Intermittent Catheterization Research Articles

Switching from intermittent catheterization with single-use catheter to a reusable catheter has a negative impact on quality of life.

It has been proposed that reusable catheters are more cost effective and environmentally sustainable than single-use catheters intended for intermittent catheterization (IC). However, the aspect of individuals' well-being and preference for catheter type is not considered. In this study, we investigated the impact on individuals' health-related quality of life (HR-QoL) when testing a reusable catheter. The study was an open-labeled, single-arm, multicenter investigation with a treatment period of 28 days. Forty subjects using single-use hydrophilic catheters were accustomed to a reusable catheter for managing IC. HR-QoL was evaluated by the Intermittent-Self Catheterization Questionnaire (ISC-Q). Additionally, satisfaction was evaluated by the Intermittent Catheterization Satisfaction Questionnaire (InCaSa-Q). The difference in total score was analyzed using a mixed linear model. Furthermore, preference for IC (single-use vs. reusable) was assessed and microbial evaluation of the catheters was performed. The total ISC-Q score measuring HR-QoL decreased significantly by 28% (p < 0.001). Two of the four subdomains (ease-of-use and discreetness) also decreased significantly (p < 0.001). The total InCaSa-score and all four subdomains evaluating satisfaction decreased significantly (p < 0.005). The primary study results were supported by the fact that 90.9% of subjects preferred to use a single-use catheter for IC. Furthermore, 50% of reusable catheters were contaminated with bacteria. Switching from single-use to reusable IC resulted in a significant decrease in HR-QoL and satisfaction. Moreover, the vast majority preferred the single-use catheter due to handling and convenience. The users' rights to their preferred bladder management method should be acknowledged.

Assessing the reliability and usefulness of ChatGPT responses on intermittent catheterization queries: A critical analysis

Assessing the reliability and usefulness of <scp>ChatGPT</scp> responses on intermittent catheterization queries: A critical analysis

Contemporary Outcomes of a National Fetal Spina Bifida Surgery Service.

To assess contemporary outcomes of fetuses who underwent open fetal spina bifida surgery in Canada. Our clinical program prospectively collected outcomes of all consecutive fetuses who underwent open fetal spina bifida closure at the Ontario Fetal Center in Toronto and who were at least 1year of age at the time of postnatal follow-up. We gathered information on the need for hydrocephalus treatment, motor function, bladder function, as well as neurodevelopment (Ages and Stages Questionnaire and Bayley's scales of infant development). Developmental outcomes were categorized as "Typical Development," "Possible Delay," or "Significantly Delayed." Between 2017 and 2022, 41 fetuses underwent open fetal spina bifida closure. Twenty-four patients (58.5%) responded to the questionnaire at a median age of 46.5months. Eight children (33.3%) required CSF diversion procedures. Bladder management included clean intermittent catheterization (43.5%), spontaneous voiding (34.8%), or both (21.7%), with 43.5% needing medication for overactive bladder. All patients could sit independently, with 50% walking outside and 50% crawling indoors. Among those walking outdoors (50%), 25% did so without orthotics or aid, 58.3% with orthotics, and 16.7% required additional walking aids. Most children demonstrated typical communication and problem-solving skills (79.2%), while gross motor development was significantly delayed in 91.7% of cases. Fine motor skills varied, with 56.5% showing typical development and 34.8% possibly experiencing delays. This study showed a mixed developmental profile among patients who underwent open fetal spina bifida repair, consistent with the MOMs trial findings.

Impact of urinary catheters including reusable catheters on quality of life and work productivity in persons with spinal cord lesion

While preventing renal damage and symptomatic urinary tract infection are of paramount importance to persons with a spinal cord lesion (SCL), patient-reported outcomes (PROs) are receiving much more attention than ever before. We performed a cross-sectional internet survey of 282 adult members of SCL patient advocacy groups and investigated, for the first time, the impact of different types of urinary catheter, including a Japanese reusable silicone catheter and a reusable intermittent balloon catheter, on PROs of persons with SCL. Intermittent self-catheterization (ISC) did not surpass continuous indwelling catheterization in terms of a disease-specific urinary quality of life. Urinary incontinence, regular ISC, and performing ISC away from home confronted these individuals. Work productivity and regular activities correlated fairly well with the disease-specific urinary quality of life. Bowel management problems affected all PROs evaluated. The absence of differences in PROs among the types of catheter used for ISC implies that Japanese reusable catheters have the potential to benefit selected persons with SCL. Further research is warranted to develop measures for maximizing work productivity by overcoming urinary as well as bowel problems.

Bladder irrigation with tap water to reduce antibiotic use for urinary tract infections in catheter users.

To evaluate the safety and effectiveness of bladder irrigation (BI) with tap water to reduce antibiotic use for the treatment of urinary tract infections (UTIs) in patients with recurrent UTI symptoms and to assess the treatment satisfaction of BI. This prospective, observational study included patients with an indwelling catheter or performing clean intermittent catheterisation (CIC) who had recurrent UTI symptoms between July 2022 and March 2024. BI with tap water was used for the treatment of UTIs without systemic symptoms (e.g., fever, flank pain or delirium). Patients started daily irrigation at the onset of UTI symptoms and used a tapering schedule. The number of antibiotic treatments for UTIs, UTI incidence rate ratio (IRR), UTI-related hospitalisations, treatment satisfaction and quality of life (QoL) were compared between a 3-month period before and after BI with tap water. A total of 60 patients were included with a median (interquartile range) age of 64.5 (50.4-72.6) years, 66.7% were male, and 83.3% were performing CIC. Antibiotic use was decreased on average by 38.1% (IRR = 0.62; P = 0.016) and catheter-associated UTIs by 37.9% (IRR = 0.62; P = 0.005). No increase was observed in the incidence of UTIs with systemic symptoms or UTI-related hospitalisations. In addition, no differences were observed in the health-related QoL. The majority of patients were positive about the subjective effectiveness (81%), ease of use (86%) and overall satisfaction (85%) of BI with tap water. These findings emphasise the potential of BI with tap water as a promising and patient-friendly alternative for the treatment of UTIs in patients with urinary catheters. BI with tap water significantly reduces antibiotic use and UTI incidence in patients with recurrent UTIs and is a safe and patient-friendly alternative that can be easily implemented in the management of UTIs.

Treatment of urinary disorders in patients with multiple sclerosis: A review

Voiding disorders are one of the most common clinical manifestations of multiple sclerosis, significantly worsening the quality of life of patients. The review article provides information about the nature and symptoms of lower urinary tract dysfunctions, the reasons for their development and possible complications. The general principles of treatment of urinary disorders in patients with multiple sclerosis are presented, as well as features of the treatment of detrusor overactivity, detrusor-sphincter dyssynergia and detrusor hypoactivity. The possibilities of non-drug and drug therapy, botulinum therapy, and neuromodulation are described in detail. The role of intermittent catheterization in the treatment of patients with impaired evacuation function of the bladder is shown. Practical issues of choosing a treatment method depending on the clinical situation are considered.

An Alternative Approach for Treating Female Underactive Bladders with Chronic Urine Retention: A Pilot Study on Combined Transvaginal Ultrasound-Guided Botulinum Toxin A External Sphincter Injection and Transurethral Incision of the Bladder Neck.

Background: Treating an underactive bladder (UAB) is challenging. Previously, we introduced a more precise method of transvaginal ultrasound-guided botulinum toxin A (BoNT-A) injection into the external urethral sphincter as a treatment option for patients with UABs. Although many patients experience good results, those with an UAB and excessive residual urine still require catheterization. Therefore, we developed a new method that combines transvaginal ultrasound-guided BoNT-A injection with a transurethral bladder neck incision. Methods: A prospective study was conducted on 16 patients who experienced symptoms of UAB and chronic urine retention. The treatment consisted of a combination of transvaginal ultrasound-guided BoNT-A injection and a transurethral incision of the bladder neck (TUI-BN). The primary objective was to assess the efficacy of this combined treatment in improving symptoms in women with UABs. Results: Our study demonstrated significant improvements after treatment, including increased voiding volume, decreased post-void residual (PVR) urine, and improved voiding efficiency. The frequency of clean intermittent catheterization (CIC) decreased at 1 and 3 months post-surgery, along with improvements in the AUA symptoms score and the Patient Perception of Bladder Condition (PPBC) score. Conclusions: Our study showed significant improvements in the surgical treatment of UABs using a combination of transvaginal ultrasound-guided BoNT-A and TUI-BN.

The relationship between uropathogens and clinical characteristics of children with urinary tract infection

Urinary tract infections (UTI) are common bacterial infections in children. This study aimed to examine the relationships between different microorganisms and both clinical and laboratory findings in pediatric patients with UTIs. We conducted a retrospective evaluation of children with UTI between 2019 and 2024. Patients were divided into four main groups as normal anatomy, vesicoureteral reflux (VUR), ureteropelvic junction obstruction (UPJO), and neurogenic bladder (NB). Information on clean intermittent catheterization (CIC) and prophylactic antibiotic use was recorded. Laboratory results were compared across these patient groups. The study included 266 patients, with a female predominance (female/male ratio: 7.33). NB was the most common urinary tract condition (43.3%), followed by VUR (10.9%) and UPJO (9%). Prophylactic antibiotics were used by 9% of the patients. Acute phase reactants in patients with CIC were significantly higher (p=0.023 for white blood cell (WBC) and p=0.002 for C-reactive protein (CRP) levels). They were also higher in patients with prophylactic antibiotics compared to those without (p=0.001 for both). The most frequently detected bacteria in urine cultures were E. coli (65%), followed by Klebsiella spp. (18.8%), Pseudomonas spp. (7.5%), and Proteus spp. (4.9%). Klebsiella spp., Enterococcus spp., and Morganella spp. were not isolated from patients receiving prophylaxis (p=0.022). Risk factors for UTIs need to be carefully assessed for every patient, and treatment should be customized according to clinical and laboratory results. Individual patient factors should guide drug selection, and treatment plans should account for potential resistance patterns.

Particularities of spasticity in myelomeningocele patients.

Myelomeningocele (MMC), a congenital neural tube defect, is the most common developmental anomaly of the central nervous system (CNS). Spasticity is among the main disabling factors in these patients, affecting up to 1/5 of children. The purpose of this article is to review the current knowledge regarding spasticity in MMC patients, mainly focusing on its manifestations and management. A literature search was conducted using the PubMed database for the terms "myelomeningocele" and "spasticity." Data were collected by 5 independent investigators and then synthesized in a scoping format. Causes of spasticity in these patients include hydrocephalus, tethered cord syndrome (TCS), syringomyelia, CNS infection, and associated congenital brain and spine anomalies. Clinical manifestations include limb spasticity and neurogenic bladder. Spasticity primarily affects muscles below the neurological level and contributes to gait impairment. Besides walking ability, spasticity also severely affects functional mobility in general, self-care, and quality of life. The majority of MMC patients experience neurogenic bladder. Treatment of spasticity can be symptomatic or target its cause. Medical and surgical options are available for both limb and bladder spasticity. Regular physiotherapy and orthotics are used to prevent contractures and the early introduction of orthoses is the cornerstone of a gait training program. Neurosurgical treatment options for spasticity include nonablative and ablative procedures such as selective dorsal rhizototmy. The urodynamic pattern guides treatment strategies, with intermittent catheterization being the best treatment option for patients with underactive detrusor and overactive sphincter muscles. Given the particularities of spasticity in MMC patients, a multidisciplinary team approach and early rehabilitation programs are keys for their optimal management.

Thermo-expandable intraprostatic nitinol stents in the treatment of bladder outlet obstruction: a consecutive case series.

In high-risk patients, prostatic stents may alleviate obstruction at the prostate level. Since 2020 we have used thermo-expandable intraprostatic nitinol stents. Here we document outcomes through the first years with the procedure. We reviewed patients who had undergone stent treatment between May 2020 and October 2023. Patient and procedural data, urinary symptoms, complications and side effects were recorded. Descriptive statistics were used to summarize outcomes and we evaluated predictors of success and complications using robust multiple regression analyses. We included 52 consecutive patients with a median age of 82 years (range 71-96) and a median Charlson Comorbidity Index of 6 (3-11). Forty-seven men used indwelling catheters, two used clean intermittent catheterization, and three had severe lower urinary tract symptoms. Stents were placed under general anesthesia, sedation, and local anesthesia in 39, 4, and 9 men, respectively. The median treatment time was 14 min (range 8-40). One complication, in the form of an infection requiring IV antibiotics, occurred. Subsequently, 45 men (87%) were able to void spontaneously without bothersome symptoms. After a median of 11 (2-44) months, 8 men had their stents removed due to recurring symptoms. This gives an overall success rate of 37/52 patients (71%). No predictors of success or complications were identified. Thermo-expandable intraprostatic nitinol stents demonstrate a high success rate with a low risk of complications and may serve as an alternative to permanent or intermittent catheterization for men who are unable or unwilling to undergo flow-improving surgery.

Clean intermittent catheterisation determinants and caregiver adherence in paediatric patients with spinal dysraphism and spinal cord injury in a paediatric spinal differences clinic: a mixed methods study protocol

IntroductionClean intermittent catheterisation (CIC) is the standard of care for treating neurogenic lower urinary tract dysfunction (NLUTD), the most common bladder dysfunction in children diagnosed with spinal dysraphism (SD) and...

An Evaluation of the Postvoid Residual Urine Volume in Acute Stroke Patients.

We analyzed the time course of postvoid residual urine volume for patients with cerebrovascular diseases in the acute phase. A multidisciplinary specialized team measured postvoid residual urine volume of 65 patients (31 patients with cerebral infarction and 34 patients with cerebral hemorrhage) from September 2021 to August 2023. If a patient's postvoid residual urine volume was 100 mL or more, an indwelling urinary catheter was reinserted with or without medication, or clean intermittent catheterization was performed with or without medication. The multidisciplinary specialized team took repeated measurements of postvoid residual urine volume for a patient at every week's round until the postvoid residual urine volume was <100 mL. The cumulative incidence of the time interval between the onset of the cerebrovascular accident and the day of postvoid residual urine volume <100 mL was calculated as 1 + the Kaplan-Meier estimator. In the Kaplan-Meier estimator, the median cumulative incidence of the period between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 16.5 days and 15.5 days for patients with cerebral infarction and cerebral hemorrhage, respectively. No significant difference existed between the two groups in the time interval from the onset of a cerebrovascular accident to the day in which postvoid residual urine volume was <100 mL (The P value from the Log-rank test was 0.845). The time interval between the onset of a cerebrovascular accident and the day in which postvoid residual urine volume was <100 mL was 75 days after the onset of both types of cerebrovascular accidents. Postvoid residual urine volume of patients with cerebrovascular disease was expected to become <100 mL within 75 days after the onset of the cerebrovascular accident.

248 - Evaluation of bacterial displacement by intermittent catheters with gel- or water-based lubricants using an in vitro urethral agar channel model

248 - Evaluation of bacterial displacement by intermittent catheters with gel- or water-based lubricants using an in vitro urethral agar channel model

253 - A novel ex vivo porcine urethral model for evaluating the effect of intermittent urinary catheters on urethral tissue

253 - A novel ex vivo porcine urethral model for evaluating the effect of intermittent urinary catheters on urethral tissue

173 - Predictive factors for clean intermittent catheterization after intravesical onabotulinumtoxinA injections in women with overactive bladder syndrome: A Danish retrospective cohort study

173 - Predictive factors for clean intermittent catheterization after intravesical onabotulinumtoxinA injections in women with overactive bladder syndrome: A Danish retrospective cohort study

317 - Development of Clinical Practice Principles for Intermittent Catheterization

317 - Development of Clinical Practice Principles for Intermittent Catheterization

319 - Mix and match: A qualitative study finds both single-use and reusable intermittent catheters are needed

319 - Mix and match: A qualitative study finds both single-use and reusable intermittent catheters are needed

Retroperitoneoscopic bladder neck closure for continuous urinary incontinence in Fournier's gangrene

IntroductionA retroperitoneoscopic procedure for bladder neck closure has not yet been described.Case presentationCase 1 was a 56‐year‐old man who underwent clean intermittent catheterization for spastic paraplegia due to a thoracic spinal cord injury 37 years prior. Case 2 was an 80‐year‐old bedridden woman who underwent urethral catheterization after a femoral fracture and brain infarction 3 years prior. Both patients presented with Fournier's gangrene, and the urogenital region, including the necrotic urethra, was debrided. Although a permanent suprapubic catheter was established, postoperative wound healing was poor owing to continuous urine leakage from the urethral stump. Therefore, we performed retroperitoneoscopic bladder neck closure, and the urinary incontinence was completely resolved.ConclusionRetroperitoneoscopic bladder neck closure is a feasible and less invasive procedure for treating continuous urinary incontinence from the urethral stump in patients with Fournier's gangrene after surgical debridement and having a permanent suprapubic catheter.

Bladder drainage methods for acute urinary retention due to benign prostatic hyperplasia: patient-preference analysis

Introduction. Currently, the classical management of acute urinary retention creates a certain discomfort for the patient and leads to explore alternative method of management, such as intermittent catheterization, including focusing on the patient opinions.Objective. To assess the preference of high-risk patients for acute urinary retention relative to bladder drainage in the occurrence of acute urinary retention.Materials &amp; methods. A survey was conducted among 200 ambulatory male patients. All the participants were tested to assess their mental status and ability to perform self-intermittent catheterization before filling out the questionnaire. The questionnaire included questions about the preferred method of bladder drainage for acute urinary retention, as well as factors influencing the patient's choice of self-intermittent catheterization in case of non-recovery. After completing the questionnaire, all the patients were shown a video on self-catheterization and asked to re-take the questionnaire after watching it. This allowed evaluating the impact of the training video on patients' preferences and their confidence in performing self-catheterization.Results. Among the 200 patients, 151 (75.5 %) preferred intermittent catheterization, while 40 (25.5 %) chose an indwelling urinary catheter. Additionally, 152 (76 %) patients opted for intermittent catheterization until the planned surgery, and 48 (24 %) selected a suprapubic catheter. The main factors influencing the patient choice of intermittent catheterization were: the desire to restore bladder function faster (on the first or second day) in 96 (63.2 %) patients; unwillingness to stay in the hospital in 56 (36.8 %); the desire to return to work in 22 (14.5 %); avoiding the use of a suprapubic catheter in 51 (33.5 %). After watching the video, there was a statistically significant change in patients' assessments of their ability to perform self-intermittent catheterization (p &lt; 0.001).Conclusion. The patient's choice of the intermittent catheterization is significantly influenced by the patient self-confidence in the ability to practice self-intermittent catheterization and the demonstration of the video tutorial. Due to the high efficiency and safety of intermittent catheterization, this method should be introduced into clinical practice based on the proposed algorithm.

Clean intermittent catheterization in multiple sclerosis patients: An adherence and long-term follow-up study

IntroductionClean Intermittent Catheterization (CIC) is considered as a gold standard of treatment for bladder emptying disorders. A large amount of literature on CIC for patients suffering from neurological disorders is available, but there is a lack of research specifically concerning multiple sclerosis (MS) patients. Our primary outcome was to determine the characteristics of our population (sex, EDSS and age when CIC was introduced). Our secondary outcomes were to determine adherence of CIC. MethodAs part of a multicenter, observational, retro-prospective study, data was collected from neuro-urologist consultation reports, and extracted from bladder diaries between 01/01/2000 and 31/03/24. MS patients, over 18 years, with the indication of CIC were included. Results195 patients (72.3% women) were included, with a mean age of 49 years old. The median of follow-up was 9 years. Median EDSS at the start of the study was 5.5. There was an adherence rate of 65.1%. Urinary leakage was present in 74.2% of patients prior to CIC and 31.6% following CIC. ConclusionCatheterization is mainly offered to patients with an EDSS between 0 and 7. Rate of adhesion is encouraging, with most patients still continuing to use CIC by the end of follow-up. During the follow-up, we observed a reduced leakage rate but CIC alone can not explain this improvement. Following studies should include a list of constraints and reasons of halted CIC.