Bladder Related Quality Of Life Research Articles

Quality of Life and Bladder Symptoms in Adolescents and Young Adults With Spina Bifida Who Catheterize via Urethra vs Catheterizable Channel.

We sought to assess associations between health-related quality of life (QOL), bladder-related QOL, bladder symptoms, and bladder catheterization route among adolescents and young adults with spina bifida. Clinical questionnaires administered to individuals ≥ 12 years old requiring catheterization between June 2019 to March 2020 in a spina bifida center were retrospectively analyzed. Questionnaires were completed in English or Spanish independently or with caregiver assistance. Medical records were reviewed for demographic and clinical characteristics. Primary exposure was catheterization route (urethra or channel). Primary outcome was health-related QOL, measured by Patient-Reported Outcomes Measurement Information System Pediatric Global Health 7 (PGH-7). Secondary outcomes were bladder-related QOL and bladder symptoms, measured by Neurogenic Bladder Symptom Score (NBSS). Nested, multivariable linear regression models assessed associations between catheterization route and questionnaire scores. Of 162 patients requiring catheterization, 146 completed both the PGH-7 and NBSS and were included. Seventy-three percent were catheterized via urethra and 27% via channel. Median age was 17.5 years (range 12-31), 58% of patients were female, and 80% had myelomeningocele. Urinary incontinence was more common among those who catheterized via urethra (60%) compared to channel (33%). On adjusted analyses, catheterization route was not significantly associated with PGH-7 or NBSS bladder-related QOL scores. More bladder symptoms were associated with worse bladder-related QOL. Patients who catheterized via channel had fewer bladder symptoms than those who catheterized via urethra. Catheterization route was not significantly associated with QOL. Though catheterization via channel was associated with fewer bladder symptoms, only degree of current bladder symptoms was significantly associated with bladder-related QOL.

Stimulation of the Tibial nerve Repetitively to Improve Incontinence in Parkinson’s Electronically (STRIPE trial): a randomised control trial of tibial nerve stimulation for bladder symptoms in Parkinson’s disease using a self-contained wearable device

BackgroundBladder symptoms are common in Parkinson’s disease (PD), affecting half of all individuals. These have significant impact on quality of life as well as implications for morbidity, contributing to falls and hospital admission. The treatment of bladder symptoms can be complicated by the tendency to side-effects in people with PD including cognitive impairment and gait instability with anti-muscarinics. The development of new, better treatments is therefore warranted. Tibial nerve stimulation is a form of neuromodulation demonstrated to improve overactive bladder symptoms in non-neurogenic cohorts. Previously requiring hospital attendance, we aim to explore the use of this intervention using a simple device that can be used by patients at home.MethodsSTRIPE is a phase II randomised control trial of tibial nerve stimulation delivered by the Geko™ device, a small, self-adhesive neuromuscular stimulation device currently used for thromboembolism prophylaxis post-surgery. Active tibial nerve stimulation will be compared to sham stimulation, with participants blinded to treatment allocation and undertaking outcome assessment whilst still blinded. Participants will be asked to self-administer stimulation at home twice per week, for 30 min per session, over the course of 3 months. Primary outcome measure will be the International Consultation on Incontinence Overactive Bladder Questionnaire (OAB) at week 12. Secondary outcomes will include pre- and post-intervention bladder diary (frequency, urgency episodes, nocturia), patient perception of global change, bowel function and bladder-related quality of life. Participants will be recruited from the Proactive Integrated Management and Empowerment (PRIME) cross-sectional trial in which participants have been screened for bladder symptoms and invited to take part, as well as clinician referral from around the region.DiscussionThis trial will involve a randomised control trial of a novel and easy to use method of delivering tibial nerve stimulation for PD in the patient’s own home. This may potentially have huge benefit, avoiding the problems with side effects that can be seen with anti-muscarinics and providing a new potential modality of treatment.Trial registrationISRCTN11484954. Registered on 22 June 2021.

MP54-16 ASSOCIATION OF URINARY STONES WITH PATIENT-REPORTED COMPLICATIONS IN SPINAL CORD INJURY

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II (MP54)1 Sep 2021MP54-16 ASSOCIATION OF URINARY STONES WITH PATIENT-REPORTED COMPLICATIONS IN SPINAL CORD INJURY Khushabu Kasabwala, Michael Borofsky, John T. Stoffel, Blayne Welk, Jeremy B. Myers, Sara M. Lenherr, and Sean P. Elliott Khushabu KasabwalaKhushabu Kasabwala More articles by this author , Michael BorofskyMichael Borofsky More articles by this author , John T. StoffelJohn T. Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , Jeremy B. MyersJeremy B. Myers More articles by this author , Sara M. LenherrSara M. Lenherr More articles by this author , and Sean P. ElliottSean P. Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002084.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: People with spinal cord injury (SCI) have an increased risk of urinary stone formation and morbidity from the surgeries to remove them. The highest risk of stones has been postulated to be in the first year after SCI, yet the natural history and health-related impact of stone disease among this patient population remains poorly defined. We hypothesized that a history of urinary stones would be associated with an increased incidence of SCI-related complications and lower quality of life (QOL). METHODS: 1479 participants with SCI in the Neurogenic Bladder Research Group registry were asked about urinary stone history (pre-dating or since SCI), SCI-related complications and neurogenic bladder-related QOL. Eligibility: age ≥ 18 years with acquired SCI and followed for 12 months. Neurogenic Bladder Symptom Score (NBSS) was used for QOL assessment. Continuous variables were compared by the t-test and categorical variables were compared by the chi-square test (R version 3.5.2). Because the presence of stones was assessed by participant recall, we limited to those with a history of stone surgery to capture clinically significant urinary calcifications. RESULTS: At study entry, participants were a median of 11 years post-SCI and 189 (12.8%) reported a history of bladder or kidney stone surgery; 99.5% of these occurred after the SCI. Median time between SCI and first stone was 5.6 years (IQR: 1.8 - 12.8). During the year of observation, the incidence of stone surgery was 8%-9% in those with a history of stone surgery and 2% per year in those without prior stone surgery (p=0.001). The rate of patient-reported UTI did not differ between cohorts, but those with prior stone surgery had an increased rate of UTI-related hospitalizations (p=0.013). There was a higher rate of hospitalizations for those with prior stone surgery, commonly for blood clots, UTI, pressure ulcers, and pneumonia (p=0.001). There was no clinically significant difference in NBSS QOL scores across the three cohorts. CONCLUSIONS: Urinary stones in people with SCI are associated with patient-reported complications though they do not appear to affect QOL. Those with a history of urinary stones warrant careful surveillance both for additional stone episodes and for other negative health outcomes. Source of Funding: PCORI/CER-1409-21,348 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e955-e956 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Khushabu Kasabwala More articles by this author Michael Borofsky More articles by this author John T. Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B. Myers More articles by this author Sara M. Lenherr More articles by this author Sean P. Elliott More articles by this author Expand All Advertisement Loading ...

Self-Reported Urological Hospitalizations or Emergency Room Visits in a Contemporary Spinal Cord Injury Cohort.

Individuals with spinal cord injuries frequently use urgent and emergent medical care. We hypothesized that urological causes are a primary driver of hospitalizations/emergency room visits in a contemporary spinal cord injury cohort. The Neurogenic Bladder Research Group spinal cord injury registry is a prospective cohort study evaluating neurogenic bladder related quality of life after traumatic spinal cord injury. Questionnaires were administered to participants querying whether a hospitalization or emergency room visit occurred during the interval 1-year followup and reason for visit. Primary outcome was the rate of urological related hospitalizations/emergency room visits in 1 year. Multivariable logistic regression was used to identify risk factors for urology related hospitalization/emergency room visit. Of the 1,479 participants enrolled 1,260 had 1-year followup. In all, 16.7% (211/1,260) reported at least 1 urological hospitalization/emergency room visit, and urinary tract infections were the most common reason cited. Patients with an indwelling catheter had the greatest odds of having a hospitalization/emergency room episode for a urological indication (OR 3.35, CI 1.68-6.67, p=0.001), followed by clean intermittent catheterization (OR 2.56, CI 1.36-4.84, p=0.004) as compared to those who voided spontaneously. Other predictors included SF-12 physical scores (OR 0.98, CI 0.96-0.996, p=0.014), diminished hand function (OR 1.83, CI 1.05-3.19, p=0.033), and unemployment (OR 1.64, CI 1.13-2.37, p=0.009). There was a high incidence of hospitalizations/emergency room visits for patients with spinal cord injuries during a 1-year followup and urological complications were the most common reason for admission. Patient self-reported physical health as well as unemployment, and bladder management strategy, particularly indwelling catheter use, were associated with increased risk of urology related hospitalization/emergency room visits.

The effect of abdominal functional electrical stimulation on bowel function in multiple sclerosis: a cohort study.

BackgroundChronic constipation is prevalent in people with multiple sclerosis, with current treatments usually only partially effective.ObjectivesThis study aims to evaluate the efficacy of abdominal functional electrical stimulation to reduce whole gut and colonic transit times and improve bowel and bladder-related quality of life.MethodsA total of 23 people with multiple sclerosis who fulfilled the Rome III criteria for functional constipation applied abdominal functional electrical stimulation for 1 hour per day, 5 days per week, for 6 weeks. Whole gut and colonic transit times and bowel and bladder-related quality of life were measured before and after the intervention period.ResultsWhole gut (mean 81.3 (standard deviation 28.7) hours pre vs. 96.1 (standard deviation 53.6) hours post-intervention, P = 0.160) and colonic transit time (65.1 (31.4) vs. 74.8 (51.1) hours, P = 0.304) were unchanged following 6 weeks of abdominal functional electrical stimulation. There was a significant improvement in bowel (mean 1.78 (SD: 0.64) pre vs. 1.28 (SD: 0.54) post, P = 0.001) and bladder (50.6 (26.49) vs. 64.5 (21.92), p = 0.007) related quality of life after the intervention period.ConclusionWhile abdominal functional electrical stimulation did not reduce whole gut and colonic transit times for people with multiple sclerosis, a significant improvement in bowel and bladder-related quality of life was reported.

Frequency of patient-reported UTIs is associated with poor quality of life after spinal cord injury: a prospective observational study.

Cross-sectional survey of the Neurogenic Bladder Research Group (NBRG) registry; a multicenter prospective observation study. To assess how patient-reported urinary tract infections (PRUTIs) in spinal cord injury (SCI) affect quality of life (QOL). Multiple United States hospitals. 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. 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). An increasing rate of PRUTIs is independently associated with worse QOL. Thorough evaluation and treatment may improve QOL in this population.

MP48-06 GENDER IMPACT ON BLADDER-RELATED OUTCOMES AND QUALITY OF LIFE AFTER PARAPLEGIC SPINAL CORD INJURY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-06 GENDER IMPACT ON BLADDER-RELATED OUTCOMES AND QUALITY OF LIFE AFTER PARAPLEGIC SPINAL CORD INJURY Sara Lenherr*, Jennifer S. Herrick, Sean P Elliott, Angela P. Presson, Odinachi Moghalu, John T Stoffel, Blayne Welk, and Jeremy B Myers Sara Lenherr*Sara Lenherr* More articles by this author , Jennifer S. HerrickJennifer S. Herrick More articles by this author , Sean P Elliott Sean P Elliott More articles by this author , Angela P. PressonAngela P. Presson More articles by this author , Odinachi MoghaluOdinachi Moghalu More articles by this author , John T StoffelJohn T Stoffel More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Jeremy B MyersJeremy B Myers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Females with spinal cord injury (SCI) have been collectively analyzed along with males with SCI, despite the fact that women have fundamentally different genitourinary anatomy. We hypothesized that women have different patient reported outcomes and quality of life (QoL) related to their neurogenic bladder dysfunction. METHODS: The Neurogenic Bladder Research Group (NBRG) SCI Registry is a multicenter prospective observational study designed to assess bladder−related symptoms and QoL after SCI. Outcomes included the Neurogenic Bladder Symptom Score (NBSS) total score and a global satisfaction with urinary function question (NBSS-QoL). Bladder management was categorized as: clean intermittent catheterization without prior bladder surgery (CIC), indwelling catheter (urethral or suprapubic), surgical (bladder augmentation, catheterizable channel, urinary diversion), or voiding (condom catheter, involuntary leaking, volitional). Multivariate linear regression analysis was conducted controlling for age, obesity, years since injury, chronic pain, UTI burden (>4 per year), severe bowel dysfunction, SCI-QoL bladder management difficulties and SCI-FI fine motor score. RESULTS: 1479 participants (894 male and 585 female) were identified. Mean age of 44 ± 13 years and mean 16 ± 12 years since SCI. SCI level was: 57% paraplegia & 43% tetraplegia. Among paraplegic participants (470 male, 373 female), females who had a bladder surgery (n=71) reported a better total NBSS score (adjusted difference (AD) -3.35, 95% CI -5.85 to -0.85, p=0.009) and better bladder-related QoL (AD -0.71, 95% CI -1.03 to -0.39, p<0.0001) compared to those using intermittent catheterization (n=198). In contrast, males who had surgery (n=30) did not have a statistically different total NBSS total score (AD 1.77, 95% CI -2.01 to 5.55, p=0.36) compared to those using intermittent catheterization (n=327) but bladder-related QoL was improved (AD -0.59, 95% CI -1.11 to -0.07, p=0.03). CONCLUSIONS: There are differences in neurogenic bladder symptoms based on gender after spinal cord injury. Women with paraplegia experience worse bladder-related symptoms and have more opportunity for improvement with surgery. Educational efforts to improve bladder-related outcomes should be tailored to address gender-specific concerns. Source of Funding: PCORI CER14092138 © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e696-e696 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sara Lenherr* More articles by this author Jennifer S. Herrick More articles by this author Sean P Elliott More articles by this author Angela P. Presson More articles by this author Odinachi Moghalu More articles by this author John T Stoffel More articles by this author Blayne Welk More articles by this author Jeremy B Myers More articles by this author Expand All Advertisement PDF downloadLoading ...

MP48-07 FREQUENCY OF PATIENT-REPORTED UTIs PREDICTS POOR QUALITY OF LIFE AFTER SPINAL CORD INJURY

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction (MP48)1 Apr 2020MP48-07 FREQUENCY OF PATIENT-REPORTED UTIs PREDICTS POOR QUALITY OF LIFE AFTER SPINAL CORD INJURY Katherine Theisen*, Rachel Mann, Joshua Roth, Joseph Pariser, John Stoffel, Sara Lenherr, Jeremy Myers, Blayne Welk, and Sean Elliott Katherine Theisen*Katherine Theisen* More articles by this author , Rachel MannRachel Mann More articles by this author , Joshua RothJoshua Roth More articles by this author , Joseph PariserJoseph Pariser More articles by this author , John StoffelJohn Stoffel More articles by this author , Sara LenherrSara Lenherr More articles by this author , Jeremy MyersJeremy Myers More articles by this author , Blayne WelkBlayne Welk More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000903.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTIs) are a major source of morbidity after spinal cord injury (SCI). People with SCI attribute a variety of symptoms to UTI; but up to 60% of the time urine culture is inconsistent with a UTI. Unfortunately, negative cultures can lead providers to dismiss the symptoms. We hypothesize that patient-reported symptoms of a UTI have a major impact on quality of life (QOL) and warrant further investigation and amelioration, regardless of urine culture results. METHODS: The Neurogenic Bladder Research Group SCI registry asked 1475 SCI participants about neurogenic bladder-related QOL. Eligibility included age >18 years and acquired SCI. UTI frequency over the past year was by patient report and classified as 0, 1-3, 4-6, or >6. Four UTI QOL questions were administered: 1) UTIs limited daily activities; 2) UTIs caused increased spasms; 3) UTIs would not go away; 4) UTIs caused me to avoid going out. A 5-point Likert scale of responses ranged from “never” to “always”. Multivariable regression was performed to identify independent predictors for poor QOL. This controlled for demographic and clinical variables, including neurogenic bladder symptom score which measures overall bladder function. RESULTS: At enrollment, patient-reported UTI frequency over the prior year was 0 in 388 patients (26%), 1-3 in 677 (46%), 4-6 in 223 (15%), and more than 6 in 190 (13%). All four UTI QOL measures were inversely related to the number of UTIs experienced (p<0.001) (Figure 1). When controlling for confounders, we found that increasing UTI frequency was an independent predictor of worse QOL across all four questions. When comparing patients with >6 UTIs to those with 0, the odds of limiting daily activity, experiencing increased muscle spasms, perceiving a UTI would not go away, and avoiding going out were 9.6 (95% CI 5.8-15.7), 13.7 (95% CI 8.3-22.6), 35.3 (95% CI 17.7-70.5), and 8.1 (95% CI 4.7-13.9), respectively. CONCLUSIONS: The frequency of patient-reported UTIs is independently associated with worse QOL. Even if a urine culture proves to be negative, providers should address the symptoms that led to the evaluation; others causes of these symptoms should be considered and addressed in order to improve the QOL of this population. Source of Funding: Patient Centered Outcomes Research Institute © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e696-e697 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Katherine Theisen* More articles by this author Rachel Mann More articles by this author Joshua Roth More articles by this author Joseph Pariser More articles by this author John Stoffel More articles by this author Sara Lenherr More articles by this author Jeremy Myers More articles by this author Blayne Welk More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry.

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.

Patient Reported Bladder Related Symptoms and Quality of Life after Spinal Cord Injury with Different Bladder Management Strategies.

Neurogenic bladder significantly impacts individuals after spinal cord injury. We hypothesized that there would be differences in bladder related symptoms and quality of life for 4 common bladder management methods. In this prospective observational study we measured neurogenic bladder related quality of life after spinal cord injury. Study eligibility included age 18 years or greater and acquired spinal cord injury. Bladder management was grouped as 1) clean intermittent catheterization, 2) an indwelling catheter, 3) surgery (bladder augmentation, a catheterizable channel or urinary diversion) and 4) voiding (a condom catheter, involuntary leaking or volitional voiding). The primary outcomes were the NBSS (Neurogenic Bladder Symptom Score) and the SCI-QoL Difficulties (Spinal Cord Injury Quality of Life Measurement System Bladder Management Difficulties). Secondary outcomes were the NBSS subdomains and satisfaction with urinary function. Multivariable regression was done to establish differences between the groups, separated by level. Of the 1,479 participants enrolled in the study 843 (57%) had paraplegia and 894 (60%) were men. Median age was 44.9 years (IQR 34.4-54.1) and median time from injury was 11 years (IQR 5.1-22.4). Bladder management was clean intermittent catheterization in 754 cases (51%), an indwelling catheter in 271 (18%), surgery in 195 (13%) and voiding in 259 (18%). In regard to primary outcomes, in cases of paraplegia and tetraplegia an indwelling catheter and surgery were associated with fewer urinary symptoms on the NBSS compared to clean intermittent catheterization while voiding was associated with more symptoms. In paraplegia and tetraplegia cases surgery was associated with fewer bladder management difficulties according to the SCI-QoL Difficulties. In regard to secondary outcomes, surgery was associated with improved satisfaction in individuals with paraplegia or tetraplegia. In individuals with spinal cord injury fewer bladder symptoms were associated with an indwelling catheter and surgery, and worse bladder symptoms were noted in voiding individuals compared to those on clean intermittent catheterization. Satisfaction with the urinary system was improved after surgery compared to clean intermittent catheterization.

Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King’s Health Questionnaire in people with spinal cord injury

Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King’s Health Questionnaire in people with spinal cord injury

PD43-10 THE EFFECTS OF AUGMENTATION CYSTOPLASTY AND BOTULINUM TOXIN INJECTION ON PATIENT-REPORTED BLADDER FUNCTION AND SATISFACTION AMONG SPINAL CORD INJURY PATIENTS PERFORMING INTERMITTENT CATHETERIZATION

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion II1 Apr 2018PD43-10 THE EFFECTS OF AUGMENTATION CYSTOPLASTY AND BOTULINUM TOXIN INJECTION ON PATIENT-REPORTED BLADDER FUNCTION AND SATISFACTION AMONG SPINAL CORD INJURY PATIENTS PERFORMING INTERMITTENT CATHETERIZATION Jeremy Myers, Sara Lenherr, John Stoffel, Sean Elliott, Angela Presson, Chong Zhang, and Blayne Welk Jeremy MyersJeremy Myers More articles by this author , Sara LenherrSara Lenherr More articles by this author , John StoffelJohn Stoffel More articles by this author , Sean ElliottSean Elliott More articles by this author , Angela PressonAngela Presson More articles by this author , Chong ZhangChong Zhang More articles by this author , and Blayne WelkBlayne Welk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.2122AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Clean intermittent catheterization (CIC) is the bladder management strategy recommended by clinicians after spinal cord injury (SCI) because it has the least complications. However, dissatisfaction with CIC is evident by high rates of switching to other forms of bladder management over time, mostly to indwelling catheters. We hypothesize that interventions such as bladder botulinum toxin injection or augmentation cystoplasty can improve satisfaction with CIC. METHODS The NBRG registry is a multicenter, prospective, observational study asking SCI participants about neurogenic bladder related quality of life. Eligibility included: age >18 years and acquired SCI. Over 1.5 years, 1479 participants enrolled. From this cohort, those performing CIC as primary bladder management were categorized into 3 groups: 1) CIC-alone, 2) CIC using botulinum toxin (CIC-BTX), and 3) CIC with augmentation cystoplasty (CIC-AUG). Multivariate linear regression was used, controlling for multiple factors, to establish differences in the Neurogenic Bladder Symptom Score (NBSS), its sub-domains (Incontinence, Storage & Voiding, and Consequences), and the final question of the NBSS (satisfaction with urinary function) between the 3 groups. The mean, across groups, for each measure was reported as a point of reference for the magnitude of change. A negative change for the NBSS indicates improvement in function / satisfaction. Values were reported with standard deviation and 95% confidence intervals. RESULTS 879 participants identified CIC as their primary bladder management. The mean age was 43.4 (±12.9) and mean years from injury was 13.7 (±10.7). Level of injury was tetraplegia in 284 (32%); 337 (38%) were women. Bladder management was CIC-alone in 593 (67%), CIC-BTX in 161 (19%), and CIC-AUG in 125 (15%). Total NBSS (mean 25±10.1) did not differ between CIC-alone and CIC-BTX but was improved for CIC-AUG (-3.9 (-5.9˜-1.8, p<0.001). Similarly, the Incontinence subdomain (mean 10.4±6.8) did not differ between CIC-alone and CIC-BTX but was improved in CIC-AUG (-2.82(-4.14˜-1.49), p<0.001). There were no differences between groups in the other 2 NBSS subdomains. Satisfaction with urinary function (mean 2.1±1.2) did not differ between CIC-alone and CIC-BTX, but was improved in CIC-AUG (-1.11(-1.43˜-0.8), p<0.001). CONCLUSIONS Individuals performing CIC after SCI had the best urinary function and satisfaction after augmentation cystoplasty. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e880 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jeremy Myers More articles by this author Sara Lenherr More articles by this author John Stoffel More articles by this author Sean Elliott More articles by this author Angela Presson More articles by this author Chong Zhang More articles by this author Blayne Welk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King's Health Questionnaire in people with spinal cord injury.

To assess the validity and reliability of the Turkish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS). Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS. Both the internal consistency (Cronbach's alpha coefficient: 0.68-0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69-0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34<r<0.76, p<0.05) were found. The comparison of patients with SCI and patients with MS in terms of KHQ revealed that patients with SCI had significantly higher scores in some of the subscales of KHQ (p<0.05). These higher scores represented the worst health state, and the uppermost limit was determined as 100 points. The KHQ scale is an internally consistent, reliable, and valid scale for people with SCI. In addition, bladder-related quality of life was poorer in patients with SCI than in MS patients.

Quality of Life and the Neurogenic Bladder: Does Bladder Management Technique Matter?

People with neurogenic bladder dysfunction often have to make choices about the use of different bladder management techniques to achieve socially acceptable bladder function and to reduce the risk of bladder-related complications. This article reviews the relevant literature on neurogenic bladder related quality of life (QOL) and the impact of different bladder management methods on QOL. There are several neurogenic bladder specific QOL measurement tools available, including the Qualiveen, Incontinence-QOL, SCI-QOL Bladder Management Difficulties/Complications questionnaires, and the Neurogenic Bladder Symptom Score. In general, the use of any type of catheter for bladder management is associated with a reduced QOL among neurogenic bladder patients, and patients who cannot do intermittent catheters independently have a lower QOL compared to patients who can. The literature does not show a consistently better QOL among patients using intermittent catheterization compared to those using indwelling catheters, despite the lower morbidity, and a clear consensus from physicians that it represents the “gold standard” for neurogenic bladder drainage. A greater understanding of the impact of bladder management on QOL is necessary to help counsel and manage patients with neurogenic bladder.

Patient reported outcome measures in neurogenic bladder.

Many interventions for neurogenic bladder patients are directed towards improving quality of life (QOL). Patient reported outcome measures (PROMs) are the primary method of evaluating QOL, and they provide an important quantification of symptoms which can’t be measured objectively. Our goal was to review general measurement principles, and identify and discuss PROMs relevant to neurogenic bladder patients. We identify two recent reviews of the state of the literature and updated the results with an additional Medline search up to September 1, 2015. Using the previous identified reviews, and our updated literature review, we identified 16 PROMs which are used for the assessment of QOL and symptoms in neurogenic bladder patients. Several are specifically designed for neurogenic bladder patients, such as the Qualiveen (for neurogenic bladder related QOL), and the Neurogenic Bladder Symptom Score (NBSS) (for neurogenic bladder symptoms). We also highlight general QOL measures for patients with multiple sclerosis (MS) and spinal cord injury (SCI) which include questions about bladder symptoms, and incontinence PROMs which are commonly used, but not specifically designed for neurogenic bladder patients. It is essential for clinicians and researchers with an interest in neurogenic bladder to be aware of the current PROMs, and to have a basic understanding of the principals of measurement in order to select the most appropriate one for their purpose.