[Bladder augmentation in the era of botulinum toxin: Indications and results]. / L'entérocystoplastie d'agrandissement à l'ère de la toxine botulique : indications et résultats.

AIM: To determine the surgical indication and results of bladder augmentation (BA) during the last decade in a neurourology center in the era of intradetrusor botulinum toxin injection. MATERIAL: We conducted a retrospective study that included patients with BA between January 1, 2012 and December 31, 2022 in our centre. We collected pre-operative demographic, clinical, and urodynamic data, BA indication, and associated procedures. We analyzed early and late complications as well as continence and postoperative voiding mode in patients with first BA in a neurological pathology context. RESULTS: We performed 77 BA over the study period. The main indication was neurogenic overactive bladder, which was secondarily resistant to botulinum toxin. The main associated procedure was continent cutaneous diversion (n=31, 57.4%). Among patients who had a first BA for neurogenic bladder, 34 patients had early complications (50%) including 12 patients with≥Clavien 3 complications (17.6%). After a median follow-up of 33 [14; 55] months, 23 patients had late complications (33.8%) and 59 patients had complete continence (86.8%). CONCLUSION: In the era of botulinum toxin, the main indication of BA is the secondary failure of botulinum toxin for overactive neurogenic bladder. The BA provided continence in 86.8% of patients. It remains however an intervention with a significant rate of severe complications whose indication must be discussed by a multidisciplinary team. LEVEL OF EVIDENCE: Weak.

The Microbiological Burden of Short-Term Catheter Reuse in Individuals with Spinal Cord Injury: A Prospective Study.

Despite the risk of developing catheter-associated urinary tract infections (CAUTI), catheter reuse is common among people with spinal cord injury (SCI). This study examined the microbiological burden and catheter surface changes associated with short-term reuse. Ten individuals with chronic SCI reused their catheters over 3 days. Urine and catheter swab cultures were collected daily for analysis. Scanning electron microscopy (SEM) and X-ray photoelectron spectroscopy (XPS) analyses were used to assess catheter surface changes. Catheter swab cultures showed no growth after 48 h (47.8%), skin flora (28.9%), mixed flora (17.8%), or bacterial growth (5.5%). Asymptomatic bacteriuria was found for most participants at baseline (n = 9) and all at follow-up (n = 10). Urine samples contained Escherichia coli (58%), Klebsiella pneumoniae (30%), Enterococcus faecalis (26%), Acinetobacter calcoaceticus-baumannii (10%), Pseudomonas aeruginosa (6%) or Proteus vulgaris (2%). Most urine cultures showed resistance to one or more antibiotics (62%). SEM images demonstrated structural damage, biofilm and/or bacteria on all reused catheter surfaces. XPS analyses also confirmed the deposition of bacterial biofilm on reused catheters. Catheter surface changes and the presence of antibiotic-resistant bacteria were evident following short-term reuse, which may increase susceptibility to CAUTI in individuals with SCI despite asymptomatic bacteriuria.

Analysis of factors affecting permanent clean intermittent catheterization and bladder function after primary neurosurgical repair of lipomyelomeningocele.

AIMS: This study was conducted to identify potential risk factors for permanent clean intermittent catheterization (CIC) and incontinence in patients with lipomyelomeningocele (LMMC) and evaluate how LMMC affects bladder function prognosis, measured by urodynamic (UD) score. METHODS: This retrospective study analyzed the electronic health records of patients who underwent primary neurosurgical repair for LMMC at a single tertiary referral center between January 2012 and December 2016 and were followed at least 3 years after surgery. Data regarding bladder function were obtained from medical records for multiple time points, including before surgery, after surgery but before hospital discharge, 3 months after surgery, and at outpatient visits during follow-up. RESULTS: This study enrolled 120 patients. At a mean follow-up of 62.6 ± 13.9 months after primary neurosurgical LMMC repair, 22 (18.3%) patients continued to require CIC for bladder emptying, only 7 (31.8%) of whom maintained bladder continence. A multivariate logistic regression model identified age at the time of surgery and the type of LMMC as significant presurgical prognostic risk factors for permanent CIC. In addition, postoperative urinary retention and a UD score greater than or equal to 5 measured 3 months after surgery were identified as significant postsurgical risk factors for permanent CIC and urinary incontinence. A linear mixed model adjusted for age at the time of surgery showed that patients with a transitional or chaotic LMMC type were more likely to experience gradual bladder function decline than patients with other LMMC types. CONCLUSIONS: This study identified both presurgical (age at the time of surgery, LMMC type) and postsurgical (postoperative urinary retention, UD score greater than or equal to 5 at 3 months postsurgery) risk factors for permanent CIC and urinary incontinence. In addition, LMMC type was identified as a prognostic risk factor for bladder function decline. These results will enhance the current understanding of bladder function outcomes in patients who undergo surgical treatment for LMMC.

Adesão ao autocuidado do paciente com disfunção neurogênica do trato urinário inferior: validação de instrumento / Adherence to self-care in patients with neurogenic lower urinary tract dysfunction: instrument validation / Adherencia al autocuidado en pacientes con disfunción neurogénica del tracto urinario inferior: validación de un instrumento

RESUMO Objetivo: construir e validar o conteúdo do instrumento de adesão ao autocuidado de pacientes com Disfunção Neurogênica do Trato Urinário Inferior que realizam o autocateterismo intermitente quanto a aparência e conteúdo. Método: Estudo metodológico de validação de conteúdo de instrumento, composto por três etapas: revisão da literatura, construção do instrumento e validação de instrumento, respectivamente. A análise foi realizada através do modelo de Agree, e pelo cálculo de índice de validação de conteúdo, entre 2020 e 2021. Resultados: O Agree II, apresentou resultado de 85,6% e 84,5% para validação dos domínios escopo e finalidade e partes interessadas. Na validação de conteúdo, o item histórico familiar foi retirado do instrumento com índice de vaidade de conteúdo de 0,77. Conclusão: O instrumento contribuirá para oferecer subsídios para a prática profissional e aos pacientes portadores da disfunção.

ABSTRACT Objective: To build and validate the content of the instrument for adherence to self-care for patients with Neurogenic Lower Urinary Tract Dysfunction who perform intermittent self-catheterization as to appearance and content. Method: Methodological study of instrument content validation, composed of three stages: literature review, instrument construction and instrument validation, respectively. The analysis was performed using the Agree model, and by calculating the content validation index, between 2020 and 2021. Results: Agree II, showed a result of 85.6% and 84.5% for validation of the scope and purpose and stakeholder domains. In content validation, the family history item was removed from the instrument with a content vanity index of 0.77. Conclusion: The instrument will contribute to offering subsidies for professional practice and to patients with the dysfunction.

RESUMEN Objetivo: construir y validar el contenido del instrumento de adición al autocuidado de pacientes con disfunción neurogénica del tracto urinario inferior que realizan el autocateterismo intermitente en cuanto a la apariencia y el contenido. Método: Estudio metodológico de validación de contenido de instrumentos, compuesto por tres etapas: revisión bibliográfica, construcción de instrumentos y validación de instrumentos, respectivamente. El análisis se realizó utilizando el modelo de Agree, y mediante el cálculo del índice de validación de contenido, entre 2020 y 2021. Resultados: El Agree II, mostró un resultado de 85,6% y 84,5% para la validación de los dominios de alcance y propósito y partes interesadas. En la validación de contenido, el ítem histórico familiar fue retirado del instrumento con un índice de vanidad de contenido de 0,77. Conclusión: El instrumento contribuirá a ofrecer subsidios para la práctica profesional y a los pacientes con disfunción.

Distal renal tubular acidosis presenting with an acute hypokalemic paralysis in an older child with severe vesicoureteral reflux and syringomyelia: a case report.

BACKGROUND: Distal renal tubular acidosis (dRTA) is the most common type of renal tubular acidosis (RTA) in children. Pediatric dRTA is usually genetic and rarely occurs due to acquired issues such as obstructive uropathies, recurrent urinary tract infections (UTIs), and chronic kidney disease (CKD). Although persistent hypokalemia frequently occurs with dRTA, acute hypokalemic paralysis is not frequently reported, especially in older children. CASE PRESENTATION: An eight-year-old girl presented with an acute first episode of paralysis. A physical examination revealed normal vital signs, short stature consistent with her genetic potential, and decreased muscle strength of her upper and lower extremities. Preexisting conditions included stage 4 CKD due to recurrent UTIs, severe vesicoureteral reflux and bilateral hydronephrosis, neurogenic bladder, and multisegment thoracic syringomyelia. Her laboratory work-up revealed hypokalemic, hyperchloremic metabolic acidosis with a normal anion gap. She also had a urine osmolal gap of 1.9 mOsmol/kg with a high urine pH. Intravenous potassium replacement resulted in a complete resolution of her paralysis. She was diagnosed with dRTA and discharged with oral bicarbonate and slow-release potassium supplementation. CONCLUSIONS: This case report highlights the importance of considering dRTA in the differential diagnosis of hypokalemic acute paralysis in children. Additionally, in children with neurogenic lower urinary tract dysfunction and recurrent UTIs, early diagnosis of spinal cord etiology is crucial to treat promptly, slow the progression of CKD, and prevent long-term complications such as RTA.

Adoption of Single-Use Clean Intermittent Catheterization Policies Does Not Appear to Affect Genitourinary Outcomes in a Large Spinal Cord Injury Cohort.

PURPOSE: In April 2008, Medicare amended its policy for clean intermittent catheterization, increasing coverage from 4 reused catheters per month to up to 200 single-use catheters. The primary reason for the policy change was an assumed decrease in risk of urinary tract infection with single-use catheters. Given its economic/environmental impact (∼50-fold increase in cost and plastic waste) and a paucity of supporting evidence, we retrospectively evaluate the policy's effect in a prospective spinal cord injury registry. MATERIALS AND METHODS: We accessed data for the years 1995 to 2020 from the National Spinal Cord Injury Database focusing on 1-year follow-up in those unable to volitionally void after injury. We asked 2 questions: (1) Did hospitalizations for genitourinary reasons decrease after the clean intermittent catheterization policy change?; and (2) Did clean intermittent catheterization adoption and adherence increase after the clean intermittent catheterization policy change? RESULTS: During the study period, 2,657 of the 6,843 (38.8%) participants unable to volitionally void after spinal cord injury were hospitalized during their first follow-up year. Of the cohort performing clean intermittent catheterization, fewer individuals were hospitalized for genitourinary reasons prior to the clean intermittent catheterization policy change compared to after (10.6% vs 14.6%, P < .001), a finding that persisted on multivariate logistic regression (odds radio, 0.67, P < .001). In addition, the number of individuals performing clean intermittent catheterization at 1-year follow-up was less after the policy change compared to prior (57.0% vs 59.1%, P = .044). CONCLUSIONS: Our findings suggest the 2008 policy change shifting clean intermittent catheterization coverage from catheter reuse to single-use did not decrease hospitalizations for urinary tract infection or increase clean intermittent catheterization uptake in individuals with spinal cord injury.

Diagnosis and treatment of urethral stricture in men with neurogenic lower urinary tract dysfunction: A systematic review.

AIM: To summarize available data focused on diagnosis and management of urethral stricture in men with neurogenic lower urinary tract dysfunction by a systematic review of the literature. MATERIALS AND METHODS: A systematic review of the literature was carried out through an extensive electronic database search performed in PubMed/MEDLINE and Scopus databases for full texts, and International Continence Society, American Urology Association, and European Association of Urology abstracts for citations related to urethral structure. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULTS: A total of 316 articles were identified, 48 of which were selected for this review. Different strategies are currently being used for the management of urethral strictures, such as clean intermittent catheterization (CIC) which reduces stricture by up to 68%; direct vision internal urethrotomy which shows lower rates of renarrowing; urethroplasty which shows a success rate up to 70%; urinary diversion is the treatment of choice when reconstruction is not possible. CONCLUSIONS: Further studies are needed in this population because of the heterogeneity of the outcomes and the lack of a standardized definition and classification of this population.

Análise da Satisfação do Paciente com o Cateterismo Vesical Intermitente Limpo / Analysis of Patient's Satisfaction With Clean Intermittent Urethral Catheterization / Análisis de la Satisfaccion del Paciente com Cateterismo Vesical Intermitente Limpio

Objetivos:Comparar e avaliar os atributos de dois cateteres vesicais para pessoa em tratamento com resíduo pós-miccional, no cateterismo intermitente limpo (CIL). Método: Estudo quantitativo, observacional e descritivo desenvolvido em ambulatório de referência para 48 municípios, entre setembro e novembro de 2020. Participaram 50 pacientes com resíduo pós-miccional que realizam CIL, com 44,8 anos de idade média, sendo 72% homens. Foram comparados dois cateteres lubrificados, de diferentes tecnologias, ambos com bolsa acoplada, por sete dias, na frequência de seis cateterismos diários, utilizando instrumento validado de percepção da satisfação do cliente. Os dados foram analisados por meio do software Statistical Package for the Social Sciences (SPSS) Statistics 23.0, e para comparação dos cateteres foi usado o teste não paramétrico de Wilcoxon. Resultados: O cateter de policloreto de vinila (PVC) pré-lubrificado com glicerol alcançou maior satisfação entre os participantes nos atributos avaliados (90% versus 86%) em relação ao cateter hidrofílico de poliuretano (PVP) pré-lubrificado, embora sem significância estatística nos escores parciais e totais do instrumento utilizado. Conclusão: O estudo possibilitou comparar os dois cateteres, e a avaliação do escore geral para ambos foi positiva. Algumas avaliações negativas para determinados atributos são passíveis de melhorias, além de ser esse modelo de estudo capaz de discriminar os cateteres, podendo ser reproduzido.

Objectives:To compare and evaluate the aspects of the use of two bladder catheters for the person undergoing treatment with post-void residual, in clean intermittent bladder catheterization (CIL). Method: Quantitative, observational, and descriptive analysis developed in a reference outpatient clinic, for 48 municipalities, from September to November 2020. Fifty patients with post-void residual, who underwent CVIL, took part in the study. Their average age was 44,8 years old, and 72% of them were male. Two lubricated catheters were compared, from different technologies, both with attached bags, for seven days, six catheterizations a day, using a validated instrument of perception of customer satisfaction. Data were analyzed by the software Statistical Package for the Social Sciences (SPSS) Statistics 23.0, and for the comparison of the two catheters it was used the Wilcoxon's non-parametric test. Results: The polyvinyl chloride (PVC) catheter pre-lubricated with glycerol reached greater participant satisfaction in the evaluated attributes (90 versus 86%) in relation to the hydrophilic polyurethane (PVP) pre-lubricated catheter, although there was no statistical significance on the partial or total scores of the instrument used. Conclusion: The study allowed the comparison of two catheters, and the evaluation of the general score for both was positive. Some negative evaluation for certain attributes is possible to be improved. This kind of study is able to discriminate the catheters, and it can be reproduced.

Objetivo:Comparar y evolución los atributos de las sondas vesicales para personas cometidas a tratamiento de residuo posmiccional, en cateterismo intermitente limpio (CIC). Método: estudio cuantitativo, observacional, descriptivo, realizado en un ambulatorio de referencia, para 48 municipios entre septiembre y noviembre de 2020. Participaron 50 pacientes con residuo posmiccional sometidos a CIC, edad media de 44,8 años, de los cuales el 72% eran hombres. Se compararon dos catéteres lubricados de diferentes tecnologías, ambos con bolsa adherida, durante 7 días, con una frecuencia de 6 cateterismos diarios, utilizando un instrumento validado para la percepción de satisfacción del cliente. Los datos se analizaron con el software SPSS Statistics 23.0 y se utilizó la prueba no paramétrica de Wilcoxon para comparar los catéteres. Resultados: El catéter de PVC - Cloruro de Polivinilo prelubricado con glicerol mostró mayor satisfacción de los participantes en los atributos evaluados (90% versus 86%) en relación con el catéter de PVP - catéter de poliuretano hidrofílico prelubricado, aunque sin significación estadística en el puntajes parciales y totales del instrumento utilizado. Conclusión: El estudio permitió comparar los dos catéteres y la evaluación de la puntuación general de los catéteres fue positiva. Algunas valoraciones negativas para determinados atributos son susceptibles de mejora y pueden ser implementadas, además de ser este modelo de estudio capaz de discriminar entre catéteres, y pudiendo ser reproducido.

The Effect of Video-Assisted Clean Intermittent Catheterization Training on Patients' Practical Skills and Self-Confidence.

PURPOSE: This research was carried out in order to examine the effect of clean intermittent catheterization (CIC) training with a video developed by the researchers on patients' ability to practice CIC and self-confidence. METHODS: The population of the study consisted of patients who had just started performing CIC in the urology polyclinic of a city hospital in Istanbul. The sample consisted of a total of 80 patients, 40 of whom were in the experimental group and 40 in the control group. The experimental group patients were given CIC training with a training video that was downloaded to the mobile phone of the patient, a family member, or caregiver. The patients' practice skills were evaluated by 2 independent observers. The DISCERN Inquiry Form and the Global Quality Score, the Patient Information Form, the CIC Skill Checklist and the Self-Confidence Scale in Clean Intermittent Self-Catheterization were used to collect data. RESULTS: In the experimental group, consisting of patients who received video-assisted training, the mean scores for the CIC Skill Checklist and the Self-Confidence Scale in Clean Intermittent Self-Catheterization were statistically significantly higher than in the control group (P<0.001), the experience of feeling pain during catheterization was less than in the control group, and the patients in the experimental group experienced statistically significantly fewer complications such as urinary tract infections, urgency, urinary incontinence, hematuria and urethral stricture (P<0.05). CONCLUSION: Video-assisted CIC training had a positive effect on patients' practical skills and self-confidence.

Longitudinal Trajectories of Clean Intermittent Catheterization Responsibility in Youths with Spina Bifida.

PURPOSE: Clean intermittent catheterization (CIC) responsibility among youths with spina bifida is not well studied. We sought to determine longitudinal trajectories of CIC responsibility to examine the transition of CIC responsibility from caregiver-CIC to self-CIC. MATERIALS AND METHODS: We performed a secondary analysis of a prospective cohort study of youths with spina bifida. Participants aged 8-15 years originally recruited from 4 hospitals and a statewide spina bifida association were followed every 2 years. Participants who required CIC were included. Group-based trajectory modeling was used to isolate distinct trajectories of CIC responsibility, which was the primary outcome and was graded from caregiver-CIC to shared-CIC to self-CIC. Predictors of trajectory group membership were entered into multivariate logistic regression models and included various demographic, clinical and psychosocial characteristics such as CIC adherence and CIC mastery. RESULTS: Of 140 youths in the original cohort study, 89 met eligibility criteria for this study. Mean age was 11 years at enrollment and 93% of patients had myelomeningocele. Two distinct trajectory groups emerged: 17% of patients had a low-flat trajectory and 83% had a high-increasing trajectory of CIC responsibility, with shared-CIC by age 8-9 years and increasing self-CIC responsibility thereafter. Significant predictors of group membership in the high-increasing trajectory group included less severe spinal lesion levels, higher CIC mastery and lower CIC adherence. CONCLUSIONS: Nearly 1 in 5 youths with spina bifida in our cohort persistently required caregiver-CIC over time, while the remainder achieved shared-CIC responsibility by age 8-9 years, with increasing self-CIC responsibility thereafter.

Evaluation of Patient-Reported Outcome Measures in Intermittent Self-Catheterization Users: A Systematic Review.

OBJECTIVE: To identify patient-reported outcome measures (PROMs) for intermittent self-catheterization (ISC) users, critically assess and summarize the quality of the measurement properties, and describe the application scenarios on each instrument. DATA SOURCES: PubMed, EMBASE, Medline, PsycINFO, and relevant reference lists were systematically searched through December 2019 (updated May 2020). STUDY SELECTION: Two reviewers independently identified original English language publications that evaluated the psychometric properties of specific PROMs used in ISC patients. DATA EXTRACTION: The following data were obtained: author and publication year, content of domains and subscales, number of items, response options, constructs measured, language, and information on measurement properties. DATA SYNTHESIS: Eleven publications were deemed eligible, including 6 PROMs for measuring patients' ISC-related quality of life, self-confidence, satisfaction, difficulties, acceptance, and adherence to treatment. The Intermittent Self-Catheterization Questionnaire provided the most detail, and the Intermittent Catheterization Acceptance Test could be evaluated on the most consensus-based standards for the selection of health status measurement instrument properties. CONCLUSIONS: Several tools are available for ISC users, but at present there is no comprehensive, concise, and robust instrument with good psychometric properties. Further research on psychometric properties is needed to verify the remaining properties of existing scales and to develop novel tools for clinicians, researchers, and patients.

Urinary catheterization from 1997 to 2018: a Dutch population-based cohort.

BACKGROUND: Our aim was to evaluate the use of indwelling, intermittent and external urinary catheters in neurogenic and non-neurogenic bladder patients in the Netherlands from 1997 to 2018. METHODS: Data were retrieved from a population-based cohort containing information about the extramural use of medical devices in the insured population in the Netherlands. The insured population increased from 9.9 million people in 1997 to 17.1 million people in 2018 (64-100% of the Dutch population). Users are expressed by users per 100,000 insured people and total users, corrected for the overall Dutch population. The expenditures are corrected for inflation and expressed by total costs and costs per user. RESULTS: During this 21-year period, indwelling catheter (IC) users doubled from 159 per 100,000 people (24,734 users) to 315 per 100,000 people (54,106 users). Clean intermittent catheter (CIC) users increased from 92 per 100,000 people (14,258 users) in 1997 to 267 per 100,000 people (45,909 users) in 2018. Of all users, 20.7% had an associated neurogenic disorder and 44.9% a non-neurogenic disorder in 2018. The total expenditure on extramural use of urinary catheters increased from 27.7 million euros in 1997 to 84.4 million euros in 2018. IC costs increased from 6.0 million euros in 1997 to 6.7 million euros in 2018, while CIC costs rose from 16.4 million euros to 74.6 million euros. Urine drainage bag costs decreased from 17.2 million in 2001 to 5.3 million in 2018. CONCLUSIONS: IC use has increased substantially over the past 21 years, despite the fact that CIC use increased as well. It seems that the main driver behind the prevalence in IC and CIC use, is the rise in incontinence care in older patients and the adaption of preferred CIC use in professional guidelines. At least one fifth of all users catheterize due to neurogenic reasons.

Determinants and impact of the time to perform clean intermittent self-catheterization on patient adherence and quality of life: A prospective observational study.

AIMS: To measure the time required to perform clean intermittent self-catheterization (CISC) in daily life and to assess its impact on adherence and quality of life. METHODS: Patients performing CISC for more than 1 month were invited to participate. At home, patients were asked to complete a 1-day diary to assess the specific duration of the CISC (time from when the equipment and environment are brought together to perform CISC) and the next day to complete a second diary for the total duration of the CISC (starting when the patient intent to self-catheterize to the return to the initial activity, including the displacement, and gathering the required device). Adherence, difficulties with CISC, and quality of life were measured with validated questionnaires: Intermittent Catheterization Satisfaction Questionnaire, Intermittent Catheterization Difficulty Questionnaire, Intermittent Catheterization Adherence Scale, and SF Qualiveen Questionnaire. RESULTS: Thirty-six patients agreed to participate but only 25 patients completed the entire protocol. The participants performed CISC for an average of 7 years. The median specific duration of CISC was 2 min and 23 s (ranging from 47'' to 11'50''). The median total duration of CISC was 3 min and 40 s (1'35''; 18'47''). No significant correlation was found between the duration of CISC and patient characteristics, adherence, difficulty to self-catheterize, or quality of life. CONCLUSION: The time to perform CISC was brief, and less than 2-3 min on average. The impact on adherence and quality of life should be assessed in a larger cohort.

Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry.

INTRODUCTION: Clean intermittent catheterization (CIC) is recommended for bladder management after spinal cord injury (SCI) since it has the lowest complication rate. However, transitions from CIC to other less optimal strategies, such as indwelling catheters (IDCs) are common. In individuals with SCI who stopped CIC, we sought to determine how individual characteristics affect the bladder-related quality of life (QoL) and the reasons for CIC cessation. METHODS: The Neurogenic Bladder Research Group registry is an observational study, evaluating neurogenic bladder-related QoL after SCI. From 1479 participants, those using IDC or urinary conduit were asked if they had ever performed CIC, for how long, and why they stopped CIC. Multivariable regression, among participants discontinuing CIC, established associations between demographics, injury characteristics, and SCI complications with bladder-related QoL. RESULTS: There were 176 participants who had discontinued CIC; 66 (38%) were paraplegic and 110 (63%) were male. The most common reasons for CIC cessation among all participants were inconvenience, urinary leakage, and too many urine infections. Paraplegic participants who discontinued CIC had higher mean age, better fine motor scores, and lower educational attainment and employment. Multivariable regression revealed years since SCI was associated with worse bladder symptoms (neurogenic bladder symptom score), ≥4 urinary tract infections (UTIs) in a year was associated with worse satisfaction and feelings about bladder symptoms (SCI-QoL difficulties), while tetraplegia was associated better satisfaction and feelings about bladder symptoms (SCI-QoL difficulties). CONCLUSIONS: Tetraplegics who have discontinued CIC have an improved QoL compared with paraplegics. SCI individuals who have discontinued CIC and have recurrent UTIs have worse QoL.

Long-term compliance with bladder management in patients with spinal cord injury: A Saudi-Arabian perspective.

Objective: To examine long-term compliance with bladder management in patients with spinal cord injury (SCI) at a tertiary care rehabilitation facility in Saudi Arabia.Design: Cross-sectional survey.Setting: Tertiary care rehabilitation facility in Saudi Arabia.Participants: A self-administered questionnaire was distributed to patients with SCI during their clinic visits. 50 patients (41 males and nine females) participated in the survey. Data documentation included demographic characteristics, type and level of injury, compliance with bladder management and barriers in compliance.Main outcome measures: The type of bladder management employed at first follow-up visit was compared with that employed at discharge.Results: Eleven out of 41 patients who were discharged on clean intermittent catheterization (CIC) stopped it within 3 months of discharge, mainly due to lack of accessibility and financial support to buy catheters. Of the total sample, 23% reported that they did not know the difference between catheter types and their advantages, and 49% stated that they did not receive proper health education regarding bladder management.Conclusion: CIC was the most commonly used bladder management technique in patients with SCI following up at a tertiary care rehabilitation facility in Saudi Arabia. Compliance with CIC may be improved by ensuring access to catheters post-discharge and by providing appropriate education about bladder management during inpatient rehabilitation.

Change in urodynamic pattern and incidence of urinary tract infection in patients with traumatic spinal cord injury practicing clean self-intermittent catheterization.

Objective: To observe changes in cystometric parameters in individuals with spinal cord injury (SCI) with neurogenic bladder practicing clean intermittent self-catheterization (CIC) and incidence of urinary tract infection (UTI) in such patients.Design: Prospective, observational study.Setting: Tertiary Urban Rehabilitation Hospital.Participants: Persons with neurogenic bladder caused by traumatic SCI and practicing CIC.Interventions: Clinical evaluation, complete urine analysis, urine culture and sensitivity, ultrasonography of the abdomen and urodynamic study were evaluated at baseline and at follow-up (6 months to 1 year).Outcome Measures: Detrusor pattern, cystometric capacity, detrusor compliance, detrusor leak point pressure, residual urine, incidence of UTI.Results: Thirty-one participants were included in the study. The baseline cystometric study showed that 15 had overactive detrusor and 16 had detrusor areflexia. The mean cystometric capacity decreased significantly between baseline and follow-up in both the groups but remained within the normal threshold limit, decline being more marked in the overactive detrusor group, who also had more marked decrease in compliance. Mean detrusor leak point pressure was below 40 cm H2O in all participants in both groups at baseline and follow-up. Mean residual urine improved at follow-up in both groups. Incidence of UTI was 2.29 episodes per patient per year, and more frequent in the overactive detrusor group. Escherichia coli was the causative agent in 45%.Conclusion: The cystometric capacity and compliance decreased significantly though patients were doing regular CIC and managed on antimuscarinics for detrusor overactivity (DO). UTI is more common in individuals with SCI with DO and E. coli is the most common cause of UTI.

What criteria affect a patient's choice of catheter for self-catheterization?

AIM: The aim was to determine which criteria are most influential in guiding the patient's choice of catheter during clean intermittent self-catheterization (CISC) education. METHODS: A questionnaire exploring five traits (catheter design, catheter length, the comfort of use, nurse's explanations, and how easy it was to carry and dispose of the catheter) was administered to all patients who succeeded in performing CISC. The patients had to report the criterion that most influenced their choice, and rate the importance of each criterion from 1 to 4 on a Likert scale (strongly disagree, somewhat disagree, somewhat agree, strongly agree). The study assessed the impact that age, sex, etiology, dependency, motor or sensory upper limb deficiency, and position required to perform CISC may have had on the importance of the different criteria. RESULTS: Seventy-three patients were included (mean age, 50.9 ± 14.3 years). The most important criterion was the nurse's explanations (44%), followed by comfort of handling (32%), the discreet aspect of carrying the catheter (15%), and catheter length (7%). The esthetic aspect was not important for 34% of patients, whereas all the other criteria were important for at least 82% of patients. The comfort of handling was more often a priority for those with motor or sensory upper limb disorders (P < .01). The other characteristics of the patients did not impact the way they prioritized the criteria. CONCLUSION: These results highlight the importance of extensive training for nurses involved in CISC education, as their explanations have the greatest impact on the patient's choice of the catheter.

Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury.

OBJECTIVE: To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). DESIGN: We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. SETTING: Multicenter study. PARTICIPANTS: Registry participants unable to volitionally void after SCI (N=1236). INTERVENTION: Not applicable. MAIN OUTCOME MEASURE: Upper extremity motor function association with CIC. RESULTS: A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]). CONCLUSION: In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.

Urological dysfunction in patients with hereditary spastic paraplegia.

AIMS: Purposes of this study were to describe lower urinary tract symptoms (LUTS) and related urodynamic patterns in patients with hereditary spastic paraplegia (HSP), and to characterize LUTS management and associated uronephrological complications. METHODS: We retrospectively reviewed medical files of HSP patients, consecutively followed in our Physical and Rehabilitation Medicine Department between 1999 and 2016. Clinical, urodynamic, and radiological data were collected and analyzed. Different treatments which have been prescribed and uronephrological complications were also recorded. Patients with other neurological or urological diseases were excluded. RESULTS: Thirty-three patients with HSP were included. Mean duration of follow-up was 8.1 ± 5 years, mean age 62 ± 14 years, and 70% were men. The most frequent LUTS was urgency and voiding dysfunction (both 69.7%). Incontinence and retention with a significant postvoid residue above 100 mL accounted for 66.7% and 57.6% of initial symptoms respectively. Neurogenic detrusor overactivity was diagnosed in 80.7% of patients. Two-thirds of our cohort were treated with anticholinergics and 9.1% required intradetrusor botulinum-toxin injections. Only 27.3% of patients performed clean intermittent self-catheterization. Febrile urinary tract infections (21.2%), urolithiasis (15,1%), hydronephrosis (6%), and chronic renal failure (9.1%) were found. CONCLUSION: Given their high prevalence and the risk of uronephrological complications, LUTS should be systematically assessed in HSP patients. The systematic screening of urological dysfunction in this population would improve its management, decrease the incidence of uronephrological complications, and increase the quality of life.

Online health forum as a support for people who perform intermittent vesical catheterization / Fórum virtual de la salud como soporte a personas que realizan cateterismo vesical intermitente / Fórum virtual de saúde como suporte às pessoas que realizam cateterismo vesical intermitente

ABSTRACT Objective: to evaluate the use of an online forum for people with myelomeningocele and their families and the profile of the users, based on intermittent catheterization. Method: a quantitative, cross-sectional, descriptive and exploratory study. Data was collected from users of the online forum, based on an online questionnaire available from March 20 to April 20, 2015. Sample consisted of 30 users. Descriptive statistical data analyses and chi-square test were performed. Results: among users, 27% were people with myelomeningocele and 73% were family members. Age, considering the total sample, ranged from 22 to 58 years old. Women represented 67% of the sample. Most users considered the language used in the forum understandable, and also thought the forum had a proper layout and was easy to navigate. It was noted that the mother and the person with myelomeningocele are the main responsible people for intermittent catheterization; 86% use a simple plastic catheter and 14% use a hydrophilic catheter; 81% do not reuse the catheter, 10% use the same catheter for one day and 9% for up to one week. The main place chosen to perform intermittent catheterization was the bed, followed by the toilet and wheelchairs. Conclusion: the use of the online forum was well evaluated by the users. It can be considered a means to obtain information, create a support network and clarify any doubts, empowering users and contributing to adherence to intermittent catheterization, which is one of the treatments for neurogenic bladder.

RESUMEN Objetivo: evaluar el uso de un fórum virtual para personas con mielomeningocele y sus familiares y el perfil de sus usuarios, según la realización del cateterismo vesical intermitente. Método: estudio cuantitativo, transversal, descriptivo y exploratorio. Se realizó la recolección de datos con usuarios del fórum virtual, en base a una encuesta online, disponible desde el 20 de marzo al 20 de abril de 2015. La muestra estuvo compuesta por 30 usuarios. Se realizaron los análisis estadísticos, descriptivos y test chi cuadrado. Resultados: de los usuarios, 27% eran personas con mielomeningocele y 73% familiares. La edad, considerándose toda la muestra, osciló entre los 22 y 58 años. El sexo femenino representó el 67% de la muestra. La mayoría de los usuarios consideró que el lenguaje utilizado en el fórum es comprensible, la imagen es adecuada y tiene una fácil navegación. Se observó que la madre y la propia persona con mielomeningocele son las principales responsables por la realización del cateterismo vesical intermitente; 86% utilizan catéter de plástico simple y 14% el catéter hidrofilico; 81% no reutilizan el catéter, 10% utilizan el mismo catéter durante un día y el 9% incluso hasta una semana. El principal lugar de realización del cateterismo vesical intermitente fue la cama, seguida de la letrina y la silla de ruedas. Conclusión: el uso del fórum virtual fue bien evaluado por los usuarios. Se lo puede considerar un medio para obtener informaciones, formación de red de apoyo y aclarar dudas, empoderando a los usuarios y contribuyendo a la adhesión al cateterismo vesical intermitente, que es uno de los tratamientos para la vejiga neurogénica.

RESUMO Objetivo: avaliar o uso de um fórum virtual para pessoas com mielomeningocele e seus familiares e o perfil dos usuários, de acordo com a realização do cateterismo vesical intermitente. Método: estudo quantitativo, transversal, descritivo e exploratório. A coleta de dados foi realizada com usuários do fórum virtual, com base em um questionário online, disponibilizado de 20 de março a 20 de abril de 2015. A amostra foi composta de 30 usuários. Foram realizadas análises estatísticas descritivas e teste qui-quadrado. Resultados: dos usuários, 27% eram pessoas com mielomeningocele e 73% familiares. A idade, considerando a amostra total, variou de 22 a 58 anos. O sexo feminino representou 67% da amostra. A maioria dos usuários considerou a linguagem utilizada no fórum compreensível, o visual adequado e a navegação fácil. Foi observado que a mãe e a própria pessoa com mielomeningocele são os principais responsáveis pela realização do cateterismo vesical intermitente; 86% utilizam cateter de plástico simples e 14% o cateter hidrofílico; 81% não reutilizam o cateter, 10% utilizam o mesmo cateter durante um dia e 9% por até uma semana. O principal local de realização do cateterismo vesical intermitente foi a cama, seguida pelo vaso sanitário e cadeira de rodas. Conclusão: o uso do fórum virtual foi bem avaliado pelos usuários. Ele pode ser considerado um meio para obtenção de informações, formação de rede de apoio e esclarecimento de dúvidas, empoderando os usuários e contribuindo para a adesão ao cateterismo vesical intermitente, que é um dos tratamentos para a bexiga neurogênica.