Condom Catheter Research Articles

Ten-year treatment complication outcomes of radical prostatectomy vs external beam radiation vs brachytherapy for 1503 patients with intermediate risk prostate cancer

To compare 10-year late complications of radical prostatectomy (RP) versus external-beam-radiation-therapy (EBRT) versus brachytherapy (BT). Retrospective analysis was performed on 1503 intermediate-risk-prostate-cancer patients treated from 2004 to 2007, using univariate comparisons. Eight hundred and nineteen underwent RP, 574 EBRT, and 110 BT. RP urinary and rectal complications were graded severe if patients required ≥3 pads/diapers per day, chronic condom catheter or penile clamp, daily clean-intermittent-catheterization, sling, artificial-urinary-sphincter, or rectal fistula. Complications for EBRT/BT were severe if graded 3/4 on the Radiation-Therapy-Oncology-Group scale for late effects. The prevalence of erectile-dysfunction-devices (EDD) of injections, pumps and/or penile implants were compared. Median follow-up for RP versus EBRT versus BT were 10.0, 9.6, and 9.8 years. Median age were 62.1, 70.8, 65.3, p < 0.0001. The 10-year prevalence of severe urinary complications for RP versus EBRT versus BT were 10.1%, 12.5%, 4.6%, p = 0.03, and were less for RP <64 years, p = 0.03, and lower Charlson score, p = 0.05. Pretreatment American-Urological-Association (AUA) score existed for 7.3%, 11.5%, 97.3% of RP versus EBRT versus BT, p < 0.0001, and the 10-year prevalence of EDD were 24.3%, 6.6%, 8.2%, respectively, p< 0.0001. Severe rectal complications were slightly higher for EBRT, p = 0.06. BT had lower prevalence of severe urinary complications, possibly by using AUA score to avoid patients with obstructive uropathy. Urinary complications may be reduced by limiting RP to younger, healthier patients, and by avoiding EBRT/BT with obstructive symptoms. RP had higher prevalence of EDD, despite having younger, healthier patients.

Urine HPV in the Context of Genital and Cervical Cancer Screening-An Update of Current Literature.

Within the previous decades, following the widespread implementation of HPV-related biomarkers and computerization in liquid-based cytology, screening for lower genital tract malignancies has been optimized in several parts of the world. Many organized anogenital cancer prevention systems have reached a point at which efficacy is more a matter of population coverage and less of available infrastructures. Meanwhile, self-sampling modalities in which biologic material (vaginal secretions, urine, etc.) is obtained by the individual and not the clinician and subsequently undergoes examination for HPV biomarkers enjoy appreciating acceptance. Bygone the initial skepticism that vaginal or urine HPV represents "passenger" transient infections, extensive scientific work has been conducted to optimize high-risk HPV (hrHPV) detection from this "novel" biologic material. Nowadays, several state-of-the-art meta-analyses have illustrated that self-sampling techniques involving urine self-sampling represent a feasible alternative strategy with potentially enhanced population coverage possessing excellent performance and sensitivity. Recently published scientific work focusing on urine HPV was reviewed, and after a critical appraisal, the following points should be considered in the clinical application of hrHPV urine measurements; (i) use of first-void urine (FVU) and purpose-designed collection devices; (ii) using a preservation medium to avoid human/HPV DNA degradation during extraction and storage; (iii) using polymerase chain reaction (PCR) based assays, ideally with genotyping capabilities; (iv) processing of a sufficient volume of whole urine; and (v) the use of an analytically sensitive HPV test/recovery of cell-free HPV DNA in addition to cell-associated DNA.

626 Female External Urinary Collection Device Utilization in a Female Burn ICU Patients: A Quality Improvement Project

Abstract Introduction A significant portion of intensive care unit (ICU) patients require a Foley catheter during their admission. Foley use has become more criticized as nationwide quality improvement processes attempt to reduce catheter associated urinary tract infections (CAUTI). Burn patients in the ICU have a higher rate of catheter utilization due to difficult fluid management, need for accurate volume measurements, and significant wound care. Males may have a condom catheter exchanged once they are stabilized. Historically, a noninvasive alternative to the Foley has not been available for females. While the female external catheter has existed for quite some time and hospital systems are increasingly encouraging their use, there is no standard of practice for when they are best utilized. Specific to the burn population, potential barriers include body habitus, perineal burns, and pain on frequent changing of the device. Our study aims to evaluate the current female external catheter use in our burn ICU in order to develop a standard protocol to increase utilization while thoughtfully delineating the contraindications. Methods A quality improvement project for guidelines on the use of a female external urinary collection device was conducted. All female patients admitted to the burn ICU during 2019 were included. Data was collected on burn TBSA, anatomic location, ICU days, ventilator days, and foley catheter days. Foley catheter days, external urinary catheter days, urinary tract infection (UTI) rates, and incidence of failure of external device were collected. Results Of the 46 total female burn patients, 31 required a foley catheter at some point during their stays. 11 patients used an external urinary collection device. Of the 11 users, one urinary device had to be removed due to skin breakdown. One other patient required replacement with a Foley catheter as a result of oliguria and the need for closer fluid management. 5 of the successful users of the external catheter were clinically obese. No patients contracted a UTI while using the external catheter. 3 UTI’s developed in women while using a Foley catheter. Patients who had altered mental status and perineal wounds were not eligible to use the external catheter. Conclusions In our practice, we found contraindications to external female catheter use to include altered mental status and perineal wounds. Obesity was not a contraindication and device usage may be most beneficial in incontinent patients. Further investigation is needed to better optimize female external urinary collection device usage within the burn ICU setting. This may help minimize CAUTI’s among female burn patients.

Impact of Collection Volume and DNA Extraction Method on the Detection of Biomarkers and HPV DNA in First-Void Urine.

The potential of first-void (FV) urine as a non-invasive liquid biopsy for detection of human papillomavirus (HPV) DNA and other biomarkers has been increasingly recognized over the past decade. In this study, we investigated whether the volume of this initial urine stream has an impact on the analytical performance of biomarkers. In parallel, we evaluated different DNA extraction protocols and introduced an internal control in the urine preservative. Twenty-five women, diagnosed with high-risk HPV, provided three home-collected FV urine samples using three FV urine collection devices (Colli-Pee) with collector tubes that differ in volume (4, 10, 20 mL). Each collector tube was prefilled with Urine Conservation Medium spiked with phocine herpesvirus 1 (PhHV-1) DNA as internal control. Five different DNA extraction protocols were compared, followed by PCR for GAPDH and PhHV-1 (qPCR), HPV DNA, and HBB (HPV-Risk Assay), and ACTB (methylation-specific qPCR). Results showed limited effects of collection volume on human and HPV DNA endpoints. In contrast, significant variations in yield for human endpoints were observed for different DNA extraction methods (p < 0.05). Additionally, the potential of PhHV-1 as internal control to monitor FV urine collection, storage, and processing was demonstrated.

Efficacy of Condom Balloon Tamponade in Management of Primary Postpartum Hemorrhage

Background: Primary postpartum hemorrhage has a significant effect on maternal morbidity and mortality. Proper treatment andin time management of the patient have showed to decrease this morbidity and mortality a lot.Objective: The objective of our study is to find out the efficacy of balloon tamponade in the management of primarypostpartum hemorrhage.Material and Method: This study was conducted in Saidu group of teaching hospital, swat from 1st august 2018 to 31st July2019. All the patient with Primary postpartum hemorrhage were included in the study. All patients were first managed bymedical therapy and when the medial therapy failed then balloon catheter tamponade were introduced and patients werenoticed for stoppage of bleeding within few minutes.Result: Mean age was 27.04±5.42 years. 72 patients failed from medical therapy which was managed by condom tamponade.The response rate of condom tamponade in these 72 patient was 69 (95.83%) while 3 (4.17%) did not respond. There was nosignificant effect of age, gravida on the response rate of Balloon tamponade.Conclusion: The response rate to Balloon Catheter tamponade is high in patient with Primary postpartum hemorrhage due touterine atony. It should be tried before preceding to other Surgical management like Be-lynch, uterine artery ligation orhysterectomy in cases of medical therapy failure.Key Words: primary postpartum hemorrhage, Medical Management, Condom catheter, Response rate.

Efficacy of Condom Balloon Tamponade in Management of Primary Postpartum Hemorrhage

Background: Primary postpartum hemorrhage has a significant effect on maternal morbidity and mortality. Proper treatment andin time management of the patient have showed to decrease this morbidity and mortality a lot.Objective: The objective of our study is to find out the efficacy of balloon tamponade in the management of primarypostpartum hemorrhage.Material and Method: This study was conducted in Saidu group of teaching hospital, swat from 1st august 2018 to 31st July2019. All the patient with Primary postpartum hemorrhage were included in the study. All patients were first managed bymedical therapy and when the medial therapy failed then balloon catheter tamponade were introduced and patients werenoticed for stoppage of bleeding within few minutes.Result: Mean age was 27.04±5.42 years. 72 patients failed from medical therapy which was managed by condom tamponade.The response rate of condom tamponade in these 72 patient was 69 (95.83%) while 3 (4.17%) did not respond. There was nosignificant effect of age, gravida on the response rate of Balloon tamponade.Conclusion: The response rate to Balloon Catheter tamponade is high in patient with Primary postpartum hemorrhage due touterine atony. It should be tried before preceding to other Surgical management like Be-lynch, uterine artery ligation orhysterectomy in cases of medical therapy failure.Key Words: primary postpartum hemorrhage, Medical Management, Condom catheter, Response rate.

805. A Single Institution Pre/Post Comparison After Introduction of an External Urinary Collection Device for Female Medical Patients

BackgroundCatheter associated urinary tract infections (CAUTIs) are the most common hospital acquired infections in the United States. External urinary collection devices (EUCDs) may serve as an alternative to indwelling urethral catheters (IUCs) and decrease the rate of CAUTIs. PureWick® is a novel female EUCD, with early case reports suggesting safe and efficacious use. However, no study has definitively proven benefit of PureWick® regarding reduction of CAUTIs. We sought to compare the CAUTI rate and median indwelling catheter days before and after availability of PureWick® at a single academic institution, as well as provide a descriptive analysis on female medical patients receiving an EUCD.MethodsWe performed a retrospective review of adult female patients admitted to our institution on a medical service who received an IUC and/or an EUCD. Patients admitted in the 3 months before (PRE) and 12 months after (POST) PureWick® availability were included. Two groups were compared: PRE patients who received an IUC vs. POST patients who received an IUC and/or EUCD.ResultsOut of 866 female patients, 296 received an EUCD in the POST cohort and overall, 673 received an IUC (261 (100%) PRE vs. 412 (68.1%) POST). There were no differences in the cohorts regarding age and comorbidities (all p >0.05). Compared to the PRE cohort, the POST cohort had a higher number of IUC days (median, 3 vs. 2 days, p< 0.001) and a higher rate of CAUTI (infections per 1,000 catheter days, 11.8 vs. 4.1, p=0.003) while overall UTI rate was similar (infections per 1,000 patient days, 19.1 vs. 14.12, p=0.410). In the POST cohort, the rate of UTI associated with EUCD use was 11.6 infections per 1,000 device days. Measurement of strict ins and outs (56.8%) was the most common indication for use of EUCD.Table 1. Characteristics and comorbidities of female catheterized patients admitted to a medical service before (PRE) and after (POST) PureWick implementation. Table 2. Urinary tract infection rates of female catheterized patients PRE and POST PureWick implementation. Table 3. Characteristics of hospitalized female patients admitted to a medical service who received a PureWick catheter. ConclusionWhile EUCDs might appear to be a promising alternative to IUCs for female patients, this single center pre/post analysis found that both the median number of IUC days and the CAUTI rate increased after introduction of a single EUCD. This may be related to selection bias, with EUCDs being ordered for patients who would not have otherwise received an IUC. Further research is needed to clarify if female EUCDs can be effective in decreasing IUC days and/or CAUTI rates prior to any widespread adoption.Disclosures All Authors: No reported disclosures

Effect of an external urinary collection device for women on institutional catheter utilization and catheter-associated urinary tract infections

External urinary collection devices (EUCDs) may reduce indwelling catheter usage and catheter-associated urinary tract infections (CAUTIs). In this retrospective quasi-experimental study, we demonstrated that EUCD implementation in women was associated with significantly decreased indwelling catheter usage and a trend (P = .10) toward decreased CAUTI per 1,000 patient days.

Cost‐effectiveness of uterine tamponade devices for the treatment of postpartum hemorrhage: A systematic review

BackgroundUterine tamponade is widely promoted for treating refractory postpartum hemorrhage (PPH); however, its cost‐effectiveness may vary depending on unit costs and setting.ObjectiveTo review available data on cost‐effectiveness of uterine tamponade devices when used for PPH treatment.Search strategyPubMed and EMBASE were searched (1980 to January 2020), as well as the National Health Services Economic Evaluation database from inception (1995) to March 2015.Selection criteriaEligible studies were any type of economic evaluation, or effectiveness studies that provided cost or economic data.Data collection and analysisTwo reviewers independently screened studies, extracted data, and assessed quality.Main resultsEleven studies using a range of devices (condom catheter, uterine suction devices, Bakri, Inpress, Ellavi) were identified. Cost of condom catheter devices or kits ranged from US$0.64 to US$6, whereas purpose‐designed device costs were up to US$400. Two studies that took a health system perspective assessed the cost‐effectiveness of using uterine balloon tamponade and suggested that it was highly cost‐effective because of the low cost per disability‐adjusted life‐year averted, although both used effect estimates from case series.ConclusionsEvidence on the cost‐effectiveness of uterine tamponade devices was limited and not generalizable. Rigorous economic evaluations based on updated effect estimates are needed.

Amidst the CAUTI Metrics Hurley Burly, a Sustained SURly Success Adaptable for Reducing Other Nosocomial Infections

Background: Surveillance metrics for catheter-associated urinary tract infections (CAUTIs) are subject to ongoing debate and refinement to best capture infectious catheter-related harm (ICRH) and noninfectious catheter-related harm (NCRH). Indwelling urinary catheters cause 5 times more NCRH than ICRH. The commonly used standardized infection ratio (SIR) does not fully capture NCRH nor the impact of prevention efforts in all settings. Alternatively, device utilization rates and ratios (DUR) do not reflect differences in other factors that may describe levels of device use. DUR lose comparability over time and across settings and can mask truly effective interventions by selecting for a higher risk group of catheterized patients. Experts now advocate use of the standardized utilization ratio (SUR). We sought to implement a multidimensional intervention to reduce exposure risk, CAUTI, and NCRH across a 5-hospital healthcare system, totaling 1,692 acute-care beds. Methods: The intervention comprised the following elements: (1) an interactive educational campaign comprising one-on-one engagements between infection preventionists and frontline providers, encouraging the use of female external urinary collection devices and male custom-fitted condom catheters, rewarding overall participation, device utilization, hand hygiene, and CAUTI rates; (2) educational emails to all staff from top executives; (3) increasing the urinalysis reflex to culture threshold from &gt;5 to ≥10 WBCs; and (4) clinical decision support (CDS) for ordering urine cultures for patients with indwelling catheters and for encouraging Foley catheter alternatives and catheter removal. Monthly, quality department representatives discuss unit level DURs with managers, who then discuss patient-level device use at daily huddles with physicians and advanced practice providers. Significance was determined using the 2-tailed t test. The results are listed in Table 1. Discussion: One year after the intervention, use of device alternatives increased 5-fold, CDS-driven ordering predominated, and the SIR and SUR remained significantly decreased. These successes are especially notable because , a ventricular-assist device program was launched in the postintervention period. By the end of the study, the program became the second-busiest of its type in the United States, resulting in a group of patients at high risk of device use and infection in the postintervention period, but absent in the preintervention period. numerous reports of effective interventions for reducing CAUTI have been published, we found no large studies using the SUR as the main metric. The limitations of this study include the lack of a population SIR and data pertaining to catheter-related bacteriuria and antibiotic usage. However, this approach is easily customizable to any infection, device, and diagnostic test.Disclosures: NoneFunding: None

Effect of an External Urinary Collection Device on Catheter Associated Urinary Tract Infections in Hospitalized Women

Background: Catheter-associated urinary tract infections (CAUTIs) are a common hospital-acquired infection (HAI) resulting in excess morbidity, mortality, and cost. Urine management can be a challenging issue, particularly in women, due to limited options for control of urinary incontinence. Issues with urinary leakage and worry for subsequent skin break down often leads to indwelling catheter insertion. In the spring of 2018, our facility implemented a female external urine collection device (EUCD) in efforts to decrease catheter days and to limit CAUTIs. Methods: Retrospective, 32-month (January 2017–August 2019), quasi-experimental, before-and-after study. Catheter use and CAUTI were defined according to CDC NHSN criteria. Poisson regression was used to model the rate of CAUTI (per 1,000 patient days [PD] and per 1,000 catheter days [CD]) comparing the 14 months prior to EUCD introduction with the 14 months after introduction and allowing a 3-month introduction period. Results: The CAUTI rate did not change significantly. The overall CAUTI rate per 1,000 PD decreased slightly from 0.24 to 0.20 (P = 0.44; model risk, 0.86; 95% CI, 0.58–1.26) whereas the rate per 1,000 CD increased slightly 1.5 to 1.6 (P = 0.76; model risk, 1.06; 95% CI, 0.73-–1.56). The CAUTI rate for men increased from 0.09 to 0.11 per 1,000 PD (P = 0.42; model risk, 1.29) and from 0.99 to 1.55 per 1,000 CD (P = 0.17; model risk, 1.56). For women, the rate of CAUTI decreased from 0.15 to 0.09 per 1,000 PD (P = 0.10; model risk, 0.61) and from 2.12 to 1.65 per 1,000 CD (P = 0.38; model risk, 0.38). A significant decrease in catheter days (CD per 1,000 PD; P &lt; .0001) was observed for all hospitalized patients (from 158.56 to 128.3; model risk, 0.81), for men (from 87.06 to 72.15; model risk, 0.83), and for women (from 71.49 to 56.15; model risk, 0.79). Of 2,347 adverse events, 5 (0.2%) involved perineal skin breakdown and redness. Three events were related to malposition of the ECUD or inappropriate level of suction and 1 event was related to latex allergy and EUCD use. Conclusions: The introduction of a EUCD for women was associated with a significant decrease in indwelling catheter usage. A trend toward a decrease in CAUTI per 1,000 PD for women was observed (P = .10). Additional studies on whether the EUCD is associated with changes in UTI rates (both CAUTIs and noncatheter UTIs) as well as cost implications of EUCD are warranted.Funding: NoneDisclosures: None

Penile gangrene: A rare but disastrous complication of the improper application of condom catheters

Penile gangrene: A rare but disastrous complication of the improper application of condom catheters

Effect of an External Urinary Collection Device on Catheter Associated Urinary Tract Infections in Hospitalized Women

Effect of an External Urinary Collection Device on Catheter Associated Urinary Tract Infections in Hospitalized Women

Implementation of External Urine Collection Devices to Decrease the Standardized Utilization Ratio of Indwelling Urinary Catheters

<h3>Background</h3> Catheter associated urinary tract infections (CAUTIs) are one of the most common hospital acquired infections. CAUTIs are associated with numerous complications including increased length of stay. The most significant risk factor for developing a CAUTI is the prolonged use of an indwelling catheter. Our purpose is to determine if the introduction of external urine collection devices for both male and female patients would impact the utilization of indwelling urinary catheters and subsequently, reduce our CAUTI events in our 24-bed Intensive Care Unit (ICU). <h3>Methods</h3> We established our baseline by measuring our urinary catheter utilization rate in our ICU for all 12-months in 2017. In June 2018, a qualitative trial was performed for three weeks for a female external device and then followed by the male external device. Prior to our trial, all team members were educated on the use of the external urine collection systems. Unit based Intensivists were updated on the product trial and encouraged to participate. During the trial, a light duty nurse rounded on each patient with an indwelling catheter to discuss the need for catheter necessity. If the patient required a device, it was advocated to remove the indwelling device and use an external device. Standardized Likert scale evaluations were completed by bedside nursing and nursing assistants during the trial. <h3>Results</h3> Based on the positive trial results, both products were implemented in the ICU and subsequently expanded hospital wide. Our baseline SUR for 2017 was 1.067. In 2018, our SUR decreased by 9.7% to 0.964. To date, our SUR data for January 2019 to October 2019 is 0.736. This is an overall 31% reduction in urinary catheter utilization from our baseline data. <h3>Conclusions</h3> In conjunction with daily conversations regarding catheter necessity, the implementation of external urine collection devices has significantly decreased the SUR on indwelling catheters.

Continuous Temperature and Humidity Monitoring Using Sensors Within an External Male Incontinence Device over 12 Hours of Wear-time

<h3>Background</h3> Skin maceration and tissue breakdown, with subsequent infection, have been long-standing challenges in hospital and long-term care environments. In this regard, we sought to devise a trial that accurately measures temperature and humidity within the skin-exposed environment of a male anatomy urine collection device. <h3>Methods</h3> A device was engineered to allow air flow and yet allow for male anatomy urine collection without a catheter in order to mitigate skin exposure risks and a novel study design using state-of-the-art sensors within the device generated robust data for 24 adult males continuously over 12 hours period in a simulated clinical setting. Weight, height, age, ingested food and liquids, along with type, frequency and volume of liquid intake, frequency of urination, and volume of urine were all documented. The sensors precisely logged temperature and humidity data from within the skin-exposed environment of the device. <h3>Results</h3> The data yielded a mean temperature of 31.09°C (88°F) [Standard Error-of-the-Mean (SEM) = 0.01; SD = 1.90; range: minimum = 23.80°C and maximum = 35.40°C] and a mean relative humidity of 54.79% [SEM = 0.13; SD = 23.31; range: minimum = 24.70% and maximum = 100.00%]. Mean temperature and relative humidity within the system stabilizes over a12-hour period to produce a skin-exposed environment for male anatomy with a mean temperature of 31.09°C (88°F) and a mean relative humidity of 54.79%. <h3>Conclusions</h3> Study findings demonstrate that an external urine management system designed for male anatomy, after 12-hours of continuous wear, was able to predictably provide a skin-exposed environment for temperature and relative humidity within the device. Since the device is designed to mitigate the risk for tissue maceration and skin breakdown in a relatively enclosed environment, this novel methodology yields evidence to support continuous wear-time in the clinical setting.

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

Mechanical and surgical interventions for treating primary postpartum haemorrhage.

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 ...

FR02-05 THE EVOLUTION OF MANAGEMENT OF MALE URINARY INCONTINENCE

INTRODUCTION AND OBJECTIVE: The struggle to treat male urinary incontinence (UI) dates back centuries, with descriptions of UI in Egyptian manuscripts as early as 1500 BCE. In this review, we chronicle the history of UI interventions that have educated the modern options available to us today. METHODS: A comprehensive literature review was performed to elucidate relevant historical and clinical information. RESULTS: Various strategies have been employed for managing UI, including storage and barrier devices, urethral bulking agents, and surgical implants. While storage devices in some form have been used for centuries, French surgeon Ambrose Pare is credited with developing the first portable urinals in 1564. In the 1600s, Wilhelm Hildanus, ‘father of German surgery’, created the first documented condom catheter and the first penile clamp. A modern version of his invention, the Cunningham Clamp, was popularized in the 1980s. Urethral bulking agents for treating UI have been used since the late 19th century. Dr. Robert Gersuny, a surgeon famous for his discovery of paraffin and Vaseline as media for injection, attempted to cure UI by injecting paraffin into periurethral tissue with mixed outcomes. Since then, various bulking agents have been shown to improve coaptation of the sphincteric zone. Lorenz Heister invented the first recorded surgical device for compressing the bulbar urethra to treat UI in 1747. Two hundred years later, Frederic Foley created a urinary sphincter, which was worn around a surgically isolated segment of corpus spongiosum. In the 1960s, surgeons attempted to reduce UI by attaching the 7th rib to the pubic bone to reduce undesired voiding. In 1973, F. Brantley Scott created the first multi-component artificial urinary sphincter (AUS), which remains the benchmark therapy for UI today. In the 1960s, John Berry described an acrylic mesh urethral sling, which was implanted ventrally into the bulbar urethra and attached to the pubic ramus. Joseph Kaufman invented a similar silicone sling in the 1970s. Early on, these devices were fraught with complications, including urethral erosion, fistulas, and pain. More recently, the transobturator male sling, which came to market during the 2000s, has become an option for select men. CONCLUSIONS: The modern devices we use for the treatment of IU are evolutionary byproducts of centuries of experimental designs by pioneering surgeons from around the world. While the materials have improved, barriers, storage devices and bulking agents almost identical to the versions first invented remain in use today. The electronic AUS will usher in the next phase of advancement in this field. Source of Funding: None.

Urine exosome gene expression assay net benefit analysis in a large pooled cohort.

287 Background: Over-diagnosis of indolent prostate cancer (PCa), supports the need for non-invasive tools that can differentiate low-grade (≤ Gleason score 6, GS 6) from high-grade (≥ GS 7). We examined the clinical benefit of ExoDx™ Prostate (IntelliScore) (EPI) results in a pooled cohort over a range of probabilities using net benefit analysis. Methods: A pooled dataset of two prior validation cohorts and additional cases from a large group practice provided a large data set (N=1,212) for net benefit analysis. The pooled population consisted of men &gt; 50 years, scheduled for initial biopsy and with a PSA measurement. Urine specimens were collected at enrollment using a provided urine collection device and the EPI tests were run at a CLIA-certified central laboratory at Exosome Diagnostics, Waltham, MA. The clinical decision value of the urine exosome gene expression assay (EPI) was assessed using net benefit analysis and compared EPI results with standard of care information across a range of probabilities for which a patient might decide on a prostate biopsy. The net benefit is determined by adding the true positive results and subtracting the false negatives across different biopsy probability thresholds. Results: The ExoDx IntelliScore or EPI assay (green) demonstrated superior clinical benefit when compared to the Prostate Cancer Prevention Trial (PCPT) prostate cancer risk calculator or PSA. Conclusions: In this new analysis of a large pooled cohort, the EPI exosome gene expression assay had the highest clinical net benefit across the 10% - 50% decision threshold compared to decision support methods currently used in the clinic.

The Real Daily Need for Incontinence Aids and Appliances in Patients with Neurogenic Bladder Dysfunction in a Community Setting in Germany.

PurposeFor successful long-term rehabilitation of patients with neurogenic lower urinary tract dysfunction (NLUTD), it is necessary to define the objective requirement for urological aids based on a scientifically validated basis.MethodsThis was a cross-sectional multicenter study, based on a questionnaire. Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD in a community setting were collected through a standardized survey.ResultsSeven hundred and sixty-seven records were analyzed: 543 males, 221 females (N/A = 3). Patients using intermittent catheterization (n= 608) required 5.06 (mean) single-use catheters per day. Out of them, 94 (15.5%) required additional pads (mean: 2.29 per day), 34 patients (5.6%) additionally used pants (mean: 2.55 per day) and 46 patients (7.6%) utilized condom catheters (mean: 3.81 per day) between catheterizations. Among all, 126 patients (16.4%) used pads (mean: 5.03 per day), and 51 patients (6.6%) used pants (mean: 3.03 per day). Women needed both pads (p < 0.0001) and diapers (p = 0.0084) significantly more frequently than men. Eighty-two of the male patients (15.1%) applied condom catheters (mean: 2.8 per day). The target value of the objective daily requirement of incontinence aids for adult patients with NLUTD (based on the upper twofold standard deviation from the mean value) was defined as follows: up to nine single-use catheters, seven condom catheters, nine pads and/or seven pants. A “mixed supply” of different incontinence aids is part of the daily supply for many patients.ConclusionFor the first time, these results allow a reasonable regulation of urological aids and appliances based on scientific data for patients with neurogenic bladder.