Healthcare utilization during transition to adult care in patients with spina bifida A population-based, longitudinal study in Ontario, Canada.

INTRODUCTION: Individuals with spina bifida (SB) may experience negative health outcomes because of an informal transition from pediatric to adult care that results in using the emergency room (ER ) for non-acute health problems. METHODS: We conducted a retrospective, population-based cohort study of all people with SB in Ontario, Canada turning 18 years old between 2002 and 2011. These patients were followed for five years before and after age 18. Primary outcome was the annual rate of ER visits. Secondary outcomes included rates of hospitalization, surgery, primary care, and specialist outpatient care. We estimated the association between age and primary and secondary outcomes using negative binomial growth curve models, adjusting for patient-level baseline covariates. RESULTS: Among the 1215 individuals with SB, there was no trend of ER visits seen with increasing age (relative risk [RR ] 0.99, 95% confidence interval [CI] 0.98-1.02); however, there was a significant increase in the rate of ER visits associated with turning 18 years (RR 1.14, 95% CI 1.03-1.27). Turning 18 years old was also associated with a decreased rate of hospital admissions (RR 0.79, 95% CI 0.66-0.95) and no change in surgeries (RR 0.80, 95% CI 0.64-1.02). Visits to primary care physicians remained stable over the same period (RR 0.96, 95% CI 0.90-1.01), while visits to SB-focused specialists decreased after age 18 (RR 0.81, 95% CI 0.75-0.87). CONCLUSIONS: In patients with SB, the rate of ER visits increased significantly at 18 years old, while hospital admissions and specialist physician visits decreased at the same time. Models of transitional care can aim to reduce non-urgent ER visits and facilitate regular specialist care.

Do larger cuff sizes with artificial urinary sphincter placement increase the risk of leakage after placement?

INTRODUCTION: To determine whether larger artificial urinary sphincters (AUS) cuff sizes of ≥ 5.0 cm have an impact on urinary incontinence after AUS implantation as compared to cuff sizes ≤ 4.5 cm. MATERIALS AND METHODS: A retrospective chart review of AUS implants performed at our institution from 1991 to 2021. Medical records were reviewed for demographics including body mass index (BMI), cause of incontinence, pelvic radiation, valsalva leak point pressure (VLPP), degree of leakage preoperatively and at 1-year post-AUS surgery, AUS revisions, erosion rate and the need for adjunct medication postoperatively. RESULTS: A total of 110 patients were included in the analysis. Of these, 44 patients had an AUS cuff size of ≥ 5.0 cm and 66 patients had a cuff size ≤ 4.5 cm. After AUS implantation at 1 year both groups had a median pad use of 1 pad per day. Lastly, the erosion rate was higher in the ≤ 4.5 cm cuff group (7.7% vs. 2.4%) but this was not statically significant. In all cases (6 patients) of cuff erosion, each patient had been radiated. CONCLUSION: AUS cuff sizes of ≥ 5.0 cm do not appear to have a negative impact on the degree of incontinence at 1-year post AUS as compared to those with cuff sizes ≤ 4.5 cm. The erosion rate was higher in those with cuffs ≤ 4.5 cm but was not statistically significant. This would suggest that at AUS implantation, the surgeon should choose a larger cuff if there is any doubt especially in those with radiation.

Artificial urinary sphincter cuffs and safe instrument/catheter passage guidelines.

PURPOSE: The artificial urinary sphincter (AUS) is the gold standard for males with urinary incontinence. It is generally a safe procedure with a high degree of satisfaction. However, there is a lifelong risk of infection and erosion. AUS cuffs are commonly placed around the bulbar urethral area. There is always a risk of trauma and erosion of cuffs with catheterization or endoscopy. At this time, there is little guidance as to which size catheters or scopes can pass through each AUS cuff sizes safely. The goal of this study was to determine which size of catheters/scopes can pass through different cuff sizes safely in an ex vivo setting. METHOD: All AUS cuff sizes available (3.5 cm up to 6.0 cm), catheter sizes between 12 and 22 Fr, and scope sizes 19 Fr flexible/rigid, 21-26 Fr rigid scopes were examined. We used deflated assembled cuffs on the bench (ex vivo) and three different blind observers to measure the free space left between the wall of the cuff and the catheter/scope to be sure that there was consistency. We created a scale from 1 to 3 to determine the ease of passage for each catheter/scope. We also had an MRI radiologist examine bulbar urethra thickness in 20 male patients to determine the average thickness without the bulbospongiosus muscle. Using our average bulbar urethral thickness, we were able to estimate how much free space remained within the urethral lumen and how easy and safe it was to pass each catheter/scope. RESULTS: For 3.5 cm cuffs, 12 Fr catheters pass easily and safely, 14-16 Fr catheters and 19 Fr flexible/rigid scopes can pass through with some mild risk of trauma. Larger catheter/scope sizes cannot pass through without a significant risk of trauma. For 4.0 cm cuffs, 12-14 Fr catheters pass easily and safely. 16-18 Fr catheters and 19-21 Fr rigid/flexible scopes can pass with some mild risk of trauma. Larger catheter/scope sizes cannot pass through safely. For 4.5 cm cuffs, 12-18 Fr catheters and 19 Fr flexible/rigid scopes pass easily and safely. 20-22 Fr catheters and 21 Fr rigid scopes can pass with some mild risk of trauma. Larger catheter/scope sizes cannot pass through safely. For 5.0 cm cuffs, 12-22 Fr catheters and 19-21 Fr flexible/rigid scopes can pass easily and safely. 22-26 Fr scopes can pass with some mild risk of trauma. For 5.5 cm cuffs, all catheters/scopes can pass easily and safely. However, the 26 Fr rigid scope can pass with some mild risk of trauma. For 6 cm cuffs, all catheters/scopes examined can pass easily and safely. CONCLUSION: Our study can guide urologists in the management of patients with an AUS who need urethral catheters or endoscopy. These recommendations are based on the measurements of our study along with bulbar urethral thickness. In general, greater caution is needed with smaller cuff sizes (3.5-4.5 cm). Our recommendations, with minimal urethral compression, are purposely conservative and safe to avoid trauma and erosion of the AUS cuffs.

Is There an Association between Urinary Incontinence and Mortality? A Retrospective Cohort Study.

PURPOSE: Previous studies have shown an association between urinary incontinence and increased mortality independently of demographics and health status. However, they do not account for the effect of frailty as a state of vulnerability. We evaluated whether there is an association between urinary incontinence and mortality and, if so, whether adjustment for a frailty index would affect the association. MATERIALS AND METHODS: We performed a cross-sectional study in a nationally representative sample of 2,282 community dwelling individuals 50 years old or older who were surveyed between 2003 and 2006. The study primary outcome was overall survival as reported on December 31, 2011. We used design adjusted Cox proportional hazards regression models to estimate the hazard of mortality associated with urinary incontinence. We adjusted the models for demographics and a validated 45-item frailty index incorporating an accumulation of deficits in the domains of health and independence. RESULTS: Of the individuals 23% reported having urinary incontinence at least a few times per week. Stress urinary incontinence and urge urinary incontinence were associated with a 13.3% (95% CI 7.2-19.7) and 18.4% (95% CI 8.3-29.4) increase in the frailty index, respectively. Without controlling for frailty individuals with urinary incontinence were at higher risk for death (HR 1.39, 95% CI 1.13-1.72). When adjusted for the frailty index, the association between urinary incontinence and mortality was no longer significant (HR 1.10, 95% CI 0.89-1.36). CONCLUSIONS: The association between urinary incontinence and mortality can be understood based on increased frailty in incontinent individuals. Urinary incontinence itself is not independently associated with mortality. In clinical practice these findings underscore the importance of screening for frailty in addition to urinary incontinence.

Complications after surgery for benign prostatic enlargement: a population-based cohort study in Ontario, Canada.

OBJECTIVES: To examine the complication rates after benign prostatic enlargement (BPE) surgery and the effects of age, comorbidity and preoperative medical therapy. DESIGN: A retrospective, population-based cohort study using linked administrative data. SETTING: Ontario, Canada. PARTICIPANTS: 52 162 men≥66 years undergoing first BPE surgery between 1 January 2003 to 31 December 2014. INTERVENTION: Medical therapy preoperatively and surgery for BPE. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was overall 30-day postoperative complication rates. Secondary outcomes included BPE-specific event rates (bleeding, infection, obstruction, trauma) and non-BPE specific event rates (cardiovascular, pulmonary, thromboembolic and renal). Multivariable analysis examined the association between preoperative medical therapy and postoperative complication rates. RESULTS: The 30-day overall complication rate after BPE surgery was 2828 events/10 000 procedures and increased annually over the study period. Receipt of preoperative α-blocker monotherapy (relative rate (RR) 1.05; 95% CI 1.00 to 1.09; p=0.033) and antithrombotic medications (RR 1.27; 95% CI 1.22 to 1.31; p<0.0001) was associated with increased complication rates. Among the ≥80-year-old group, the rate of complications increased by 39% from 2003 to 2014 (RR 1.39; 95% CI 1.21 to 1.61; p<0.0001). The mean duration of medical and conservative management increased by a mean of 2.1 years between 2007 and 2014 (p<0.0001 for trend). CONCLUSIONS: Thirty-day complication rates after BPE surgery have increased annually between 2003 and 2014. Preoperative medical therapy with alpha blockers or antithrombotics was independently associated with higher rates of complications. Over this time, the duration of conservative therapy also increased.

A pilot randomized-controlled trial of the urodynamic efficacy of mirabegron for patients with neurogenic lower urinary tract dysfunction.

AIMS: To determine the effectiveness of mirabegron in patients with neurogenic lower urinary tract dysfunction. METHODS: Randomized, double-blind, placebo-controlled study. Canadian patients with spinal cord injury (SCI) or multiple sclerosis (MS) with urinary symptoms and incontinence were recruited. Patients were randomized to mirabegron 25 mg (or an identical placebo) for 2 weeks at which point a dose escalation to mirabegron 50 mg (or an identical placebo) was maintained for 8 weeks. Urodynamics were performed before and after treatment. The primary outcome measure was maximum cystometric capacity (MCC). Intention to treat analysis and ANCOVA models (with adjustment for baseline values) were used and marginal means (MM) are reported; P-value <0.05 was considered significant. RESULTS: Sixteen (9 SCI and 7 MS) patients were randomized to mirabegron and 16 (10 SCI and 6 MS) to placebo. At study completion, there was no significant difference in MCC between mirabegron and placebo (MM 305 vs 369 mL, P = 0.20). There was no significant difference in volume at first neurogenic detrusor overactivity (NDO, MM 167 vs 137 mL, P = 0.14) and peak pressure of NDO (MM 69 vs 82 cmH2 O, P = 0.25). There was no significant difference in pad weights or voiding diary parameters. There was a significantly lower symptom burden among those treated with mirabegron (total neurogenic bladder symptom score MM 29 vs 34, P = 0.047). CONCLUSIONS: Among patients with SCI or MS, we demonstrated non-significant trends towards improvement in some urodynamic parameters with mirabegron 50 mg compared to placebo, and a significantly lower neurogenic bladder symptom burden.

Complications and Interventions in Patients with an Artificial Urinary Sphincter: Long-Term Results.

PURPOSE: The artificial urinary sphincter is a common treatment of male urinary incontinence. We sought to characterize long-term rates of artificial urinary sphincter revision/removal and reimplantation, and associated risk factors. MATERIALS AND METHODS: We performed a population based, retrospective study using the Ontario Health Insurance Plan database of all male patients who underwent artificial urinary sphincter implantation from 1994 to 2013. Hospital, diagnostic and billing codes were used to identify patients. The Kaplan-Meier method and multivariable Cox proportional hazards models were applied to examine the cumulative incidence of artificial urinary sphincter reimplantation and revision/removal, and identify risk factors, respectively. RESULTS: A total of 1,632 male patients underwent initial implantation of an artificial urinary sphincter. The 10-year revision/removal and reimplantation rates were 34% and 27%, respectively. There was no difference between high and low volume hospitals or between community and academic hospitals in terms of revision/removal. A high level of comorbidity was associated with an increasing risk of removal/revision. The reimplantation rate was significantly lower in patients who underwent insertion at hospitals with the highest volume of surgery (HR 0.55, 95% CI 0.37-0.82, p <0.01). A high level of comorbidity was not associated with an increasing risk of reimplantation. Preimplantation radiotherapy was not significantly associated with the risk of reimplantation (p = 0.17) or revision/removal (p = 0.95). Other factors were not significantly associated with reimplantation or revision/removal. CONCLUSIONS: Most men who undergo artificial urinary sphincter placement still have a device without repeat surgery 10 years following insertion. Radiotherapy does not increase the risk of repeat surgery. A high level of comorbidity was associated with an increasing risk of removal/revision.

Comparing a novel hand held device (Peritron+) to standard urodynamics in measuring intravesical pressure.

AIMS: Peritron+ is a new handheld device, which can be attached to a urethral catheter to measure intravesical pressures (Pves). The goal of this study was to assess if Pves recorded by standard urodynamics (UDs) are comparable to those recorded by the Peritron+. METHODS: Patients with voiding dysfunction and an indication for UD underwent measurement of Pves with nonvideo UD and Peritron+. Pves were recorded at volumes of 50, 100, and 200 mL for the supine and sitting positions. A failure of the Peritron+ was considered to be a discrepancy of Pves values >3 cmH2 O between Peritron+ and UD recordings. Two-way ANOVA was used to assess for statistical significance. P-values < 0.05 were considered significant. RESULTS: Ten female patients, mean age 51 years old, were enrolled in the study. The difference in Pves measurements between Peritron+ and UD were ≤3 cmH2 O at all bladder volumes measured in a supine and sitting positions. There were no adverse events and there were no malfunctions of the Peritron+ device during the study. CONCLUSIONS: Peritron+ handheld device accurately assessed Pves at different intravesical volumes when compared to UD measurements. The Peritron+ is a simple and safe device, which can be used in the office by a clinician and at home by a patient to monitor Pves and help to select patients who may require standard UD re-evaluation. This will be a valuable tool in managing patients with neurogenic and nonneurogenic bladders who are at a risk of upper urinary tract deterioration.

Long-Term Treatment with OnabotulinumtoxinA Results in Consistent, Durable Improvements in Health Related Quality of Life in Patients with Overactive Bladder.

PURPOSE: We present the long-term effects of repeat onabotulinumtoxinA 100 U treatment on health related quality of life in patients with overactive bladder and urinary incontinence who had an inadequate response to and/or were intolerant of an anticholinergic. MATERIALS AND METHODS: Patients who completed either of 2, 24-week phase III trials could enter a 3-year extension study and request multiple onabotulinumtoxinA 100 U treatments as needed. Results of the I-QOL (Incontinence-Quality of Life) and KHQ (King's Health Questionnaire) are reported for up to 6 treatments. Consistency of the response to repeat onabotulinumtoxinA treatments was evaluated by classifying patients by the I-QOL response to the first treatment and analyzing responses to treatments 2 to 6. RESULTS: After onabotulinumtoxinA treatments 1 to 6, improvements in I-QOL scores were consistently 2 to 3 times the minimally important difference, and improvements in KHQ role limitations and social limitations domain scores were 5 to 6 and 3 to 4 times the minimally important difference, respectively. Most patients achieved or exceeded the minimally important difference for I-QOL and KHQ domain scores. Furthermore, 72.9% of patients who achieved or exceeded the minimally important difference for I-QOL after treatment 1 did so for all subsequent treatments. Of patients with a poor response after treatment 1, 38.3% achieved improvements greater than the minimally important difference for all subsequent treatments. CONCLUSIONS: In patients with overactive bladder and incontinence consistent and clinically meaningful improvements in health related quality of life were observed with repeat onabotulinumtoxinA 100 U treatments. A positive response after treatment 1 tended to predict similar responses to subsequent treatments, whereas a lack of response to treatment 1 did not preclude positive response(s) to later treatments.

Review of the epidemiology of overactive bladder.

Overactive bladder (OAB) is common in both men and women. It is a symptom complex that causes significant detriment to quality of life in patients. Although the prevalence of OAB is similar in both sexes, there are sex-specific differences in individual symptoms and the impact on quality of life. The coexistence of benign prostatic hyperplasia with OAB can worsen quality of life in men. This review examines the major studies that looked at the epidemiology of OAB as it relates to both sexes. It focuses on both the overall prevalence rates and the incidence of individual symptoms. This paper also addresses the level of bother and quality of life in men and women with OAB. In addition, the relationship between OAB and benign prostatic hyperplasia is reviewed.

Durable Efficacy and Safety of Long-Term OnabotulinumtoxinA Treatment in Patients with Overactive Bladder Syndrome: Final Results of a 3.5-Year Study.

PURPOSE: These are the final results of the prospective, multicenter, long-term (3.5-year) study of the efficacy/safety of onabotulinumtoxinA for overactive bladder syndrome. MATERIALS AND METHODS: Patients who completed either of 2, 24-week phase 3 trials could enter a 3-year extension and continue treatment with onabotulinumtoxinA 100 U as needed to control overactive bladder symptoms. Data were analyzed by the treatment(s) received (up to 6) and in discrete subgroups that received 1, 2, 3, 4, 5 or 6 treatments (to evaluate the consistency of the response after repeat treatments in the same patient groups). Assessments included the change from baseline in the number of urinary incontinence episodes per day and the proportion of patients who reported improvement/great improvement in urinary symptoms on the TBS (Treatment Benefit Scale) at week 12 as co-primary end points. Other end points were the change from baseline in I-QOL (Incontinence Quality of Life), the number of urgency and micturition episodes per day; duration of effect; the number of adverse events; and the initiation of intermittent catheterization. RESULTS: Consistent mean reductions in urinary incontinence were observed following continued onabotulinumtoxinA treatment, ranging from -3.1 to -3.8 in the overall population and -2.9 to -4.5 in the discrete subgroups. Durable improvements were seen in overactive bladder symptoms and quality of life. A high proportion of patients rated their condition as improved/greatly improved. The median duration of effect was 7.6 months. The most common adverse event was urinary tract infection. The rate of de novo catheterization after the first treatment was 4.0% and it ranged from 0.6% to 1.7% after subsequent treatments. CONCLUSIONS: Long-term onabotulinumtoxinA treatment consistently decreased overactive bladder symptoms and improved quality of life with no new safety signals.

Gender differences in overactive bladder.

Overactive bladder (OAB) is a common condition in both women and men. Although prevalence's are similar in both genders, sex specific differences do exist in relation to individual OAB symptoms as well as degree of bother and quality of life. The added effect of prostatic enlargement in men leads to slightly different evaluation and treatment regimens in both genders. This review will examine the gender differences in OAB related to epidemiology, OAB evaluation, investigation and treatment. This information will assist the primary care physician in assessing and initiating treatment in patients with OAB. It will further the understanding of the spectrum of treatments available for OAB and assist in determining the appropriateness and timing of referral of such patients to a urologist.

Anterior segment optical coherence tomography changes with introduction and discontinuation of tamsulosin.

PURPOSE: The aim of this study was to quantify changes and reversibility in pupil dilation and iris dilator muscle region thickness associated with introduction and subsequent discontinuation of tamsulosin in patients naïve to this drug with the aid of an anterior OCT system. METHODS: The study was carried out on 7 patients (14 eyes) naïve to tamsulosin and with benign prostatic hypertrophy (BHP). Measurements taken by Vistante OCT were done pre- and post-dilation of the following: pupil size, iris dilator muscle region (DMR) thickness, sphincter muscle region (SMR) thickness, and anterior chamber depth. These measurement were taken at Day 0 (tamsulosin naive), Day 30 (after one month of tamsulosin, the treatment period) and day 60 (after one month of no tamsulosin, the discontinuation period). RESULTS: Post-dilation pupil diameter significantly increased during the discontinuation period (P = 0.047). Iris DMR thickness measurements post-dilation significantly decreased during treatment (P = 0.00044), discontinuation (0.00011), and combined periods (P = 0.000050). Anterior chamber depth measurements in post-dilation were significantly decreased during treatment (P = 0.0016), discontinuation (P = 0.017), and combined periods (P = 0.00022). CONCLUSION: Tamsulosin discontinuation effectively increases dilated pupil size, a measure that has been inversely linked to IFIS incidence pre-operatively. Decreased DMR thickness in this short term likely illustrates changes aside from atrophy, such as vascular changes. Decreased anterior chamber depths suggest aqueous humor production is decreased as well.

Artificial urinary sphincter erosion after radical prostatectomy in patients treated with and without radiation.

INTRODUCTION: There has been increasing evidence supporting the use of adjuvant radiotherapy after radical prostatectomy (RP) for prostate cancer. Significant stress incontinence after RP is not uncommon and the artificial urinary sphincter (AUS) is the gold standard of treatment. Our objective was to assess if increased use of radiotherapy after RP has changed the rate of erosion and infection in the face of improvement in radiation technique and equipment in men who had an AUS implanted in the last 10 years. METHODS: We retrospectively examined 118 patients from December 2001 to January 2012 who underwent a RP with or without postoperative radiotherapy and subsequently had an AUS implanted. We divided the patients into two cohorts (Group 1: December 2001-December 2006 and Group 2: January 2007-January 2012). We reviewed all patient records for age, cuff size implanted, history of postoperative radiotherapy, previous incontinence surgery, revisions, and complications (erosion/infection). RESULTS: There were 36 and 82 patients in Groups 1 and 2, respectively. The mean age was similar between groups, 67 years both groups (p = 0.980). The number of patients treated with postoperative radiotherapy was similar between groups (36% vs. 32%, p = 0.640, respectively). There was no difference in the incidence of erosion or infection between Group 1 and 2 (p = 0.848 and p = 0.178, respectively). The overall relative risk (RR) of erosion was significantly higher in those who had radiotherapy compared to those who did not (RR 4.05, 95% confidence interval 1.1-15.3). CONCLUSIONS: Over the last 10 years, there has not been an increase in the number of patients receiving an AUS after RP and radiotherapy at our centre. During this time, the incidence of erosion and infection has not increased. However, our study reaffirms that the relative risk of erosion remains higher in patients who have had radiotherapy despite improvement in radiation treatment techniques and equipment.

Update on medical therapy for male LUTS.

The medical management of lower urinary tract symptoms (LUTS) is aimed at addressing voiding and storage symptoms in patients with benign prostate hyperplasia (BPH) symptoms with or without an over-active bladder (OAB). Current available options for BPH include alpha-blockers, 5-alpha reductase inhibitors and phosphodiesterase type 5 inhibitors. For OAB, options include antimuscarinics, with or without an alpha-blocker, the beta-3-adrenergic agonist mirabegron and the synthetic diuretic desmopressin. With the availability of numerous options and combinations available for the treatment of LUTS, individual patient assessment is the key to optimal symptom control and management of adverse effects.

Long-term complications in men who have early or late radiotherapy after radical prostatectomy.

INTRODUCTION: Choosing adjuvant radiotherapy (RT) or salvage RT after radical prostatectomy (RP) for locally advanced prostate cancer is controversial. Performing RT early after RP may increase the risk of urinary complications compared to RT performed later. We evaluated the urinary complication rates of men treated with surgery followed by early or late RT. METHODS: Using a retrospective chart review, we compared rates of urinary incontinence (UI), bladder neck contracture (BNC), or urethral stricture in men with prostate cancer treated with early RT (<6 months after RP) or late RT (≥6 months after RP), 3 years after RT. RESULTS: In total, 652 patients (between 2000 and 2007) underwent early RT (162, 24.8%) or late RT (490, 75.2%) after RP. The mean time to early RT was 3.6 months (range: 1-5 months) and to late RT was 30.1 months (range: 6-171 months). At 3 years post-RT, UI rates were similar in the early RT and the late RT groups (24.5% vs. 23.3%, respectively, p = 0.79). Prior to RT, 27/652 (4%) patients had a BNC and 11/652 (1.7%) had a urethral stricture, of which only 1 BNC persisted at 3 years post-RT. After RT, 17/652 (2.6%) BNC and 4/652 (0.6%) urethral stricture developed; of these, 6 BNC and 2 urethral strictures persisted at 3 years. CONCLUSION: Rates of UI, BNC, and urethral stricture were similar with early and late RT at 3 years post-RT. These findings suggest that the timing of RT after RP does not alter the incidences of these urinary complications and can aid in the decision-making process regarding adjuvant RT versus salvage RT.

Success rates of patients with poor emptying on clean intermittent catheterization.

INTRODUCTION: Clean intermittent catheterization (CIC) theoretically reduces incontinence, urinary tract infections (UTIs) and lower urinary tract symptoms (LUTS) in the face of poor emptying. It is unclear whether all patients realize these benefits or if CIC is only helpful for some. MATERIALS AND METHODS: A retrospective review of 321 patients all of whom underwent urodynamic study prior to starting CIC for impaired emptying. Success was considered to be no incontinence, no UTIs, and no LUTS while performing CIC. Patients who did not meet these criteria or who stopped CIC for whatever reason were classified as failures. RESULTS: The mean duration of follow up was 4.3 years (+/- 4.4 years). Overall 51% of the cohort was classified as a success. Among those patients started on CIC to treat incontinence, recurrent UTIs or LUTS the success rate was 43%. We identified the comorbidity of diabetes mellitus, the use of anticholinergic medications, the need for a homecare nurse to perform the CIC, and a post-void residual (PVR) of <300 cc at initial urodynamics to be independently associated with failure on CIC. CONCLUSIONS: CIC resolved incontinence, recurrent UTIs, and LUTS in some but not all patients with impaired emptying. We identified characteristics associated with failure on CIC. Our study has provided some direction as to those individuals most and least likely to benefit from adopting this mode of bladder management for poor emptying.