Developing a strategy to reduce the high morbidity of patients with long-term urinary catheters: the BioMed catheter research clinic.
Khan AA, Mathur S, Feneley R, Timoney AG. BioMed Centre, Bristol Urological Institute, Southmead Hospital, Bristol, UK. BJU Int. 2007 Dec;100(6):1298-301.
OBJECTIVE: To assess the idea of managing patients having problems with long-term catheterization (LTC, normally used when all other methods of bladder management have failed or are unsuitable) in a dedicated clinic, to present a prospective analysis of consecutive new patients attending between February 2002 and October 2006, and to establish the incidence of bladder stones in patients who have recurrent catheter encrustation and blockage.
PATIENTS AND METHODS: Patients treated with LTC are a large heterogeneous group, mainly consisting of elderly people who have chronic disabilities, and catheter-associated complications occur in > 70% of them. In all, 260 consecutive new patients having problems with LTC were assessed; the evaluation consisted of basic demographics, a detailed history, clinical examination, urine analysis and flexible cystoscopy (FC) via the catheterization route. Patients with bladder stones were screened with FC for recurrence of stones at 3, 6 and 12 months after treatment. RESULTS: In all, 117 men and 143 women (mean age 67.7 years, range 23-97) were assessed; 147 (55.5%) had catheter encrustation. FC showed that 66 of the 147 patients (45%) had bladder stones. Forty-eight patients (73%) were successfully treated at the same clinic appointment and their stones were removed with the help of a tip-less stone basket. Eighteen patients (27%) were referred for inpatient treatment of bladder stones under general anaesthesia. Twenty of 66 patients with bladder stones (30%) formed recurrent bladder stones at a mean (range) follow-up of 8.1 (3-18 months). In addition, 36 patients had successful insertion of suprapubic catheter (SPC) under local anaesthetic in the clinic, and 11 were referred for SPC insertion under general anaesthesia. Two patients were diagnosed with bladder transitional cell carcinoma. CONCLUSION: The introduction of a dedicated catheter clinic, equipped with facilities such as FC and a hoist, enables patients to be treated in an environment that meets their needs and potentially reduces the risk of more complex stone removal and catheter problems at a later date. It can also act as a potential source of data for use in research and development. A significant proportion (45%) of patients with catheter encrustation and blockage had formed bladder stones. Our study provides a rationale for FC of all such patients to detect and remove stones.
A novel product for intermittent catheterisation: its impact on compliance with daily life–international multicentre study.
Bjerklund Johansen T, Hultling C, Madersbacher H, Del Popolo G, Amarenco G; LoFric Primo Study Group. Telemark Hospital, Porsgrunn, Norway. Eur Urol. 2007 Jul;52(1):213-20. Epub 2006 Nov 29. Comment in: Eur Urol. 2007 Jul;52(1):220.
OBJECTIVES: This study was undertaken to evaluate patient openness to changing and satisfaction with catheters used in intermittent catheterisation (IC) for urinary retention from neurogenic bladder dysfunction, and to compare patient response to conventional catheters and a novel packaged hydrophilic catheter: LoFric Primo.
PATIENTS AND METHODS: Of 409 patients recruited, 378 (283 males, 95 females; mean age: 43.5 yr) completed a 12-d trial of the novel catheter. The diagnoses were spinal cord lesion in 65.6%, multiple sclerosis in 9.6%, spina bifida in 2.3%, and other neurologic conditions in 22.5%; the mean duration of IC was 4.6 yr. Patients evaluated their current catheter at recruitment and the novel catheter after the 2-wk trial by questionnaire. Patient satisfaction was expressed on a Visual Analogue Scale for seven topics covering use and general satisfaction.
RESULTS: Of the 378 patients, 55.2% were happy to continue with the novel device, which was 74% of patients using standard polyvinyl chloride (PVC) catheters and 36% of those using prelubricated PVC (p=0.04). No individual patient factors were found to be significant in catheter choice. For the whole study population “ability to comply with daily life activities” was maintained with the novel product despite handling and general satisfaction being found more troublesome.
CONCLUSIONS: The main finding was that more than 50% of the patients wished to continue with the novel catheter and reported increased satisfaction regarding introduction of the catheter, handling, time spent, perception of IC, general satisfaction, and ability to cope with daily life.
Reinnervation for neurogenic bladder: historic review and introduction of a somatic-autonomic reflex pathway procedure for patients with spinal cord injury or spina bifida.
Xiao CG. Department of Urology, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. xiaocg@mails.tjmu.edu.cn Eur Urol. 2006 Jan;49(1):22-8; discussion 28-9. Epub 2005 Nov 2.
Neurogenic bladder caused by SCI or spina bifida is a major problem. Research in restoring functional micturition has mainly focused on electrical stimulation for many decades with good progress, but it is still not the definitive solution for majority of the SCI patients. An alternative approach has been to investigate restoring innervation to the lower urinary tract after spinal SCI. Different animal and clinical studies were reviewed historically in this article, focused on mainly cross over nerve surgery for reinnervation of the bladder. An artificial somatic-autonomic reflex pathway procedure and its mechanisms were introduced. Clinical application and the satisfactory results of the new procedure were reviewed in details in restoring voluntary bladder control in patients with SCI or spina bifida.