A Scoping Literature Review on Patient Education in Intermittent Catheterization.

PURPOSE: To summarize evidence related to (1) research studies examining patient/caregiver educational interventions related to intermittent self/caregiver catheterization (ISC), (2) studies examining issues related to teaching ISC, and (3) evidence-based clinical practice guidelines addressing ISC. PROBLEM: Avoiding lower urinary tract trauma during catheter insertion, adequate frequency of catheterization, and complete emptying of the bladder are essential to prevent and reduce complications associated with ISC. Consequently, proper patient/caregiver education is essential to achieving good outcomes. METHODS: Scoping review of literature. SEARCH STRATEGY: We searched PubMed, EMBASE, and CINAHL databases, and the reference lists of background and included studies for quantitative and qualitative research studies and professional and healthcare organization-generated evidence-based clinical practice guidelines published between 2005 and September 2021. Eleven studies and 2 clinical practice guidelines met our eligibility criteria and are included in the review. FINDINGS: Research conducted in the United States examining the effectiveness of educational interventions for patients needing ongoing ISC is extremely limited. The single study identified was a small pilot feasibility study. Eight studies examining issues potentially related to patient/caregiver ISC education were identified, suggesting that catheter characteristics, patient barriers, and complications, particularly urinary tract infections, adherence, and upper extremity function, are important considerations when developing education interventions. The small number of studies and limitations in the methodologies limit the current evidence base to support patient/caregiver education about ISC. We also identified 2 evidence-based guidelines generated by European professional organizations that included recommendations related to ISC education. CONCLUSIONS: Additional research is needed to support the development of patient/caregiver educational interventions and to examine their effectiveness.

Patient Education in Intermittent Catheterization: A Consensus Conference.

Despite recent advances in intermittent catheter features, evidence guiding how to best educate patients when beginning and continuing a program of intermittent catheterization remains sparse. To address this gap and guide best practice, a scoping review was conducted and a consensus panel of clinicians and researchers with expertise in intermittent catheterization was convened in person during December 2022 in Austin, Texas, to develop evidence and consensus-based statements guiding instruction of patients beginning intermittent self or assisted catheterization. This article describes the 15 consensus-based statements that can be used to guide best practice in patient education on intermittent catheterization.

Defining the urology nurse practitioner role in the United States: A Delphi study.

BACKGROUND: Nurse practitioners (NPs) achieve expertise in urology environments due to on-the-job training and independent study, coupled with mentoring. This creates a wide variety of preparation and role descriptions, and despite the availability of sought NP certification in urology, there is not a current definition for a "urology NP." PURPOSE: This project sough to develop a contemporary definition of the urology NP role, based on expert opinion. METHODS: Study design was the Delphi method, which evaluates consensus and opinion when there is incomplete knowledge or lack of evidence. Participants were a nonrandom panel of experts on the urology NP role with at least 2 years as a full-time urology NP. This exempted study collected data via an online platform that ensured anonymity, and was completed in two rounds. RESULTS: The following definition is proposed after the study results: "The Urology NP provides acute and chronic care to individuals experiencing urological health care needs across the lifespan, engages in office-based urology procedures in accordance with the state Board of Nursing, maintains membership in professional organizations and acts as preceptor to all health care disciplines." Certification in the specialty role was deemed important. IMPLICATIONS FOR PRACTICE: Results demonstrated the very patient-care centered nature of this specialty NP role, as professional roles of the NP were given less weight. The project offers a definition of the urology NP role that can be offered to educators and other stakeholders.

Intradetrusor injection of adult muscle-derived cells for the treatment of underactive bladder: pilot study.

We conducted the first-regenerative medicine cellular therapy for underactive bladder (UAB) in an FDA-approved, compassionate-use IND trial to evaluate treatment safety and potential clinical efficacy of autologous muscle-derived stem cells (AMDC) on a patient with UAB. No study-related adverse events or side effects were reported. In the 1-year follow-up period, the subject denied any gross hematuria, urgency, frequency or infection. A reduction in maximum cystometric capacity from 844 to 663 mL was observed, and the patient was able to void small amounts but continues to require self-catheterization 1 year after AMDC injection. Intradetrusor injection of AMDC is safe, minimally invasive and a promising treatment option for the UAB.

Epidemiology and demographics of the underactive bladder: a cross-sectional survey.

The aim of this study was to evaluate the prevalence and awareness of symptoms suggestive of underactive bladder (UAB) in a heterogeneous, non-specific population to garner additional epidemiologic information about UAB. After IRB approval, an 18-item survey was mailed to 5,000 people living in metro Detroit to collect demographic data and questions regarding clinical urinary symptoms and familiarity with UAB. A total of 633 subjects (13; 54 % men, 46 % women) returned the survey. Nearly one quarter (23 %, n = 137) of respondents reported difficulty emptying his/her bladder, yet only 11 % (n = 70) had ever heard of UAB. The study results indicated that patient-reported bladder emptying symptoms are prevalent, as common in women as men, and significantly associated with comorbidity and poor self-reported health. The results suggest that the burden and impact of UAB might be significant and that a syndromic concept of UAB warrants research to determine the true burden of disease, increase awareness, and broaden efforts to investigate therapeutic directions.

Defining and advancing education and conservative therapies of underactive bladder.

In contrast to other forms of voiding dysfunction, underactive bladder (UAB) has traditionally received little research or educational attention. This is changing as our understanding of the underlying mechanisms of detrusor dysfunction and other forms of underactive bladder improves. In addition, the impact of UAB on patient symptoms, general and health-related quality of life, and caregiver burden are becoming more recognized. However, there remains a paucity of data on the subject, and an extensive need for additional research and education on the topic. This paper explores the current state of knowledge about UAB with an emphasis on education regarding the condition and conservative methods of assessment and treatment. Recommendations for future work in this area are considered.

Gelnique (oxybutynin chloride) 10% gel for overactive bladder.

This article provides an overview of oxybutynin transdermal gel (Gelnique), its uses, and product information.

Group session teaching of behavioral modification program (BMP) for urinary incontinence: a randomized controlled trial among incontinent women.

PURPOSE: To determine effectiveness of Group BMP in managing female urinary incontinence (UI), using a standardized protocol taught to adult incontinent women. MATERIALS AND METHODS: Forty-four adult women with slight to severe UI had baseline parameters collected (UI questionnaires, 3-day voiding diary, pelvic floor muscle strength testing, 24-h pad test, and cough stress test) and were randomized to a control group (CG) with no treatment and a treatment group (TG) who underwent a single group session lecture by two trained urology nurses on BMP followed 2-4 weeks later with individualized assessment of knowledge acquired and reinforcements if needed. The same baseline measures were collected after 6-8 weeks, and statistical analysis comparing changes within groups and between CG and TG were performed. RESULTS: Baseline data for both groups showed no statistically significant difference except for an age difference. At 6-8 weeks post-intervention, a statistically significant higher proportion of the TG (52.2%) improved when compared to the CG (16.7%). Also, the TG showed statistically significant improvement in 24-h voids, reduced leak diameter on cough test, improved pelvic muscle strength in pressure score, displacement, and duration, respectively, compared to their baseline pre-intervention data. The CG had only a statistically significant change for displacement score. CONCLUSIONS: Group session teaching of BMP by trained urology nurses reduces UI severity, increases pelvic floor muscle strength, and reduces voiding frequency. This pilot study may precede establishment of single session Group BMP as both preventive and therapeutic for a cost-effective broad-based program in the future.

The use of botulinum toxin type A in urological procedures.

Botox is a sterile, vacuum-dried, purified BoNT-A produced from fermentation of Clostridium botulinum. There is an abundance of literature to support the use of Botox in urology, and its off-label use continues to grow. While there are no FDA-approved clinical indications, there are ongoing phase II and III studies to approve Botox for use in some urological conditions. This article will explore the use of Botox in urology and provide a brief review of the literature supporting its use.

Sacral neuromodulation reprogramming: is it an office burden?

Our objective was to evaluate the burden of sacral neuromodulation (SNM) reprogramming and the reasons for reprogramming, and to correlate these with the underlying diagnosis. A retrospective review of 50 consecutive subjects implanted with SNM was completed from November 2002 through December 2005. Of the 50 SNM implants, 47 subjects had adequate follow-up. The mean age was 53.1 (22-90 years) with 83% women. Of the SNM performed, 91.5% were done for urinary urgency, frequency, or incontinence and 47.4% of those had interstitial cystitis. Overall, 239 programming visits were recorded, and subjects on average had two reprogramming visits per year. There was no correlation with number of reprogramming events and patient age, sex, reason for implantation, or diagnosis. These data suggest that the number of reprogramming episodes is small, and the majority is done as part of routine follow-up. No additional burden was seen in subjects with interstitial cystitis.

Group session teaching of behavioral modification program for urinary incontinence: establishing the teachers.

In a past study it was determined that a nurse scientist and an urologist were able to prevent incontinence in women through teaching strategies in a group setting. This study determined that the same knowledge could be taught by an experienced nurse practitioner and an experienced urology nurse.