Best Practice and Algorithm for Intermittent Catheterization (IC) in Neurogenic Bladder (NGB)

Risk Factors for Recurrent Urinary Tract Infection in Children With Neurogenic Bladder Following Clean Intermittent Catheterization

Health Care Economic Burden of Treatment and Rehabilitation for Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review.

Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on clean intermittent catheterization

To study the association of recurrent symptomatic urinary tract infections (UTIs) with the long-term use of clean intermittent catheterization (CIC) for the management of neurogenic bladder in patients with spinal cord injury (SCI). Retrospective study of 61 SCI patients with neurogenic bladder managed by CIC. Subjects were selected from 210 SCI patients seen at the Yale Urology Medical Group between 2000 and 2010. Medical UTI prophylaxis (PRx) with oral antimicrobials or methenamine/ascorbic acid was used to identify patients with recurrent UTI. The number of positive cultures (≥10(3) cfu/mL) within a year prior to starting PRx was used to confirm the recurrence of UTI. Fifty-one male and 10 female subjects were managed with CIC. Forty-one (67%) subjects were placed on medical PRx for symptomatic recurrent UTI. Seventeen (28%) subjects had at least 3 positive cultures within the year prior to starting PRx. Fifteen of 20 (75%) subjects not on PRx had no complaints of UTI symptoms in the final year of follow-up. Recurrent symptomatic UTIs remain a major complication of long-term CIC in SCI patients. Although CIC is believed to have the fewest number of complications, many SCI patients managed with long-term CIC are started on medical PRx early in the course of management. Future studies are needed to determine the efficacy of routine UTI PRx in these patients as well as determine what factors influence why many patients on CIC experience frequent infections and others do not.

Narrowing the Focus: What We Now Know (and Still Don’t Know) About Antibiotic Prophylaxis for Children With Vesicoureteral Reflux

Review Objective The purpose of this systematic review is to establish the best available evidence on strategies to promote intermittent urethral self-catheterisation in adults with neurogenic / neuropathic bladders. More specifically, the review questions are: What are the extrinsic and/or intrinsic factors that influence the suitability of individuals to perform self intermittent [urethral] catheterisation (SIMC)? What strategies promote long term compliance with SIMC? What are the advantages and disadvantages of using SIMC? Does SIMC improve the quality of life for people using this bladder management strategy? Criteria for considering studies for this review Types of Studies This review will incorporate the best available evidence for each of the sub-topics identified by the objectives and specific questions asked in this systematic review. Quantitative This component of the review will consider any randomised controlled trials (RCT) that examine the effectiveness of strategies to promote long term compliance with self-intermittent catheterisation. In the absence of RCT other quantitative research designs such as non-randomised experimental and quasi experimental, before and after studies, cohort studies and case series/case reports will be considered for inclusion in a narrative summary. For the remaining three sub-topics, i.e. quality of life, advantages and disadvantages of SIMC, and factors influencing suitability of individuals to perform SIMC, all quantitative research designs will be considered for inclusion. Qualitative This component of the review will consider any interpretive studies that draw on the experiences of intermittent self-catheterisation by adults for each of the sub-topics. This will include, but not be limited to, designs such as phenomenology, grounded theory and ethnography. Studies excluded from this review include: Those involving children and adolescents, i.e. > 18 years of age, Catheterisation performed by a carer or health professional, Catheterisation of a surgically created stoma, Indwelling catheters, Comparison of catheter types, Strategies to specifically reduce infection. Types of participants The review will include adults who are 18 years or older, who undertake urethral self-catheterisation for management of their neurogenic bladder dysfunction. Types of interventions/phenomena of interest The interventions, programs and strategies of primary interest are those TRUNCATED AT 350 WORDS

Clean intermittent catheterization (CIC) is the gold standard for bladder management in patients with neurogenic bladder (NB). Although CIC remains the preferred method for bladder management in NB, long-term compliance is a complex, multifactorial issue. Thus, this study aimed to evaluate real-world CIC compliance, catheter preference, and reasons for discontinuation in a patient population initiated on CIC. We retrospectively reviewed 310 patients between March 2019 and May 2023. When starting CIC for the first time, we provide patients with three types of catheter samples. During follow-up, patients were interviewed about: current catheter preference, continuation or discontinuation of CIC, duration of CIC use prior to cessation, reasons for discontinuation, number and frequency of treated urinary tract infections (UTIs) during CIC use. Among the 310 new CIC patients (mean age: 72 years), 186 patients (60.0%) eventually discontinued CIC. Discontinuation was more frequent in males (122 cases, 66.0%), and the median duration of CIC use prior to cessation was 3.5 months. The most common reasons of CIC cessation were symptoms improvement, pain or discomfort during catheterization, recurrent UTI, declining general condition, and death due to unrelated causes. The CIC is a reliable method. Increasing the convenience of catheter use and reducing the rate of side effects are ways to improve adherence to this method, and hydrophilic-coated catheter products are most suitable for this purpose. And education of patients on catheterization technique and periodic follow-up is necessary to maintain patient compliance.

A retained ureteral stump with calculi.

Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.

In this article, we review the outcome and complications of renal transplantation in patients with reconstructed bladders and address specific issues and controversies regarding the management of such cases. Twenty-five articles covering the subjects of renal transplantation, lower urinary tract anomalies, and bladder reconstruction have been selected. Although urologic complications are higher when kidneys are transplanted into reconstructed bladders or urinary diversions, the graft and patient survival rates in most series are comparable with those transplanted into nonreconstructed bladders. The reported series of renal transplantation into abnormal bladders are small, and controlled studies are lacking. Bladder reconstruction should be performed before transplantation when clinically indicated.

Are the clean intermittent catheterization (CIC)‐cgQ and the CIC‐childQ feasible and generate valid measures of success performing CIC? CIC is the primary treatment for neurogenic bladder. However, instituting CIC with children can be challenging. Currently there are no validated instruments to measure the abilities of paediatric patients and their caregivers to perform CIC. The purpose of this study was to evaluate the validity and reliability of a modified version of the Intermittent Self Catheterization Questionnaire (ISC‐Q) in children with neurogenic bladder and their caregivers performing CIC. Children with spinal dysraphism, such as myelomeningocele (MMC) may face urologic challenges related to neurogenic bladder including renal compromise, recurrent urinary tract infections, and urinary incontinence due to bladder deterioration. CIC is an important intervention in the management of patients with neurogenic bladder. There are no valid tools currently available to measure the success of CIC in paediatric patients or their caregivers. A non‐experimental, psychometric research design was employed for this pilot study. Data collection was performed using online and paper surveys. The ISC‐Q was modified into two versions for use in the United States, one for caregivers of children on CIC (CIC‐cgQ) and one for paediatric patients on CIC (CIC‐childQ). A convenience sample of subjects was recruited from Spinal Differences Clinic and the local spina bifida support group. Informed consent was embedded in the invitation letter/email with survey completion indicating consent to participate. Criterion related validity was described using known group sum scores along with Cronbach's α for internal reliability. The tools were pilot tested on 15 caregivers and four children. Cronbach's alphas were .84 and .83 for the caregivers and children, respectively. Subjects identified a priori as successful with CIC scored higher than those identified as unsuccessful. The CIC‐cgQ and the CIC‐childQ are valid and reliable measures of the impact of CIC on the lives of caregivers and children. Future studies with larger sample sizes will allow further psychometric testing. This instrument gives researchers the ability to measure the impact of CIC on the lives of children and caregivers.

Objective To retrospectively study the treatment of neuropathic bladder with clean intermittent catheterization (CIC). Methods From Jan. 2001 to May. 2006, 57ases were recruited in this research, including 38 males and 19 females, aged from 3mo to 17yr. Thirtyfive of the patients had repetitive urinary tract infection(UTI), and 45 patients had urinary incontinence. Hydronephrosis was evaluated using the Society of Fetal Urology (SFU) grading based on the long-axis sonographic appearance of the renal parenchyma and pelvicalyceal system. Thirty-eight kidneys had SFU grade 3 to 4hydronephrosis, and 39 had 0 to 2. Urodynamic study revealed hypocontractile bladder in 12 cases, hyper-reflexive bladder in 10 cases, sphincter function failure in 10 cases and dyssynergia in 20 cases. Results Thirty-six of the patients had been followed up for a long term. Out of the 36 patients, 27 patients underwent CIC, 5 patients underwent CIC combined with crede maneuver, the other 4 patients just underwent crede maneuver. CIC was performed 2-3 times daily on 2 patients, 4-6 times daily on 25 patients and more than 6 times daily on 5 patients. The volume of expelled urine was 80-400 ml. Thirty-one patients had repetitive UTI before treatment. Mter CIC treatment, 25 had bacteriuria, and only 8 had episode of febrile UTI For urinary incontinence, Likert score was 2. 25 before treatment, and was significantly improved comparing with 4. 04 of post-treatment score. For hydronephrosis, 30 kidneys were degraded as SFU stage 2, and 42 kidneys were SFU stage 3 or 4 before treatment. After CIC treatment, 40 were below stage 2 and 32 were above stage 3. There was significant difference between the two groups. Conclusions CIC is an important modality for neuropathic bladder. It is effective in controlling UTI and improving incontinence. Key words: Neurogenic bladder; Follow-up studies

Introduction: Neurogenic bladder disorders after spinal cord injury (SCI) are often problematic with urinary incontinence (UI) and recurrent urinary tract infections (UTIs) contributing to patient morbidity. Our study objective was to provide a current snapshot of the frequency of UI and UTIs in the SCI population while also quantifying their association with hospitalization. Methods: The National Spinal Cord Injury Database (2016-2021) was accessed for persons within five years of injury. The self-reported frequency of UI in the last month (none, daily, weekly, monthly), the number of UTIs requiring antibiotic treatment, and the number of hospitalizations (including reason) in the prior year were evaluated. Results: Our cohort comprised 5106 individuals within 5 years of SCI. Approximately 40% reported UI in the past month and over 50% had a UTI requiring antibiotics in the past year. Incontinence was significantly more frequent in those performing clean intermittent catheterization (CIC) (52% overall, 17% daily) compared to indwelling catheters (29% overall) or volitional void (22% overall) (p < 0.001 for each). Conversely, UTIs were most common in those using indwelling catheters (79% with at least one UTI) or CIC (70%) compared to diapers/condom catheters (46%) or volitional void (19%) (p < 0.001 for each). Increasing UI and UTI occurrences were both associated with an increased frequency of hospitalization in the prior year. Conclusions: UI and UTIs are common problems after SCI. While differing frequencies of UI and UTI are present based on bladder management, the overall frequency suggests that a continued emphasis on prevention is needed to potentially increase quality of life and decrease hospitalization.

Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.

BackgroundRecurrent urinary tract infection (UTI) occurs in sizable percentages of patients after a single episode and is a frequent cause of primary healthcare visits and hospital admissions, accounting for up to one quarter of emergency department visits. We aim to describe the pattern of continuous antibiotic prophylaxis prescription for recurrent urinary tract infections, in what group of adult patients they are prescribed and their efficacy.MethodsA retrospective chart review of all adult patients diagnosed with single and recurrent symptomatic urinary tract infection in the period of January 2016 to December 2018.ResultsA total of 250 patients with a single UTI episode and 227 patients with recurrent UTI episodes were included. Risk factors for recurrent UTI included diabetes mellitus, chronic renal disease, and use of immunosuppressive drugs, renal transplant, any form of urinary tract catheterization, immobilization and neurogenic bladder. E. coli infections were the most prevalent organism in patients with UTI episodes. Prophylactic antibiotics were given to 55% of patients with UTIs, Nitrofurantoin, Bactrim or amoxicillin clavulanic acid. Post renal transplant is the most frequent reason to prophylaxis antibiotics (44%). Bactrim was more prescribed in younger patients (P < 0.001), in post-renal transplantation (P < 0.001) and after urological procedures (P < 0.001), while Nitrofurantoin was more prescribed in immobilized patients (P = 0.002) and in patients with neurogenic bladder (P < 0.001). Patients who received continuous prophylactic antibiotics experienced significantly less episodes of urinary tract infections (P < 0.001), emergency room visits and hospital admissions due to urinary tract infections (P < 0.001).ConclusionDespite being effective in reducing recurrent urinary tract infection rate, emergency room visits and hospital admissions due to UTI, continuous antibiotic prophylaxis was only used in 55% of patients with recurrent infections. Trimethoprim/sulfamethoxazole was the most frequently used prophylactic antibiotic. Urology and gynecological referral were infrequently requested as part of the evaluation process for patients with recurrent UTI. There was a lack of use of other interventions such as topical estrogen in postmenopausal women and documentation of education on non-pharmacological methods to decrease urinary tract infections.