Intermittent Catheterization Research Articles

Indications and Outcomes for Intermittent Catheterization following Bulbar AUS Cuff Placement

ObjectiveTo evaluate the functional and surgical impact of CIC protocols in men with a bulbar AUS in place. Stress urinary incontinence (SUI) and poor bladder emptying are both sequelae of prostate cancer treatment, though there is sparse data to guide concomitant management. The safety of intermittent catheterization (CIC) in men with an artificial urinary sphincter (AUS) at the bulbar urethra remains unclear. MethodsWe performed a retrospective review of all bulbar urethral AUS procedures at our institution. Inclusion criteria were patients with a history of prostate cancer treatment, AUS placement for SUI, and a history of CIC before and/or after AUS placement. All eligible cases were retrospectively reviewed. Surgical and continence outcomes were analyzed. ResultsA total of 57 patients were identified with a history of CIC and AUS placement under the care of two surgeons. Eighteen continued to perform CIC or first initiated CIC after AUS placement and 39 discontinued CIC prior to AUS placement. The incidence of erosion was no different amongst patients who continued or discontinued CIC after AUS placement (17.9% vs 22.2%, P = .79). There was no difference in future AUS removal or replacement (56.4% vs 44.4%, P = .41). Both groups experienced improvement in urinary incontinence after placement of an AUS. ConclusionBulbar AUS placement in the setting of continuous intermittent catheterization can be considered in patients who are not surgical candidates for definitive treatment of their outlet obstruction.

Translation and Validation of the Intermittent Catheterization Difficulty Questionnaire (ICDQ) into Greek.

Clean intermittent self-catheterization (CISC) is a safe and effective alternative to managing incomplete bladder emptying in patients afflicted with neurogenic bladder conditions. The Intermittent Catheterisation Difficulty Questionnaire (ICDQ) is a validated questionnaire concerning the assessment of catheter use and patient difficulties during CISC. The present study aimed to translate and validate the ICDQ into the Greek language. A subsequent outcome was to substantiate the requirement of both urologist consultation with patients undergoing CISC and the detailed evaluation of various therapeutic options with the consultation of other specialist physicians. The study was undertaken between March 2022 and July 2022 and involved patients in an outpatient department of a Rehabilitation Centre. Sixty-two neurologic patients suffering from spinal cord injury (SCI), multiple sclerosis (MS), cauda equina (CE), and myelitis represented a convenience sample. To calculate test-retest reliability, patients filled out two consecutive questionnaires; an initial one and a second after one week. The socio and demographic circumstances of all participants were evaluated. The mean ICDQ total score at the test and retest was 5.96±1.28 (mean total score ± standard deviation) and 5.91±1.29, respectively. Evaluation of the data concerning alterations between men and women did not reveal statistically significant differences. Cronbach's alpha coefficient was 0.94, which proves the inter-correlation between the different topics. An ICC of 0.97 indicated very high intra-rater reliability. ICDQ, a valid and reliable self-administered screening tool for CISC difficulties faced by patients using this procedure regularly, was successfully translated and validated into Greek. A more detailed evaluation and understanding of these difficulties would enhance the quality of CISC and allow for more suitable treatment and the selection of catheter types used. These improved treatment strategies are possible as repeated use and constant comparison of ICDQ scores determine treatment impact, facilitating treatment regimen modification, should it be required.

Frequency of Cathetrization in the Management of Overt Postpartum Urinary Retention

Urinary retention after postpartum can be defined as “inability of the patient to pass urine after six hours of postpartum. Objective: To determine the role of catheterization in patients with postpartum urinary retention. Methods: It was multicenter study. Patients from five different hospitals were included in the study. Duration of study was one and half years. Patients suffering from overt postpartum urinary retention who refused self intermittent catheterization were included in the study. Results: Total 68 patients were included in the study from five different teaching hospitals. In Social Security Teaching Hospital 13 patients, in Lady Wallingdon Hospital 32patients, in Lahore General Hospital 13, in Ali Fatima Teaching Hospital 12 and in Central Park Hospital 8 patients were reported. The age of these patients was from 18 to 29 years with a mean age of 21 years (+ 1.6). The duration of catheterization was from 3 to 18 days with mean days was 7 (+ 1.8). Conclusions: In overt type of postpartum urinary retention, early treatment results in saving patients to develop long term urinary complications.

Urinary Tract Infections: Epidemiology, Mechanisms of Infection, and Treatment

Purpose: The main purpose of this study was to determine the mechanism of infection and the response of preferred antibiotic treatment during this study. Study: This study was conducted from February to March 2022. The approval for this randomized study was taken by the Ethical Committee of the concerned hospital. Written informed consent was signed by all participants. Total of 110 participants who reported problems with UTIs were part of this study. Levofloxacin 750 mg per day for five days and ciprofloxacin 500 mg twice per day for ten days were given to patients for treatment. Results: The total number of patients was 110, 65 (59.09%) males and 45 (40.90%) females having a mean age of 28 ± 5, urinary tract abnormalities were observed in 28 (25.45%) patients including obstruction in 16 (14.54%) patients, stone in 8 (7.27%)cases, the neurogenic bladder was in 4 (3.63%) patients and poly-microbial etiology was in 25 (22.72%) and catheterized patients was 35 (31.81%) in which chronic catheter cases were 15 (13.63%), intermittent catheter cases were 20 (18.18%), and Complicated UTIs was found in 22 (20.02%). 55 patients were treated with levofloxacin 51 (46.36%) reported a positive response and 51 (46.36%) were not cured with a p-value of 0.05. 55 patients were treated with ciprofloxacin of which 48 (43.63%) patients were cured and 7 (6.36%) were not cured with a p-value of 0.05. The number of patients treated with levofloxacin had a higher cured percentage 46.36% than those treated with Ciprofloxacin. Conclusion: Eventually, this study demonstrated that UTIs of all the microorganisms detected during the study can be cured with levofloxacin and ciprofloxacin. While ciprofloxacin was slightly less effective in a few cases than levofloxacin. Keywords: Urinary tract infection (UTIs), Ciprofloxacin, levofloxacin, infection treatment

Novel Combination of Harrington and Pedicular Screw Fixation in Traumatic Fracture-dislocation of Thoracic Spine: A Case Report and Literature Review

Background and Importance: Fracture-dislocation of the thoracic or lumbar spine (traumatic spondyloptosis) occurs in less than 5% of all spinal injuries mainly affecting the ventral direction. Case Presentation: A paraplegic young man was admitted to Shahid Kamyab Hospital in Mashhad City, Iran due to a motor vehicle accident. Computerized tomography (CT) showed a complete posterior dislocation of the T10 vertebral body on T9, with the superior articular processes of T9 bilaterally locked in the inferior endplate of T10 and complete fractures of the posterior elements. Conclusion: The spinal dislocation was re-aligned by a combination of Harrington fixation and pedicular screws leading to spinal fusion. Six months after surgery, the patient was still paraplegic but the sensory symptoms in the lower extremities and clean intermittent catheterization improved.

Development of an ex-vivo porcine lower urinary tract model to evaluate the performance of urinary catheters

Intermittent catheterization is the gold standard method for bladder management in individuals with urinary retention and/or incontinence. It is therefore important to understand the performance of urinary catheters, especially on parameters associated to risks of developing urinary tract infections, and that may impact the quality of life for urinary catheter users. Examples of such parameters include, urine flowrate, occurrence of flow-stops, and residual urine left in the bladder after flow-stop. Reliable in-vitro and/or ex-vivo laboratory models represent a strong asset to assess the performance of urinary catheters, preceding and guiding in-vivo animal studies and/or human clinical studies. Existing laboratory models are generally simplified, covering only portions of the catheterization process, or poorly reflect clinical procedures. In this work, we developed an ex-vivo porcine lower urinary tract model that better reflects the catheterization procedure in humans and allows to investigate the performance of standard of care catheters. The performance of three standard of care catheters was investigated in the developed model showing significant differences in terms of flowrate. No differences were detected in terms of residual volume in the bladder at first flow-stop also when tuning the abdominal pressure to mimic a sitting down and standing up position. A newly discovered phenomenon named hammering was detected and measured. Lastly, mucosal suction was observed and measured in all standard of care catheters, raising the concern for microtrauma during catheterization and a need for new and improved urinary catheter designs. Results obtained with the ex-vivo model were compared to in-vivo studies, highlighting similar concerns.

Single institution experience of cloacal malformation

IntroductionThe aim of this study is to report on the outcomes of patients born with cloacal malformation, managed at a single institution more than the last 28 years. The focus of this study is the long term renal and colorectal outcomes. MethodsPatients were identified from the departmental database from 1994 to 2021. The medical records and operative notes were retrospectively reviewed. ResultsTwenty-one patients fulfilled the inclusion criteria. Eleven long common channel (LCC) and ten short common channel (SCC) cloacae patients were identified. Median age at the time of primary reconstruction was 11 months in both groups. In the LCC group, seven (63.6%) patients underwent a Total Urogenital Mobilisation (TUM), and 4 (36.4%) required a vaginal replacement. 6/11 (54.5%) of patients required drainage of a hydrocolpos. In the SCC group, four patients required a TUM, two patients underwent mobilisation of the rectum and vagina alone, and three underwent rectal mobilisation alone. Two patients have required renal transplant for congenital renal dysplasia, and two have developed chronic renal failure associated with the sequalae of vesicoureteric reflux. Eleven (52.3%) of the patients manage their bowels with an antegrade continent enema (ACE), and two of the LCC cloaca are defunctioned with a colostomy. Clean intermittent catheterisation is performed by 12 (57%) of the patients, either per urethra or via a Mitrofanoff channel. ConclusionThe urinary and faecal continence are the main challenges in the management of cloaca patients. Many require surgical intervention to achieve social continence. Level of evidenceLevel IV.

Intravesical injection of botulinum toxin type a may be an effective treatment option for autonomic dysreflexia in patients with high-level spinal cord injury

Objective To evaluate the efficacy of intravesical injection of botulinum toxin type A (BTX-A) for neurogenic detrusor overactivity (DO) in reducing the frequency and severity of autonomic dysreflexia (AD). Design A cross-sectional nonrandomized trial with before (baseline) and after (follow-up) assessments. Setting A single spinal cord injury (SCI) rehabilitation center in China. Participants Twenty-five patients with SCI at or above T6 and a history of AD who underwent urodynamic studies (UDS) before and 3 months after BTX-A injection. Interventions Received bladder injection treatment wtih 200 U BTX-A. Outcome Measures The maximum detrusor pressure(Pdetmax) and voume at first DO(VFIDC), baseline and overall maximum systolic blood pressure (SBP) during UDS, and scores of Incontinence Specific Quality of Life Instrument (IQoL) were recorded before and 3 months after the injection. The change in SBP (ΔSBP) from baseline to maximum SBP during UDS was calculated to assess the severity. The frequency of AD was recorded using ambulatory blood pressure monitoring during a 24 h period before and 3 months after the injection. Results BTX-A injection decreased the Pdetmax and increased the VFIDC and mean urine volume per catheterization increased. The maximum SBP and the ΔSBP during UDS decreased significantly decreased after the injection (151.44 ± 13.92 vs 133.32 ± 9.20 mmHg and 49.44 ± 12.81 vs 33.08 ± 9.11 mmHg respectively, P < 0.05). The frequency of bladder-related ADs (i.e. performed a clean intermittent catheterization or leakage) during a 24-h period significantly decreased from 11.04 ± 1.81–7.88 ± 2.15 (P < 0.001). Conclusions BTX-A decreases the severity of SBP increase and the number of AD episodes 3 months after intravesical injection.

The frequency of UTIs in people who undertake intermittent catheterization: A systematic review

Abstract Background Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC. Methods A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included. Results Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted. Conclusions Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients’ quality of life and also reduce the impact of diseases associated with this procedure on health systems and society. Key messages

Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele.

This study was conducted to identify potential risk factors for permanent clean intermittent catheterization (CIC) and incontinence in patients with lipomyelomeningocele (LMMC) and evaluate how LMMC affects bladder function prognosis, measured by urodynamic (UD) score. This retrospective study analyzed the electronic health records of patients who underwent primary neurosurgical repair for LMMC at a single tertiary referral center between January 2012 and December 2016 and were followed at least 3 years after surgery. Data regarding bladder function were obtained from medical records for multiple time points, including before surgery, after surgery but before hospital discharge, 3 months after surgery, and at outpatient visits during follow-up. This study enrolled 120 patients. At a mean follow-up of 62.6 ± 13.9 months after primary neurosurgical LMMC repair, 22 (18.3%) patients continued to require CIC for bladder emptying, only 7 (31.8%) of whom maintained bladder continence. A multivariate logistic regression model identified age at the time of surgery and the type of LMMC as significant presurgical prognostic risk factors for permanent CIC. In addition, postoperative urinary retention and a UD score greater than or equal to 5 measured 3 months after surgery were identified as significant postsurgical risk factors for permanent CIC and urinary incontinence. A linear mixed model adjusted for age at the time of surgery showed that patients with a transitional or chaotic LMMC type were more likely to experience gradual bladder function decline than patients with other LMMC types. This study identified both presurgical (age at the time of surgery, LMMC type) and postsurgical (postoperative urinary retention, UD score greater than or equal to 5 at 3 months postsurgery) risk factors for permanent CIC and urinary incontinence. In addition, LMMC type was identified as a prognostic risk factor for bladder function decline. These results will enhance the current understanding of bladder function outcomes in patients who undergo surgical treatment for LMMC.

Urinary and bowel management in cloacal exstrophy: A long-term multi-institutional cross-sectional study

We sought to evaluate long-term surgical urinary and bowel management in cloacal exstrophy (CE) in a multi-institutional study. We performed a cross-sectional study of people with CE and covered variants managed at five participating institutions. Those with <1 year follow-up or born with variants without hindgut involvement were excluded. Primary outcomes were methods of urinary and bowel management. Urinary management included: voiding via urethra, clean intermittent catheterizations (CIC), incontinent diversion and incontinent in diaper. Bowel management included: intestinal diversion (colostomy/ileostomy) and pull-through (with/without MACE). We evaluated three age groups: children (<10 years), older children (10 to <18) and adults (≥18). We assessed if management varied by age, institution or time (born≤2000 vs. >2000). A total of 160 patients were included (40% male). Median follow-up was 15.2 years (36% children, 22% older children, 43% adults). While 42% of children were incontinent in diapers, 73% of older children and adults managed their bladder with CIC, followed by incontinent urinary diversion (21%) (p<0.001, Table). CIC typically occurred after augmentation (88%) via a catheterizable channel (89%). Among older children and adults, 86% did not evacuate urine per urethra and 28% of adults had an incontinent urinary diversion. No child or adult voided per urethra. Age-adjusted odds of undergoing incontinent diversion was no different between institutions (p=0.31) or based on birthyear (p=0.08). Most patients (79%) had an intestinal diversion, irrespective of age (p=0.99). Remaining patients had a pull-through, half with a MACE. The probability of undergoing bowel diversion varied significantly between institutions (range: 55-91%, p=0.001), but not birth year (p=0.85). We believe this large long-term data presents a sobering but realistic view of outcomes in CE. A limitation is our data does not assess comorbidities or patient-reported outcomes. Rarity of volitional urethral voiding in CE forces the question of whether is a potentially unachievable goal. We advocate thoughtful surgical decision making and thorough counseling about appropriate expectations, distinguishing between volitional voiding and urinary and fecal dryness. In this long-term, multi-institutional study of patients with CE, 94% of older children and adults manage their bladder with incontinent diversion or CIC. Nearly 80% of patients, regardless of age, have an intestinal diversion. Given that no patients were dry and voided via urethra and 86% of older patients do not evacuate urine per urethra, these data bring into question what functional goals are achievable when performing reconstructive surgery for these patients.

Initial experience with vibegron for the treatment of neurogenic lower urinary tract storage dysfunction in patients with spinal cord injury

Introduction:The objective of this study was to investigate the efficacy of the β3-adrenoreceptor agonist vibegron for the treatment of neurogenic lower urinary tract storage dysfunction in patients with spinal cord injury (SCI). Materials and Methods:Twenty-three SCI patients treated with vibegron (50 mg/day) for at least 28 days were included in the study. All patients had urinary management with clean intermittent catheterization, and suffered from urinary incontinence (UI) associated with neurogenic detrusor overactivity (NDO) diagnosed with cystometrogram (CMG). Subjective symptoms and objective parameters were retrospectively evaluated before and after treatment with vibegron, using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and CMG parameters, respectively. Results:ICIQ-SF scores for the frequency, amount, and overall impact of UI, as well as the total score, were statistically significantly improved after treatment with vibegron. In terms of objective parameters, maximum detrusor pressure during storage phase statistically significantly decreased with vibegron treatment (53.0 vs 23.0 cmH2O, P<0.001). In addition, maximum cystometric capacity (291 vs 401 ml, P<0.001), bladder volume at first NDO (160 vs 270 ml, P=0.002), and bladder compliance (7.2 vs 25.4 ml/cmH2O, P<0.001) all statistically significantly improved after treatment with vibegron. Conclusion:Vibegron improved UI symptoms and CMG parameters in SCI patients. These results suggest that vibegron would be an efficacious treatment option for neurogenic lower urinary tract storage dysfunction in patients with SCI.

UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management

BackgroundUrinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user.MethodsThe Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs.ResultsThe literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs.The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user’s general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users.The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section.ConclusionsThe UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.

Factors associated with postoperative urinary retention in patients undergoing penile prosthesis implantation.

Placement of penile prosthesis had been well described in the outpatient setting, however, one barrier to same-day discharge is postoperative urinary retention (POUR). POUR remains a condition encountered during ambulatory surgical procedures and has yet to be characterized in patients undergoing penile prosthesis. We characterized POUR in a cohort of penile prosthesis recipients along with risk factors and management. Patients undergoing penile prosthesis implantation from 2014 through 2020 without pre-existing retention were included. All patients underwent a void trial immediately following penile prosthesis in the post-anesthesia care unit. POUR was strictly defined as (1) any patient requiring catheter replacement after prosthesis, (2) a rising post-void residual, or (3) inability to void after 6 h regardless of whether a catheter was placed. Independent procedures, demographic, intraoperative, and postoperative risk factors for POUR were assessed. 317 men were included of whom 27.1% experienced POUR. Men experiencing POUR and those not in retention were essentially indistinguishable with respect to previously described risk factors for POUR. Only use of both α-blockers and 5-α-reductase inhibitors was significantly associated with a greater risk of POUR, a finding maintained on adjusted analysis (adjusted odds ratio 10.1, 95% confidence interval 2.1 to 49.8). POUR resolved without intervention in 3.5%, a single episode of clean intermittent catheterization (CIC) in 7.0% of patients, and repeated CIC or indwelling catheter placement with a successful delayed void trial in 88.4% of patients. Rate of prosthesis infection in patients who experienced POUR did not significantly differ from those who did not experience POUR (4.7% vs. 2.2% p = 0.26). Our findings suggest that POUR is experienced in as many as 1 in 4 men undergoing penile prosthesis placement, most of whom must be managed with indwelling catheterization or repeated CIC. Those with indicators of symptomatic prostate enlargement are at significantly greater risk of urinary retention.

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury.

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.

Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery?

This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. Ninety-fourpatients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection(UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95%CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95%CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.

Randomized controlled trial of intravesical electrical stimulation for underactive bladder.

To evaluate the efficacy and safety of intravesical electrical stimulation (IVES) performed with a novel device in patients with underactive bladder (UAB). This was a multicentre, prospective, single-blind, randomized controlled clinical trial of patients with UAB in China. Eligible patients were randomly assigned in a 1:1 ratio to receive conventional IVES (n = 38) or IVES with an open circuit (n = 38). The primary efficacy measure was change from baseline in post-void residual urine volume (PVR) after 4 weeks of treatment. Secondary efficacy measures included changes in maximum urinary flow rate (Qmax ), bladder voiding efficiency (BVE), number of 24-h clean intermittent catheterization (CIC) procedures, and Patient Perception of Bladder Condition-Scale (PPBC-S) and American Urological Association Symptom Index Quality of Life (AUA-SI-QoL) scores from baseline after 4 weeks of treatment. Adverse events (AEs) were monitored throughout the trial. In the full analysis set (FAS), the mean (sd) PVR changes in the trial and control groups at 4 weeks were -97.1 (107.5) mL and -10.5 (86.7) mL, respectively (P < 0.01). Similar results were obtained in the per-protocol set (PPS): -102.9 (100.0) mL vs 0.7 (82.5) mL (P < 0.01). In the FAS and PPS, Qmax improved significantly at 4 weeks (P = 0.04 and P = 0.03). In the FAS and PPS, BVE was significantly improved at 4 weeks in the two groups (P < 0.01 and P < 0.01), whereas no significant differences in the number of 24-h CIC procedures, PPBC-S score or AUA-SI-QoL score were observed between the groups. Six possible therapy-related AEs occurred in six patients (four in the trial group and two in the control group; P = 0.67), all of which were urinary tract infections. No severe AEs were reported. The results of this clinical study strongly demonstrate that UAB patients benefit from this novel IVES device. More research is needed to validate the clinical utility of this device.

Risk of Retention After OnabotulinumtoxinA Injection for Overactive Bladder in a Diverse Urban Population With High BMI and Comorbidity Rates.

OnabotulinumtoxinA (BTX-A) injection is a third-line therapy for overactive bladder (OAB). Patients undergoing treatment have a 6.5% chance of requiring clean intermittent catheterization (CIC) due to postoperative urinary retention (POUR). The aim of this study was to evaluate risk factors for retention after BTX-A injections for OAB to decrease treatment hesitancy and enhance shared decision-making. This is a retrospective review of patients who underwent BTX-A injection for OAB at an urban university hospital between November 2015 and January 2021. Patients with neurogenic OAB, incomplete follow-up, or concomitant vaginal surgery were excluded. The primary outcome was POUR requiring CIC or postvoid residual volume (PVR) >200 mL at follow-up visit. Secondary outcomes included number of BTX-A injections, interval to reinjection, and whether patients reported symptom improvement. Our sample (N = 185) was 84% female with high prevalence of obesity (50%) and diabetes (32%). Twenty-one (11.4%) met the criteria for POUR with 17 (9.2%) requiring CIC. The retention and nonretention groups were similar in age, sex, smoking history, body mass index (BMI), hemogloblin A1c, and birth history, but significantly differed in preoperative PVR. Logistic regression revealed that patients with preoperative PVR 100+ mL had nearly 4-fold higher odds of POUR compared with patients with PVR less than 50 mL (odds ratio, 3.77; 95% confidence interval, 1.08-16.19). Our findings reassure patients with high BMI, as well as their physicians, that retention after BTX-A injection is not associated with BMI. However, patients presenting with high baseline PVR (100 + mL) should be counseled regarding a potentially higher risk of retention after BTX-A injection.

What is new in intermittent self-catherisation?

British Journal of Community NursingVol. 27, No. 10 TreatmentsWhat is new in intermittent self-catherisation?Aysha MendesAysha MendesE-mail Address: [email protected]Freelance Journalist, specialising in Healthcare and PsychologySearch for more papers by this authorAysha MendesPublished Online:4 Oct 2022https://doi.org/10.12968/bjcn.2022.27.10.474AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bladder and Bowel Community. Intermittent Self Catheterisation. 2017. https://www.bladderandbowel.org/conservative-treatment/intermittent-self-catheterisation/ (accessed 7 September 2022) Google ScholarHarding C, Mossop H, Homer T et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. https://doi.org/10.1136/bmj-2021-0068229 Medline, Google ScholarNational Institute for Health and Care Excellence. Healthcare-associated infections: prevention and control in primary and community care Clinical guideline [CG139]. 2017. https://www.nice.org.uk/guidance/cg139/chapter/2-Research-recommendations#intermittent-urinary-catheters-catheter-selection (accessed 7 September 2022) Google ScholarPickard R, Chadwick T, Oluboyede Y et al. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Health Technol Assess. 2018;22(24):1-102. https://doi.org/10.3310/hta22240. PMID: 29766842 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 October 2022Volume 27Issue 10ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 4 October 2022 Published in print 2 October 2022 Information© MA Education LimitedPDF download

PO247 / #518 TWO-STAGED SACRAL NEUROMODULATION PROCEDURE FOR THE TREATMENT OF NON-OBSTRUCTIVE URINARY RETENTION: A MULTI-CENTER STUDY ASSESSING PREDICTORS OF SUCCESS: E-POSTER VIEWING

Most patients with non-obstructive urinary retention (NOUR) use clean intermittent catheterization to ensure urinary drainage. Sacral neuromodulation (SNM) can be offered to restore voiding. A tined lead test phase precedes the implantation of a neuromodulator. The success rate of the test is limited. Therefore, patient selection must improve. The aims of this study were to determine the success rate of the tined lead test phase in patients with NOUR, to determine predictive factors of a successful test phase, and to determine long term efficacy and patient satisfaction.