Intermittent Urinary Catheterization Research Articles

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

Reply to Editorial Comment on "Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device"

Reply to Editorial Comment on "Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device"

Editorial Comment on “Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device”

Editorial Comment on “Initial Antimicrobial Testing of a Novel Reusable Intermittent Urinary Catheter System and Catheter Reprocessing Device”

Reduction in lower urinary tract mucosal microtrauma as an effect of reducing eyelet sizes of intermittent urinary catheters

Intermittent catheterization (IC) utilizing conventional eyelets catheters (CECs) for bladder drainage has long been the standard of care. However, when the tissue of the lower urinary tract comes in close proximity to the eyelets, mucosal suction often occurs, resulting in microtrauma. This study investigates the impact of replacing conventional eyelets with a drainage zone featuring multiple micro-holes, distributing pressure over a larger area. Lower pressures limit the suction of surrounding tissue into these micro-holes, significantly reducing tissue microtrauma. Using an ex vivo model replicating the intra-abdominal pressure conditions of the bladder, the intra-catheter pressure was measured during drainage. When mucosal suction occurred, intra-catheter images were recorded. Subsequently affected tissue samples were investigated histologically. The negative pressure peaks caused by mucosal suction were found to be very high for the CECs, leading to exfoliation of the bladder urothelium and breakage of the urothelial barrier. However, a micro-hole zone catheter (MHZC) with a multi-eyelet drainage zone showed significantly lower pressure peaks, with over 4 times lower peak intensity, thus inducing far less extensive microtraumas. Limiting or even eliminating mucosal suction and resulting tissue microtrauma may contribute to safer catheterizations in vivo and increased patient comfort and compliance.

Comparing an Integrated Amphiphilic Surfactant to Traditional Hydrophilic Coatings for the Reduction of Catheter-Associated Urethral Microtrauma.

Hydrophilic-coated intermittent catheters have improved the experience of intermittent urinary catheterization for patients compared to conventional gel-lubricated uncoated catheters. However, the incorporation of polyvinylpyrrolidone (PVP) within hydrophilic coatings can lead to significant issues with coating dry-out. Consequently, increased force on catheter withdrawal may cause complications, including urethral microtrauma and pain. Standard methods of evaluating catheter lubricity lack physiological relevance and an understanding of the surface interaction with the urethra. The tribological performance and urethral interaction of commercially available hydrophilic PVP-coated catheters and a coating-free integrated amphiphilic surfactant (IAS) catheter were evaluated by using a biomimetic urethral model designed from a modified coefficient of friction (CoF) assay. T24 human urothelial cells were cultured on customized silicone sheets as an alternate countersurface for CoF testing. Hydrophilic PVP-coated and coating-free IAS catheters were hydrated and the CoF obtained immediately following hydration, or after 2 min, mimicking in vivo indwell time for urine drainage. The model was observed for urethral epithelial cell damage postcatheterization. The majority of hydrophilic PVP-coated catheters caused significantly greater removal of cells from the monolayer after 2 min indwell time, compared to the IAS catheter. Hydrophilic PVP-coated catheters were shown to cause more cell damage than the coating-free IAS catheter. A biomimetic urethral model provides a more physiologically relevant model for understanding the factors that govern the frictional interface between a catheter surface and urethral tissue. From these findings, the use of coating-free IAS catheters instead of hydrophilic PVP-coated catheters may help reduce urethral microtrauma experienced during catheter withdrawal from the bladder, which may lead to a lower risk of infection.

Transurethral laser lithotripsy using the Mitrofanoff urethral conduit for bladder stones: a case report

BackgroundThe Mitrofanoff (appendicovesicostomy) procedure is a contraindicated urinary modification that maintains urinary continence by forming a flap-valve mechanism at the site of anastomosis between the appendage and bladder wall, which is used as a guide for urinary drainage. This technique has been used by intermittent self-catheterization patients who have difficulty voiding from the native urethra or in cases where voiding from the abdominal wall would improve quality of life. However, the risk of stone formation is high due to intermittent urinary catheterization using the Mitrofanoff conduit urethrostomy as a conduit.Case presentationThe patient was a 22-year-old Asian-Japanese woman. At 6 years of age, she underwent bilateral vesicoureteral reflux surgery, Mitrofanoff urethrostomy using the appendix, abdominal wall plication, and vaginoplasty using the ileum. During follow-up, ultrasound performed due to persistent pain during urinary drainage revealed a 26 mm bladder stone. We performed ureteroscopic lithotripsy 6Fr using ureteral access sheath and made lithotripsy using Ho: YAG laser, then successfully removed the target stone.ConclusionsWe report a case of transurethral laser lithotripsy using the Mitrofanoff urethral conduit for bladder stones. Using with ureteral access sheath made lithotripsy and retrieved ureteral stone more effective.

Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort.

Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.

Evaluation of an Integrated Amphiphilic Surfactant as an Alternative to Traditional Polyvinylpyrrolidone Coatings for Hydrophilic Intermittent Urinary Catheters

IntroductionPolyvinylpyrrolidone (PVP) is commonly used to provide catheters with a lubricious coating when hydrated, however, it becomes adhesive as it dries which may cause catheters to adhere to the urethral mucosa and potentially leave a sticky residue. The aim of this study was to compare catheters coated with PVP with an integrated amphiphilic surfactant (IAS) using an in vitro agar model to assess potential sticking and shedding of the catheter surface on removal. MethodsHydrated catheter samples were attached to the upper grips of a texture analyser, lowered vertically into agar, and withdrawn after two minutes. Resultant force-distance plots were used to determine maximum forces for withdrawal. Catheter surfaces were stained with red dye and the agar was visually inspected for dye residues after withdrawal. ResultsA sharp peak in force on initial withdrawal was observed for six of the eight PVP-containing catheters indicating that a greater force was required to initiate withdrawal from the agar suggesting sticking of the catheter. This peak was absent for catheters with the IAS which also displayed lower mean maximum withdrawal forces compared with many of the PVP-based catheters (p < 0.05). Red dye was observed to remain in the agar after withdrawal of all PVP-coated catheters indicating that there had been shedding of the hydrophilic coating. In contrast, there was no evidence of dye residues in the agar from IAS-based catheters suggesting that no shedding occurred. ConclusionIAS catheters show absence of adhesive properties and delamination observed for many PVP catheters when tested in vitro.

A Real-world Data Analysis of Intermittent Catheterization, Showing the Impact of Prelubricated Versus Hydrophilic Catheter Use on the Occurrence of Symptoms Suggestive of Urinary Tract Infections

BackgroundSystematic reviews have highlighted the lack of evidence on choosing the type of intermittent urinary catheter (IUC) with regard to the occurrence of urinary tract infections (UTIs). ObjectiveTo describe the incidence and frequency of symptoms suggestive of UTIs (ssUTIs) for prelubricated versus hydrophilic IUCs. Design, setting, and participantsAn observational study of a patient database compiled by UK general practitioners was conducted. Outcome measurements and statistical analysisThe primary outcome measures were the proportion of patients with at least one ssUTI (prescription of a nonspecific antibiotic with a UTI-related diagnosis, or prescription of a UTI-specific antibiotic) and the mean number of ssUTIs per affected patient in the 12 mo following the index IUC prescription. Comparable prelubricated (“PRELUBE”) and hydrophilic (“HYDRO”) catheter groups were obtained with 1:1 propensity score matching (PSM). Results and limitationsA total of 5296 patients were included (prelubricated: n = 458; hydrophilic: n = 4838). After PSM, the two groups had similar proportions of patients with ssUTIs at baseline. The proportion of patients with ssUTIs during exposure was similar in the PRELUBE (36.9%) and HYDRO groups (41.5%; p = 0.155). However, among patients having used the same type of catheter throughout the exposure period, the proportion with ssUTIs was significantly lower in the PRELUBE group (44.6%, vs 55.0% for HYDRO; p = 0.015), as was the number of ssUTIs per patient (1.3 vs 1.8; p = 0.036). ConclusionsWhen choosing a coated IUC, physicians and patients should not rule out PRELUBE IUCs for safety reasons alone. Patient summaryUsing real-world data compiled by UK general practitioners, we described the incidence and frequency of symptoms suggestive of urinary tract infection in people who were using various types of intermittent urinary catheters. When the same type of prelubricated catheter was used throughout the study period, the incidence of these symptoms was lower than for hydrophilic catheters.

Association between emergency department modifiable risk factors and subsequent delirium among hospitalized older adults.

To evaluate the association between potential emergency department (ED)-based modifiable risk factors and subsequent development of delirium among hospitalized older adults free of delirium at the time of ED stay. Observational cohort study of patients aged ≥75years who screened negative for delirium in the ED, were subsequently admitted to the hospital, and had delirium screening performed within 48h of admission. Potential ED-based risk factors for delirium included ED length of stay (LOS), administration of opioids, benzodiazepines, antipsychotics, or anticholinergics, and the placement of urinary catheter while in the ED. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CIs) were calculated. Among 472 patients without delirium in the ED (mean age 84years, 54.2% females), 33 (7.0%) patients developed delirium within 48h of hospitalization. The ED LOS of those who developed delirium was similar to those who did not develop delirium (312.1 vs 325.6min, MD -13.5min, CI -56.1 to 29.0). Patients who received opioids in the ED were as likely to develop delirium as those who did not receive opioids (7.2% vs 6.9%: OR 1.04, CI 0.44 to 2.48). Patients who received benzodiazepines had a higher risk of incident delirium, the difference was clinically but not statistically significant (37.3% vs 6.5%, OR 5.35, CI 0.87 to 23.81). Intermittent urinary catheterization (OR 2.05, CI 1.00 to 4.22) and Foley placement (OR 3.69, CI 1.55 to 8.80) were associated with a higher risk of subsequent delirium. After adjusting for presence of dementia, only Foley placement in the ED remained significantly associated with development of in-hospital delirium (adjusted OR 3.16, CI 1.22 to 7.53). ED LOS and ED opioid use were not associated with higher risk of incident delirium in this cohort. Urinary catheterization in the ED was associated with an increased risk of subsequent delirium. These findings can be used to design ED-based initiatives and increase delirium prevention efforts.

Psychometrics of the self-efficacy instrument of clean intermittent urinary catheterization in patients with neural bladder admitted to rehabilitation hospitals in Tehran in 2019

Psychometrics of the self-efficacy instrument of clean intermittent urinary catheterization in patients with neural bladder admitted to rehabilitation hospitals in Tehran in 2019

P0029 - Symptoms suggestive of urinary tract infection rates among intermittent urinary catheter users: Real-world evidence research based on a longitudinal patient database in the UK

P0029 - Symptoms suggestive of urinary tract infection rates among intermittent urinary catheter users: Real-world evidence research based on a longitudinal patient database in the UK

Trends in the use and costs of intermittent urinary catheters in the Netherlands from 1997 to 2018: A population‐based observational study

AimTo obtain insight into the the use and costs of clean intermittent catheterization (CIC) in the Netherlands from 1997 to 2018.MethodsFor this population‐based study, data on the use and costs of disposable catheters were provided by the Drug Information Project database. This database contains information about the Dutch insured population, which increased from 9.9 to 17.1 million persons between 1997 and 2018 (64%–100% of the Dutch population). The following trends were evaluated: (1) CIC users, (2) distribution of users by gender and age‐group, (3) distribution of users by neurogenic and non‐neurogenic cause for CIC, (4) total costs, and (5) costs per user. Total users are adjusted for the Dutch population. Costs are corrected for inflation and expressed in euros.ResultsExtramural use of CIC increased from 14,258 users in 1997 to 45,909 users in 2018. CIC users per 100,000 persons nearly tripled from 92 users to 267 users. Male CIC users almost quadrupled from 92 to 334 per 100,000 insured persons, whereas female users more than doubled from 91 to 201 per 100,000 insured persons. In 2018, 49% of the users had a non‐neurogenic cause for CIC. Total costs increased from 16.4 million euros in 1997 to 74.6 million euros in 2018. Costs per user rose from 1151 to 1624 euros (41.1%).ConclusionsThe use and costs of disposable catheters in the Netherlands increased substantially over the past two decades. Non‐neurogenic bladder patients represent 49% of the population on CIC, which has not been described before in the literature.

Development and Effectiveness Testing of “Punsook”: A Smartphone Application for Intermittent Urinary Catheter Users with Spinal Cord Injury

Objective: To develop and evaluate effectiveness of a smartphone application to assist the self-management of intermittent urinary catheter users Methods: This is experimental clinical research as part of a medical device trial. In phase 1, 10 intermittent urinary catheter users were recruited from spinal cord injury (SCI) patients who had been admitted to a rehabilitation ward at Siriraj Hospital. They used the preliminary version of “Punsook”, a web-based application (app) for a smartphone, alongside usual intermittent urinary catheterization (IC), and gave feedback on their experiences. Their qualitative opinions were used to further develop a second version of the “Punsook” app. In phase 2, the new version was used by 35 participants, who were asked to complete an effectiveness questionaire after using the app, including providing details on their history of urinary tract infection (UTI), urinary leakage, and catheterization-related pain. This information was gathered at the end of first and third months in the second phase of the study. Results: More than half the participants agreed at the end of the first month that every part of the app was acceptably pleasant. They liked the simplicity and ease of use of the app, accessibility, ease of return to use, and interest in the program. No statistically significant changes in urinary leakage, UTI, or pain were found. Conclusion: The app was considered effective in terms of the positive user satisfaction with all aspects of the app. However, despite this positive reception, the app may not have contributed to an improvement in participant bladder control.

The frequency of urinary tract infections and the value of antiseptics in community-dwelling people who undertake intermittent urinary catheterization: A systematic review

This systematic review had 2 aims. First to identify the incidence of urinary tract infection (UTI) and bacteriuria in people undertaking intermittent catheterization (IC), second to determine the effectiveness of antiseptic cleaning of the meatal area prior to IC in reducing the incidence of UTI and bacteriuria. A systematic review was conducted. Medline and the Cumulative Index to Nursing and Allied Health Literature electronic databases were systematically searched between January 1, 1990 and January 31, 2020, to identify studies that reported either the incidence of UTI or bacteriuria or the impact of using antiseptics for meatal cleaning prior to IC on incidence of these same outcomes. Twenty-five articles were identified for the first aim, 2 articles for the second. The proportion of participants experiencing ≥1 UTIs per year ranged from 15.4% to 86.6%. Synthesis of these studies suggest a combined incidence of 44.2% (95%CI 40.2%-48.5%) of participants having ≥1 UTIs per year. One of the 2 studies exploring the benefit of antiseptics in reducing UTI suggest some potential benefit of using chlorhexidine in reducing UTIs. Both studies have significant limitations, making interpretation difficult. A large proportion of people undertaking IC in the community have UTIs each year. Evidence on the role of antiseptics in the prevention of UTI for people who undertake IC remains unclear.

Favorable evolution on functional key components but with multiple remaining phatological elements in a patient diagnosed with toraco-lombar SCI - Case report

Introduction: This paper presents an extremely complex case: paraplegia with T11 neurological level after a thoraco-lumbar spinal cord injury (SCI), with T12 commutative fracture, by falling from about 2 meters (operated on 17.02.2020), currently having an AIS/ Frankel C motor deficit, with multiple complications and successive aggravation, as well as the approach of its therapeutically-rehabilitation management. Materials and methods: 41-year-old male patient admitted to our Clinical Division for motor deficiency of paraplegia type, immediately postoperative AIS/ Frankel C, currently AIS/ Frankel D, for superficial sensitivity disorders with T11 level was clinically and functionally evaluated, according to the implemented standard protocols of our Clinic, by the following measurement evaluation scales: AIS, FIM, QQL (Quality of life), Ashworth, Penn, FAC, WISCI II and investigated paraclinical). Duringh hospitalization, the patient presented numerous aggravations and complications such as: urinary tract infection with E. Coli; left epididymo-orchities, all this aggravating and delaying therapeutic procedures, respectively recovery results. Results: Following an optimal treatment including pharmacological and a complex neuro-rehabilitation program, the patient had a favorable evolution with increased values of the measurement scales (motor AIS with 13 points, FIM motor with 5 points, QQL with 9 points, and FAC with 1 point ); incomplet remission of the bladder and neurogenic bowel dysfunction (intermittent urinary catheterization); increased muscle strength with improved walking speed and balance. Conclusion: The rehabilitation of patients with spinal cord injury is a complex process which requires taking into account all associated pathologies that can play a decisive role in the evolution of the patient. A multidisciplinary team is required for such purposes. Keywords: spine-cord injury, paraplegia, poly-pathologic, rehabilitation,

Editorial Comment: An Effective Evidence-Based Cleaning Method for the Safe Reuse of Intermittent Urinary Catheters: In Vitro Testing

Editorial Comment: An Effective Evidence-Based Cleaning Method for the Safe Reuse of Intermittent Urinary Catheters: In Vitro Testing

Levator ani muscle avulsion: a risk factor for persistent postpartum voiding dysfunction

Persistent postpartum voiding dysfunction (P-PPVD) is defined as the inability to empty the bladder properly 72h after delivery despite the use of intermittent urinary catheterization. Our aim was to find predictive factors for P-PPVD and to compare its urogynecologic outcomes with transient dysfunctions. A case-control study was performed in a university hospital center between January 2018 and April 2019. The case group included women diagnosed with P-PPVD after vaginal delivery, and the control group included women with PPVD that resolved before 72h. Patients were followed up at 12weeks and 12months postpartum, including an ultrasound assessment of the levator ani muscle (LAM). Of 2308 deliveries, 1894 (81%) were vaginal, 75 (3.85%) presented PPVD, and 1 lasted > 72h (0.69% P-PPVD). LAM avulsion (OR 6.3, 95% CI 1.24-32.01) was the only independent risk factor for P-PPVD found. No significant differences in urogynecologic symptoms between transient and persistent PPVD were found in the short and the long term, except that women with P-PPVD had a lower prevalence of urinary incontinence at 12weeks postpartum. PPVD is a common, self-limited event, but in 17.3% of cases persists > 3days. Levator ani muscle avulsion acts as an independent risk factor for P-PPVD. Early diagnosis and appropriate treatment of P-PPVD can help minimize any clinical implications for long-term urogynecologic disorders.

A biomimetic urethral model to evaluate urinary catheter lubricity and epithelial micro-trauma

The standard method of evaluating the lubricity of intermittent urinary catheters with coefficient of friction (CoF) testing is not physiologically relevant, while there is also a dearth of published research on catheter-associated urethral micro-trauma. We developed a novel human urethral epithelial cell-seeded model of the urethra to replace the rubber counter-surface used in standard CoF testing. This cell-seeded model, in conjunction with a novel testing device, allows an investigation of catheter-associated epithelial micro-trauma in vitro for the first time. The CoF of four brands of commercially-available hydrophilic-coated intermittent catheters was measured using both the rubber and urethral model counter-surfaces. Post-catheterisation of the urethral model, the damage to the epithelial layer was analysed using standard cell imaging. The rubber counter-surface was shown to over-estimate the CoF of gel-coated catheters compared to our urethral model due to stick-slip behaviour caused by polymer-on-polymer interaction of the catheter base material on the rubber counter-surface. We identified no deleterious effect due to the presence or design of catheter eyelets to either the CoF measurements or the degree of epithelium damage in our model. Furthermore, the epithelial damage did not correlate with the measured CoF of the low friction catheters, suggesting a more nuanced pathogenesis of urethral irritation and casting doubt on the translatability of a solely mechanical assessment of lubricity of urinary catheters to a clinical effect.

An effective evidence-based cleaning method for the safe reuse of intermittent urinary catheters: In vitro testing.

To determine a safe bactericidal cleaning method that does not damage urethral catheters used for intermittent catheterization. In some countries, single-use catheters are the norm; in others, the reuse of catheters is common depending on health insurance, personal preference, or individual concerns about the environment. However, no recent study of cleaning methods has been published to provide evidence for the safe reuse of catheters. Using advanced microbiological methods, a laboratory study of eight cleaning methods was conducted. Sections of uncoated polyvinylchloride (PVC) catheters were exposed to bacterial uropathogens in physiologically correct artificial urine media then tested with a range of heat, chemical, and mechanical cleaning methods. Analysis of culturable and viable but nonculturable (VBNC) bacteria was done and direct microscopy was used. Descriptive statistics were used to compare values. Heat treatments, although effective, resulted in catheter surface breakdown and damage. Ultrasonic cleaning and vinegar showed evidence of VBNC populations indicating the methods were bacteriostatic. Detergent and water wash followed by immersion in a commercially available 0.6% sodium hypochlorite solution and 16.5% sodium chloride (diluted Milton) gave consistent bactericidal results and no visible catheter damage. Combined mechanical and chemical treatment of a detergent and water wash followed by immersion in diluted Milton (the "Milton Method") provided consistent and effective cleaning of uncoated PVC catheters, showing bactericidal action for all uropathogens tested after repeated exposure. If found safe in clinical testing, this method could increase the reuse of catheters, reduce plastic waste in the environment, reduce cost, and increase patient choice.