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

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.

Assessment of patient satisfaction with home vs office indwelling catheter removal placed for urinary retention after female pelvic floor surgery: a randomized controlled trial

BACKGROUND

Postoperative urinary retention is burdensome for patients. We seek to improve patient satisfaction with the voiding trial process.

OBJECTIVE

This study aimed to assess patient satisfaction with location of indwelling catheter removal placed for urinary retention after urogynecologic surgery.

STUDY DESIGN

All adult women who were diagnosed with urinary retention requiring postoperative indwelling catheter insertion after undergoing surgery for urinary incontinence and/or pelvic organ prolapse were eligible for this randomized controlled study. They were randomly assigned to catheter removal at home or in the office. Those who were randomized to home removal were taught how to remove the catheter before discharge, and were discharged home with written instructions, a voiding hat, and 10-mL syringe. All patients had their catheter removed 2 to 4 days after discharge. Those patients who were allocated to home removal were contacted in the afternoon by the office nurse. Subjects who graded their force of urine stream 5, on a scale of 0 to 10, were considered to have safely passed their voiding trial. For patients randomized to the office removal group, the voiding trial consisted of retrograde filling the bladder to maximum they could tolerate up to 300 mL. Urinating >50% of instilled volume was considered successful. Those who were unsuccessful in either group had catheter reinsertion or self-catheterization training in the office. The primary study outcome was patient satisfaction, measured based on patients' response to a question, "How satisfied were you with the overall removal process of the catheter?" A visual analogue scale was created to assess patient satisfaction and 4 secondary outcomes. A sample size of 40 participants per group were needed to detect a 10 mm difference in satisfaction between groups on the visual analogue scale. This calculation provided 80% power and an alpha of 0.05. The final number accounted for 10% loss to follow up. We compared the baseline characteristics, including urodynamic parameters, relevant perioperative indices, and patient satisfaction between the groups.

RESULTS

Of the 78 women enrolled in the study, 38 (48.7%) removed their catheter at home and 40 (51.3%) had an office visit for catheter removal. Median and interquartile range for age, vaginal parity, and body mass index were 60 (49-72) years, 2 (2-3), and 28 (24-32) kg/m2, respectively, in the overall sample. Groups did not differ significantly in age, vaginal parity, body mass index, previous surgical history, or type of concomitant procedures. Patient satisfaction was comparable between the groups, with a median score (interquartile range) of 95 (87-100) in the home catheter removal group and 95 (80-98) in the office catheter removal group (P=.52). Voiding trial pass rate was similar between women who underwent home (83.8%) vs office (72.5%) catheter removal (P=.23). No participants in either group had to emergently come into the office or hospital due to inadequate voiding afterwards. Within 30 days post operatively, a lower proportion of women in the home catheter removal group (8.3%) had urinary tract infection, compared to patients in the office catheter removal group (26.3%) (P=.04).

CONCLUSION

In women with urinary retention after urogynecologic surgery, there is no difference in satisfaction concerning the location of indwelling catheter removal when comparing home and office.

Healthy bladder storage and emptying functions in community-dwelling women measured by a 2-day bladder health diary

INTRODUCTION

The prevalence of healthy bladder storage and emptying function in community-dwelling women is not well established.

METHODS

A planned secondary analysis of a US cross-sectional study designed to validate a bladder health instrument was conducted in women aged ≥18 years. A subset was invited to complete the novel 2-day bladder health diary capturing bladder storage and emptying experiences. Overall healthy bladder function was defined as ≤8 waking/daytime voids and ≤1 void during sleeping/nighttime; along with the absence of leakage, urgency, emptying difficulties (initiation, flow, efficacy, relief of urge sensation) and pain. Descriptive statistics of healthy bladder functions and regression models of factors associated with healthy function are reported.

RESULTS

Of the 383 invited, 237 (62%) eligible women returned complete dairies. Of these, 12% (29/237) met criteria for overall healthy bladder function. Most (96%) denied pain, 74% had healthy daytime and 83% had healthy nighttime voiding frequency, 64% were continent, 36% reported healthy emptying and 30% denied any urgency episodes. Middle income (odds ratio [OR]:95% confidence interval [CI] = 11.4:1.9-67.4 for $75k-$99 999 vs. $25 000-$49 999), Graduate education (4.8:1.4-17) and previously seeking treatment for bladder problems (OR:95%CI = 0.1; 0-0.9) were associated with overall healthy function.

CONCLUSION

The prevalence of overall healthy bladder function was very low based on our strict definition of health as measured on a 2-day diary. However, most women had healthy voiding frequency and denied pain or urinary leakage. Postvoid dribbling and urgency most commonly contributed to an overall unhealthy bladder. Further investigation is needed to determine whether these diary derived measures are meaningful for patient-oriented bladder health research.

ROLE OF BLADDER EMPTYING ON OUTCOMES OF TRANSURETHRAL RESECTION OF THE PROSTATE

OBJECTIVE

To assess the role of bladder emptying on outcomes of males undergoing transurethral resection of the prostate (TURP).

MATERIALS AND METHODS

This prospective study involved candidates for TURP (January 2017-January 2018) with a follow-up of 3 yrs. Preoperative and follow-up evaluation comprised: UF, simple PVR (S-PVR), PVR-Ratio (PVR-R) as the ratio of PVR to bladder volume (BV: voided volume (VV) + PVR), Bladder voiding efficiency (BE) as the ratio between VV and BV -(voided volume/total bladder capacity) X 100 - and the IPSS. Patients were stratified for S-PVR, PVR-R and BVE.

RESULTS

Patients recruited were 100 (mean ± SD age: 68.8 ± 8.7 yrs). No patient had severe complications, re-admission, nor needed blood transfusion. At baseline, 38% of the patients showed S-PVR ≤ 50 ml, 62% a S-PVR ≤ 100 ml, and 25% a S-PVR >150 ml. In both pre- and post-operative evaluation there were no significant differences in Qmax and IPSS score among the groups. In each group we found a significant improvement in Qmax, IPSS score and S-PVR, PVR-R and BVE after TURP (except for PVR in group with lowest pre-operative S-PVR). Analysing a pre-operative S-PVR threshold >100 ml, PVR-R significantly increased and BVE significantly decreased after TURP. Conversely, when pre-operative S-PVR was >100 ml, PVR-R and BVE relevantly but non significantly improved after surgery.

CONCLUSION

Bladder emptying is only partially related to TURP outcomes and other pre-operative parameters. Patients with baseline S-PVR lower than 100 ml had the chance of greater recovery of bladder emptying after TURP.

Pathways to causation and surgical cure of chronic pelvic pain of unknown origin, bladder and bowel dysfunction - an anatomical analysis

Introduction

Current thinking is that chronic pelvic pain of unknown origin (CPPU) is poorly understood and its treatment is empirical and ineffective. According to the Integral Theory System (ITS), however, CPPU is secondary to uterosacral ligament (USL) laxity which is associated with bladder and bowel symptoms and all are potentially curable by surgical reinforcement of USLs.

Material and methods

We applied the ITS to anatomically explain the pathogenesis and cure of these conditions.

Results

The first mention of CPPU being caused by lax USLs was in the pre- WWII German literature by Heinrich Martius. CPPU was first described in the English literature in 1993 as one of the four pillars of the posterior fornix syndrome (PFS) (CPPU, urgency, nocturia and abnormal bladder emptying). Surgical cure/improvement of CPPU was achieved by shortening and reinforcing USLs initially with USL ligament plication and later with tensioned tapes because of deteriorating cure rates. Non-invasive ‘simulated operations’ which support USLs in the posterior fornix help predict USL causation.

Conclusions

USL tapes cure/improve CPPU, bladder and bowel dysfunctions by reinforcing the USLs against which the 3 directional forces contract. Weak suspensory ligaments may invalidate these forces to cause incontinence, emptying and pain symptoms, all of which can be potentially reversed by using tapes to reinforce the damaged ligaments, as demonstrated.

Effectiveness of intramuscular neostigmine to accelerate bladder emptying after spinal anesthesia

Purpose

Postoperative urinary retention (POUR) is one of the most common complications following spinal anesthesia. Spinal anesthesia may influence urinary bladder function due to interruption of the micturition reflex. Urinary catheterization is the standard treatment of POUR. Urinary catheter insertion is an invasive procedure, which is associated with catheter-related infections, urethral trauma, and patient discomfort. The purpose of this study was to determine the effectiveness of intramuscular (IM) neostigmine to accelerate bladder emptying after spinal anesthesia.

Patients and methods

A total of 36 patients undergoing lower abdominal (except for pelvic, urologic, anorectal, and hernia surgery) and lower extremity surgery under spinal anesthesia were divided into two groups randomly (n=18), to either neostigmine (N) group or control (C) group. Neostigmine 0.5 mg (N group) or NaCl 0.9% (C group) was administered intramuscularly when Bromage score 0 and sensory level sacral two have been achieved. The time to first voiding after IM injection and the time to first voiding after spinal anesthesia were measured.

Results

The time to first voiding after IM injection was significantly faster (P≤0.05) in the N group than that in the C group, with median time as 40 minutes (20–70 minutes) and 75 minutes (55–135 minutes), respectively. Time to first voiding after spinal anesthesia was also significantly faster (P≤0.05) in the N group than that in the C group (mean of 280.8±66.6 minutes and 364.2±77.3 minutes, respectively).

Conclusion

IM neostigmine effectively accelerates bladder emptying after spinal anesthesia.

Patients' experiences of bladder emptying in connection with hip surgery: an issue but of varying impact

AIM

To describe patients' experiences of bladder emptying and urinary catheterization in connection with hip surgery.

BACKGROUND

The capacity of bladder emptying in connection with hip surgery is affected by pain, medication and confinement to bed. In connection with such surgery urinary catheterization is often performed, either intermittent or indwelling. Hip surgery patients' experiences of urinary catheterization and urination have not been studied before.

DESIGN

A qualitative study with descriptive design was conducted among hip surgery patients.

METHODS

Thirty face-to-face interviews were conducted from October 2009-March 2010 and analysed with inductive qualitative content analysis.

RESULTS

The main category 'An issue but of varying impact' illustrated the patients' experiences of bladder emptying and urinary catheterization. Five generic categories were identified: ability to urinate, catheter is convenient, bothersome bladder emptying, intrusion on dignity and concern about complications. Irrespectively of whether the patients were able to urinate or were catheterized, the bladder emptying situation was not as usual. It was described as uncomplicated and experienced as being positive if the patients were able to urinate by themselves or when catheterization was experienced as convenient. Some patients did not want to be catheterized, approving it only reluctantly. Independently of the method for bladder emptying, the patients in our study would choose the same method next time.

CONCLUSIONS

The patients undergoing hip surgery seem to experience bladder emptying as an issue but of varying impact. Both bladder emptying through micturition and bladder emptying through catheterization are described in positive and negative terms.