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Krassioukov A, Wyndaele M, Walter M, Keppenne V, Welk B, Vrijens D, Theron F. Intermittent catheterisation: individuals' rights, accessibility, and environmental concerns. Spinal Cord Ser Cases 2024; 10:39. [PMID: 38821946 PMCID: PMC11143204 DOI: 10.1038/s41394-024-00651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Andrei Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, The University of British Columbia (UBC), Vancouver, 818 W 10th Ave, V5Z 1M9, BC, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority, Vancouver, 4255 Laurel St, V5Z 2G9, BC, Canada.
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia (UBC), Vancouver, 4255 Laurel St, V5Z 2G9, BC, Canada.
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, The University of British Columbia (UBC), Vancouver, 818 W 10th Ave, V5Z 1M9, BC, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Veronique Keppenne
- Department of Urology, Centre Hospitalier Universitaire (CHU) de Liege, Liege, Belgium
| | - Blayne Welk
- Department of Surgery, and Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Francois Theron
- Department of Orthopedics, University of Pretoria, Pretoria, South Africa
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Zhao F, Zhang L, Chen X, Lei M, Sun L, Ma L, Wang C. Construction and Verification of Urinary Tract Infection Prediction Model for Hospitalized Rehabilitation Patients with Spinal Cord Injury. World Neurosurg 2024:S1878-8750(24)00885-4. [PMID: 38810877 DOI: 10.1016/j.wneu.2024.05.122] [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: 01/29/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To explore the influencing factors of urinary tract infection (UTI) in hospitalized patients with spinal cord injury and to construct and verify the nomogram prediction model. METHODS This study is a retrospective cohort study. From January 2017 to March 2022, 558 patients with spinal cord injury admitted to the Department of Rehabilitation Medicine of a tertiary hospital in Anhui Province, China, were selected as the research objects, and they were randomly divided into training group (n = 390) and verification group (n = 168) according to the ratio of 7:3, and clinical data including socio-demographic characteristics, disease-related data, and laboratory examination data were collected. Univariate analysis and multivariate logistic regression were used to analyze the influencing factors of UTI in hospitalized patients with spinal cord injuries. Based on this, a nomogram prediction model was constructed with the use of R software, and the risk prediction efficiency of the nomogram model was verified by the receiver operating characteristic curve and calibration curve. RESULTS Logistic regression analysis showed that the American Spinal Cord Injury Association (ASIA)-E grade (compared with ASIA-A grade) was an independent protective factor for UTI in hospitalized patients with spinal cord injury (odds ratio < 1, P < 0.05), while white blood cell count and indwelling catheter were independent risk factors for UTI in hospitalized patients with spinal cord injury (odds ratio > 1, P < 0.05). Based on this, a nomogram risk predictive model for predicting UTI in hospitalized rehabilitation patients with spinal cord injury was constructed, which proved to have good predictive efficiency. In the training group and the verification group, the area under the receiver operating characteristic curve of the nomogram model is 0.808 and 0.767, and the 95% confidence interval of the area under the receiver operating characteristic curve of the nomogram in the training group and the verification group is 0.760∼0.856 and 0.688∼0.845, respectively, indicating the nomogram model has good discrimination. According to the calibration curve, the prediction probability of the nomogram model and the actual frequency of UTI in the training group and the verification group are in good consistency, and the results of the Hosmer-Lemeshow bias test also suggest that the nomogram model has a good calibration degree in both the training group and the verification group (P = 0.329, 0.067). CONCLUSIONS ASIA classification level, white blood cell count, and indwelling catheter are independent influencing factors of UTI in hospitalized patients with spinal cord injury. The nomogram prediction model based on the above factors can simply and effectively predict the risk of UTI in hospitalized patients with spinal cord injury, which is helpful for clinical medical staff to identify high-risk groups early and implement prevention, treatment, and nursing strategies in time.
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Affiliation(s)
- Fangfang Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lixiang Zhang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Xia Chen
- Department of Nursing, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Mengling Lei
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China; The Graduate School, Bengbu Medical University, Bengbu, Anhui, China
| | - Liai Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Lina Ma
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China
| | - Cheng Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
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Logan K. Understanding the challenges faced by men learning to live with clean intermittent self-catheterisation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S4-S8. [PMID: 38722016 DOI: 10.12968/bjon.2024.33.9.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Clean intermittent self-catheterisation (CISC) is considered the preferred option to an indwelling catheter for emptying the bladder in people with a range of voiding dysfunctions. CISC has a lower risk of complications and urinary tract infections. This narrative review of previous qualitative research explores the quality-of-life impacts and highlights the challenges that men face. It will provide nurses who teach CISC with some useful insights into the male experience and the issues of concordance and adherence. This will help to better inform and guide clinical practice in this specialist area of nursing practice.
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Affiliation(s)
- Karen Logan
- Nurse Consultant, Aneurin Bevan University Health Board, The Grange University Hospital, Cwmbran, at the time of writing and is now an Independent Nurse Consultant
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4
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Sekido N, Takahashi R, Matsuyama F, Tatsunori M, Matsuoka M, Sengoku A, Nomi M, Kitta T, Mitsui T. Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single-use catheters. Low Urin Tract Symptoms 2024; 16:e12515. [PMID: 38693055 DOI: 10.1111/luts.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/15/2024] [Accepted: 04/13/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVES To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC). METHODS Among respondents to an internet survey on the burden of illness on persons with SCL who were considered to be able to perform ISC, 111 persons using single-use catheters were included to examine factors associated with self-reported sUTI by univariate as well as multivariable analysis. RESULTS The incidence of sUTI was significantly higher in males than in females (56.9% vs. 31.6%, p = .011), persons with stocks of antibiotics than those without it (82.9% vs. 28.6%, p < .011), and persons with more frequent bleeding during catheterization than those with less frequent bleeding (100% vs. 46.5%, p = .036). The incidence did not significantly differ between respective groups when various variables were evaluated by other characteristics of the participants, adherence to ISC procedures, and complications. On multivariable analysis, male gender and stocks of antibiotics were significant independent factors for sUTI. CONCLUSIONS Male gender and stocks of antibiotics were associated with sUTI in persons with SCL who were performing ISC with single-use catheters.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | | | | | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital, Osaka, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Kobe, Japan
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Yamanashi, Japan
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Juszczak M, Shem K, Elliott CS. The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction. Urol Clin North Am 2024; 51:263-275. [PMID: 38609198 DOI: 10.1016/j.ucl.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.
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Affiliation(s)
- Michael Juszczak
- Department of Physical Medicine and Rehabilitation, Tower Health, Reading Hospital Rehabilitation at Wyomissing, Reading, PA 19610, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | - Christopher S Elliott
- Division of Urology, Department of Urology, Stanford University Medical Center, Santa Clara Valley Medical Center, Valley Specialties Center-Division of Urology, 4th Floor, 751 South Bascom Avenue, San Jose, CA 95128, USA.
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Stærk K, Schrøder B, Jensen LK, Petersen T, Andersen TE, Nielsen LF. Catheter-associated bladder mucosal trauma during intermittent voiding: An experimental study in pigs. BJUI COMPASS 2024; 5:217-223. [PMID: 38371199 PMCID: PMC10869658 DOI: 10.1002/bco2.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/09/2023] [Indexed: 02/20/2024] Open
Abstract
Objective The objective of this study is to characterize bladder mucosal trauma associated with intermittent catheterization with conventional eyelet catheters (CECs) and to assess if a microhole zone catheter (MHZC) design concept reduces this adverse effect. Materials and Methods A porcine model was developed to reflect human catheterization and bladder drainage. Nine pigs were randomized for catheterization with CEC (n = 6) or MHZC (n = 3). The bladder was drained repeatedly 20 times through the catheter. Cystoscopy was performed before and after the procedure, and bladders were analysed by histopathology. Two additional pigs were used for cystoscopy visualization of suction events in vivo. Cystoscopy, gross pathology, histopathological score, leucocyte infiltration, and intracatheter pressure at flow stops during voiding were compared for each group. Results A significant higher pressure gradient was measured inside the CECs compared with MHZCs during flow stop. Consequently, CECs resulted in suction events inflicting bladder trauma characterized by loss of epithelium, oedema, haemorrhage, and neutrophil tissue infiltration. No significant trauma was identified when using MHZC. Conclusions Considerable mucosal bladder trauma is inflicted by CECs which may be an overlooked risk factor for urinary tract infection. Catheters can be designed to minimize mucosal suction and reduce associated trauma. This may be a solution to reduce infection frequency and increase user comfort. Furthermore, the study demonstrates the potential of pigs as an attractive animal model for investigating urinary catheter performances.
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Affiliation(s)
- Kristian Stærk
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Clinical Microbiology Odense University Hospital Odense Denmark
| | - Brit Schrøder
- Preclinical, R&D, Innovation Coloplast A/S Humlebaek Denmark
| | | | - Troels Petersen
- Preclinical, R&D, Innovation Coloplast A/S Humlebaek Denmark
| | - Thomas Emil Andersen
- Department of Clinical Research University of Southern Denmark Odense Denmark
- Department of Clinical Microbiology Odense University Hospital Odense Denmark
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Rempel L, Malik RN, Shackleton C, Calderón-Juárez M, Sachdeva R, Krassioukov AV. From Toxin to Treatment: A Narrative Review on the Use of Botulinum Toxin for Autonomic Dysfunction. Toxins (Basel) 2024; 16:96. [PMID: 38393175 PMCID: PMC10892370 DOI: 10.3390/toxins16020096] [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: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Since its regulatory approval over a half-century ago, botulinum toxin has evolved from one of the most potent neurotoxins known to becoming routinely adopted in clinical practice. Botulinum toxin, a highly potent neurotoxin produced by Clostridium botulinum, can cause botulism illness, characterized by widespread muscle weakness due to inhibition of acetylcholine transmission at neuromuscular junctions. The observation of botulinum toxin's anticholinergic properties led to the investigation of its potential benefits for conditions with an underlying etiology of cholinergic transmission, including autonomic nervous system dysfunction. These conditions range from disorders of the integument to gastrointestinal and urinary systems. Several formulations of botulinum toxin have been developed and tested over time, significantly increasing the availability of this treatment for appropriate clinical use. Despite the accelerated and expanded use of botulinum toxin, there lacks an updated comprehensive review on its therapeutic use, particularly to treat autonomic dysfunction. This narrative review provides an overview of the effect of botulinum toxin in the treatment of autonomic dysfunction and summarizes the different formulations and dosages most widely studied, while highlighting reported outcomes and the occurrence of any adverse events.
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Affiliation(s)
- Lucas Rempel
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
| | - Raza N. Malik
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Martín Calderón-Juárez
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Rahul Sachdeva
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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Thiruchelvam N, Landauro MH, Biardeau X, Rovsing C, Hahn M, Nascimento OFD, Gardner S, Amarenco G, Bagi P. Improved emptying performance with a new micro-hole zone catheter in adult male intermittent catheter users: A comparative multi-center randomized controlled cross-over study. Neurourol Urodyn 2024; 43:464-478. [PMID: 38196237 DOI: 10.1002/nau.25383] [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: 07/13/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIMS To confirm the improved performance of the micro-hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs). METHODS Male self-catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi-center, randomized, cross-over study performed across six European sites. Subjects tested the MHZC, featuring a drainage zone with 120 micro-holes and a CEC with two eyelets. The study consisted of four study visits (V0-V3), during which endpoints related to catheter performance (urinary flow-stops, bladder emptying, and intra-catheter pressure) were measured and two 4-week test periods at home (T1 and T2) where dipstick hematuria and user perception between catheters were evaluated. RESULTS Seventy-three male subjects with non-neurogenic and neurogenic bladder dysfunction (3:2) were enrolled. On average, catheterizations with the MHZC led to close to mean zero flow-stops compared to ≥1 flow-stops with the CEC, during both HCP- and self-led catheterizations (both p < 0.001). Residual urine at first flow-stop was significantly reduced for the MHZC compared to CEC (p = 0.001 and p = 0.004, for HCP- and self-led catheterizations, respectively). This was substantiated by a significantly smaller pressure peak at first flow-stop, a proxy for minimized mucosal suction (both HCP- and self-led catheterizations, p < 0.001). After home-use catheterizations, dipstick hematuria was comparable between catheters, whereas catheterizations were associated with significantly improved perception in favor of MHZC regarding bladder emptying, less blocking sensation, and improved hygienic catheterization compared to the CEC. CONCLUSION This study confirmed the evidence of improved bladder emptying with the MHZC compared to a CEC without the need to reposition the catheter. The MHZC therefore offers an enhanced benefit for the dependent CIC user securing complete bladder emptying in an uninterrupted free flow and reducing the need to reposition the catheter during emptying.
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Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | | | - Xavier Biardeau
- Centre Hospitalier Universitaire de Lille, Lille Cedex, France
| | | | - Markus Hahn
- ARTIMED Medical Consulting GmbH, Kassel, Germany
| | | | | | | | - Per Bagi
- Department of Urology, Rigshospitalet, København Ø, Denmark
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Schrøder B, Tentor F, Miclăuş T, Stærk K, Andersen TE, Spinelli M, Rendeli C, Del Popolo G, Bagi P, Nielsen LF. New micro-hole zone catheter reduces residual urine and mucosal microtrauma in a lower urinary tract model. Sci Rep 2024; 14:2268. [PMID: 38280939 PMCID: PMC10821950 DOI: 10.1038/s41598-024-52505-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/19/2024] [Indexed: 01/29/2024] Open
Abstract
Urinary tract infections (UTIs) are the main complication associated with clean intermittent catheterization (CIC) and are facilitated by post-void residual urine and trauma to the mucosa during voiding. The risk of UTI may be diminished by reducing the residual volumes and preventing microtrauma caused by mucosal suction through the eyelets of conventional eyelet catheters (CEC). A new micro-hole zone catheter (MHZC) was developed and tested in an ex vivo porcine lower urinary tract model and in vivo, in pigs, against a CEC. It was shown that, irrespective of the micro-hole diameter, the new catheter ensured increased flowrates and significantly lower residual volumes at the first flow-stop. Furthermore, with a micro-hole diameter of 0.4 mm, mucosal suction was virtually eliminated, regardless of the insertion depth or simulated intra-abdominal pressure mimicking sitting or standing humans. Pressure profile experiments and endoscopy studies indicated that the bladder gradually folds against the drainage tip of the new catheter, without blocking the flow, and, unlike with the CEC, sharp pressure variations and flow-stops did not occur during voiding. The MHZC outperformed the CEC in all tested scenarios and decreased residual volumes, thus potentially decreasing the risk of UTIs.
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Affiliation(s)
| | - Fabio Tentor
- Coloplast A/S, Holtedam 1, 3050, Humlebaek, Denmark
| | | | - Kristian Stærk
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | - Thomas Emil Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Claudia Rendeli
- Department of Pediatrics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giulio Del Popolo
- Neuro-Urology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Per Bagi
- Department of Urology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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DE Palma L, Balsamo R, Cicalese A, Frasca G, Granile A, Dell'olio L, Ladisa I, Falcone F, Ranieri M, Megna M. Intermittent self-catheterization training and effects on treatment adherence and infection. Eur J Phys Rehabil Med 2023; 59:782-788. [PMID: 37750862 DOI: 10.23736/s1973-9087.23.08008-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Intermittent self-catheterization (CISC) is the preferred treatment for patients with bladder dysfunction due to spinal cord injuries or multiple sclerosis (MS). However, the learning phase plays a crucial role in the still frequent drop-out. AIM To examine whether the timing of training affects the treatment compliance and the prevalence of urinary tract infections in patients with neurogenic urinary retention. DESIGN This is a non-randomized observational study. SETTING The study was carried out from January 2017 to December 2019 in outpatient settings at the Bari Polyclinic Unipolar Spinal Unit (Bari, Italy). POPULATION The study included adults with a CISC prescription for neurogenic urinary retention and learning the technique for the first time. METHODS One hundred patients were enrolled, 75 trained immediately after diagnosis and physician prescription, while 25 in the contest of a separate training visit, one or two days after physician prescription. After the training (T0), patient's data and number of prescribed daily catheterizations were recorded and compared with those collected after 6 and 12 months. Accuracy of the procedure and episodes of infections were assessed as well. RESULTS Adherence to prescribed CISC frequency and complications were not affected by the timing of training. However, patients adherent to the prescribe frequency of catheterization had less risk of infection than those who were not. Further post-hoc analysis confirmed that urodynamic findings and the pathology did not impact the overall occurrence of complications, but infections occurred more frequently in patients with MS (P<0.03). CONCLUSIONS The timing of CISC education does not affect treatment adherence or the occurrence of complications. However, the adherence to the CISC prescription seems to reduce the risk of infection. CLINICAL REHABILITATION IMPACT Patient training can be scheduled according to the organization of the centers, as patient compliance and the occurrence of complications are not affected.
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Affiliation(s)
- Luisa DE Palma
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy -
| | - Raffaele Balsamo
- Department of Urology, Monaldi Hospital, Naples, Italy
- AORN dei Colli, Naples, Italy
| | - Annarita Cicalese
- Department of Urology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Giuseppina Frasca
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Adriana Granile
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Lucrezia Dell'olio
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Ilaria Ladisa
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Francesca Falcone
- Unit of Physical, Rehabilitation Medicine and Spinal Cord, Polyclinic of Bari, Bari, Italy
| | - Maurizio Ranieri
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari Aldo Moro, Bari, Italy
| | - Marisa Megna
- Department of Translational Biomedicine and Neuroscience (DiBrain), University of Bari Aldo Moro, Bari, Italy
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11
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Xing H, Dai H, Li B, Yuan X, Liu X, Cui G, Liu N, Biering-Sørensen F. Factors associated with urinary tract infection in the early phase after performing intermittent catheterization in individuals with spinal cord injury: a retrospective study. Front Med (Lausanne) 2023; 10:1257523. [PMID: 38046407 PMCID: PMC10691259 DOI: 10.3389/fmed.2023.1257523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To investigate the occurrence rate of urinary tract infections (UTIs) in the early phase after performing intermittent catheterization (IC) and to explore the possible factors associated with UTIs after performing IC among people with spinal cord injury (SCI). Setting An inpatient rehabilitation department of a teaching hospital in China. Design Retrospective chart review. Methods A retrospective chart review was carried out for traumatic and non-traumatic SCI patients after performing IC during their inpatient stay. Demographic information, comorbidity of diabetes, urine analysis results before IC, method of IC (sterile or clean), use of bladder irrigation, cessation of IC and its reasons, and UTI events were collected. Results A total of 183 adult individuals were included, of which 60 (32.8%) of them were women. The median age was 49.0 years. The median time post-injury was 2 months. The overall occurrence rate of UTI after performing IC was 1.31 (95% confidence intervals: 0.96-1.77) events per 100 days. Sixty-nine (37.7%) patients discontinued IC during hospitalization, and UTIs were the leading reason for cessation (50.7%). Female sex, use of antibiotics for infections other than UTI, and use of bladder irrigation were found to be associated with a lower occurrence rate of UTI in the early phase after performing IC, with an odds ratio of 0.38 (p = 0.019), 0.20 (p = 0.022), and 0.24 (p < 0.001), respectively. Conclusion UTI after performing IC is prevalent among people with SCI. The study indicated that antibiotic prophylaxis and routine bladder irrigation might be associated with the reduction in UTI in the early phase after performing IC. Further research is needed to provide more evidence.
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Affiliation(s)
- Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Hongyue Dai
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Baohua Li
- Department of Nursing, Peking University Third Hospital, Beijing, China
| | - Xiaoning Yuan
- Department of Hospital-Acquired Infection Control, Peking University Third Hospital, Beijing, China
| | - Xiaoxuan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Guoqing Cui
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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12
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Landauro MH, Tentor F, Pedersen T, Jacobsen L, Bagi P. Improved Performance With the Micro-Hole Zone Intermittent Catheter: A Combined Analysis of 3 Randomized Controlled Studies Comparing the New Catheter Technology With a Conventional Eyelet Catheter. J Wound Ostomy Continence Nurs 2023; 50:504-511. [PMID: 37966080 PMCID: PMC10681284 DOI: 10.1097/won.0000000000001029] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the performance of a new urinary intermittent catheter (IC) prototype designed with a micro-hole drainage zone compared to a conventional eyelet catheter (CEC) in terms of flow-stop, bladder emptying, and hematuria. DESIGN Randomized controlled crossover studies. SUBJECT AND SETTING The sample comprised 15 male healthy volunteers (HV) and 15 IC users, along with 15 female HV and 15 IC users. The age range was lower for HV participants than for IC users (range: 20-57 years for HV vs 21-82 years for IC users). The study setting was the Department of Urology, located in Rigshospitalet, Copenhagen. METHODS Number of flow-stop incidents, residual urine volume at first flow-stop (RV1), and dipstick hematuria were measured during and after catheterization by a health care professional (HV) and by self-catheterisation (IC-users). Results from the 3 studies were combined for HV and IC users on RV1 and number of flow-stop incidents but separated on sex. For incidents of hematuria, an effect of underlying condition was assumed, and a combined analysis on sex was performed, separating HV and IC users. RESULTS When compared to the micro-hole drainage zone design, catheterizations with CEC resulted in a significantly higher mean RV1 (mean difference: 49 mL in males and 32 mL in females, both P < .001) and average number of flow-stop incidents (8 and 21 times more frequent for males and females, respectively, both P < .001). The likelihood for hematuria was 5.84 higher with CEC than with micro-hole drainage hole design, P = .053, during normal micturition in HV postcatheterization. No serious adverse events were reported. CONCLUSION The micro-hole drainage zone catheter provides IC users fewer premature flow-stops. This design feature reduces modifiable urinary tract infection risk factors, such as residual urine and micro-trauma; additional research is needed to determine its effects on bladder health.
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Affiliation(s)
- Malene Hornbak Landauro
- Correspondence: Malene Hornbak Landauro, PhD, Coloplast A/S, Holtedam 3, 3050 Humlebaek, Denmark ()
| | - Fabio Tentor
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Troels Pedersen
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Jacobsen
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Bagi
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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13
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Averbeck MA, Kennelly M, Thiruchelvam N, Konstantinidis C, Chartier-Kastler E, Krassioukov A, Landauro M, Jacobsen L, Vaabengaard R, Islamoska S. Risk factors for urinary tract infections associated with lower quality of life among intermittent catheter users. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S8-S16. [PMID: 37830866 DOI: 10.12968/bjon.2023.32.18.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Evidence shows that intermittent catheterisation (IC) for bladder emptying is linked to urinary tract infections (UTIs) and poor quality of life (QoL). AIM To investigate the association between UTI risk factors and QoL and patient-reported UTIs respectively. METHODS A survey was distributed to IC users from 13 countries. FINDINGS Among 3464 respondents, a significantly poorer QoL was observed when experiencing blood in the urine, residual urine, bowel dysfunction, recurrent UTIs, being female, and applying withdrawal techniques. A lower UTI risk was found when blood was not apparent in urine (RR: 0.63; 95% CI: 0.55-0.71), the bladder was perceived empty (RR: 0.83; 95% CI: 0.72-0.96), not having bowel dysfunction (RR: 0.86; 95% CI: 0.76-0.98), and being male (RR: 0.70; 95% CI: 0.62-0.79). CONCLUSION This study underlines the importance of risk factors and their link to QoL and UTIs, highlighting the need for addressing symptoms before UTIs become problematic.
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Affiliation(s)
| | - Michael Kennelly
- Professor and Director, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Emmanuel Chartier-Kastler
- Professor and Head of Urology, Sorbonne Université, Academic hospital Pitié Salpétrière, Paris, France
| | - Andrei Krassioukov
- Principal Investigator, Professor and Associate Director, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, The University of British Columbia; GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority; Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Malene Landauro
- Senior Medical Writer, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Lotte Jacobsen
- Principal Biostatistician, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Rikke Vaabengaard
- Lead Medical Specialist, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
| | - Sabrina Islamoska
- Senior Evidence Manager, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
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14
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CALABRÒ GIOVANNAELISA, D’AMBROSIO FLORIANA, ORSINI FRANCESCA, PAPPALARDO CIRO, SCARDIGNO ANNA, RUMI FILIPPO, FIORE ALESSANDRA, RICCIARDI ROBERTO, CICCHETTI AMERICO. Feasibility study on a new enhanced device for patients with intermittent catheterization (LUJA). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2023; 64:E1-E89. [PMID: 38125911 PMCID: PMC10730013 DOI: 10.15167/2421-4248/jpmh2023.64.3s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- GIOVANNA ELISA CALABRÒ
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - FLORIANA D’AMBROSIO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FRANCESCA ORSINI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - CIRO PAPPALARDO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - ANNA SCARDIGNO
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - FILIPPO RUMI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ALESSANDRA FIORE
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - ROBERTO RICCIARDI
- VIHTALI (Value In Health Technology And Academy For Leadership & Innovation), Spin Off of the Università Cattolica del Sacro Cuore, Rome, Italy
| | - AMERICO CICCHETTI
- Postgraduate School of Health Economics and Management (ALTEMS), Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Landauro MH, Jacobsen L, Tentor F, Pedersen T, Rovsing C, Feix do Nascimento O, Kennelly M. New Intermittent Urinary Micro-Hole Zone Catheter Shows Enhanced Performance in Emptying the Bladder: A Randomised, Controlled Crossover Study. J Clin Med 2023; 12:5266. [PMID: 37629309 PMCID: PMC10455232 DOI: 10.3390/jcm12165266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/13/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Urinary tract infections (UTIs) are common and troublesome complications of clean intermittent catheterisation (CIC) in individuals suffering from incomplete bladder emptying, which may exacerbate the underlying disease and lead to hospitalisation. Aside from the design of the intermittent catheter and its handling, a recent review highlighted residual urine as one of several UTI risk factors. A new urinary intermittent catheter with multiple micro-holes has been developed for improved bladder emptying. In a controlled crossover study, adult male CIC users were randomised for a health care professional-led catheterisation with the new micro-hole zone catheter (MHZC) and a conventional eyelet catheter (CEC) in two individual test visits to compare the number of flow-stops and the residual urine at the first flow-stop as co-primary endpoints. In 42 male CIC users, the MHZC resulted in significantly fewer flow-stop episodes compared to the CEC (mean 0.17, 95% CI [0.06, 0.45] vs. mean 1.09, 95% CI [0.75, 1.6], respectively; p < 0.001) and significantly less residual urine at the first flow-stop (mean 5.10 mL, SE [1.14] vs. mean 39.40 mL, SE [9.65], respectively; p < 0.001). No adverse events were observed in this study. The results confirm the enhanced performance of the MHZC compared to a CEC, ensuring an uninterrupted free urine flow with no need to reposition the catheter until the bladder is thoroughly empty.
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Affiliation(s)
| | - Lotte Jacobsen
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | - Fabio Tentor
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | - Troels Pedersen
- Coloplast A/S, 3050 Humlebæk, Denmark; (L.J.); (F.T.); (T.P.); (O.F.d.N.)
| | | | | | - Michael Kennelly
- Department of Urology, Carolinas Medical Center, Charlotte, NC 28207, USA;
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16
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Miller T, Roik LJ, Kalimullina T, Samejima S, Shackleton C, Malik RN, Sachdeva R, Krassioukov AV. The temporal burden of preparing catheters for re-use in adults with spinal cord injury: a cross-sectional study. Spinal Cord Ser Cases 2023; 9:39. [PMID: 37528074 PMCID: PMC10393987 DOI: 10.1038/s41394-023-00596-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/11/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
STUDY DESIGN Cross-sectional OBJECTIVES: Neurogenic lower urinary tract dysfunction is common among people with spinal cord injury (SCI). Although single-use clean intermittent catheterization is recommended to facilitate routine bladder emptying, catheter re-use is common. Barriers associated with the preparation (i.e., cleaning) of catheters for re-use are unknown. This study examined barriers to catheter re-use in adult individuals with SCI by assessing (1) the time needed to clean a catheter, and (2) the perceived difficulty of the catheter cleaning routine. SETTING Laboratory METHODS: Twenty individuals with chronic SCI ( ≥ 1 year since injury; Group 1 = 10 with tetraplegia; Group 2 = 10 with paraplegia) completed the study. Using a standardized cleaning procedure (i.e., Milton method), catheter cleaning was timed for each participant. Perceived difficulty was assessed using a 5-point Likert scale. Functional impairment was assessed with the Upper Extremity Motor Score (UEMS). RESULTS Significant between-group differences were observed for total cleaning time (Group 1 = 1584.1 ± 179.8 s; Group 2 = 1321.0 ± 93.8 s, p = 0.004) and perceived difficulty [Group 1 = 2.6 (2, 3); Group 2 = 2 (1.7, 2.3), p = 0.028]. Total cleaning time was significantly correlated with UEMS (ρ = -0.709, p ≤ 0.001) and perceived difficulty (ρ = 0.468, p = 0.037). UEMS emerged as an independent predictor of total cleaning time (R2 = 0.745, β = -0.833, p ≤ 0.001). CONCLUSIONS Preparing catheters for re-use is time-intensive and difficult for people with higher SCI level, severity and more pronounced upper limb motor impairment, which was independently associated with total cleaning time. Performing this routine on a consistent basis would require a substantial time commitment and would have a profoundly negative impact on overall quality of life.
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Affiliation(s)
- T Miller
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - L J Roik
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - T Kalimullina
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Samejima
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R N Malik
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - R Sachdeva
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A V Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
- Spinal Cord Program, GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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17
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Miller T, Lange D, Kizhakkedathu JN, Yu K, Felix D, Samejima S, Shackleton C, Malik RN, Sachdeva R, Walter M, Krassioukov AV. The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study. Biomedicines 2023; 11:1929. [PMID: 37509568 PMCID: PMC10377649 DOI: 10.3390/biomedicines11071929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.
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Affiliation(s)
- Tiev Miller
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Dirk Lange
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Jayachandran N Kizhakkedathu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The School of Biomedical Engineering, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Kai Yu
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Centre for Blood Research, Life Science Institute, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Demian Felix
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- The Stone Centre at Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Soshi Samejima
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Raza N Malik
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Department of Urology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC V6T 1Z3, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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18
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Moore JV, Burns J, McClelland N, Quinn J, McCoy CP. Understanding the properties of intermittent catheters to inform future development. Proc Inst Mech Eng H 2023:9544119231178468. [PMID: 37300485 DOI: 10.1177/09544119231178468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite the extensive use of intermittent catheters (ICs) in healthcare, various issues persist for long-term IC users, such as pain, discomfort, infection, and tissue damage, including strictures, scarring and micro-abrasions. A lubricous IC surface is considered necessary to reduce patient pain and trauma, and therefore is a primary focus of IC development to improve patient comfort. While an important consideration, other factors should be routinely investigated to inform future IC development. An array of in vitro tests should be employed to assess IC's lubricity, biocompatibility and the risk of urinary tract infection development associated with their use. Herein, we highlight the importance of current in vitro characterisation techniques, the demand for optimisation and an unmet need to develop a universal 'toolkit' to assess IC properties.
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Affiliation(s)
- Jessica V Moore
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jane Burns
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicola McClelland
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - James Quinn
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Colin P McCoy
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
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19
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Looby A, Davies H, Mealing S, Smith AB, Avey B, Laezza A, Crossland A, Lane EF, Ridler M, Cawson M. Time trade-off study to establish utility decrements in individuals with a spinal cord injury who perform intermittent catheterisation. J Med Econ 2023; 26:430-440. [PMID: 36892952 DOI: 10.1080/13696998.2023.2189395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
AIMS To generate utility decrements for three attributes associated with catheterisation for individuals with a spinal cord injury (SCI): the process of catheterisation, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalisation. MATERIALS AND METHODS Health state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire. RESULTS Utility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p < 0.001) for the SCI population. A significant decrement of 0.02 (p <0.001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371. LIMITATIONS Modest sample size of respondents from the SCI population (n = 48). CONCLUSIONS Worry associated with hospitalisation had the greatest impact on patients' health-related quality of life (HRQoL). The catheterisation process, such as the lubrication and repositioning of the catheter, also impacted on patients' HRQoL.
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Affiliation(s)
- A Looby
- York Health Economics Consortium
| | - H Davies
- York Health Economics Consortium
| | | | | | - B Avey
- York Health Economics Consortium
| | | | | | - E F Lane
- York Health Economics Consortium
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20
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Baker H, Avey B, Overbeck Rethmeier L, Mealing S, Lynge Buchter M, Averbeck MA, Thiruchelvam N. Cost-effectiveness analysis of hydrophilic-coated catheters in long-term intermittent catheter users in the UK. Curr Med Res Opin 2023; 39:319-328. [PMID: 36444510 DOI: 10.1080/03007995.2022.2151734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To estimate the cost-effectiveness of single-use hydrophilic-coated intermittent catheters (HCICs) versus single-use uncoated intermittent catheters (UICs) for urinary catheterization. METHODS The evaluation took a UK national health service (NHS) perspective. The population of interest were people using intermittent catheters, with either a spinal cord injury or multiple sclerosis. A Markov model was developed that estimated costs and clinical evidence over the lifetime of a hypothetical cohort and applied health-related quality-of-life estimates. Model inputs were sourced from published evidence, including a network meta-analysis to inform the treatment effect (reduction in catheter-associated urinary tract infections [CAUTIs]), and were supported by expert opinion. The model outputs included per-patient lifetime costs, quality-adjusted life years (QALYs), and the incremental cost effectiveness ratio (ICER). Event counts were also produced. RESULTS Using HCICs instead of UICs could prevent seven CAUTI events per patient over a lifetime horizon (1.8 requiring secondary care). Overall, lifetime use of HCICs is £3,183 more expensive than use of UICs per patient. However, for these additional costs, 0.55 QALYs are gained. The ICER is £5,755 per additional QALY gained. Key drivers of the model results were identified and subject to sensitivity analyses. The results were found to be robust to parameter uncertainty. CONCLUSION HCICs are likely to be a cost-effective alternative to UICs, a result driven by substantial reductions in the number of CAUTIs. Their adoption across clinical practice could avoid a substantial number of infections, freeing up resources in the NHS and reducing antibiotic use in urinary catheter users.
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Affiliation(s)
| | | | | | | | | | | | - Nikesh Thiruchelvam
- Department of Urology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, UK
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21
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Varga G, Fedorko M, Wasserbauer R, Markusova J, Praksova P, Adedokun V, Trinh T. Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation. Actas Urol Esp 2022; 46:606-612. [PMID: 36216764 DOI: 10.1016/j.acuroe.2022.08.007] [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: 10/19/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES To evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. MATERIALS AND METHODS Patients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. RESULTS 54 MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<0.05). Causative agents significantly differed in both groups (P=0.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>0.99 at visit 0, 1 and 3, P=0.078 at visit 2). CONCLUSIONS There is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.
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Affiliation(s)
- G Varga
- Department of Urology, University Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - M Fedorko
- Department of Urology, University Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic.
| | - R Wasserbauer
- Department of Urology, University Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic
| | - J Markusova
- Department of Urology, University Hospital Brno, Czech Republic
| | - P Praksova
- Department of Neurology, University Hospital Brno, Czech Republic
| | - V Adedokun
- Department of Urology, University Hospital Brno, Czech Republic
| | - T Trinh
- Department of Urology, University Hospital Brno, Czech Republic; Faculty of Medicine, Masaryk University Brno, Czech Republic
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Tentor F, Grønholt Schrøder B, Nielsen S, Schertiger L, Stærk K, Emil Andersen T, Bagi P, Feldskov Nielsen L. Development of an ex-vivo porcine lower urinary tract model to evaluate the performance of urinary catheters. Sci Rep 2022; 12:17818. [PMID: 36280778 PMCID: PMC9592621 DOI: 10.1038/s41598-022-21122-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 09/22/2022] [Indexed: 01/19/2023] Open
Abstract
Intermittent catheterization is the gold standard method for bladder management in individuals with urinary retention and/or incontinence. It is therefore important to understand the performance of urinary catheters, especially on parameters associated to risks of developing urinary tract infections, and that may impact the quality of life for urinary catheter users. Examples of such parameters include, urine flowrate, occurrence of flow-stops, and residual urine left in the bladder after flow-stop. Reliable in-vitro and/or ex-vivo laboratory models represent a strong asset to assess the performance of urinary catheters, preceding and guiding in-vivo animal studies and/or human clinical studies. Existing laboratory models are generally simplified, covering only portions of the catheterization process, or poorly reflect clinical procedures. In this work, we developed an ex-vivo porcine lower urinary tract model that better reflects the catheterization procedure in humans and allows to investigate the performance of standard of care catheters. The performance of three standard of care catheters was investigated in the developed model showing significant differences in terms of flowrate. No differences were detected in terms of residual volume in the bladder at first flow-stop also when tuning the abdominal pressure to mimic a sitting down and standing up position. A newly discovered phenomenon named hammering was detected and measured. Lastly, mucosal suction was observed and measured in all standard of care catheters, raising the concern for microtrauma during catheterization and a need for new and improved urinary catheter designs. Results obtained with the ex-vivo model were compared to in-vivo studies, highlighting similar concerns.
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Affiliation(s)
- Fabio Tentor
- grid.424097.c0000 0004 1755 4974Coloplast A/S, Holtedam 1, 3050 Humlebæk, Denmark
| | | | - Simon Nielsen
- grid.424097.c0000 0004 1755 4974Coloplast A/S, Holtedam 1, 3050 Humlebæk, Denmark
| | - Lars Schertiger
- grid.424097.c0000 0004 1755 4974Coloplast A/S, Holtedam 1, 3050 Humlebæk, Denmark
| | - Kristian Stærk
- grid.10825.3e0000 0001 0728 0170Research Unit of Clinical Microbiology, University of Southern Denmark, J.B. Winsløws Vej 21, 5000 Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 5000 Odense, Denmark
| | - Thomas Emil Andersen
- grid.10825.3e0000 0001 0728 0170Research Unit of Clinical Microbiology, University of Southern Denmark, J.B. Winsløws Vej 21, 5000 Odense, Denmark ,grid.7143.10000 0004 0512 5013Department of Clinical Microbiology, Odense University Hospital, J.B. Winsløws Vej 21, 5000 Odense, Denmark
| | - Per Bagi
- grid.475435.4Department of Urology, Centre for Cancer and Organ Diseases, Rigshospitalet, Blegdamsvej 9, 2100 København, Denmark
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Lauridsen SV, Averbeck MA, Krassioukov A, Vaabengaard R, Athanasiadou S. UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management. BMC Nurs 2022; 21:272. [PMID: 36199133 PMCID: PMC9535847 DOI: 10.1186/s12912-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user. METHODS The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs. RESULTS The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section. CONCLUSIONS The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.
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Affiliation(s)
- S V Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark. .,WHO-CC, Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
| | | | - A Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Endowment Lands, Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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Barken KB, Vaabengaard R. A scoping review on the impact of hydrophilic versus non-hydrophilic intermittent catheters on UTI, QoL, satisfaction, preference, and other outcomes in neurogenic and non-neurogenic patients suffering from urinary retention. BMC Urol 2022; 22:153. [PMID: 36123663 PMCID: PMC9487088 DOI: 10.1186/s12894-022-01102-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background For patients suffering from urinary retention due to neurogenic [e.g., spinal cord injury (SCI), spina bifida (SB), multiple sclerosis (MS)] or non-neurogenic [e.g., cancer, benign prostate hypertrophy (BPH)] causes, intermittent catheterization is the primary choice for bladder emptying. This scoping review compared hydrophilic-coated intermittent catheters (HCICs) with non-hydrophilic (uncoated) catheters in neurogenic and non-neurogenic patients with respect to satisfaction, preference, adverse events, urinary tract infection (UTI), quality of life (QoL), cost effectiveness, pain, and discomfort. Methods A systematic literature search was conducted using PubMed, Cochrane Library, Google Scholar, Embase, and available clinical practice guidelines and was limited to systematic reviews/meta-analysis and clinical studies (randomized trials, cohort and case–control studies) published in English between 2000 and 2020. A narrative synthesis was performed, comparing HCIC with non-hydrophilic catheters in each pathology. The articles where critically appraised and weighted according to their level of evidence based on the Oxford Centre for Evidence-Based Medicine Levels of Evidence grading. Results Thirty seven original articles and 40 reviews were included. The comparison of HCICs versus non-hydrophilic catheters was well-documented in patients with mixed pathology, SCI, and to some extent SB. The available evidence predominantly indicates better outcomes with HCICs as reported by study authors, particularly, greater UTI reduction and improved satisfaction, cost-effectiveness, and QoL. However, SB studies in children did not report reduction in UTIs. Children complained about slippery catheters, indicating possible touching of the surface during insertion, which may compromise cleanliness of the procedure and affect outcomes such as UTI. Limited studies were available exclusively on BPH and none on MS; however, most studies performed on mixed pathologies, including BPH and MS, indicated strong preference for HCICs compared to non-hydrophilic catheters. Conclusions The findings generally support HCICs over non-hydrophilic catheters; however, most studies were fairly small, often used a mix of pathologies, and the conclusions were often based on studies with high drop-out rates that were therefore underpowered. Larger studies are needed to support the general finding that HCICs are the preferred choice in most populations. Additional training in children or redesigned catheters may be necessary for this age-group to fully benefit from the advantages of HCICs. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01102-8.
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Patient Support Program and Healthcare Resource Utilization in Patients Using Clean Intermittent Catheterization for Bladder Management. J Wound Ostomy Continence Nurs 2022; 49:470-480. [PMID: 36108231 PMCID: PMC9481293 DOI: 10.1097/won.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary purpose of this study was to evaluate the impact of a patient-centered, chronic care self-management support program of clean intermittent catheterization (CIC) on emergency department (ED) visits and hospitalizations within the first 30 days of starting CIC. Secondary research objectives were to compare reuse of catheters, adherence to healthcare provider–instructed frequency of CIC, and reasons for nonadherence.
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26
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Firoozeh N, Agah E, Bauer ZA, Olusanya A, Seifi A. Catheter-Associated Urinary Tract Infection in Neurological Intensive Care Units: A Narrative Review. Neurohospitalist 2022; 12:484-497. [PMID: 35755214 PMCID: PMC9214946 DOI: 10.1177/19418744221075888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Catheter-associated urinary tract infection (CAUTI) is among the most common types of healthcare-associated infection (HAI), which is associated with poor outcomes and prolonged hospitalization in critically ill patients. Previous studies have mentioned that patients admitted to neurological ICUs are at higher risk of CAUTI compared to patients in other ICU settings. This review paper aims to review studies published during the last decade that evaluated the incidence, risk factors, causative pathogens, and preventive strategies and treatment in neuro-critically ill patients.
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Affiliation(s)
- Negar Firoozeh
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elmira Agah
- Iranian Center of Neurological Research, Neuroscience Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zaith Anthony Bauer
- Department of Pulmonary Critical Care, Brooke Army Medical Center, San Antonio, TX, USA
| | - Adedeji Olusanya
- Department of Physical Medicine and Rehabilitation, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neurocritical Care, University of Texas Health, San Antonio, TX, USA
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Varga G, Fedorko M, Wasserbauer R, Markusova J, Praksova P, Adedokun V, Trinh T. Infecciones del tracto urinario en pacientes con esclerosis múltiple y los diferentes sistemas de vaciado vesical. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Berger A, Goldstine J, Hofstad C, Inglese GW, Kirschner-Hermanns R, MacLachlan S, Shah S, Vos-van der Hulst M, Weiss J. Incidence of urinary tract infection following initiation of intermittent catheterization among patients with recent spinal cord injury in Germany and the Netherlands. J Spinal Cord Med 2022; 45:461-471. [PMID: 33054606 PMCID: PMC9135430 DOI: 10.1080/10790268.2020.1829416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To assess incidence of urinary tract infection (UTI) among patients with recent spinal cord injury (SCI) who initiated intermittent catheterization (IC).Design: Retrospective chart review.Setting: Two European SCI rehabilitation centers.Participants: Seventy-three consecutive patients with recent SCI who initiated IC.Outcome measures: Incidence of UTI, using six different definitions, each based on microbiology ± symptomatology ± mention of UTI . Rates were expressed in terms of numbers of UTIs per 100 patient-months (PMs). Attention was focused on first-noted UTI during the three-month follow-up, as assessed with each of the six definitions.Results: Fifty-eight percent of patients (n = 33) met ≥1 definitions for UTI during follow-up (rate: 31.5 UTIs per 100 PMs), ranging from 14% (5.3 per 100 PMs; definition requiring bacteriuria, pyuria, and presence of symptoms) to 45% (22.7 per 100 PMs; definition requiring "mention of UTI"). Ten cases were identified using the definition that required bacteriuria, pyuria, and symptoms, whereas definitions that required bacteriuria and either pyuria or symptoms resulted in the identification of 20-25 cases. Median time to UTI ranged from 42 days ("mention of UTI") to 81 days (definition requiring bacteriuria and ≥100 leukocytes/mm3).Conclusion: Depending on definition, 14% to 45% of patients with recent SCI experience UTI within three months of initiating IC. Definitions requiring bacteriuria and either pyuria or symptoms consistently identified about twice as many cases as those that required all three conditions. Standardizing definitions may help improve detection, treatment, and prevention of UTI within this vulnerable population.
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Affiliation(s)
- Ariel Berger
- Real-World Evidence, Evidera Inc., Waltham, Massachusetts, USA,Correspondence to: Ariel Berger, Real-World Evidence, Evidera Inc., 500 Totten Pond Road, 5th Floor, Waltham, Massachusetts02451, USA.
| | - Jimena Goldstine
- Global Market Access, Hollister Inc., Libertyville, Illinois, USA
| | - Cheriel Hofstad
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands
| | - Gary W. Inglese
- Global Market Access, Hollister Inc., Libertyville, Illinois, USA
| | - Ruth Kirschner-Hermanns
- Neuro-Urology, Neurological Rehabilitation Center Godeshoehe e.V., Bonn, Germany,Neuro-Urology/Clinic of Urology, University Clinic, Bonn, Germany
| | | | - Surbhi Shah
- Real-World Evidence, Evidera Inc., Waltham, Massachusetts, USA
| | - Marije Vos-van der Hulst
- Department of Research, Sint Maartenskliniek, Ubbergen, Netherlands,Rehabilitation Spinal cord Injury, Sint Maartenskliniek, Nijmegen, Netherlands
| | - Jerome Weiss
- Neuro-Urology, Neurological Rehabilitation Center Godeshoehe e.V., Bonn, Germany
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Welk B, Lenherr S, Santiago-Lastra Y, Norman HS, Keiser MG, Elliott CS. Differences in the incidence of urinary tract infections between neurogenic and non-neurogenic bladder dysfunction individuals performing intermittent catheterization. Neurourol Urodyn 2022; 41:1002-1011. [PMID: 35332597 DOI: 10.1002/nau.24914] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE To measure the incidence and severity of urinary tract infections (UTI) in intermittent catheter (IC) users with neurogenic and non-neurogenic diagnoses. MATERIALS AND METHODS Administrative health insurance claims data from the IBM MarketScan® Database between January 1, 2015 and December 31, 2019, were analyzed. New IC-users with neurogenic lower urinary tract dysfunction (NLUTD); IC-users without NLUTD (non-NLUTD); and age-and-sex-matched general population without IC use (GEN) were compared. Individuals were followed for one year after initial IC utilization or random index date for GEN. The primary outcome was a patient seeing a physician or attending a hospital for a UTI (measured with a primary or secondary diagnosis code related to a UTI). UTI incidence, hospitalizations, and length of hospital stay were compared. RESULT We identified 6944 NLUTD, 5102 non-NLUTD, and 120 426 GEN individuals. The annualized UTI incidence was higher in IC-users (54.9% NLUTD IC-users and 38.9% non-NLUTD IC-users) compared to GEN individuals (9.8%) (p < 0.001 between groups). Hospitalization for UTI was more common in NLUTD and non-LUTD (11.3% and 4.0%, respectively) compared with GEN individuals (1.0%) (p < 0.001 between groups). NLUTD individuals had a greater average length of hospital stay than non-NLUTD (2.2 ± 3.6 vs. 1.6 ± 2.1 days, p < 0.001). CONCLUSION IC users had a significantly higher incidence of UTIs than the general population. NLUTD IC-users had a higher incidence of UTIs that required hospitalization compared to non-NLUTD individuals. Strategies to decrease the patient and healthcare burden of UTIs in those that catheterize should be prioritized.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, Ontario, Canada
| | - Sara Lenherr
- Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Christopher S Elliott
- Stanford University Medical Center, Stanford, California, USA.,SantaClara Valley Medical Center, San Jose, California, USA
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Sampogna G, Barbosa F, Brambillasca PM, Montanari E, Rampoldi A, Spinelli M. Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease intermittent catheterization in case of concomitant benign prostatic hyperplasia. Spinal Cord Ser Cases 2022; 8:34. [PMID: 35332117 PMCID: PMC8948271 DOI: 10.1038/s41394-022-00499-6] [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: 07/04/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES To assess the safety and efficacy of prostatic artery embolization (PAE) to reduce prostate volume (PV) and facilitate intermittent catheterization (IC) in individuals with concurrent benign prostatic hyperplasia (BPH) and spinal cord injury (SCI). SETTING Italian tertiary referral center for people with SCI. METHODS We retrospectively collected all data of individuals undergoing PAE from 2015 to 2020 because of BPH-related problems during IC. PAE was performed under local anesthesia with superselective catheterization of the prostatic arteries. Technical success was defined as bilateral embolization. We determined pre- and post-procedural PV by magnetic resonance imaging. RESULTS We considered 10 cases with tetraplegia (n = 5) and paraplegia (n = 5). Nine (90%) procedures were technically successful, while we performed monolateral PAE in one case. The median pre-procedural PV was 61 mL. After 6 months, all patients experienced significant PV reduction (median: 19.6%), and 7/7 patients with indwelling urinary catheter started successfully IC. Neither intra- nor post-procedural complications occurred within a median follow-up of 33 months. CONCLUSIONS PAE proved to be a safe and effective treatment for BPH to facilitate IC in people with SCI. Considering the minimal morbidity of PAE, further multi-center studies are mandatory to draw definitive conclusions and warrant its widespread adoption in this population.
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Affiliation(s)
- Gianluca Sampogna
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabiane Barbosa
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | | | - Emanuele Montanari
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Rampoldi
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | - Michele Spinelli
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy.
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The microbiological and physical properties of catheters for intermittent catheterization: a systematic review on the impact of reuse and cleaning. Spinal Cord 2022; 60:581-593. [PMID: 35066573 DOI: 10.1038/s41393-021-00740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To review systematically the clinical evidence of the effectiveness of various intermittent catheter cleaning methods that have been proposed as methods to prepare catheters for reuse. METHODS A keyword search in Medline, Excerpta Medica dataBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various intermittent catheter cleaning methods. Studies selected for review included analytical experimental, prospective cohort and cross-sectional. Cleaning methods reviewed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods. RESULTS Overall, 12 studies were included. Heat-based sterilization and mechanical abrasion methods were either not effective or damaged the physical properties of catheters. Two studies reported evidence that their chemical cleaning methods (i.e., soaked catheters in a 70% alcohol solution for 5 min or combined approach detergent wash followed by soaking in Milton sterilizing fluid also known as the Milton method) both preserved the structural integrity of their catheters and were bactericidal. CONCLUSIONS Numerous cleaning methods resulted in the destruction of catheters. However, there are two reported cleaning methods, submersion for 5 min in 70% alcohol and the "Milton method", that eliminate bacterial colonization while leaving the physical properties of the catheters unchanged. While these cleaning methods are promising, each was published in just one study, therefore higher-powered / longitudinal studies confirming the safety and efficacy of these cleaning methods must be obtained before current clinical recommendations can be modified.
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Bonello A, Faci MC, de Mello MP. THE SATISFACTION OF THE PERSON WITH URINARY RETENTION IN THE USE OF DIFFERENT TYPES OF URINARY CATHETERS. ESTIMA 2021. [DOI: 10.30886/estima.v19.1099_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: to assess the satisfaction of the person with urinary retention in the face of the use of different types of urinary catheters, as well as to compare and analyze different attributes of these after their use in clean intermittent catheterization (CIC). Method: descriptive exploratory cross-sectional study, developed in a reference clinic in the state of São Paulo, from February to March 2020. The sample consisted of 32 adults registered in the service, and who adopted the CIC as a form of bladder emptying . Data collection was performed through individual interviews using a semi-structured questionnaire. Data were analyzed using descriptive, inferential statistics and categorization of responses to open questions. Results: of the 32 users, 84% were male, with a mean age of 54.16 years, 81% performed the procedure between 1 and 5 years, with a frequency of 4 to 6 times a day (66%). Most respondents (73%) preferred the hydrophilic-coated polyurethane catheter, converging with the percentage of users satisfied with the same catheter. Conclusion: the most satisfying technology is the hydrophiliccoated polyurethane catheter due to several attributes such as lubrication, firmness, packaging, urethral slip, handling, rapid urine clearance and comfort
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Bonello A, Faci MC, de Mello MP. A SATISFAÇÃO DA PESSOA COM RETENÇÃO URINÁRIA NO USO DE DIFERENTES TIPOS DE CATETERES VESICAIS. ESTIMA 2021. [DOI: 10.30886/estima.v19.1099_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:avaliar a satisfação da pessoa com retenção urinária diante do uso de diferentes tipos de cateteres vesicais bem como comparar e analisar diferentes atributos desses após a sua utilização no cateterismo intermitente limpo (CIL). Método: estudo exploratório descritivo de corte transversal, desenvolvido em um ambulatório de referência do estado de São Paulo, no período de fevereiro a março de 2020. A amostra constituiu-se de 32 adultos cadastrados no serviço, e que adotavam o CIL como forma de esvaziamento vesical. A coleta de dados foi realizada por entrevista individual com a utilização de um questionário semiestruturado. Os dados foram analisados por estatística descritiva, inferencial e categorização das respostas para as questões abertas. Resultados: dos 32 usuários, 84% eram do sexo masculino, com média de idade de 54,16 anos, 81% realizavam o procedimento entre 1 a 5 anos, com frequência de 4 a 6 vezes ao dia (66%). A maioria dos entrevistados (73%) preferiu o cateter de poliuretano com revestimento hidrofílico, convergindo com o percentual de usuários satisfeitos com o mesmo cateter. Conclusão: a tecnologia com maior satisfação é o cateter de poliuretano com revestimento hidrofílico devido a diversos atributos, como lubrificação, firmeza, embalagem, deslizamento na uretra, manipulação, eliminação rápida da urina e conforto
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Chalas C, Jilet L, Wolf JP, Drouineaud V, Abdoul H, Patrat C, Denys P, Giuliano F. Prospective analysis over time of semen parameters in spinal cord-injured patients: Results of a pilot study. Andrology 2021; 10:120-127. [PMID: 34347944 DOI: 10.1111/andr.13089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/20/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spinal cord injury often results in erectile dysfunction and an ejaculation along with impaired semen parameters. Fertility is a major concern in spinal cord injury adult males and some fear that the delay post-spinal cord injury may negatively affect sperm quality. OBJECTIVES We aimed to (i) assess semen parameters over time in SCI patients according to age at spinal cord injury, time post-spinal cord injury, and the spinal cord injury level and completeness and (ii) measure markers in semen for inflammation and marker of oxidative stress to investigate their impact on sperm parameters. MATERIALS AND METHODS The study is a prospective, longitudinal, pilot study over 18 months. Thirty-five men with spinal cord injury from 18 to 60 years of age were enrolled. Their mean age was 29.4 ± 6.4 years. Semen retrieval was scheduled every 6 months, allowing analysis of four ejaculates, in association with measurement of granulocyte and seminal plasma elastase concentrations to assess markers in semen for inflammation and spermatozoa DNA fragmentation to assess oxidative stress. RESULTS Based on reference limits, a normal total sperm number, decreased motility and vitality of the spermatozoa, and increased morphological abnormalities were found. Mean round cell and granulocyte concentrations were elevated in the semen. Markers in semen for inflammation and marker of oxidative stress were elevated in several semen samples, compared to reference limits. However, neither the presence of markers in semen for inflammation or oxidative stress, the completeness or the level of the spinal cord lesion, the age or the time post-spinal cord injury had a negative impact on the semen quality over time. DISCUSSION There was no significant decline in semen quality in spinal cord injury patients over time within the limitations of this pilot study. Moreover, a chronic genital inflammatory status was not associated with impairment of semen quality. CONCLUSION The present findings are reassuring for men with spinal cord injury and could guide the management of their reproductive ability. According to these preliminary data, not all spinal cord injury patients who are able to ejaculate require systematic freezing of their spermatozoa.
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Affiliation(s)
- Celine Chalas
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France
| | - Lea Jilet
- Unité de Recherche Clinique-Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, Paris, France
| | - Jean-Philippe Wolf
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France.,Institut Cochin, U 1016, Université de Paris, Paris, France
| | - Veronique Drouineaud
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France
| | - Hendy Abdoul
- Unité de Recherche Clinique-Centre d'Investigation Clinique, Paris Descartes Necker/Cochin, Hôpital Tarnier, Paris, France
| | - Catherine Patrat
- Laboratoire d'Histologie-Embryologie-Biologie de la Reproduction-CECOS, Cochin Academic Hospital, AP-HP, Centre Université de Paris, Paris, France.,Institut Cochin, U 1016, Université de Paris, Paris, France
| | - Pierre Denys
- Neuro-Uro-Andrology Raymond Poincare Academic Hospital, AP-HP, Garches, France.,Inserm U1179, UFR des sciences de la santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
| | - Francois Giuliano
- Neuro-Uro-Andrology Raymond Poincare Academic Hospital, AP-HP, Garches, France.,Inserm U1179, UFR des sciences de la santé, University of Versailles Saint-Quentin, Montigny-le-Bretonneux, France
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Balhi S, Arfaouni RB, Mrabet A. Intermittent catheterisation: the common complications. Br J Community Nurs 2021; 26:272-277. [PMID: 34105361 DOI: 10.12968/bjcn.2021.26.6.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intermittent catheterisation (IC) has been in practice for more than 40 years and is considered the gold standard in the management of urinary retention in the neurological bladder. IC has many advantages over indwelling urethral or suprapubic catheterisation, including reducing the risk of infection, protecting the bladder and improving quality of life. However, complications can be caused by the practice of this technique, the most common of which is infection. This review discusses some of the common complications that can occur with the use of intermittent catheterisation, including urinary tract infection (UTIs) and urethral complications. It also highlights the role of the nurse in the management of its complications.
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Affiliation(s)
- Salma Balhi
- Doctor, Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Rym Baati Arfaouni
- Doctor, Urodynamics and Functional Exploration Unit, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ali Mrabet
- Doctor, Department of Epidemiology and Public Health, Faculty of Medicine of Tunis, Tunis, Tunisia
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Cohen AJ, Cheng PJ, Song S, Patino G, Myers JB, Roy SS, Elliott SP, Pariser J, Drobish J, Erickson BA, Fuller TW, Buckley JC, Vanni AJ, Baradaran N, Breyer BN. Multicenter urethroplasty outcomes for urethral stricture disease for patients with neurogenic bladder or bladder dysfunction requiring clean intermittent catheterization. Transl Androl Urol 2021; 10:2035-2042. [PMID: 34159084 PMCID: PMC8185657 DOI: 10.21037/tau-20-988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Our objective is to better comprehend treatment considerations for urethral stricture disease (USD) in patients requiring long-term clean intermittent catheterization (CIC). Patient characteristics, surgical outcomes and complications are unknown in this population. Methods Six members of the Trauma and Urologic Reconstruction Network of Surgeons (TURNS) participated in a prospective (2009 to present) and retrospective (prior to 2009) database recording patient demographics, surgical approach and outcomes. We included all patients undergoing urethroplasty who perform CIC. Descriptive statistics were used to analyze results. Results A total of 37 patients with 39 strictures were included. Bladder dysfunction was characterized as detrusor failure in 35% and neurogenic etiology in 65%. Median stricture length was 3 cm (IQR: 1.5–5.5) with 28% repaired with dorsal onlay buccal mucosal graft, 26% excision and primary anastomosis, 8% dorsal inlay, 8% ventral and dorsal, 8% flap based 8% non-transecting and 15% other. Functional success was 90%: 4 patients required DVIU or dilation due to recurrence, with 2 of those ultimately requiring repeat urethroplasty. 86% of patients returned to CIC; no patients reported new pad use for urinary leakage after urethroplasty. During a median follow-up period of 3.1 years (IQR: 1.0–5.3), no patients underwent urinary diversion. Conclusions Urethroplasty is suitable, safe and effective for patients dependent on CIC suffering from USD. The effect of continual CIC on long-term outcomes remains uncertain.
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Affiliation(s)
- Andrew J Cohen
- James Buchanan Brady Urological Institute, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Philip J Cheng
- Department of Urology, University of Utah, Salt Lake City, UT, USA
| | - Sikai Song
- Department of Urology, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA
| | - German Patino
- Department of Urology, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA.,Hospital San Ignacio, Bogota, Colombia
| | - Jeremy B Myers
- Department of Urology, University of Utah, Salt Lake City, UT, USA
| | - Samit S Roy
- University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Alex J Vanni
- Lahey Hospital and Medical Center, Burlington, MA, USA
| | | | - Benjamin N Breyer
- Department of Urology, Zuckerberg San Francisco General Hospital, University of California-San Francisco, San Francisco, CA, USA
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Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider's Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:108-115. [PMID: 32760189 DOI: 10.46292/sci2602-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.
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Affiliation(s)
- James Milligan
- The Centre for Family Medicine, Kitchener, Ontario, Canada.,McMaster University Department of Family Medicine, Hamilton, Ontario, Canada
| | - Lance L Goetz
- Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Michael J Kennelly
- Carolinas Rehabilitation, Charlotte, North Carolina.,Atrium Health, Charlotte, North Carolina
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Donzé C, Papeix C, Lebrun-Frenay C. Urinary tract infections and multiple sclerosis: Recommendations from the French Multiple Sclerosis Society. Rev Neurol (Paris) 2020; 176:804-822. [PMID: 32900473 DOI: 10.1016/j.neurol.2020.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Establish recommendations for the management of UTIs in MS patients. BACKGROUND Urinary tract infections (UTIs) are common during multiple sclerosis (MS) and are one of the most common comorbidities potentially responsible for deaths from urinary sepsis. METHODS The recommendations attempt to answer three main questions about UTIs and MS. The French Group for Recommendations in MS (France4MS) did a systematic review of articles from PubMed and universities databases (01/1980-12/2019). The RAND/UCLA appropriateness method, which has been developed to synthesize the scientific literature and expert opinions on health care topics, was used for reaching a formal agreement. 26 MS experts worked on the full-text review and a group of 70 multidisciplinary health care specialists validated the final evaluation of summarized evidences. RESULTS UTIs are not associated with an increased risk of relapse and permanent worsening of disability. Only febrile UTIs worsen transient disability through the Uhthoff phenomenon. Some immunosuppressive treatments increase the risk of UTIs in MS patients and require special attention especially in case of hypogammaglobulinemia. Experts recommend to treat UTIs in patients with MS, according to recommendations of the general population. Prevention of recurrent UTIs requires stabilization of the neurogenic bladder. In some cases, weekly oral cycling antibiotics can be proposed after specialist advice. Asymptomatic bacteriuria should not be screened for or treated systematically except in special cases (pregnancy and invasive urological procedures). CONCLUSION Physicians and patients should be aware of the updated recommendations for UTis and MS.
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Affiliation(s)
- C Donzé
- Faculté de médecine et de maïeutique de Lille, hôpital Saint-Philibert, groupement des hôpitaux de l'institut catholique de Lille, Lomme, France.
| | - C Papeix
- Département de neurologie, CRCSEP, Sorbonne université, hôpital de la Salpêtrière, AP-HP6, Paris 13, France
| | - C Lebrun-Frenay
- URC2A, université Nice Côté-d'Azur, CRCSEP, neurologie hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06003 Nice, France
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Suh J, Oh SJ, Cho SY. Comprehensive Review of Effective Application of Questionnaires for Clinical Research on Lower Urinary Tract Symptoms With Translation and Cultural Adaptation to the Korean Language. Int Neurourol J 2020; 24:313-323. [PMID: 33401352 PMCID: PMC7788330 DOI: 10.5213/inj.2040074.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/11/2020] [Indexed: 11/08/2022] Open
Abstract
Lower urinary tract symptoms are highly prevalent and closely related to patients' quality of life. Clinical research on urologic disease is essential for accumulating evidence on patient management; however, the major obstacle is converting patients' subjective symptoms to objective parameters. The optimal application of well-developed and validated questionnaires is vital in achieving objectivity and minimizing bias in clinical research. Numerous questionnaires for measuring symptoms and quality of life in urologic diseases have been developed worldwide; however, they cannot be directly used in clinical studies without validation processes. This review aimed to explain the common procedures for translation, linguistic, and psychometric validation of developed questionnaires from other languages. Furthermore, we comprehensively reviewed currently available questionnaires for evaluating lower urinary tract symptoms in the Korean population.
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Affiliation(s)
- Jungyo Suh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sung Yong Cho
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Cranberry for Bacteriuria in Individuals with Spinal Cord Injury: A Systematic Review and Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:9869851. [PMID: 33194008 PMCID: PMC7648708 DOI: 10.1155/2020/9869851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/06/2020] [Accepted: 10/12/2020] [Indexed: 12/20/2022]
Abstract
Background Urinary tract infection (UTI) is common in individuals with spinal cord injury (SCI) and neurogenic lower urinary tract dysfunction (NLUTD) and in veterans with SCI who use antibiotics improperly for asymptomatic bacteriuria. Cranberry (CB) has been suggested for UTI prevention. Methods We performed a systematic search up to May 2020 in the following databases: AccessMedicine, BioMed Central, CINAHL, Cochrane Library, ProQuest, and PubMed. Quality assessment was performed using a specifically designed quality score. Risk ratio was calculated with both random effect model analysis (DerSimonian-Laird method) and quality effect model analysis (Doi Thalib method). Results Six studies on bacteriuria and SCI were reviewed. From the four studies available for meta-analysis, two of which with individuals taking both CB and control, 477 data from 415 participants were analysed (241 CB and 236 control). No significant differences were detected with meta-analysis. However, bias, limitations, and incompleteness were observed in the reviewed studies. Conclusion Although further studies are needed, we suggest an accurate monitoring of diet and fluid intake, the evaluation of risk for potential food or nutraceutical interactions with drugs, and the inclusion of inflammatory markers among the outcomes in addition to UTI.
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Walter M, Ruiz I, Squair JW, Rios LAS, Averbeck MA, Krassioukov AV. Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury. Spinal Cord 2020; 59:1018-1025. [PMID: 33051562 PMCID: PMC8397616 DOI: 10.1038/s41393-020-00565-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To identify the prevalence of complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury (SCI). SETTING International and national sporting events. METHODS A total 130 competitive wheelchair athletes living with SCI completed a self-reported questionnaire during international or national sporting events. The questionnaire collected information regarding demographics, injury characteristics, method of bladder emptying, and complications related to intermittent catheterization. RESULTS Overall, 84% (109/130) of wheelchair athletes used intermittent catheterization. Within this group, 77% of athletes (84/109) experienced at least one complication associated with intermittent catheterization. Twenty-seven percent (29/109) sustained urethral injuries and 63% (69/109) had at least one episode of urinary tract infection during the last 12 months. Almost one-fourth of male athletes (22/95, 23%) had a history of inflammation / infection of genital organs associated with intermittent catheterization. CONCLUSIONS Here we report a high prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with SCI. Considering their potential impact on lower urinary tract function, athletic performance, and health, further studies are needed to assess the role of preventative strategies to reduce complications related to intermittent catheterization in wheelchair athletes with SCI. SPONSORSHIP Coloplast Brazil and Instituto Lado a Lado pela Vida (a nongovernmental, nonprofit organization based in São Paulo) and Wellspect provided funding for this study.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ian Ruiz
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Luis A S Rios
- Department of Urology, IAMSPE Hospital, São Paulo, Brazil.,Videourodynamic Unit, Albert Einstein Hospital, São Paulo, Brazil
| | - Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC, Vancouver, BC, Canada. .,G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada.
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Liu B, Reid J, Silverman M, Welk B. High risk of Clostridium difficile infection among spinal cord injured patients after the use of antibiotics commonly used to treat urinary tract infections. Neurourol Urodyn 2020; 39:2401-2408. [PMID: 32902908 DOI: 10.1002/nau.24502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/17/2020] [Accepted: 08/27/2020] [Indexed: 02/06/2023]
Abstract
AIM To characterize the use of common urinary tract infections (UTI)-relevant antibiotics after an SCI and determine the risk of Clostridium difficile infection (CDI) from these antibiotics. METHODS We used routinely collected data from Ontario (Canada) to conduct a retrospective, cohort study. We identified people >18 years of age with a traumatic SCI between April 2003 and March 2017. The primary exposure was an outpatient UTI-relevant antibiotic prescription during our observation period, and the primary outcome was evidence of a CDI. An adjusted cox proportional hazards model was used, and antibiotic exposure was modeled as a categorical, time-varying variable based on whether the patient likely had a UTI or not. RESULTS We identified 2528 people with SCI; 1642 (65%) were exposed at least once to an antibiotic of interest. The most commonly prescribed UTI-relevant antibiotic was fluoroquinolone (34%). Most patients did not have investigations for a UTI before the use of any of the different antibiotic classes. A small number of patients (5%) used chronic (>3 months) UTI-relevant antibiotics. The overall proportion of patients diagnosed with CDI was 7.4% (9.3/10 000 patient-days). The adjusted hazard ratio for CDI within 30 days was 3.5 (95% confidence interval, 1.9-6.7, p < .01) if they were exposed to a UTI-relevant antibiotic likely associated with a UTI, which was similar to the risk from UTI-relevant antibiotics which may not have been for a UTI. CONCLUSIONS The rate of CDI is high in this population and outpatient antibiotics that are commonly used for UTIs are a significant risk factor for CDI.
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Affiliation(s)
- Bonnie Liu
- Department of Surgery, Western University, London, ON, Canada
| | | | - Michael Silverman
- Division of Infectious Diseases, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Blayne Welk
- Department of Surgery, Western University, London, ON, Canada.,ICES, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
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Theisen KM, Mann R, Roth JD, Pariser JJ, Stoffel JT, Lenherr SM, Myers JB, Welk B, Elliott SP. Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study. Spinal Cord 2020; 58:1274-1281. [PMID: 32409777 DOI: 10.1038/s41393-020-0481-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. OBJECTIVES To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). SETTING Multiple United States hospitals. METHODS 1479 participants with SCI were asked about neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI. PRUTI frequency over the last year was classified as 0, 1-3, 4-6, or >6. Four UTI QOL domains were assessed: (1) UTIs limited daily activities, (2) UTIs caused increased muscle spasms, (3) UTIs would not go away, and (4) UTIs made me avoid going out. Multivariable regression identified variables associated with poor QOL. RESULTS PRUTI frequency was 0 in 388 patients (26%), 1-3 in 677 (46%), 4-6 in 223 (15%), and more than 6 in 190 (13%). Increasing PRUTI rate was independently associated with worse QOL for all four questions. Compared with those with 0 PRUTIs, participants reporting >6 were more likely to limit daily activities (OR 9.0 [95% CI 8.1-21.2] p < 0.0001), experience increased muscle spasms (OR 12.4 [95% CI 7.5-20.6] p < 0.0001), perceive a UTI would not go away (OR 30.1 [95% CI 15.0-60.4] p < 0.0001), and avoid going out because of UTIs (OR 7.2 [95% CI 4.2-12.4] p < 0.0001). CONCLUSIONS An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.
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Affiliation(s)
| | - Rachel Mann
- University of Minnesota, Minneapolis, MN, USA
| | | | | | - John T Stoffel
- University of Michigan, Ann Arbor, MI, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
| | - Sara M Lenherr
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Jeremy B Myers
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,University of Utah, Salt Lake City, UT, USA
| | - Blayne Welk
- Neurogenic Bladder Research Group, Salt Lake City, Utah, USA.,Western University, London, ON, Canada
| | - Sean P Elliott
- University of Minnesota, Minneapolis, MN, USA.,Neurogenic Bladder Research Group, Salt Lake City, Utah, USA
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Konstantinidis C, Karafotias A, Eleftheropoulos I, Delakas D. Chronic prostatitis effectively managed by transurethral prostatectomy (TURP) in a spinal cord injury male. Spinal Cord Ser Cases 2019; 5:78. [PMID: 31632736 PMCID: PMC6786416 DOI: 10.1038/s41394-019-0224-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/28/2019] [Accepted: 09/01/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Spinal cord injury (SCI), specifically suprasacral SCI, results in high intravesical pressures, elevated post-void residual and urinary incontinence which are all risk factors for urinary tract infections (UTIs). The management of UTIs usually is conservative medical antibiotic treatment. However, recurrent UTIs in the SCI patient population warrant further investigation. The method of urinary drainage (intermittent or indwelling urinary catheters, urinary diversion) and untreated complications of NLUTD (vesicoureteral reflux, stone formation, chronic incomplete emptying of the bladder) are risk factors for recurrent UTIs (rUTIs). Removal of these UTI risk factors and improving urinary drainage are goals of urologic management; however, when conservative interventions do not succeed, surgery may be a viable solution in select cases of rUTIs. Case presentation We present a case of complicated persisting rUTIs and associated urethral discharge in a middle-aged SCI male who manages his bladder with intermittent catheterization (IC). We detail the evaluation and management approach that leads to an eventual transurethral prostatectomy (TURP) as a final solution for his rUTIs. Fortunately, the surgical intervention was successful, and the patient is free of UTIs after 4 years of follow-up. Discussion In SCI male patients with rUTIs and suspected chronic prostatitis, TURP may be a valuable treatment option once all predisposing factors have been remediated.
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Affiliation(s)
| | | | | | - Dimitrios Delakas
- Urology Department, General hospital “Asklepieio Voulas”, Athens, Greece
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