculate hazard ratios. RESULTS A total of 13,616 patients were included. Comparison was performed between "IndC" group (n = 4872; 36.1%) vs "Other" (n = 8744; 63.9%). After adjusting for age and change in bladder management method, "IndC" is associated with elevated NPNWS mortality (2.10; 95% confidence interval 1.72-2.56, P < .001). Multivariable analysis, adjusting for age at injury, gender, race, education, insurance status, etiology of SCI, injury level, neurologic impairment level, and change in bladder management method, showed IndC was associated with significantly higher risk of death from NPNWS compared to other methods of bladder management. CONCLUSION In a large cohort of SCI patients, bladder management with IndC is predictive of significantly propagated NPNWS related mortality compared to other methods of bladder management. While identifying IndC is an independent mortality risk factor, a better understanding of the underlying mechanisms could inform strategies to improve neurourological care and survival after SCI.
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Affiliation(s)
- Nima Baradaran
- Department of Urology, The Ohio State University, Wexner Medical Center, Columbus, OH.
| | - Juan Peng
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - YuYing Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, Departments of Neurology, Physical Medicine and Rehabilitation, Neuroscience and Center for Brain and Spinal Cord Repair, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH
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Ull C, Yilmaz E, Jansen O, Lotzien S, Schildhauer TA, Aach M, Königshausen M. Spinal Cord Injury With Tetraplegia in Young Persons After Diving Into Shallow Water: What Has Changed in the Past 10 to 15 Years? Global Spine J 2021; 11:1238-1247. [PMID: 32909818 PMCID: PMC8453686 DOI: 10.1177/2192568220944124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective, monocentric, observational study in a tertiary health care center. OBJECTIVES To analyze prehospital and clinical findings, complications, neurological improvement and follow-up in a young person cohort with spinal cord injury (SCI) and tetraplegia according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) A to D after diving into shallow water. METHODS Included were all persons younger than 50 years with SCI after head-first diving into shallow water between June 2001 and June 2019. All persons with SCI were divided into complete tetraplegia (AIS A) and incomplete tetraplegia (AIS B, C, and D) to test differences. RESULTS A total of 59 males (98.7%) and 1 female with a mean age of 27.7 years suffered an SCI. Alcohol use was documented in 25 cases (41.7%). At the time of admission, 33 people (55%) showed a complete tetraplegia (AIS A) and 27 showed an incomplete tetraplegia with 8 AIS B (13.3%), 15 AIS C (25%), and 4 AIS D (6.7%). At the time of discharge, people with initially complete tetraplegia showed a significant improvement from admission to discharge (P ≤ .004). Persons with incomplete tetraplegia were more likely to improve their neurological status compared with complete tetraplegia patients (P ≤ .001). Especially persons with complete tetraplegia suffered from typical SCI-related problems and complications. CONCLUSIONS People with SCI and tetraplegia at the time admission show neurological improvement in 50% of the cases with an overall better outcome in persons with incomplete tetraplegia. The surgical treatment of SCI within 24 hours seems to be associated with a better neurological outcome and a lower level of tetraplegia. The incidence of SCI caused by diving into shallow water remains stable without a significant change, especially in high-risk groups. More education and prevention programs are necessary to avoid these injuries.
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Affiliation(s)
- Christopher Ull
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany,Christopher Ull, Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Oliver Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Sebastian Lotzien
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Thomas A. Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Mirko Aach
- Department of Spinal Cord Injuries, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Matthias Königshausen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
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Velaer KN, Welk B, Ginsberg D, Myers J, Shem K, Elliott C. Time Burden of Bladder Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:83-91. [PMID: 34456549 DOI: 10.46292/sci20-00007] [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] [Indexed: 11/19/2022]
Abstract
Background While clean intermittent catheterization (CIC) is the gold standard for bladder management after spinal cord injury (SCI), many individuals with SCI, for reasons not fully understood, choose alternative bladder management. We hypothesized that CIC is associated with an increased time burden in individuals with SCI. Objectives To investigate the time required to perform neurogenic bladder management in individuals with SCI. Methods An electronic nonvalidated questionnaire was designed to determine the self-reported time spent performing bladder management. It was sent to participants in the Neurogenic Bladder Research Group SCI Registry, a national quality of life study of individuals with SCI. Results Eighty-seven individuals responded to the survey. CIC was the most common bladder management (76%). Men and women performing independent CIC had similar average times with each catheterization episode (8.8 vs. 8.5 minutes, p = .864) as did women with a catheterizable stoma compared to women catheterizing per urethra (8.2 minutes, p = .913). Longer catheterization times were associated with cervical spine injury (mean 12.4 minutes per catheterization) and women requiring caregiver assistance (mean 20 minutes per catheterization). In addition, obese/overweight women had longer CIC times than normal weight women (14.5 minutes vs. 7 minutes; p = .036), while catheterization time was similar for all men regardless of body mass index. Individuals with indwelling catheters spent less than a third of the time on bladder management per day compared to those doing CIC (17 vs. 53 minutes per day, p < .001). Conclusion Management of neurogenic bladder after SCI, especially in those performing CIC, is time consuming. This time burden may play a role in long-term bladder management decisions.
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Affiliation(s)
| | - Blayne Welk
- Division of Urology, Western University, Pomona, California
| | - David Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Jeremy Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
| | - Christopher Elliott
- Department of Urology, Stanford Hospital and Clinics, Palo Alto, California.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California
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Chen J, Mohapatra A, Zhao J, Zhong Y, Shen B, Wang J, Shen Z, Beckel J, de Groat WC, Tai C. Superficial peroneal neuromodulation of persistent bladder underactivity induced by prolonged pudendal afferent nerve stimulation in cats. Am J Physiol Regul Integr Comp Physiol 2021; 320:R675-R682. [PMID: 33719564 DOI: 10.1152/ajpregu.00346.2020] [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] [Indexed: 11/22/2022]
Abstract
The purpose of this study is to determine whether superficial peroneal nerve stimulation (SPNS) can reverse persistent bladder underactivity induced by prolonged pudendal nerve stimulation (PNS). In 16 α-chloralose-anesthetized cats, PNS and SPNS were applied by nerve cuff electrodes. Skin surface electrodes were also used for SPNS. Bladder underactivity consisting of a significant increase in bladder capacity to 157.8 ± 10.9% of control and a significant reduction in bladder contraction amplitude to 56.0 ± 5.0% of control was induced by repetitive (4-16 times) application of 30-min PNS. SPNS (1 Hz, 0.2 ms) at 1.5-2 times threshold intensity (T) for inducing posterior thigh muscle contractions was applied either continuously (SPNSc) or intermittently (SPNSi) during a cystometrogram (CMG) to determine whether the stimulation can reverse the PNS-induced bladder underactivity. SPNSc or SPNSi applied by nerve cuff electrodes during the prolonged PNS inhibition significantly reduced bladder capacity to 124.4 ± 10.7% and 132.4 ± 14.2% of control, respectively, and increased contraction amplitude to 85.3 ± 6.2% and 75.8 ± 4.7%, respectively. Transcutaneous SPNSc and SPNSi also significantly reduced bladder capacity and increased contraction amplitude. Additional PNS applied during the bladder underactivity further increased bladder capacity, whereas SPNSc applied simultaneously with the PNS reversed the increase in bladder capacity. This study indicates that a noninvasive superficial peroneal neuromodulation therapy might be developed to treat bladder underactivity caused by abnormal pudendal nerve somatic afferent activation that is hypothesized to occur in patients with Fowler's syndrome.
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Affiliation(s)
- Jialiang Chen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Anand Mohapatra
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jun Zhao
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Urology, The Second Affiliated Hospital of Xian Jiaotong University, Xian, People's Republic of China
| | - Yihua Zhong
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Zhijun Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Wang X, Cao X, Li J, Deng C, Wang T, Fu L, Zhang Q. Evaluation of patient-reported outcome measures in intermittent self-catheterization users: A systematic review. Arch Phys Med Rehabil 2021; 102:2239-2246. [PMID: 33839103 DOI: 10.1016/j.apmr.2021.03.020] [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: 08/13/2020] [Revised: 01/14/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify patient-reported outcome measurements (PROMs) for intermittent self-catheterization (ISC) users, critically assess and summarize the quality of the measurement properties, and describe the application scenarios on each instrument. DATA SOURCES PubMed, EMBASE, Medline, PsycINFO and relevant reference lists were systematically searched until December 2019 (updated May 2020). STUDY SELECTION Two reviewers independently identified original English language publications that evaluated the psychometric properties of specific PROMs used in ISC patients. DATA EXTRACTION The following data were obtained: author and publication year, content of domains/subscales, number of items, response options, constructs measured, language and information on measurement properties. DATA SYNTHESIS Eleven publications were deemed eligible, including 6 PROMs for measuring patients' ISC-related quality of life, self-confidence, satisfaction, difficulties, acceptance and adherence to treatment. The Intermittent Self-Catheterization Questionnaire provided the most detail, and the Intermittent Catheterization Acceptance Test could be evaluated on the most COSMIN properties. CONCLUSION Several tools are available for ISC users, but at present there is no comprehensive, concise and robust instrument with good psychometric properties. Further research on psychometric properties is needed to verify the remaining properties of existing scales and to develop novel tools for clinicians, researchers and patients.
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Affiliation(s)
- Xue Wang
- Tianjin Medical University Second Hospital, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China
| | - Xiaona Cao
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin 300070, People's Republic of China
| | - Jialin Li
- Tianjin Medical University Second Hospital, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China
| | - Cuiyu Deng
- Tianjin Medical University Second Hospital, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China
| | - Ting Wang
- Tianjin Medical University Second Hospital, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China; School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin 300070, People's Republic of China
| | - Li Fu
- Tianjin Medical University Second Hospital, Pingjiang Road, Hexi District, Tianjin 300211, People's Republic of China.
| | - Qing Zhang
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin 300070, People's Republic of China.
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Denys P, Chartier-Kastler E, Even A, Joussain C. How to treat neurogenic bladder and sexual dysfunction after spinal cord lesion. Rev Neurol (Paris) 2021; 177:589-593. [PMID: 33610350 DOI: 10.1016/j.neurol.2020.07.013] [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: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/09/2023]
Abstract
Neurogenic bladder and sexual dysfunction after spinal cord lesions are highly prevalent. The treatment algorithm for neurogenic bladder is well described. Clean intermittent self-catheterisation associated with treatment of neurogenic detrusor overactivity is the gold standard. Goals of treatment are twofold: i) control risk factors to avoid upper urinary tract complications, and ii) improve quality of life by treating incontinence when feasible. Lower urinary tract dysfunction is still a major cause of complications and hospitalisation. Sexual dysfunction must be addressed and treated and is at the top of patient expectations one year after injury.
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Affiliation(s)
- P Denys
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France.
| | - E Chartier-Kastler
- Department of urology, Hôpital de la Pitié, Paris-Sorbonne Université, Paris, France
| | - A Even
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France
| | - C Joussain
- Neurourology and andrology unit, department of physical medecine and rehabilitation, Raymond-Poincaré Hospital AP-HP; Université Paris-Saclay; UMR 1179 Inserm, Paris, France
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Neyaz O, Srikumar V, Equebal A, Biswas A. Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization. J Spinal Cord Med 2018; 43:347-352. [PMID: 30277852 PMCID: PMC7241564 DOI: 10.1080/10790268.2018.1512729] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients.Design: Prospective, observational study.Setting: Tertiary Urban Rehabilitation Hospital.Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC.Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year).Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI.Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40 cm H2O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%.Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.
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Affiliation(s)
- Osama Neyaz
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
| | - Venkataraman Srikumar
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India,Correspondence to: Venkataraman Srikumar, Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India; Ph: +91 011 26593232.
| | - Ameed Equebal
- National Institute for Locomotor Disabilities, Kolkata, India
| | - Abhishek Biswas
- National Institute for Locomotor Disabilities, Kolkata, India
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Lane GI, Elliott SP. Safely Avoiding Surgery in Adult Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0479-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Guinet-Lacoste A, Charlanes A, Chesnel C, Blouet E, Tan E, Le Breton F, Amarenco G. Intermittent Catheterization Adherence Scale (ICAS): A new tool for the evaluation of patient adherence with clean intermittent self-catheterization. Neurourol Urodyn 2018; 37:2753-2757. [DOI: 10.1002/nau.23746] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/05/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Amandine Guinet-Lacoste
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
- Service de Médecine Physique et de Réadaptation; HCL Hôpital Henry Gabrielle; Saint Genis Laval France
| | - Audrey Charlanes
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Camille Chesnel
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Emilie Blouet
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Eliane Tan
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Frédérique Le Breton
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Gérard Amarenco
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon; APHP; GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
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Honore T, Le Breton F, Turmel N, Bignani B, Chesnel C, Charlanes A, Amarenco G. [Efficacy of botulinum toxin A injections in the urethral sphincter in patients with difficulties to perform self-intermittent catherization]. Prog Urol 2018; 28:370-376. [PMID: 29776876 DOI: 10.1016/j.purol.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate safety and efficacy of botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization. METHODS In this prospective study, 12 patients suffering from upper motor neuron diseases (8 multiple sclerosis, 2 myelitis, 1 brain injury, 1 multi system atrophy) and with difficulties to perform self-intermittent catherization, defined by a ICDQ score>1 (Intermittent Catheterization Difficulty Questionnaire) have had injections of 100U BOTOX® under EMG guidance in the urethral striated sphincter, for a total of 15 injections. Evaluations consisted of two questionnaires (ICDQ and PGI-A, Patient Global Improvement) 30 days after the injection. RESULTS 30 days after the injection, ICDQ was improved with a mean decrease of the total score of 7.8 (SD=5.9, P<0,001). In the same manner, all the patients were improved with a mean PGI-A score of 2.3. In 73.3 % of cases, the PGI-A score was equal to 2 (improvement=much better), and in 20 % it was equal to 3 (improvement=a little better). CONCLUSIONS Botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization seem to safe and effective. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- T Honore
- Service MPR, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - F Le Breton
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Turmel
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - B Bignani
- Service de MPR, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Chesnel
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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13
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Böthig R, Geng V, Kurze I. Management and implementation of intermittent catheterization in neurogenic lower urinary tract dysfunction. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2017. [DOI: 10.1111/ijun.12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ralf Böthig
- Abteilung Neuro-Urologie [Neuro-Urology Department]; BG-Klinikum Hamburg [BG Trauma Hospital Hamburg]; Hamburg Germany
| | - Veronika Geng
- Manfred Sauer-Stiftung [Manfred Sauer Foundation]; Lobbach Germany
| | - Ines Kurze
- Querschnittgelähmten-Zentrum, Klinik für Paraplegiologie und Neuro-Urologie [Centre for spinal cord injured patients Clinic for Paraplegiology and Neuro-Urology]; Zentralklinik Bad Berka; Bad Berka Germany
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[S2k guidelines of the German Society of Urology. Management and implementation of intermittent catheterization in neurogenic bladder dysfunction]. Urologe A 2015; 54:385-93. [PMID: 25784447 DOI: 10.1007/s00120-014-3701-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND As a considerable heterogeneity in the procedure of intermittent catheterization (IC) was identified by a questionnaire survey conducted in hospitals and institutions for the treatment of patients with spinal cord injury in 2010, it became necessary to standardize the IC procedure (i.e. self-catheterization and assisted catheterization). METHOD These guidelines were developed within a structured consensus process (e.g. several consensus conferences and nominal group process) by members of the working group on neurourology (Arbeitskreis Neuro-Urologie) and the working group on nursing (Arbeitskreis Pflege) of the German-speaking Medical Society of Paraplegia (DMGP), a section of the German Society for Orthopedics and Traumatology (DGOU) and were published as S2k guidelines of the German Society of Urology (DGU). The guidelines developer group consisted of representatives from the following professional groups: neurourology, surgery, health and nursing, nursing science, urotherapy and hygiene. RESULTS Firstly, the indications for IC are presented and concepts such as sterile, aseptic and hygienic catheterization are defined. The materials necessary for the IC (e.g. quality of the customized single-use catheter and approved disinfectants for disinfection of the meatus) are presented in detail. The disinfection and catheterization techniques are described and a detailed explanation of the potential complications and their management is given. Finally, the legal aspects and issues of eligibility of catheter material and disinfectants are discussed. CONCLUSIONS The purpose of this consensus is to contribute to the standardization of IC. It should remove uncertainty and offer assistance to users (i.e. patients, staff and care providers). A particular focus is placed on practical instructions for carrying out the IC. The intention is to support the realization of IC in various settings (e.g. hospital, rehabilitation, long-term care institutions and home-based care). A wide implementation of the guidelines should lead to a reduction of the risks and complications of IC, which in most cases is a procedure that will be necessary throughout life.
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Homan HD, Dmochowski R, Cochran JS, Karsh L, Sherman ND, Yalla S. Safety and efficacy of a patient-controlled bladder management system for treating urinary retention in men. Neurourol Urodyn 2015; 35:630-5. [PMID: 25856157 DOI: 10.1002/nau.22770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/02/2015] [Indexed: 11/09/2022]
Abstract
AIMS The CymActive™ Bladder Management System (BMS) is a self-retaining, intraurethral catheter with a patient-controlled magnetic valve that allows cyclical bladder filling and emptying, without external appliances. We determined the safety and efficacy of the BMS in men with urinary retention who required catheterization for more than 7 days. METHODS Men requiring continuous drainage, bladder capacity less than 300 ml, history of prostatic or urethral surgery, or urethral length outside of defined limits, were excluded. Data were collected from patient diaries and weekly visits during catheterization for up to 30 days. The primary composite endpoint assessed four outcomes: placement, post-void residual volume (PVR) of 75 ml or less, adverse device-related events requiring early removal, and removal. RESULTS Nine of 23 patients met all four criteria: eight of 18 non-neurogenic (7/11 prior Foley users and 1/7 without Foley experience) and one of five neurogenic spinal cord injury (SCI) patients. Secondary outcomes in non-neurogenic patients included: 17/18 successful insertions; of these, 16/17 average PVR of 75 ml; successful valve openings and closings ≥ 95% of more than 1,400 voids; and minimal leakage. Four of five SCI patients discontinued within 7 days. Cystourethroscopy after removal revealed no marked inflammation or mucosal changes. CONCLUSIONS This pilot study demonstrated the BMS is potentially useful, convenient, and safe for appropriate patients. A follow-up study will better define the characteristics of patients who benefit from this device and examine whether the use of antimuscarinic agents improves outcomes. Neurourol. Urodynam. 35:630-635, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Neil D Sherman
- Premier Urology Group-Urological Surgery Associates, Edison, New Jersey
| | - Subbarao Yalla
- Department of Urology, Harvard Medical School, VA Boston Healthcare System, Boston, Massachusetts
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16
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Guinet-Lacoste A, Jousse M, Tan E, Caillebot M, Le Breton F, Amarenco G. Intermittent catheterization difficulty questionnaire (ICDQ): A new tool for the evaluation of patient difficulties with clean intermittent self-catheterization. Neurourol Urodyn 2014; 35:85-9. [DOI: 10.1002/nau.22686] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/02/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Amandine Guinet-Lacoste
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Marylène Jousse
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Eliane Tan
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Murielle Caillebot
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Frédérique Le Breton
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
| | - Gérard Amarenco
- Service de Neuro-Urologie et Explorations Périnéales; Hôpital Tenon, APHP, GREEN (Group of clinical REsEarch in Neurourology, University Pierre and Marie Curie); Paris France
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17
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Redshaw JD, Elliott SP, Rosenstein DI, Erickson BA, Presson AP, Conti SL, McAdams S, Nguyen A, West JM, Brant WO, Myers JB. Procedures Needed to Maintain Functionality of Adult Continent Catheterizable Channels: A Comparison of Continent Cutaneous Ileal Cecocystoplasty with Tunneled Catheterizable Channels. J Urol 2014; 192:821-6. [DOI: 10.1016/j.juro.2014.03.088] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jeffrey D. Redshaw
- Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Sean P. Elliott
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Daniel I. Rosenstein
- Department of Urology, Stanford University of School of Medicine, Stanford, California
| | - Bradley A. Erickson
- Department of Urology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Simon L. Conti
- Department of Urology, Stanford University of School of Medicine, Stanford, California
| | - Sean McAdams
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew Nguyen
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jeremy M. West
- Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - William O. Brant
- Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jeremy B. Myers
- Department of Surgery, Center for Reconstructive Urology and Men's Health, University of Utah School of Medicine, Salt Lake City, Utah
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Guinet-Lacoste A, Jousse M, Verollet D, Sheikh Ismael S, Le Breton F, Tan E, Amarenco G. Validation of the InCaSaQ, a new tool for the evaluation of patient satisfaction with clean intermittent self-catheterization. Ann Phys Rehabil Med 2014; 57:159-68. [DOI: 10.1016/j.rehab.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 11/17/2022]
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Rey D, Helou E, Oderda M, Robbiani J, Lopez L, Piechaud PT. Laparoscopic and robot-assisted continent urinary diversions (Mitrofanoff and Yang-Monti conduits) in a consecutive series of 15 adult patients: the Saint Augustin technique. BJU Int 2013; 112:953-8. [PMID: 23937141 DOI: 10.1111/bju.12257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present a series of 15 laparoscopic and robot-assisted Mitrofanoff and Yang-Monti vesicostomies in an adult population, and to assess the feasibility and safety of these minimally invasive approaches. PATIENTS AND METHODS Between 2009 and 2012, 15 patients underwent laparoscopic (n = 11) or robot-assisted (n = 4) construction of vesicostomy by a single surgeon (D.R.): Mitrofanoff appendicovesicostomy (n = 11) or double Yang-Monti ileal conduit (n = 4). Fourteen patients underwent concomitant augmentation enterocystoplasty. Indications for surgery included neurogenic bladder (n = 11) and urethral dysfunction (n = 4). The patients were evaluated postoperatively using cystography. Quality of life (QoL) was evaluated using an internally developed questionnaire. RESULTS All surgeries were successfully completed with no conversions. Operating time was always <5 h. The mean estimated blood loss was 150 mL and the mean follow-up was 22 months. Early postoperative complications included deep retrovesical abscess (n = 2) and upper urinary tract infections (n = 4), and one patient had peri-operative cardiac failure. Late postoperative complications included stomal stenosis (n = 2), persistent low-pressure bladder incontinence (n = 1) and recurrent infections (n = 1). Surgical excision of the conduit was necessary in one patient. Postoperatively, patients showed complete bladder emptying and no leak on follow-up cystography. According to our QoL questionnaire, 13/15 patients did not regret the surgery. CONCLUSIONS While a longer follow-up is needed to assess the durability of our results, this series shows that the laparoscopic and robot-assisted approaches for the construction of continent urinary diversions are feasible and safe in an adult population.
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Affiliation(s)
- Denis Rey
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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20
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Edokpolo LU, Stavris KB, Foster HE. Intermittent catheterization and recurrent urinary tract infection in spinal cord injury. Top Spinal Cord Inj Rehabil 2012; 18:187-92. [PMID: 23459635 PMCID: PMC3584766 DOI: 10.1310/sci1802-187] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To study the association of recurrent symptomatic urinary tract infections (UTIs) with the long-term use of clean intermittent catheterization (CIC) for the management of neurogenic bladder in patients with spinal cord injury (SCI). METHODS Retrospective study of 61 SCI patients with neurogenic bladder managed by CIC. Subjects were selected from 210 SCI patients seen at the Yale Urology Medical Group between 2000 and 2010. Medical UTI prophylaxis (PRx) with oral antimicrobials or methenamine/ascorbic acid was used to identify patients with recurrent UTI. The number of positive cultures (≥10(3) cfu/mL) within a year prior to starting PRx was used to confirm the recurrence of UTI. RESULTS Fifty-one male and 10 female subjects were managed with CIC. Forty-one (67%) subjects were placed on medical PRx for symptomatic recurrent UTI. Seventeen (28%) subjects had at least 3 positive cultures within the year prior to starting PRx. Fifteen of 20 (75%) subjects not on PRx had no complaints of UTI symptoms in the final year of follow-up. CONCLUSION Recurrent symptomatic UTIs remain a major complication of long-term CIC in SCI patients. Although CIC is believed to have the fewest number of complications, many SCI patients managed with long-term CIC are started on medical PRx early in the course of management. Future studies are needed to determine the efficacy of routine UTI PRx in these patients as well as determine what factors influence why many patients on CIC experience frequent infections and others do not.
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Affiliation(s)
- Leonard U Edokpolo
- Department of Urology, Yale University School of Medicine , New Haven , Connecticut
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21
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Wang QW, Song DK, Zhang XP, Wu YD, Zhang RL, Wei JX, Wen JG. Urodynamic parameters development and complications of clean intermittent self-catheterization in Chinese schoolchildren with neurogenic underactive bladder. Urol Int 2011; 86:461-5. [PMID: 21555862 DOI: 10.1159/000324481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/19/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the urodynamic parameters, development of bladder function and complications of clean intermittent self-catheterization (CIC) in Chinese schoolchildren with neurogenic underactive bladder. METHODS Ninety-three children with neurogenic underactive bladder were successfully treated with CIC or combined with oxybutynin for two years follow-up. According to bladder compliance before CIC, they were subdivided into a normal bladder compliance (NBC) group and a low bladder compliance (LBC) group. Urodynamic parameters and complications were recorded. RESULTS At follow-up, the incidence of neurogenic detrusor overactivity was found to have significantly decreased in both groups. Moreover, maximum cystometric capacity (CC) and relatively safe CC in the NBC group was significantly higher than those before CIC. However, relatively safe CC was significantly lower than that before CIC, and detrusor leakage point pressure was significantly higher than that before CIC in the LBC group. The incidences of bacteriuria, vesicureteral reflux (VUR), febrile urinary tract infections (UTI) and macroscopic hematuria were, respectively, 62, 13, 25 and 15%, and those of VUR and febrile UTI in the LBC group were significantly higher than those in the NBC group. CONCLUSION For these cases, the complications of CIC are rare, and bladder compliance seems to be correlated with the development of bladder function and complications during CIC.
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Affiliation(s)
- Qing Wei Wang
- Department of Urology and Urodynamic Center, First Affiliated Hospital of Zhengzhou University, Zhengzhou City, China.
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Donlau M, Imms C, Glad Mattsson G, Mattsson S, Sjörs A, Falkmer T. Children and youth with myelomeningocele's independence in managing clean intermittent catheterization in familiar settings. Acta Paediatr 2011; 100:429-38. [PMID: 20942859 DOI: 10.1111/j.1651-2227.2010.02044.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the ability of children and youth with myelomeningocele to independently manage clean intermittent catheterization. METHODS There were 50 participants with myelomeningocele (5-18 years); 13 of them had also participated in a previous hospital-based study. Their abilities and interest in completing the toilet activity were examined at home or in school using an interview and the Canadian Occupational Performance Measure (COPM). Actual performance was observed and rated. Background variables were collected from medical records and KatAD+E tests. RESULTS In total, 48% were observed to perform the toilet activity independently, in comparison with 74% who self-reported independence. Univariate analyses found KatAD+E could predict who was independent. COPM failed to do so. Ability to remain focused and ambulation were predictors of independence, but age, sex and IQ were not. Multivariable analysis found time to completion to be the strongest predictor of independence. Four children were independent in their familiar environment, but not in the hospital setting, and six of 13 children maintained focus only in their familiar environment. CONCLUSIONS Interviews were not sufficiently accurate to assess independence in the toilet activity. Instead, observations including time to completion are recommended. The execution of the toilet activity is influenced by the environmental context.
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Affiliation(s)
- Marie Donlau
- Vuxenhabiliteringen Landstinget i Östergötland, Linköping, Sweden
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23
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Singh S, Joshi M, Chourishi V. Management of neurogenic bladder in myelodysplasia patients: experience at our center. Cerebrospinal Fluid Res 2010. [PMCID: PMC3026540 DOI: 10.1186/1743-8454-7-s1-s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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de Jong TPVM, Chrzan R, Klijn AJ, Dik P. Treatment of the neurogenic bladder in spina bifida. Pediatr Nephrol 2008; 23:889-96. [PMID: 18350321 PMCID: PMC2335291 DOI: 10.1007/s00467-008-0780-7] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 12/26/2007] [Accepted: 01/15/2008] [Indexed: 11/30/2022]
Abstract
Renal damage and renal failure are among the most severe complications of spina bifida. Over the past decades, a comprehensive treatment strategy has been applied that results in minimal renal scaring. In addition, the majority of patients can be dry for urine by the time they go to primary school. To obtain such results, it is mandatory to treat detrusor overactivity from birth onward, as upper urinary tract changes predominantly start in the first months of life. This means that new patients with spina bifida should be treated from birth by clean intermittent catheterization and pharmacological suppression of detrusor overactivity. Urinary tract infections, when present, need aggressive treatment, and in many patients, permanent prophylaxis is indicated. Later in life, therapy can be tailored to urodynamic findings. Children with paralyzed pelvic floor and hence urinary incontinence are routinely offered surgery around the age of 5 years to become dry. Rectus abdominis sling suspension of the bladder neck is the first-choice procedure, with good to excellent results in both male and female patients. In children with detrusor hyperactivity, detrusorectomy can be performed as an alternative for ileocystoplasty provided there is adequate bladder capacity. Wheelchair-bound patients can manage their bladder more easily with a continent catheterizable stoma on top of the bladder. This stoma provides them extra privacy and diminishes parental burden. Bowel management is done by retrograde or antegrade enema therapy. Concerning sexuality, special attention is needed to address expectations of adolescent patients. Sensibility of the glans penis can be restored by surgery in the majority of patients.
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Affiliation(s)
- Tom P. V. M. de Jong
- Pediatric Renal Center, Department of Pediatric Urology, University Children’s Hospital, UMCU, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Rafal Chrzan
- Pediatric Renal Center, Department of Pediatric Urology, University Children’s Hospital, UMCU, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Aart J. Klijn
- Pediatric Renal Center, Department of Pediatric Urology, University Children’s Hospital, UMCU, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Pieter Dik
- Pediatric Renal Center, Department of Pediatric Urology, University Children’s Hospital, UMCU, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
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Abstract
In the past, renal failure was the leading cause of death after spinal cord injury (SCI). Today mortality from SCI has declined dramatically partly owing to the improved management of urologic dysfunction associated with SCI. The goals of bladder management in spinal cord injury patients are intended to (1) ensure social continence for reintegration into community, (2) allow low-pressure storage and efficient bladder emptying at low detrusor pressures, (3) avoid stretch injury from repeated overdistension, (4) prevent upper and lower urinary tracts complications from high intravesical pressures, and (5) prevent recurrent urinary tract infections. This article provides an overview of neurogenic bladder dysfunction associated with SCI and current management options.
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Affiliation(s)
- Gregory Samson
- Department of Rehabilitation Medicine, Leonard M. Miller School of Medicine, P.O. Box 016960 (D-461), Miami, FL 33101, USA
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26
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Abstract
Urinary tract infection (UTI) is the most common infection in hospitalized adults. Nosocomial UTIs are mainly associated with the use of urinary catheters. Thus, the decision for catheterization should be made carefully and catheters removed in time. In order to prevent unnecessary antibiotic use in patients with urinary catheters correct diagnosis is crucial. Chinolones, broad-spectrum penicillins and third-generation cephalosporins are the mainstay of therapy. Comorbidities should be considered and potential obstructions of urinary flow removed. Economically important are the normally higher prices of i.v. antibiotics compared to oral use.
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Affiliation(s)
- B L Hug
- Medizinische Klinik, Universitätsspital Basel, Basel, Schweiz.
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Lavoura N, D'Ancona CAL, Borges GM, Netto NR, Neves FC, da Silva D. Laparoscopic Ileocystoplasty: An Experimental Study in Pigs. J Endourol 2007; 21:218-22. [PMID: 17338623 DOI: 10.1089/end.2006.0158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Bladder dysfunction may lead to urinary incontinence and progressive kidney deterioration. When clinical treatment fails, bladder augmentation is the operation of choice in most cases. The purpose of this study was the standardization of the technique of videolaparoscopic ileocystoplasty in a porcine model and demonstration of a tutor-supervised learning curve. MATERIALS AND METHODS The study was conducted on 15 Large-White male pigs (20-25 kg) that underwent ileocystoplasty with 15 cm of distal ileum shaped into a using extracorporeal technique and laparoscopic ileovesical anastomosis. Operative time, ileovesical anastomosis time, intraoperative complications, and extravasation after anastomosis were evaluated. To assess the learning curve, the animals were divided into three groups of five: group I (operated on in collaboration with a tutor), group II (treated under the supervision of tutor), and group III (without the tutor's collaboration or supervision). RESULTS Total surgical time and ileovesical anastomosis time revealed significant differences (P < 0.05) between groups I and III (70% reduction) as well as between groups II and III (64% reduction). CONCLUSIONS Laparoscopic ileocystoplasty in pigs is feasible without special laparoscopic material. Ten initial procedures with a tutor's help were important for technique acquisition and mastery. A sharp increase in efficiency occurs between the tenth and fifteenth procedures. These procedures should be executed at least ten times in the presence of the tutor to enable the surgeon to overcome the learning curve.
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Affiliation(s)
- Nivaldo Lavoura
- Urology Institute of Piracicaba (IUP), Piracicaba, SP, Brazil.
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Dik P, Klijn AJ, van Gool JD, de Jong-de Vos van Steenwijk CCE, de Jong TPVM. Early Start to Therapy Preserves Kidney Function in Spina Bifida Patients. Eur Urol 2006; 49:908-13. [PMID: 16458416 DOI: 10.1016/j.eururo.2005.12.056] [Citation(s) in RCA: 148] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2005] [Accepted: 12/30/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. We reviewed our data of spina bifida patients to evaluate whether optimal treatment of the neurogenic bladder from birth onwards can preserve kidney function. METHODS We reviewed data on all newborns with spinal dysraphism who were referred to our hospital between January 1988 and June 2001. We looked at their situations at referral and at follow-up: the type of treatment, antimuscarinic agents, clean intermittent catheterisation (CIC), antibiotic prophylaxis, and operations (sling procedures, bladder augmentations, antireflux procedures). Renal function (ultrasound, DMSA scan, serum creatinin, creatinin clearance) and bladder function (urodynamic studies) were evaluated over time. RESULTS Data of 144 children of 176 could be evaluated by the end of the study: 5 patients had pre-existing renal abnormalities, 69 had an overactive sphincter, 27 had reflux, and six had renal scarring. None are currently developing end-stage renal disease. All patients with spina bifida aperta started CIC and antimuscarinic therapy shortly after birth. Five of the six patients with renal scarring were started on therapy with intermittent catheterisation and antimuscarinic therapy several months after birth. Sixty-three of 82 children with spina bifida were dry at school age (age six), although 37 of these had not had an operation. CONCLUSION We show that an early start to therapy helps to safeguard renal function for children born with spina bifida. Our data support other recent reports that children born with spina bifida can probably use their own kidneys for a lifetime, if they are given adequate urological treatment. To protect the upper urinary tract, we need to ensure low intravesical pressure by starting children early on CIC (the preferred treatment); antimuscarinic agents to counteract detrusor instability are indispensable in most cases. Proactive treatment of risks for upper tract deterioration results in a negligible loss of renal function, even when early urinary continence is included in the treatment protocol.
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Affiliation(s)
- Pieter Dik
- Paediatric Renal Centre, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
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Abstract
BACKGROUND Millions of Americans with incontinence use some type of device or product to manage or collect urine or feces. However, research on their clinical uses, problems requiring nursing care, and patient satisfaction is lacking. OBJECTIVES To review the various products and devices used for incontinence, identify directions for research and development on technology, and outline the ways nurses can influence and participate in those investigations. METHODS Existing literature on incontinence technology, devices, and products was analyzed to generate a plan for future research. RESULTS Gaps in knowledge exist about the uses, best practices, quality of life factors, and problems associated with catheters, absorbent products, other internal and external devices, and skin care products. CONCLUSIONS Collaboration among public and private sectors would result in greater likelihood of high quality clinical research that has sufficient power and integrity, more efficient use of resources special to each setting, and expedited application of technologies for patient use.
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Affiliation(s)
- Diane K Newman
- Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania Medical Center, Philadelphia, USA.
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