Bladder management in patients with pediatric onset neurogenic bladders.

Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p = 0.04), > 10 catheters per month (p = 0.01) and gloves (p < 0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations.

Tissue-engineered cartilage for implantation and grafting.

Facial plastic and reconstructive surgeons are continually faced with the dilemma of what material to use for implantation and grafting. Tissue-engineered cartilage is a relatively new and exciting concept which utilizes chondrocytes and cultures them on a three-dimensional biodegradable template. This template/cell complex is first briefly incubated in vitro, then implanted into a recipient host. In situ the template resorbs and is replaced with new cartilage that is viable, compatible, and mature. This paper discusses the biochemical composition of cartilage, the concept of tissue engineering, advances in template quality, and cartilage immunogenicity. Future clinical applications of this type of graft research include microtia repair, facial reconstruction, rhinoplasty, and other facial cosmetic procedures.