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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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Campeau L, Shamout S, Baverstock RJ, Carlson KV, Elterman DS, Hickling DR, Steele SS, Welk B. Canadian Urological Association Best Practice Report: Catheter use. Can Urol Assoc J 2020; 14:E281-E289. [PMID: 32432528 DOI: 10.5489/cuaj.6697] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Lysanne Campeau
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Samer Shamout
- Division of Urology, Department of Surgery, Montreal Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Richard J Baverstock
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Kevin V Carlson
- vesia [Alberta Bladder Centre] and Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Dean S Elterman
- Division of Urology, University Health Network, Toronto, ON, Canada
| | - Duane R Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Blayne Welk
- Division of Urology, Department of Surgery, University of Western Ontario, London, ON, Canada
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Jeong SJ, Oh SJ. Recent Updates in Urinary Catheter Products for the Neurogenic Bladder Patients with Spinal Cord Injury. Korean J Neurotrauma 2019; 15:77-87. [PMID: 31720260 PMCID: PMC6826099 DOI: 10.13004/kjnt.2019.15.e41] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/13/2019] [Accepted: 10/14/2019] [Indexed: 11/15/2022] Open
Abstract
Clean intermittent catheterization (CIC) is one of the core elements of neurogenic bladder management in the patients with spinal cord injury and is effective and safe to maintain low intra-bladder pressure and achieve urinary continence. Until now, the most notable development in urinary catheter products for CIC is the introduction of hydrophilic coating. Fortunately, in Korea, the national medical insurance has recently covered the cost for urinary catheters in this patient group. The purpose of this review is to summarize the history of CIC and the recent development of urinary catheter products. From our review, we would like to suggest a way of thinking that is the way forward for the future to improve the implementation of CIC with minimal morbidity.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Subramaniam R. Robotic Approach to Creation of Continent Catheterisable Channels-Technical Steps, Current Status, and Review of Outcomes. Front Pediatr 2019; 7:1. [PMID: 30719432 PMCID: PMC6348248 DOI: 10.3389/fped.2019.00001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 01/03/2019] [Indexed: 12/28/2022] Open
Abstract
Purpose: To report the current status of Robotic approach to creation of Catheterisable channel (CC) with the author's personal experience compared to published literature on technical steps, follow up, and outcomes. Methods: CC data was extracted from the prospective database set up for all Robotic pediatric urology procedures performed by the author at his institution. A literature search was then performed to look at the evidence base. Results: Eighteen consecutive cases (8M:7F) of Robotic approach to creation of CC was identified and included. All attempted cases were successfully completed without any conversion to open approach. Median age at surgery was 10.75 years (IQR 6.9-16.5); Median OT 197 min (IQR 131-295) with concomitant procedures in 4 cases. Appendix was used in 14 cases as CC conduit and distal ureter in 4 cases. Median Length of stay (LOS) was 2.75 days (IQR 2-6) and Median FU 27.3 m. Whilst FU duration is comparable to published series, average OT and LOS was much lower in this series. The LOS in this robotic series is much lower than the author's experience with open approach (2.75 vs. 5.8 days). No major complications postoperatively except for one exit site wound infection managed conservatively. None of the CC have been revised in this series and all channels are patent with 12 F or 14 F admissible catheter size. There were no cases of incontinence related to technique of creation of CC and no incidence of exit site stomal stenosis with use of ACE stopper until channel matures and Clean intermittent catheterisation (CIC) is established. Conclusion: Robotic approach to CC is feasible, safe with excellent outcomes and minimum morbidity. Robotic complex bladder reconstructive surgery offers some advantages to children compared to open approach but is only currently performed in few tertiary centers with expertise.
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Affiliation(s)
- Ramnath Subramaniam
- Consultant Paediatric Urologist, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom.,Department of Paediatric Urology, University of Leeds, Leeds, United Kingdom.,Department of Paediatric Urology, University of Ghent, Ghent, Belgium
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Li Y, Wen Y, He X, Li Y, Wu J, Feng J, Wang Q, Wen J. Application of clean intermittent catheterization for neurogenic bladder in infants less than 1 year old. NeuroRehabilitation 2018; 42:377-382. [PMID: 29660959 DOI: 10.3233/nre-172366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yanwei Li
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yibo Wen
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiangfei He
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yunlong Li
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junwei Wu
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinjin Feng
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingwei Wang
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianguo Wen
- Pediatric Urodynamics Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Anjum S, Singh S, Benedicte L, Roger P, Panigrahi M, Gupta B. Biomodification Strategies for the Development of Antimicrobial Urinary Catheters: Overview and Advances. GLOBAL CHALLENGES (HOBOKEN, NJ) 2018; 2:1700068. [PMID: 31565299 PMCID: PMC6607219 DOI: 10.1002/gch2.201700068] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/05/2017] [Indexed: 05/27/2023]
Abstract
Microbial burden associated with medical devices poses serious health challenges and is accountable for an increased number of deaths leading to enormous medical costs. Catheter-associated urinary tract infections are the most common hospital-acquired infections with enhanced patient morbidity. Quite often, catheter-associated bacteriuria produces apparent adverse outcomes such as urosepsis and even death. Taking this into account, the methods to modify urinary catheters to control microbial infections with relevance to clinical drug resistance are systematically evaluated in this review. Technologies to restrict biofilm formation at initial stages by using functional nanomaterials are elucidated. The conventional methodology of using single therapeutic intervention for developing an antimicrobial catheter lacks clinically meaningful benefit. Therefore, catheter modification using naturally derived antimicrobials such as essential oils, curcumin, enzymes, and antimicrobial peptides in combination with synthetic antibiotics/nanoantibiotics is likely to exert sufficient inhibitory effect on uropathogens and is extensively discussed. Futuristic efforts in this area are projected here that demand clinical studies to address areas of uncertainty to avoid development of bacterial resistance to the new generation therapy with minimum discomfort to the patients.
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Affiliation(s)
- Sadiya Anjum
- Bioengineering LaboratoryDepartment of Textile TechnologyIndian Institute of TechnologyNew Delhi110016India
| | - Surabhi Singh
- Bioengineering LaboratoryDepartment of Textile TechnologyIndian Institute of TechnologyNew Delhi110016India
| | - Lepoittevin Benedicte
- ICMMO ‐ LG2M ‐ Bât 420Université Paris‐Sud XI, 15rue Georges Clémenceau91405Orsay CedexFrance
| | - Philippe Roger
- ICMMO ‐ LG2M ‐ Bât 420Université Paris‐Sud XI, 15rue Georges Clémenceau91405Orsay CedexFrance
| | - Manoj Panigrahi
- Department of Urology and PathologySikkim Manipal Institute of Medical SciencesGangtokSikkim737101India
| | - Bhuvanesh Gupta
- Bioengineering LaboratoryDepartment of Textile TechnologyIndian Institute of TechnologyNew Delhi110016India
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Shamout S, Biardeau X, Corcos J, Campeau L. Outcome comparison of different approaches to self-intermittent catheterization in neurogenic patients: a systematic review. Spinal Cord 2017; 55:629-643. [PMID: 28117329 DOI: 10.1038/sc.2016.192] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/01/2016] [Accepted: 12/11/2016] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN Systematic review (Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA); http://www.prisma-statement.org). OBJECTIVES Different types of catheters and techniques have been described in the past three decades to identify the best self-intermittent catheterization method. Our aim is to review systematically the literature on the most appropriate material and technique to perform self-intermittent catheterization in the adult neurogenic population. METHODS A systematic review search was performed through PubMed/Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases to study all types of self-intermittent catheters, and analyzing their impact on urinary tract infections (UTIs), urethral trauma, cost-effectiveness, quality of life and patient's satisfaction. We used the following keywords: 'intermittent catheterization/catheterisation', 'neurogenic', 'urinary catheters for intermittent use' and 'urethral catheterization/catheterisation' published by November 2015. RESULTS After screening 3768 articles, 31 were included in the final synthesis (level of evidence 1b to 2b). The 2188 trial participants were mainly spinal cord injury adults and women with multiple sclerosis. Hydrophilic-coated catheters tended to decrease the incidence of UTI as well as urethral trauma and improve patient's satisfaction when compared with non-hydrophilic-coated catheters. Similarly, prelubricated catheters were associated with better results in terms of patient satisfaction. Sterile technique seemed to decrease the incidence of recurrent UTI; however, these results are counter-balanced by significantly increasing cost compared with clean catheterization. CONCLUSIONS The present review demonstrated advantages of hydrophilic-coated catheters in decreasing risk of UTI and urethral trauma as well as improving patient's satisfaction. Prelubricated catheters has been shown to be superior to conventional polyvinyl chloride catheters. Randomized controlled trials comparing hydrophilic and prelubricated catheters must be conducted to assess possible superiority and cost-effectiveness.
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Affiliation(s)
- S Shamout
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - X Biardeau
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - J Corcos
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - L Campeau
- Division of Urology, Department of Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
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Guinet-Lacoste A, Kerdraon J, Rousseau A, Gallien P, Previnaire JG, Perrouin-Verbe B, Amarenco G. Intermittent catheterization acceptance test (I-CAT): A tool to evaluate the global acceptance to practice clean intermittent self-catheterization. Neurourol Urodyn 2017; 36:1846-1854. [DOI: 10.1002/nau.23195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 11/25/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Amandine Guinet-Lacoste
- Sorbonne Universités; UPMC Univ Paris 06, GRC 01, GREEN; Group of Clinical Research in Neuro-Urology; Paris France
- AP-HP, Hôpital Tenon; Neuro-urologie et Explorations Périnéales; Paris France
| | | | - Alexandra Rousseau
- Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST); AP-HP, Hôpital Saint Antoine; Paris France
| | | | | | | | - Gérard Amarenco
- Sorbonne Universités; UPMC Univ Paris 06, GRC 01, GREEN; Group of Clinical Research in Neuro-Urology; Paris France
- AP-HP, Hôpital Tenon; Neuro-urologie et Explorations Périnéales; Paris France
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Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH. Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-year experience at a single center. Korean J Urol 2013; 54:59-65. [PMID: 23362450 PMCID: PMC3556556 DOI: 10.4111/kju.2013.54.1.59] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 10/20/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms. MATERIALS AND METHODS A retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. RESULTS There were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%). CONCLUSIONS The factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.
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Affiliation(s)
- Joon Ho Lee
- Department of Urology, The Catholic University of Korea College of Medicine, Seoul, Korea
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Affiliation(s)
- Karen Logan
- Continence Care, Aneurin Bevan Health Board, Continence Service, Llanfrechfa Grange Hospital
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12
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Le Breton F, Guinet A, Verollet D, Jousse M, Amarenco G. Therapeutic education and intermittent self-catheterization: recommendations for an educational program and a literature review. Ann Phys Rehabil Med 2012; 55:201-12. [PMID: 22424733 DOI: 10.1016/j.rehab.2012.01.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 01/25/2012] [Accepted: 01/28/2012] [Indexed: 11/19/2022]
Abstract
PURPOSE To review the literature and to clarify the recommendations for therapeutic education programs for intermittent self-catheterization. MATERIALS AND METHODS The literature on Medline, Pubmed, and Cochrane Library, with specific keywords, as well as the recommendations based on expert consensus. RESULTS Clean intermittent self-catheterization (CICS) is the gold standard for managing chronic urinary retention, which allows the patients to improve their quality of life and to reduce the complications of upper urinary tract infections. Patient education needs to have a structured procedure in order to evaluate the ability to understand, accept and perform CISC. CONCLUSION Teaching self-catheterization is now well known; nevertheless, the effectiveness of CISC educational therapeutic programs remains to be demonstrated.
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Affiliation(s)
- F Le Breton
- UR6/UPMC, service de neuro-urologie et d'explorations périnéales, hôpital Tenon, Paris cedex, France.
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Iwatsubo E. [Diaper cystitis as recurrent cause of urinary infections in geriatric community hospital]. Nihon Ronen Igakkai Zasshi 2012; 49:114-118. [PMID: 22466781 DOI: 10.3143/geriatrics.49.114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM Chronic cystitis in diaper-dependent elderly patients can be a causative pathology for recurrent urinary tract infections (UTIs) in community hospitals. METHODS We analyzed hospital infections to determine causative organisms from January 2007 to December 2009 in patients in a long-term care hospital. The reading causes of hospital infections were UTIs (30.4%), aspiration pneumonia (CAP; 26%) and hospital-acquired pneumonia (HAP; 17.2%). Of a total of 3,097 hospital infections over the investigation period, UTIs were the most common (n=940, 30.4%) followed by CAP (n=809, 26%) and HAP (n=533, 17.2%). Of 278 UTIs in 2007, the causative strains were Escherichia coli (n=106, 38%), Enterococcus faecalis (n=44, 16%), Proteus mirabilis (n=31, 11%), α-hemolytic streptococcus (n=22, 8%), and β-hemolytic streptococcus (n=14, 5%). Extended spectrum β-lactamase (n=14, 13%) strains were noted in 106 patients with Escherichia coli. We then retrospectively examined the records of 110 diaper dependent elderly patients, (medical words, n=52, mix-care wards, n=68) for UTIs over the same study period. Of these 16 (14.5%) had no UTIs at any time, 12 (11%) were infected 50% of the time, 17 (15.5%) were infected 51% to 99% of the time and 65 (59%) were infected 100% of the time. The UTI rate was not correlated with bladder function or between the 2 wards. We treated bacterial cystitis with antibiotics for 3-5 days but these were unsuccessful. Antiseptics worked temporarily, but recurrence or re-infection always occurred. It remains unknown if diapers are a potential cause of chronic cystitis in dependent elderly patients. The clinical dilemma of whether recurrent diaper cystitis should be treated and prohibit the growth and spread of drug-resistant strains, remains challenging.
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Affiliation(s)
- Eiji Iwatsubo
- Division of Geriatric Medicine and Urology, Kitakyushu-Koga Hospital
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Amarenco G, Guinet A, Jousse M, Verollet D, Ismael SS. Pencil and Paper Test: A New Tool to Predict the Ability of Neurological Patients to Practice Clean Intermittent Self-Catheterization. J Urol 2011; 185:578-82. [DOI: 10.1016/j.juro.2010.09.106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Gerard Amarenco
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Er 6, Université Pierre et Marie Curie, Paris, France
| | - Amandine Guinet
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Er 6, Université Pierre et Marie Curie, Paris, France
| | - Marylene Jousse
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Er 6, Université Pierre et Marie Curie, Paris, France
| | - Delphine Verollet
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Er 6, Université Pierre et Marie Curie, Paris, France
| | - Samer Sheikh Ismael
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Er 6, Université Pierre et Marie Curie, Paris, France
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Adams J, Watts R, Yearwood M, Watts A, Hartshorn C, Simpson S, Continence Nurse Consultant KA, Denison S, Hardcastle B. Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A comprehensive systematic review. ACTA ACUST UNITED AC 2011; 9:1392-1446. [PMID: 27819976 DOI: 10.11124/01938924-201109340-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
EXECUTIVE SUMMARY Background Clean intermittent self-catheterisation is the gold standard in the management of neurogenic/neuropathic bladder disorders, providing independence, alleviating symptoms and complications of the urinary tract.Objectives The objective of this systematic review was to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic/neuropathic bladders.Methods The search strategy identified published and unpublished studies reported from 1970 to 2009. Individual search strategies were developed for the 12 databases accessed and search alerts established. The review considered qualitative and quantitative studies, mixed methods and case studies. Interventions, programs and strategies preparing adults to self-catheterise included education, suitability for selfcatheterisation and interventions promoting compliance and continuity. Outcomes of interest were the quality of life and depression, long-term compliance, advantages/disadvantages of urethral self-catheterisation and limitations to selfcatheterisation.Standardised critical appraisal instruments developed by the Joanna Briggs Institute were used by two independent reviewers to assess the quality of eligible studies for inclusion in the review. Standardised Joanna Briggs Institute tools were also used to extract data. Criteria developed by Yin were employed to assess case studies. Qualitative findings were synthesised. As statistical pooling of the quantitative results was not possible, these results were presented in narrative form.Results From the 18 studies reviewed, three interventions (education and preparation, suitability to self-catheterise, and interventions promoting compliance/continuity), and three outcomes (effect of self-catheterisation on quality of life and depression, and longterm compliance) were addressed with multiple studies in each intervention and outcome. The results are discussed under four headings: (i) education essentials for selfcatheterisation (ii) factors promoting compliance and continuity with self-catheterisation, (iii) factors influencing quality of life and (IV) diagnostic sub-groups of people with a neurogenic bladder. CONCLUSION The narrative and synthesised data from the 18 included studies identified findings to provide a basis for strategies to promote clean intermittent self-catheterisation in adults. These include an extended education program with a pre-education component, ongoing support and skills training. All aspects of education should reflect sound research findings related to quality of life issues.Implications for Practice The implications for clinical practice are the development of a comprehensive standardised education program that includes background information, skills training and follow-up support.Implications for Research The review highlights the need for further experimental research to confirm factors that will promote self-catheterisation in adults with neurogenic/neuropathic bladders, with particular reference specific sub-groups.
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Affiliation(s)
- Jillian Adams
- 1 a Joanna Briggs Institute Evidence Synthesis Group, Royal Perth Hospital, Perth, Western Australia affiliated with the WACEIHP 2 Director, WACEIHP 3. Royal Perth Hospital Box X2213 GPO Perth 6847, Western Australia
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Adams J, Watts R, Yearwood M, Watts A, Hartshorn C, Simpson S, Continence Nurse Consultant KA, Denison S, Hardcastle B. Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A comprehensive systematic review. ACTA ACUST UNITED AC 2011. [DOI: 10.11124/jbisrir-2011-128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Elvy J, Colville A. Catheter associated urinary tract infection: what is it, what causes it and how can we prevent it? J Infect Prev 2009. [DOI: 10.1177/1757177408094852] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Catheter associated urinary tract infection (CAUTI) is one of the most frequently encountered health care associated infections today. Indwelling urinary catheters frequently become colonised with micro-organisms but the majority of cases will be asymptomatic. Differentiation between such colonisation and CAUTI is important for patient management, but unfortunately is not straightforward. This article discusses the diagnosis, causative microbiology and pathogenesis of CAUTI, and briefly considers complications of catheterisation and how these might be prevented.
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Affiliation(s)
- Juliet Elvy
- Medical Microbiology and Virology, Royal Devon and Exeter Foundation NHS Trust, Church Lane, Exeter EX2 5AD, UK,
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Andrade MJ. Lower urinary tract dysfunction in familial amyloidotic polyneuropathy, Portuguese Type. Neurourol Urodyn 2008; 28:26-32. [DOI: 10.1002/nau.20600] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Adams J, Watts A, Philp C, Watts R, Yearwood M, Kidd H, Simpson S, Cardiothoracics PB, Allingham K, Consultant CN, Petrie A. Strategies to promote intermittent self-catheterisation in adults with neurogenic bladders: A systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2008; 6 Suppl 8S:1-21. [PMID: 27819902 DOI: 10.11124/01938924-200806081-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Jillian Adams
- 1 Royal Perth Hospital, 2. Royal Perth Hospital, 3. Royal Perth Hospital, 4. Curtin University of Technology, 5 Royal Perth Hospital, 6. Royal Perth Hospital, 7. Royal Perth Hospital, sally.simpson(rph)@health.wa.gov.au 8. Royal Perth Hospital, 9. Royal Perth Hospital,
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Karsenty G, Vidal F, Ruffion A, Chartier-Kastler E. [Continent cutaneous urinary diversion in neurourology]. Prog Urol 2007; 17:542-51. [PMID: 17622088 DOI: 10.1016/s1166-7087(07)92366-0] [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: 10/22/2022]
Abstract
The management of some neurological patients can require urinary diversion. Continent cystostomy is one of the treatment options proposed in young patients, usually for cosmetic reasons. In this article, the authors describe the main techniques used in this particular indication and then review the literature to define the results of the various techniques used, as well as the modalities of follow-up in these patients in view of the potential complications.
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Affiliation(s)
- G Karsenty
- Service d'urologie, Centre hospitalo-universitaire de Marseille, France.
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22
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C. Sondage. Prog Urol 2007. [DOI: 10.1016/s1166-7087(07)92357-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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23
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Abstract
Urinary incontinence is a common primary care problem. With the proper understanding of normal and abnormal bladder function, pediatricians can create a protocol that will benefit most children seen with this condition. Emphasis should be placed on primary therapy: establishing healthy dietary habits, treating constipation, maintaining appropriate hygiene, and developing a regular voiding pattern. When the initial evaluation identifies an anatomic abnormality or when primary therapy fails, referral to a pediatric urologist is warranted.
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Affiliation(s)
- C D Anthony Herndon
- Section of Pediatric Urology, Division of Urology, Department of Surgery, University of Alabama at Birmingham, Children's Hospital, 1600 7th Avenue S, Birmingham, AL 35233-1711, USA.
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Seki N, Masuda K, Kinukawa N, Senoh K, Naito S. Risk factors for febrile urinary tract infection in children with myelodysplasia treated by clean intermittent catheterization. Int J Urol 2005; 11:973-7. [PMID: 15509200 DOI: 10.1111/j.1442-2042.2004.00943.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify the factors involved in the incidence of febrile urinary tract infection (UTI) in a retrospective study of children with myelodysplasia who were treated by clean intermittent catheterization. METHODS A total of 76 myelodysplastic children were included in the present study. Any factors, including urodynamic parameters and urinary tract abnormalities, that may have been associated with the incidence of febrile UTI were evaluated using both a univariate analysis and a multiple logistic regression analysis. RESULTS Of the 76 patients, 19 (25%) had one or more episodes of febrile UTI. A univariate analysis showed low bladder compliance (<10 mL/cmH2O), detrusor overactivity, bladder trabeculation and the presence of vesico-ureteral reflux (VUR) to be significant factors in the incidence of febrile UTI. The presence of detrusor overactivity and a low bladder compliance, in addition to the presence of VUR, were found to be significant factors for the incidence of febrile UTI using a multivariate analysis. CONCLUSION These results demonstrate that, in addition to VUR, urodynamics linked to bladder storage function disorder appear to be directly correlated with the cause of febrile UTI in children with myelodysplasia.
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Affiliation(s)
- Narihito Seki
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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25
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Clarke SA, Samuel M, Boddy SA. Are prophylactic antibiotics necessary with clean intermittent catheterization? A randomized controlled trial. J Pediatr Surg 2005; 40:568-71. [PMID: 15793737 DOI: 10.1016/j.jpedsurg.2004.11.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND/PURPOSE Clean intermittent catheterization has been an established practice for more than 3 decades. The validity of antibiotic prophylaxis has been questioned although not tested. METHODS Eighty-five patients were recruited into a randomized controlled trial. The randomization involved the placement into 1 of 2 groups: (A) continuing antibiotics or (B) discontinuing antibiotics. The trial would last 4 months with the outcome being a confirmed urinary tract infection. All groups were matched for age, sex, and pathology. RESULTS The incidence of urinary tract infections was significantly increased in the group who continued to use antibiotics (n = 20) when compared with the group who discontinued prophylaxis (n = 3). The common infecting organism was Escherichia coli. CONCLUSIONS The use of prophylactic antibiotics for children who intermittently catheterize may not be necessary. The use of prophylactic antibiotics may result in increased rates of infection because of the development of resistant organisms.
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Affiliation(s)
- Simon A Clarke
- Department of Paediatric Surgery, St Georges Hospital Medical School, Tooting, London, SE17 8QT, UK.
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26
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Bogaert GA, Goeman L, de Ridder D, Wevers M, Ivens J, Schuermans A. The Physical and Antimicrobial Effects of Microwave Heating and Alcohol Immersion on Catheters that Are Reused for Clean Intermittent Catheterisation. Eur Urol 2004; 46:641-6. [PMID: 15474276 DOI: 10.1016/j.eururo.2004.06.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2004] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Due to worldwide different health insurance policies, patients are often forced to reuse the catheters when performing Clean Intermittent Catheterisation (CIC). We have compared the physical qualities and the antimicrobial effects of two methods of reusing catheters: microwave heating and storage of the catheters in a 70% alcohol solution. The studies were performed during different lengths of time. MATERIALS AND METHODS Three types of catheters (a standard polyvinylchloride catheter, a special polyvinylchloride catheter with flexible Ergothan tip and a prelubrified catheter), normally intended for single use, were submitted to the effect of a microwave oven (Multitech 215 High Grade and Whirlpool M220 750 W and 1000 W with rotating plate) or preservation in a 70% alcohol solution. To study the effects of microwave heating, a recipient of water was placed in the oven to spread the microwaves and to absorb the heat. The catheters were placed in a resealable plastic bag (Ziploc. To study the effects of preservation in a 70% alcohol solution, the catheters were immerged in the solution for different lengths of time. Thereafter were the physical qualities of the catheters evaluated by using the technique of Differential Scanning Calorimetry (DSC). The antimicrobial effect of the method was evaluated after grafting the catheters with pathogenic E. coli, P. aeruginosa or S. aureus strains. RESULTS Microwave heating up to 12 minutes at 750 W caused only minimal changes in the physical qualities of all the catheters. However, there was only an antimicrobial effect of the microwave heating on E. coli and not on P. aeruginosa or S. aureus. If the catheter remained longer than 45 minutes in a 70% alcohol solution, the physical qualities of the catheter changed either minimal in the special polyvinylchloride catheter with flexible Ergothan top but changed significantly in the prelubrified catheter). However, already after 5 minutes of immersion in the 70% alcohol solution there was a complete antimicrobial effect on E. coli, P. aeruginosa and S. aureus in all catheters. CONCLUSIONS It should be recommended to patients on CIC to use a sterile packed and not previously used catheter. In this study we have shown that immersing the catheters in a 70% alcohol solution during 5 minutes can effectively disinfect the catheter without jeopardising the physical qualities. Thereafter, the catheters could be placed in a resealable (e.g. Ziploc bag without being rinsed under water, in order that the few drops of alcohol cause alcohol vapours within the closed plastic bag and maintain the antimicrobial effect.
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Affiliation(s)
- Guy A Bogaert
- UZ Gasthuisberg, Department of Urology, Herestraat 49, 3000 Leuven, Belgium.
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Abstract
The predominant form of life for the majority of microorganisms in any hydrated biologic system is a cooperative community termed a "biofilm." A biofilm on an indwelling urinary catheter consists of adherent microorganisms, their extracellular products, and host components deposited on the catheter. The biofilm mode of life conveys a survival advantage to the microorganisms associated with it and, thus, biofilm on urinary catheters results in persistent infections that are resistant to antimicrobial therapy. Because chronic catheterization leads almost inevitably to bacteriuria, routine treatment of asymptomatic bacteriuria in persons who are catheterized is not recommended. When symptoms of a urinary tract infection develop in a person who is catheterized, changing the catheter before collecting urine improves the accuracy of urine culture results. Changing the catheter may also improve the response to antibiotic therapy by removing the biofilm that probably contains the infecting organisms and that can serve as a nidus for reinfection. Currently, no proven effective strategies exist for prevention of catheter-associated urinary tract infection in persons who are chronically catheterized.
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Affiliation(s)
- Barbara W Trautner
- Department of Medicine, Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Trautner BW, Darouiche RO. Catheter-associated infections: pathogenesis affects prevention. ARCHIVES OF INTERNAL MEDICINE 2004; 164:842-50. [PMID: 15111369 PMCID: PMC2963580 DOI: 10.1001/archinte.164.8.842] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intravascular catheters and urinary catheters are the 2 most commonly inserted medical devices in the United States, and they are likewise the two most common causes of nosocomially acquired bloodstream infection. Biofilm formation on the surfaces of indwelling catheters is central to the pathogenesis of infection of both types of catheters. The cornerstone to any preventive strategy of intravascular catheter infections is strict attention to infection control practices. Antimicrobial-impregnated intravascular catheters are a useful adjunction to infection control measures. Prevention of urinary catheter-associated infection is hindered by the numbers and types of organisms present in the periurethral area as well as by the typically longer duration of catheter placement. Antimicrobial agents in general have not been effective in preventing catheter-associated urinary tract infection in persons with long-term, indwelling urethral catheters. Preventive strategies that avoid the use of antimicrobial agents may be necessary in this population.
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Affiliation(s)
- Barbara W Trautner
- Department of Medicine, Infectious Diseases Section, Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030, USA.
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Prévention des infections urinaires nosocomiales chez le patient ayant une vessie neurologique. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00160-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Urinary catheter-related infections are commonly seen in several different patient populations and lead to substantial morbidity. The overall health care costs caused by these infections are sizable given how often urinary catheters are used in acute care settings, extended care facilities, and in persons with injured spinal cords. Recent attention has appropriately focused on biofilm development on the catheter surface because biofilm has important implications for the pathogenesis, treatment, and prevention of catheter-related infection. Because the most important risk factor for infection is duration of catheterization, indwelling urethral catheterization should be avoided or at least limited whenever possible. Additional methods to prevent this infection include aseptic insertion and maintenance use of a closed drainage system, anti-infective catheters in patients at high-risk for infection, and systemic antibiotics in select patients. Alternative urinary collection strategies may be appropriate in certain patient groups. Specifically, condom catheters should be considered in men likely to be adherent with this urinary collection method, suprapubic catheters should be considered in patients requiring long-term indwelling drainage, and intermittent catheterization seems appropriate in patients with injured spinal cords. Future research should focus on additional methods for preventing this common infection.
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Affiliation(s)
- Sanjay Saint
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA.
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Prasad RS, Smith SJ, Wright H. Lower abdominal pressure versus external bladder stimulation to aid bladder emptying in multiple sclerosis: a randomized controlled study. Clin Rehabil 2003; 17:42-7. [PMID: 12617378 DOI: 10.1191/0269215503cr583oa] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the change in post-void residual bladder volumes (PVR) with 'abdominal vibration' using a percutaneous bladder stimulator in multiple sclerosis (MS) patients compared with either 'no treatment' or 'abdominal pressure'. DESIGN Randomized controlled cross-over study. SETTING Regional neurorehabilitation clinics. SUBJECTS Twenty-eight MS patients with urinary symptoms and PVR > 100 ml. Twelve patients had urinary incontinence. METHODS MS patients with voiding dysfunction and elevated PVR of 100-500 ml on BVI-3000 Ultrasound Scanner were randomized to either 'abdominal pressure' or 'vibration' by a portable, percutaneous, vibrating device (Queen Square Bladder Stimulator; Malem Medical) or to 'no treatment'. PVR was assessed at the end of each two-week phase. OUTCOME MEASURE PVR reduction by greater than 100 ml. RESULTS The 28 patients ranged in age from 29 to 71 years with a mean age of 49 years and a mean duration of MS of 12 years (range 1-37 years). The PVR decreased from 231 (SD 119) ml during no treatment to 191 (SD 132) ml with abdominal pressure (p = 0.242). Using suprapubic vibration the PVR reduced further to 126 (SD 121) ml, which was highly significant (p = 0.002) compared with no treatment. The difference between abdominal pressure and vibration just failed to reach significance (p = 0.059). There was no significant reduction in either the frequency of micturition or episodes of incontinence. The device was well-tolerated by patients. CONCLUSION Abdominal vibration is an effective method of reducing PVR in MS patients and appears more effective than abdominal pressure alone.
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Affiliation(s)
- R S Prasad
- Neurorehabilitation Unit, Astley Ainslie Hospital, Edinburgh, Scotland, UK
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Moroóka M, e Faro AC. [Clean intermittent bladder autocatheterization: description of the procedure carried out by patients with spinal cord injuries]. Rev Esc Enferm USP 2002; 36:324-31. [PMID: 12876843 DOI: 10.1590/s0080-62342002000400005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The present study describes the sequence and its materials used in the vesical autocatheterism intermittent--clean technique. The information were obtained together with the patients, who go through such procedure and were directed to follow the instructions, given by the inter disciplinary Service, attending patients with traumatic medullar injury. The study intends to contribute to increase the knowledge about the vesical autocatheterism and provide to the patients this technique in a therapeutic way.
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Affiliation(s)
- Mitiko Moroóka
- Departamento de Enfermagem, Universidade Estadual de Londrina
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34
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Griffith G. Importance of continence advice for people with multiple sclerosis. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2002; 11:1363-4, 1366, 1368-71. [PMID: 12514469 DOI: 10.12968/bjon.2002.11.21.10933] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Bladder and bowel problems are a common feature in patients with multiple sclerosis (MS). This article demonstrates how patients benefit from specialist input relating to continence as part of a multidisciplinary neurological rehabilitation service (MNRS). The implementation of the MNRS has offered a 'one-stop' referral system for people with an acquired or progressive neurological condition. The patient's condition should be such that active and effective rehabilitation can take place. One of the key aims of the service is to enable people to function as independently as possible by improving/maintaining their physical, social, and psychological well-being through appropriate assessment and treatment regimes. The Multiple Sclerosis Society recommends the involvement of specialist nurses and specialist multidisciplinary teams in the management of patients. The recommended standards suggest that people with MS should be put in contact with a specialist multidisciplinary team in their area where appropriate treatment in relation to tone management, posture, fatigue management and continence can be provided. Without specialist advice, patients may develop more serious and intractable problems in the longer term. The author will describe how working in a specialized team has moved towards meeting these recommendations and in so doing has enhanced care for people with MS.
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Abstract
STUDY DESIGN Literature review to evaluate the complications seen in patients on intermittent catheterization (IC) and intermittent self-catheterization (ISC). OBJECTIVES To find the prevalence of most complications seen in patients on IC. To study the prevention and the treatment of these complications. SETTING An international literature review. METHODS Most relevant articles on the subject are reviewed. CONCLUSION Urinary tract infection is the most frequent complication in patients performing IC. Catheterization frequency and the avoidance of bladder overfilling are amongst the most important prevention measures. Asymptomatic bacteriuria does not need to be treated with antibiotics. Long-term antibacterial prevention does seem to bear a risk of development of bacterial resistance. Previous treatment with indwelling catheters is a risk factor for chronic infection and urinary sepsis. Prostatitis is more frequently present than often thought. Epididymitis and urethritis are rare. Trauma from catheterization occurs regularly, but lasting effects are more limited. However, the prevalence of urethral strictures and false passages increases with longer use of IC. The use of hydrophilic catheters might be able to lower the urethral complication rate but additional proof through comparative studies is needed. The most important prevention measures are good education of all involved in IC, good patient compliance, the use of a proper material and the application of a good catheterization technique.
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Affiliation(s)
- J J Wyndaele
- Department of Urology, University Antwerpen, University Hospital Antwerpen, Belgium
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Schlager TA, Clark M, Anderson S. Effect of a single-use sterile catheter for each void on the frequency of bacteriuria in children with neurogenic bladder on intermittent catheterization for bladder emptying. Pediatrics 2001; 108:E71. [PMID: 11581479 DOI: 10.1542/peds.108.4.e71] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters. METHODS A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded. RESULTS A total of 158 urine samples were collected during 164 patient-weeks on the new catheter method for each void; 115 (73%) were positive for a pathogen. Of the 161 samples collected during 169 patient-weeks on the standard, reuse method for voiding, 123 (76%) were positive (115 [73%] of 158 vs 123 [76%] of 161). Escherichia coli was the most common pathogen detected during both method periods. CONCLUSION A new, sterile catheter for each void did not decrease the high frequency of bacteriuria in patients with neurogenic bladder on intermittent catheterization.
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Affiliation(s)
- T A Schlager
- Department of Pediatrics, University of Virginia Health System, Charlottesville, Virginia, USA.
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Unsworth J, Freeman L. Management of bladder problems in patients with multiple sclerosis. Br J Community Nurs 2000; 5:230, 232, 234, 236-8. [PMID: 12271205 DOI: 10.12968/bjcn.2000.5.5.7403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Bladder problems are a common feature in patients with multiple sclerosis (MS). Many patients experience distressing symptoms such as frequency, urgency and incontinence, unaware of the range of treatments which are available to either overcome or manage their bladder problems. While patients with MS may experience many types of bladder dysfunction, certain types of problem are more common in this patient group. These problems can be grouped under the headings of storage, emptying or combined dysfunction. Community nurses are well-placed to offer methods of containment by providing first-line treatment as well as identifying which patients need to be referred to other members of the multidisciplinary team.
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Affiliation(s)
- J Unsworth
- Northumbria Healthcare NHS Trust, Wallsend, UK
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Easton S. InstantCath from Hollister: pre-lubricated self-catheterization. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2000; 9:357-60. [PMID: 11051886 DOI: 10.12968/bjon.2000.9.6.6341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over the centuries a variety of substances have been used to make a hollow tube to pass through the urethra to empty a poorly functioning bladder. The ancient Greeks used dried water reeds from the riverbank. The Romans and the Egyptians experimented with gold and silver. Following the industrial revolution stainless steel was used and catheters are still manufactured today using stainless steel. PVC and plastic catheters became popular in the 1970s and various hydrophilic coatings have been added to provide self-lubrication of the catheter when it comes into contact with water. The most recent development in the clean, intermittent self-catheterization (CISC) range is the Hollister InstantCath which is a self-lubricating catheter that does not require any water. It has shown itself to be well received by patients and is a welcome addition to the choice available to healthcare professionals and their patients when instigating CISC as therapy.
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Affiliation(s)
- S Easton
- Royal Berkshire Hospital NHS Trust, Reading
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Khoury JM, Freeman JA. Transitional cell carcinoma of the bladder in a patient on clean intermittent catheterization. BJU Int 1999; 84:378-9. [PMID: 10468747 DOI: 10.1046/j.1464-410x.1999.00230.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- J M Khoury
- Division of Urology, University of North Carolina, Chapel Hill, North Carolina, USA
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Pachler J, Frimodt-Møller C. A comparison of prelubricated hydrophilic and non-hydrophilic polyvinyl chloride catheters for urethral catheterization. BJU Int 1999; 83:767-9. [PMID: 10368193 DOI: 10.1046/j.1464-410x.1999.00013.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate whether patients performing clean intermittent self-catheterization (CISC) for a short period preferred a prelubricated, hydrophilic, disposable polyvinyl chloride (PVC) catheter or a non-hydrophilic PVC catheter which could be used several times and that had to be lubricated by the patient. PATIENTS AND METHODS In a prospective cross-over study, 32 patients used each type of catheter for 3 weeks. After each 3-week period, the patients completed a questionnaire to assess comfort and preference, and urine specimens were obtained for culture. RESULTS There was no significant difference between the groups in the frequency of CISC, discomfort when used, opinion on handling the catheters, preference toward one of the catheters, or of infection. CONCLUSION Non-hydrophilic PVC catheters may be used safely and with no discomfort to the patient. In addition it may be possible for the healthcare system to save money, as the non-hydrophilic PVC catheters are much cheaper.
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Affiliation(s)
- J Pachler
- Department of Urology H, Gentofte University Hospital, Copenhagen, Denmark
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Tanaka H, Kakizaki H, Kobayashi S, Shibata T, Ameda K, Koyanagi T. The relevance of urethral resistance in children with myelodysplasia: its impact on upper urinary tract deterioration and the outcome of conservative management. J Urol 1999; 161:929-32. [PMID: 10022727 DOI: 10.1016/s0022-5347(01)61822-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Upper urinary tract deterioration, such as vesicoureteral reflux and hydronephrosis, affects the long-term prognosis in children with myelodysplasia. We retrospectively analyzed the relevance of urethral resistance to upper tract deterioration in untreated children with myelodysplasia as well as the outcome of conservative treatment based on urethral resistance. MATERIALS AND METHODS Included in our study were 32 boys and 29 girls with a mean age at presentation of 3.6 years and a mean followup of 9.2 years. The children were divided into group 1-31 with high and group 2-30 with low urethral resistance, as determined by leak point pressure or maximum urethral closing pressure. Clean intermittent catheterization with or without anticholinergics was instituted in all children in group 1 and those in group 2 with documented upper tract deterioration and/or problematic urinary incontinence after school age. We compared the incidence of upper tract deterioration at the initial evaluation and during followup as well as the final status of the upper tract in the 2 groups. RESULTS At the initial evaluation 17 of 31 group 1 (55%) and 4 of 30 group 2 (13%) patients had upper tract deterioration (p <0.01). Deterioration was refractory to conservative management in 5 group 1 children who required bladder augmentation. The incidence of de novo upper tract deterioration during followup was not statistically different in the 2 groups (10 and 7% in groups 1 and 2, respectively). At the final evaluation the upper tract was normal in 26 (84%), improved in 3 and stable in 2 group 1 patients, while it was normal in 26 (87%) in group 2. CONCLUSIONS Urethral resistance is relevant to upper tract deterioration in untreated children with myelodysplasia. Although bladder augmentation was necessary in some children with high urethral resistance, the outcome of conservative treatment was generally satisfactory with the preservation or normalization of the upper tract in more than 80% regardless of urethral resistance.
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Affiliation(s)
- H Tanaka
- Department of Urology, Hokkaido University School of Medicine, Sapporo, Japan
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44
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THE RELEVANCE OF URETHRAL RESISTANCE IN CHILDREN WITH MYELODYSPLASIA. J Urol 1999. [DOI: 10.1097/00005392-199903000-00064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gallien P, Nicolas B, Robineau S, Le Bot MP, Durufle A, Brissot R. Influence of urinary management on urologic complications in a cohort of spinal cord injury patients. Arch Phys Med Rehabil 1998; 79:1206-9. [PMID: 9779672 DOI: 10.1016/s0003-9993(98)90263-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To study urologic complications in patients with spinal cord injury (SCI) in relation to their bladder management. DESIGN AND SETTING A cohort study of patients with SCI in a rehabilitation center. PARTICIPANTS One hundred eighty-two patients were studied; demographic data, disease characteristics, and urologic history were obtained for each. INTERVENTION Patients responding to a questionnaire were given a clinical exam. Their medical records were reviewed, with particular attention given to the following urologic complications: lithiasis, urinary infections, orchiepididymitis, urethral trauma, vesicorenal reflux, and renal failure. RESULTS Results are reported for 123 patients. Time since SCI was 8 years. Intermittent catheterization was the main method of bladder management. Only 32 patients had changed their method of vesical voiding. Urinary complications had developed in 75% of patients. The most common complication was urinary infection. Vesicoureteral reflux occurred in 26% of patients using percussion. Trauma related to catheterization was the main problem with intermittent catheterization, responsible for a high rate of orchiepididymitis. CONCLUSION Intermittent catheterization is the most-used method of bladder management, but with a nonnegligible rate of urethral trauma in men. Percussion and Credé maneuver appear to be acceptable techniques of bladder management if the patient is closely monitored.
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Affiliation(s)
- P Gallien
- Clinique de Rééducation Fonctionnelle, Centre Hospitalier et Universitaire de Rennes, Hôpital Pontchaillou, France
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Ventimiglia B, Patti F, Reggio E, Failla G, Morana C, Lopes M, Savoca F, Consoli C, Reggio A. Disorders of micturition in neurological patients. A clinical study of 786 patients. J Neurol 1998; 245:173-7. [PMID: 9553849 DOI: 10.1007/s004150050200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Our aim was to evaluate the utility and effectiveness of a study protocol for neurological involvement in neurological disorders. We studied a sample of 786 patients with neurological disorders followed by the Neurological Department of Catania University and applied to them a four-step diagnostic protocol. Fifty-six per cent of the sample showed urological functional abnormalities; only 78 patients (9.9%) presented with an organic urological disease. Among the vesicosphincteric dysfunctions, bladder hyperreflexia was the most common pattern with remarkable differences between diseases. The present study demonstrated the utility of a standardized urological protocol in the screening and detection of neurological involvement in neurological diseases. Our protocol showed good specificity and reasonable low costs.
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Sutherland RS, Kogan BA, Baskin LS, Mevorach RA. Clean Intermittent Catheterization in Boys Using the Lofric Catheter. J Urol 1996. [DOI: 10.1016/s0022-5347(01)65430-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Ronald S. Sutherland
- Department of Urology, University of California School of Medicine, San Francisco, California
| | - Barry A. Kogan
- Department of Urology, University of California School of Medicine, San Francisco, California
| | - Laurence S. Baskin
- Department of Urology, University of California School of Medicine, San Francisco, California
| | - Robert A. Mevorach
- Department of Urology, University of California School of Medicine, San Francisco, California
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Van Kerrebroeck PEV. Micturition disturbances in multiple sclerosis: Diagnostic and treatment options. SEXUALITY AND DISABILITY 1996. [DOI: 10.1007/bf02590614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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