Can we increase the value of data from bladder diaries? International Consultation on Incontinence-Research Society 2023.

BACKGROUND: Bladder diaries represent a fundamental component in the assessment of patients presenting with lower urinary tract symptoms. Nevertheless, their importance often remains underappreciated and undervalued within clinical practice. This paper aims to conduct a comprehensive review of the existing literature concerning the utility of bladder diaries, underscore the criticality of their precision, elucidate the factors contributing to noncompliance with bladder diary completion, and investigate potential strategies for enhancing patient compliance. MATERIALS AND METHODS: A review of the English-language scientific literature available in the domains of Medline, Embase, Emcare, Midirs, and Cinahl was conducted. This was supplemented by discussion at the International Consultation on Incontinence Research Society Proposal session to define knowledge and identify gaps in knowledge surrounding the utility of bladder diaries. The existing evidence and outcome of the relevant discussion held in the meeting are presented. RESULTS: Bladder diaries (BD) serve to characterize the nature and severity of storage lower urinary tract symptoms (LUTS) and provide an objective record of an individual's urination patterns. They aid in the refinement and customization of treatment strategies based on the clinical responses documented in the diary, optimizing treatment outcomes. Notably, both BD and urodynamic studies (UDS) play complementary yet distinct roles in LUTS evaluation. BD offers a more comprehensive and accessible approach to assessing specific storage LUTS, particularly due to their affordability and widespread availability, especially in resource-limited settings. Nevertheless, the absence of a standardized BD format across global healthcare systems presents a significant challenge. Despite being recognized as reliable, noninvasive, validated, and cost-effective tools for evaluating patients with LUTS, the implementation and completion of BD have proven to be complex. The introduction of automated bladder diaries heralds an era of precise, real-time data collection, potentially enhancing the patient-clinician relationship. Completion of bladder diaries depends on an array of individual, social, and healthcare-specific factors. Compliance with bladder diary completion could be enhanced with clear instructions, patient education, regular follow-ups and positive re-enforcement. This study has identified four critical areas for future research: Addressing healthcare disparities between affluent and developing nations, enhancing the current functionality and effectiveness of bladder diaries, exploring the feasibility of incorporating bladder diaries into the treatment and education process and improving the quality and functionality of existing bladder diaries. CONCLUSION: Bladder diaries play a pivotal role in the evaluation and management of patients with LUTS, providing a holistic perspective. When their complete potential is harnessed, they have the capacity to revolutionize the paradigm of LUTS management, ushering in a patient-centered era of care.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023.

AIMS: The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. METHODS: The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. RESULTS: There is no consensus on the threshold value of PVR that is considered "elevated" or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. CONCLUSIONS: There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated" or "significant" PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

Understanding the basic assessment and treatment of lower urinary tract symptoms in older women.

Lower urinary tract symptoms (LUTS) are prevalent in older women. These symptoms are often under-reported due to the potentially embarrassing nature of the symptoms and a belief that they are an inevitable consequence of ageing. LUTS such as urinary incontinence have a significant negative effect on people's quality of life; however, with the appropriate assessment and management, improvements can be achieved. This article reviews the different types of LUTS and their causes, assessment and treatment, focusing on older women. It aims to provide nurses with an understanding of LUTS so that they can identify appropriate interventions.

How can we improve investigation, prevention and treatment for recurrent urinary tract infections - ICI-RS 2018.

BACKGROUND: Recurrent urinary tract infection (rUTI) is a chronic condition and has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR). AIM: The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. METHODS: A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. DISCUSSION: Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI.

Current controversies in urinary tract infections: ICI-RS 2017.

AIMS: The current definition of urinary tract infection (UTI) relies on laboratory and clinical findings, which may or may not be relevant, depending upon the patient group under consideration. This report considers the utility of current definitions for UTI in adults with and without underlying neurological conditions in order to identify gaps in current understanding and to recommend directions for research. METHODS: This is a consensus report of the proceedings of Think Tank TT3: "How do we define and when do we treat UTI in neurological and non-neurological adult patients?" from the annual International Consultation on Incontinence-Research Society (ICI-RS), June 8-10, 2017 (Bristol, UK). RESULTS: Evidence considering the definitions of UTI in patients with and without neurological diseases was reviewed and synthesized. We examined research on laboratory methods and clinical definitions, focusing on specific cut-off values for the quantification of significant bacteriuria, and leucocyturia. Several areas were identified, mostly related to the lack of evidence-based definitions of significant bacteriuria for different patient groups, as well as uncertainties about the role of inflammatory biomarkers, and non-specific symptoms and signs. CONCLUSIONS: One of the biggest challenges in clinical practice is to discriminate between asymptomatic bacteriuria and symptomatic UTI. Future research should concentrate on risk factors for developing symptomatic UTI in different patient groups. Targeted investigations for specific populations, such as the frail elderly, and patients with neurogenic bladder dysfunction, are still needed.

When should video be added to conventional urodynamics in adults and is it justified by the evidence? ICI-RS 2014.

AIMS: To debate and evaluate the evidence base regarding the added value of video to urodynamics in adults and to define research questions. METHODS: In the ICI-RS Meeting 2014 a Think Tank analyzed the current guidelines recommending video urodynamics (VUD) and performed a literature search to determine the level of evidence for the additional value of the imaging with urodynamic assessment of both neurogenic and non-neurogenic lower urinary tract dysfunction. RESULTS: Current guidelines do not specify the added value of imaging to urodynamics. Recommendations are based on single center series and expert opinion. Standard imaging protocols are not available and evidence regarding the balance between number and timing of pictures, patient positioning, and exposure time on the one hand and diagnosis on the other hand is lacking. On the basis of expert consensus VUD is relevant in the follow-up of patients with spinal dysraphism. Evidence for the value of VUD in non-neurogenic lower urinary tract dysfunction is sparse. There is some evidence that VUD is not necessary in uncomplicated female SUI, but expert opinion suggests it might improve the evaluation of patients with recurrent SUI. CONCLUSIONS: There is only low level evidence for the addition of video to urodynamics. The ICI-RS Think Tank encourages better reporting of results of imaging and systematic reporting of X-ray doses. Specific research hypotheses regarding the added value of imaging are recommended. The panel suggests the development of standards for technically optimal VUD that is practically achievable with machines that are on the market.

Intermittent self-catheterisation in women.

This article reviews intermittent self-catheterisation (ISC) in women, including the advantages and disadvantages of the procedure. It will also discuss barriers that patients may face when learning to perform ISC and how healthcare professionals can support patients in overcoming any difficulties. Finally, the article will address common complaints and concerns of patients who regularly perform ISC and suggests how these can be prevented or improved.

Current and future approaches to the management of female urinary incontinence.

Urinary incontinence is an increasingly prevalent condition affecting women of all ages and is known to have significant impact on quality of life. At present there are a variety of treatment options available to manage urinary incontinence in the form of conservative therapies, medication and surgical interventions. However, research continues to explore other treatment options that offer improved efficacy, tolerability and a reduction in adverse effects. This article aims to provide a review of all available treatment options for women with urinary incontinence and highlights current research outcomes that may be further developed in this area.