Comparison of quality of life after bladder augmentation in patients previously treated with intradetrusor botulinum toxin A for neurogenic detrusor overactivity.

PURPOSE: To compare the quality of life (QoL) in the same patients first treated with botulinum toxin A (BTA) injections for neurogenic detrusor overactivity (NDO) and then with bladder augmentation (BA). METHOD: Retrospective study of patients who had BA after BTA treatment between January 2012 and December 2022. Qualiveen Short Form questionnaires and a 7-level Likert/PGI-I scale to answer the question "How would you describe your quality of life after surgery compared to when you felt your best with BTA injections?" were collated and analyzed. RESULTS: Fifty-two BAs for neurogenic bladder (NDO or low compliance) were performed in patients with a median age of 43years [33; 52] previously treated with BTA. After a median follow-up of 33.5 [13.8; 54.3] months, the median Qualiveen-SF global score after BA was significantly higher than that obtained at best BTA efficacy (1.63 [1; 2.63] vs. 2.63 [1.88; 3], P=0.012), as were the scores for the fear, constraints/restrictions and limitations/inconvenience domains. The median PGI-I score was +3 [2; 3] (truly better QoL) and 85.4% of patients reported a QoL after BA superior to the best QoL under BTA. CONCLUSION: BA provides a greater range of QoL improvement than BTA injection for patients who have experienced both treatments. Long-lasting effects and absence of need to perform iterative retreatment were the main reasons.

Risk factors of video urodynamics and bladder management for long-term complications in patients with chronic spinal cord injury.

This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.

Factors associated with symptomatic urinary tract infection in persons with spinal cord lesions who perform clean intermittent catheterization with single-use catheters.

OBJECTIVES: To investigate factors associated with symptomatic urinary tract infection (sUTI) in persons with chronic spinal cord lesion (SCL) who were using single-use catheters for intermittent self-catheterization (ISC). METHODS: Among respondents to an internet survey on the burden of illness on persons with SCL who were considered to be able to perform ISC, 111 persons using single-use catheters were included to examine factors associated with self-reported sUTI by univariate as well as multivariable analysis. RESULTS: The incidence of sUTI was significantly higher in males than in females (56.9% vs. 31.6%, p = .011), persons with stocks of antibiotics than those without it (82.9% vs. 28.6%, p < .011), and persons with more frequent bleeding during catheterization than those with less frequent bleeding (100% vs. 46.5%, p = .036). The incidence did not significantly differ between respective groups when various variables were evaluated by other characteristics of the participants, adherence to ISC procedures, and complications. On multivariable analysis, male gender and stocks of antibiotics were significant independent factors for sUTI. CONCLUSIONS: Male gender and stocks of antibiotics were associated with sUTI in persons with SCL who were performing ISC with single-use catheters.

Isolated continent cystostomy on neurologic native bladder: Functional results.

INTRODUCTION: Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS: Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS: Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION: The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE: Grade C - retrospective study.

Intermittent Self-catheterization for Bladder Dysfunction After Deep Endometriosis Surgery: Duration and Factors that Might Affect the Recovery Process.

STUDY OBJECTIVE: To assess the duration needed for regaining normal bladder voiding function in patients with postoperative bladder dysfunction requiring intermittent self-catheterization after deep endometriosis surgery and identify risk factors that might affect the recovery process. DESIGN: Retrospective study based on data recorded in a large prospective database. SETTING: Endometriosis referral center. PATIENTS: From September 2018 to June 2022, 1900 patients underwent excision of deep endometriosis in our center; 61 patients were discharged with recommendation for intermittent self-catheterization and were thus included in the study. INTERVENTIONS: Intermittent self-catheterization after endometriosis surgery. MEASUREMENTS AND MAIN RESULTS: A total of 43 patients (70.5%) stopped self-catheterization during the follow-up period. Median follow-up was 25 weeks (range, 7-223 wk). Surgery was performed laparoscopically in 48 patients (78.7%) and robotically in 13 (21.3%); 47 patients (77%) had nodules involving the digestive tract, 11 (18%) had urinary tract involvement, 29 had parametrial nodules (47.5%), and 13 (21.3%) had sacral plexus involvement. The probability of bladder voiding function recovery and arrest of self-catheterization was 24.5%, 54%, 59%, 72%, and 77% at 4, 8, 12, 52, and 78 weeks, respectively. Cox's multivariate model identified preoperative bladder dysfunction as the only statistically significant independent predictor for arrest of self-catheterization (hazard ratio, 0.36; 95% confidence interval, 0.15-0.83). CONCLUSION: Patients requiring intermittent self-catheterization for bladder dysfunction after deep endometriosis excision may spontaneously recover bladder function in 77% of cases. Symptoms suggesting preoperative bladder voiding dysfunction should be reviewed before planning surgery, and patients should be informed of the higher postoperative risk of long-term bladder voiding dysfunction.

Desenvolvimento e validação de vídeo educativo para autocateterismo vesical intermitente limpo / Development and validation of an educational video for clean intermittent bladder catheterization

Trata-se do desenvolvimento e validação de um vídeo educativo sobre autocateterismo vesical intermitente limpo. Estudo metodológico, realizado em três etapas: pré-produção (elaboração e validação do roteiro e storyboard), produção do vídeo, e pós-produção (validação do vídeo por juízes experts em reabilitação e/ou saúde). O roteiro para produção do vídeo foi desenvolvido e validado por 18 juízes, com 91,1% de concordância. O vídeo, com 10 minutos e cinco segundos, também foi validado e atingiu 97,4% de concordância entre os 17 juízes participantes nos quesitos funcionalidade, usabilidade, eficiência, técnica audiovisual, ambiente e procedimentos. A versão final do vídeo desenvolvido e validado pode ser visualizada no Portal do Núcleo de Pesquisa NEUROREHAB, www.demaisinformacao.com.br. Essa ferramenta pode contribuir para a capacitação de pessoas com bexiga neurogênica a realizar o autocateterismo urinário, bem como profissionais de saúde e estudantes de enfermagem, e apoiar metodologicamente o desenvolvimento de outros vídeos educativos na área da saúde.

The purpose of this study was to develop and validate an educational video on clean intermittent self-catheterization. It was a methodological study, carried out in three stages: pre-production (elaboration and validation of the script and storyboard), video production, and post-production (validation of the video by expert judges working in the field of rehabilitation and/or health). The script for video production was developed and validated by 18 judges, with 91.1% agreement. The video, with a duration time of 10 minutes and five seconds, was also validated and reached 97.4% of agreement among the 17 participating judges regarding functionality, usability, efficiency, audiovisual technique, environment and procedures. The final version of the video developed and validated can be viewed at the NEUROREHAB Research Center Portal, https://demaisinformacao.com.br/ autocatetrismourinario/. This tool can contribute to the training of people with neurogenic bladder, as well as health professionals and nursing students, to perform self-catheterization, and methodologically support the development of other educational videos in the health area.

Application of Non-contact Technology in Clean Intermittent Self-catheterization / 中国康复理论与实践

Objective To explore the best methods of catheterization in patients with neurogenic bladder using clean intermittent self-catheterization. Methods From December, 2014 to December, 2015, sixty patients with neurogenic bladder were equally divided into observation group who were taught the non-contact clean intermittent self-catheterization, and control group who were taught routine clean intermittent self-catheterization. Their materials, times to learn, and the incidence of catheter contamination and urinary tract infection were compared. Results The observation group mastered the catheterization in fewer times of learning than the control group (Z=-4.400, P<0.001). The incidence of catheter contamination (χ2=5.880, P=0.015) and urinary tract infection (χ2=4.043, P=0.044) were less in the observa-tion group than in the control group. Conclusion Non-contact clean intermittent catheterization is beneficial to manage neurogenic bladder.

Experience of Non-sterile Intermittentent Self Catheterization for Neurogenic Bladder / 대한비뇨기과학회지

A non-sterile technique of intermittent self catheterization was performed for 6 months to 3 years of duration an 4 patients with in inability to void in a normal fashion because of neurogenic bladder. Marked improvement was noted in urinary infection, renal function, bladder emptying, and perhaps most important the mental and emotional status of the patients and/or parents. The extremely low incidence of complications and its therapeutic efficacy clearly make non-sterile intermittent self catheterization an outstanding weapon in the urological field.