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Abuzied Y, Al-Amer R, Saleh MYN, Somduth S, AlBashtawy M, Ali AM. Exploring the lived experience of Arab male patients on intermittent catheterization after spinal cord injury: A phenomenological study. Int J Nurs Pract 2024:e13268. [PMID: 38798100 DOI: 10.1111/ijn.13268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/19/2024] [Accepted: 05/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Intermittent catheterization (IC) has been identified as one of the critical techniques used by spinal cord injury (SCI) patients to cope with emptying the bladder, despite several problems impeding this procedure. AIM The study aimed accordingly to explore the lived experience of Arab male patients on IC after their SCI. DESIGN This study was carried out by using a descriptive qualitative approach with a phenomenological analysis of data. METHODS A qualitative study was carried out on 10 Arab male patients from the Rehabilitation Hospital at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia who were utilizing intermittent catheters following SCI. The interviews were analysed using Husserl's phenomenology and the Colaizzi method of data analysis. RESULTS Two major themes and six sub-themes were identified from exploring the patients experience. These themes are as follows: Theme 1: The Way to IC; with two sub-themes: (i) 'service provided and acceptance' and (ii) 'educational experience'; Theme 2: Lifestyle and self-adaptation; with four sub-themes: (i) 'Flexibility and freedom', (ii) 'Physical access to the community', (iii) 'Traveling' and (iv) 'Work and Social life balance'. CONCLUSION It is evident that using an intermittent catheter among patients with SCI influenced almost all aspects of the participant's life, including their social lives and body image appearance.
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Affiliation(s)
- Yacoub Abuzied
- Department of Nursing, Spinal Cord Injury, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | | | - Mohammad Y N Saleh
- Clinical Nursing Department, School of Nursing, The University of Jordan, Amman, Jordan
| | - Shreemathie Somduth
- Nursing Administration, Rehabilitation Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed AlBashtawy
- Nursing Community Health, Princess Salma Faculty of Nursing, Al Al-Bayt University, Al-Mafraq, Jordan
| | - Amira Mohammed Ali
- Department of Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Wang XL, Wang YX, Chen JZ, Liu XY, Liu X, Zhong QK, Zhao ZL, Shi ZD, Han CH. Clinical characteristics and molecular mechanisms underlying bladder cancer in individuals with spinal cord injury: a systematic review. BMC Urol 2024; 24:111. [PMID: 38778291 PMCID: PMC11110351 DOI: 10.1186/s12894-024-01457-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/15/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Patients with spinal cord injury have a relatively high risk for bladder cancer and often complicated with bladder cancer in advanced stages, and the degree of aggressiveness of malignancy is high. Most of the literature is based on disease clinical features while, our study reviews the clinical characteristics and molecular mechanisms of spinal cord injury patients with bladder cancer, so that it might help clinicians better recognize and manage these patients. METHOD We searched PubMed, Web of Science and Embase, using retrieval type like ("Neurogenic Lower Urinary Tract Dysfunction" OR "Spinal cord injury" OR "Spinal Cord Trauma") AND ("bladder cancer" OR "bladder neoplasm" OR "bladder carcinoma" OR "Urinary Bladder Neoplasms" OR "Bladder Tumor"). In Web of Science, the retrieval type was searched as "Topic", and in PubMed and Embase, as "All Field". The methodological quality of eligible studies and their risk of bias were assessed using the Newcastle-Ottawa scale. This article is registered in PROSPERO with the CBD number: CRD42024508514. RESULT In WOS, we searched 219 related papers, in PubMed, 122 and in Embase, 363. Thus, a total of 254 articles were included after passing the screening, within a time range between 1960 and 2023. A comprehensive analysis of the data showed that the mortality and incidence rates of bladder cancer in spinal cord injury patients were higher than that of the general population, and the most frequent pathological type was squamous cell carcinoma. In parallel to long-term urinary tract infection and indwelling catheterization, the role of molecules such as NO, MiR 1949 and Rb 1. was found to be crucial pathogenetically. CONCLUSION This review highlights the risk of bladder cancer in SCI patients, comprehensively addressing the clinical characteristics and related molecular mechanisms. However, given that there are few studies on the molecular mechanisms of bladder cancer in spinal cord injury, further research is needed to expand the understanding of the disease.
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Affiliation(s)
- Xin-Lei Wang
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Yi-Xuan Wang
- Suzhou High School of Jiangsu Province, Suzhou, Jiangsu, China
| | - Jun-Zhi Chen
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xin-Yu Liu
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Xing Liu
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Qi-Kai Zhong
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Zi-Lin Zhao
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China
| | - Zhen-Duo Shi
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
- Department of Urology, Xuzhou Central Hospital, Jiefang South Road, No. 199, Xuzhou, Jiangsu, China.
- School of Life Sciences, Jiangsu Normal University, Xuzhou, Jiangsu, China.
- Jiangsu Provincial Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Xuzhou City Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Jiangsu, China.
| | - Cong-Hui Han
- Department of Urology, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou Central Hospital, Xuzhou, Jiangsu, China.
- School of Life Sciences, Jiangsu Normal University, Xuzhou, Jiangsu, China.
- Jiangsu Provincial Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Xuzhou City Engineering Research Center of Cancer Cell Therapy and Translational Medicine, Jiangsu, China.
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Chen SF, Kuo HC. Management of spinal cord injury patients with neurogenic lower urinary tract dysfunction using minimally invasive and surgical therapies in Taiwan. Int Urol Nephrol 2024; 56:1205-1216. [PMID: 38036803 DOI: 10.1007/s11255-023-03884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
The main problems of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury (SCI) consist of impaired urine storage, impaired bladder emptying, or both. The priorities in the management of SCI-NLUTD should be preservation of renal function, followed by freedom from urinary tract infections and improvement of quality of life. Management of NLUTD in patients with SCI must be based on urodynamic findings rather than clinical evaluations. In the hospital without urodynamic equipment, careful measurement of intravesical pressure and safety functional bladder capacity in conjunction with clinical assessment are also feasible. Identification of high-risk patients is important for preventing urological complications in patients with chronic SCI. The management of NLUTD should start with conservative bladder management and medical treatment. Patients with SCI should be regularly followed up, and any NLUTDs and urological complications should be adequately treated. When surgical intervention is necessary, less invasive and reversible procedures should be considered first, and any unnecessary surgery should be avoided. This article reports the current evidence and expert opinions on the patient-centered bladder management of NLUTD in chronic SCI patients in Taiwan. To avoid renal function deterioration and urological complications, annual active surveillance of bladder and renal function is mandatory, especially for high-risk SCI patients.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
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Elliott CS, Seufert C, Zlatev D, Kreydin E, Crew J, Shem K. Do improvements in upper extremity motor function affect changes in bladder management after cervical spinal cord injury? J Spinal Cord Med 2024; 47:239-245. [PMID: 34792429 PMCID: PMC10885770 DOI: 10.1080/10790268.2021.1999715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION One of the most important predictors of clean intermittent catheterization (CIC) adoption after spinal cord injury (SCI) is upper extremity (UE) motor function at discharge from rehabilitation. It is not clear however if post-discharge improvements in UE motor function affect future bladder management decisions. METHODS We assessed persons with cervical SCI in the National Spinal Cord Injury Dataset for the years 2000-2016 who underwent motor examination at discharge from rehabilitation and again at 1-year follow-up. Individuals were stratified based on a previously described algorithm which categorizes the ability to independently perform CIC based upon UE motor scores. Improvements in the predicted ability to self-catheterize over the first year after rehabilitation discharge were evaluated in relation to bladder management. RESULTS Despite 15% of our SCI cohort improving from "less than able to independently catheterize" to "able to independently catheterize", more patients in the overall cohort dropped out of CIC (175/643 = 27.2%) than adopted CIC (68/548 = 12.4%) (P < .001). We found that in those initially categorized as "less than able to independently catheterize" at the time of rehabilitation discharge, CIC adoption was not significantly different at 1-year follow-up whether or not there was motor improvement to "able to independently catheterize" (12.7% vs 9.2% respectively, P = 0.665). Between these two groups, CIC dropout was also equivalent (34.3% vs 30.0% respectively, P = 0.559). CONCLUSIONS In the first year after rehabilitation, more overall SCI patients transition away from CIC than convert to CIC. Significant improvements in UE motor function during the first year after rehabilitation discharge do not appear to affect bladder management decisions.
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Affiliation(s)
- Christopher S. Elliott
- Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Caleb Seufert
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Dimitar Zlatev
- Department of Urology, Stanford University Medical Center, Stanford, California, USA
| | - Evgeniy Kreydin
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - James Crew
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California, USA
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Poublon CG, Scholten EWM, Wyndaele MIA, Post MWM, Stolwijk-Swüste JM. Changes in bladder emptying during inpatient rehabilitation after spinal cord injury and predicting factors: data from the Dutch Spinal Cord Injury Database. Spinal Cord 2023; 61:624-631. [PMID: 37608226 DOI: 10.1038/s41393-023-00925-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/24/2023]
Abstract
STUDY DESIGN Secondary analysis of multicentre prospective observational data. OBJECTIVES To describe methods of bladder emptying at admission and discharge in patients with recently acquired spinal cord injury (SCI) and to describe predictors of bladder emptying methods at discharge. SETTING First inpatient rehabilitation in specialised rehabilitation centres in the Netherlands. METHODS Data from the Dutch Spinal Cord Injury Database collected between 2015 and 2019 were used. McNemar-Bowker test was used to evaluate if bladder emptying methods differed over time; One-Way ANOVA and Chi-Square tests to see if bladder emptying methods differed by demographic and injury-related characteristics. Binary logistic regression was used to predict the type of bladder emptying at discharge with demographic and injury-related characteristics measured at admission. RESULTS Of 1403 patients, 44.1% had cervical, 38.4% thoracic and 17.5% lumbosacral lesions at admission. AIS classification was mostly D (63.8%). The method of bladder emptying changed significantly (p < 0.001) from admission to discharge: decrease of clean intermittent assisted catheterisation (17.1% to 4.1%) and indwelling catheter (33.4% to 16.3%) and increase in clean intermittent self-catheterisation (CISC, 7.8% to 22.2%) and normal voiding (40.2% to 56.1%). Age, sex, SCI level, AIS classification and level of independence predicted the method of bladder emptying at discharge (all p < 0.001). CONCLUSIONS During first inpatient rehabilitation, the method of bladder emptying changed resulting in more patients discharged with normal voiding and CISC. Age, sex, SCI level, AIS classification and level of independence in self-care were all confirmed as factors playing a role in this change.
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Affiliation(s)
- Claire G Poublon
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Eline W M Scholten
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Michel I A Wyndaele
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Centre Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
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Takahashi R, Sekido N, Matsuoka M, Sengoku A, Nomi M, Matsuyama F, Murata T, Kitta T, Mitsui T. Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan. Low Urin Tract Symptoms 2023; 15:165-172. [PMID: 37300392 DOI: 10.1111/luts.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI). METHODS We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI. RESULTS Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI. CONCLUSIONS There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.
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Affiliation(s)
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital, Osaka, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | | | | | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Yamanashi, Japan
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Moore JV, Burns J, McClelland N, Quinn J, McCoy CP. Understanding the properties of intermittent catheters to inform future development. Proc Inst Mech Eng H 2023:9544119231178468. [PMID: 37300485 DOI: 10.1177/09544119231178468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Despite the extensive use of intermittent catheters (ICs) in healthcare, various issues persist for long-term IC users, such as pain, discomfort, infection, and tissue damage, including strictures, scarring and micro-abrasions. A lubricous IC surface is considered necessary to reduce patient pain and trauma, and therefore is a primary focus of IC development to improve patient comfort. While an important consideration, other factors should be routinely investigated to inform future IC development. An array of in vitro tests should be employed to assess IC's lubricity, biocompatibility and the risk of urinary tract infection development associated with their use. Herein, we highlight the importance of current in vitro characterisation techniques, the demand for optimisation and an unmet need to develop a universal 'toolkit' to assess IC properties.
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Affiliation(s)
- Jessica V Moore
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jane Burns
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nicola McClelland
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - James Quinn
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Colin P McCoy
- School of Pharmacy, Queen's University Belfast, Belfast, Northern Ireland, UK
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Kanai A, Andersson KE, Fry C, Yoshimura N. Targeting neurotrophin and nitric oxide signaling to promote recovery and ameliorate neurogenic bladder dysfunction following spinal cord injury - Mechanistic concepts and clinical implications. CONTINENCE (AMSTERDAM, NETHERLANDS) 2023; 6:100703. [PMID: 37389025 PMCID: PMC10310066 DOI: 10.1016/j.cont.2023.100703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
This review summarizes the presentations made to a workshop entitled "Targeting Neurotrophin and Nitric Oxide Signaling to Promote Recovery and Ameliorate Neurogenic Bladder Dysfunction following Spinal Cord Injury - Mechanistic Concepts and Clinical Implications" at the International Continence Society (ICS) 2022 Vienna Meeting. Spinal cord injury (SCI; T8-T9 contusion/transection) causes impaired mobility, neurogenic detrusor overactivity (NDO), detrusor sphincter dyssynergia (DSD) and subsequent decreased quality of life. This workshop discussed the potential of future therapeutic agents that manage the lesion and its consequences, in particular possibilities to reduce the lesion itself and manage pathophysiological changes to the lower urinary tract (LUT). Attenuation of the spinal cord lesion itself was discussed with respect to the potential of a trio of agents: LM11A-3, a p75 neurotrophin receptor modulator to counter activation of local apoptotic pathways; LM22B-10 to promote neuronal growth by targeting tropomyosin-related kinase (Trk) receptors; and cinaciguat, a soluble guanylate cyclase (sGC) activator as an agent promoting angiogenesis at the injury site. The workshop also discussed targets on the bladder to block selectivity sites associated with detrusor overactivity and poor urinary filling profiles, such as purinergic pathways controlling excess contractile activity and afferent signaling, as well as excess fibrosis. Finally, the importance of increased mechanosensitive signaling as a contributor to DSD was considered, as well as potential drug targets. Overall, an emphasis was placed on targets that help restore function and reduce pathological LUT consequences, rather than downregulate normal function.
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Affiliation(s)
- A.J. Kanai
- University of Pittsburgh, School of Medicine, Department of Medicine, Renal-Electrolyte Division, United States
| | - K.-E. Andersson
- Lund University, Division of Clinical Chemistry and Pharmacology, Lund, Sweden
| | - C.H. Fry
- University of Bristol, School of Physiology, Pharmacology, and Neuroscience, UK
| | - N. Yoshimura
- University of Pittsburgh, School of Medicine, Department of Urology, United States
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A cost-effectiveness analysis of bladder management strategies in neurogenic lower urinary tract dysfunction after spinal cord injury: A publicly funded health care perspective. Spinal Cord 2023; 61:269-275. [PMID: 36894764 DOI: 10.1038/s41393-023-00883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/22/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
STUDY DESIGN Economic evaluation study. OBJECTIVES To investigate the long-term cost-effectiveness of clean intermittent catheterization (CIC) compared with suprapubic catheters (SPC) and indwelling urethral catheters (UC) among individuals with neurogenic lower urinary tract dysfunction (NLUTD) related to spinal cord injury (SCI) from a public healthcare perspective. SETTING University affiliated hospital in Montreal, Canada. METHODS A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and lifetime horizon to estimate the incremental cost per quality-adjusted life years (QALYs). Participants were assigned to treatment with either CIC or SPC or UC. Transition probabilities, efficacy data, and utility values were derived from literature and expert opinion. Costs were obtained from provincial health system and hospital data in Canadian Dollars. The primary outcome was cost per QALY. Probabilistic and one-way deterministic sensitivity analyses were performed. RESULTS CIC had a lifetime mean total cost of $ 29,161 for 20.91 QALYs. The model predicted that a 40-year-old person with SCI would gain an additional 1.77 QALYs and 1.72 discounted life-years gained if CIC were utilized instead of SPC at an incremental cost savings of $330. CIC confer 1.96 QALYs and 3 discounted life-years gained compared to UC with an incremental cost savings of $2496. A limitation of our analysis is the lack of direct long-term comparisons between different catheter modalities. CONCLUSIONS CIC appears to be a dominant and more economically attractive bladder management strategy for NLUTD compared with SPC and/or UC from the public payer perspective over a lifetime horizon.
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Variation in Provider Practice Patterns and the Perceived Need for a Shared Decision-making Tool for Neurogenic Lower Urinary Tract Dysfunction. Urology 2023; 174:185-190. [PMID: 36709856 DOI: 10.1016/j.urology.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To evaluate neurogenic lower urinary tract dysfunction (NLUTD) care providers' current practice patterns, their perceived need for a shared decision-making tool for NLUTD management. METHODS We developed an electronic survey to assess multiple factors surrounding NLUTD management including practice patterns, perceived need for a decision aid and willingness to use it. Prior to survey dissemination, a panel of expert NLUTD care providers reviewed and provided a critique of the survey. It was delivered via email to the members of the Genitourinary Reconstructive Surgeons, and the Society of Urodynamics, female pelvic medicine and urogenital reconstruction between March and May 2022. RESULTS A total of 117 NLUTD care providers from 11 countries participated in this survey. Most participants were urologists (n: 109, 93%) working at academic teaching hospitals (n: 82, 70%). The most common treatments the providers had provided for stress urinary incontinence and detrusor overactivity were sling procedures (n: 76, 65%) and anticholinergics (n: 111, 95%). Participants believed that NLUTD management can be highly patient-specific and extensively vary from one individual to another. Most participants believed that patients performing clean intermittent catheterization have better QoL compared to those utilizing indwelling urinary catheters (n: 81, 69%). Participants believed there is a need for a NLUTD decision aid, and they expressed their willingness to use one if available. CONCLUSION We found discordances between guideline recommendations, provider practice patterns, and patient-reported outcome measures and essential attributes that indicated the need for a decision aid to improve patient-provider communication and shared decision-making in NLUTD management.
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Welk B, Fenderski K, Myers JB. Catheter Use in Neurogenic Lower Urinary Tract Dysfunction—Can Shared Decision-Making Help Us Serve Our Patients Better? CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00682-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bladder Management Strategies for Urological Complications in Patients with Chronic Spinal Cord Injury. J Clin Med 2022; 11:jcm11226850. [PMID: 36431327 PMCID: PMC9697498 DOI: 10.3390/jcm11226850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients' quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
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Chen SF, Lee YK, Kuo HC. Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury. J Clin Med 2022; 11:jcm11195864. [PMID: 36233731 PMCID: PMC9571409 DOI: 10.3390/jcm11195864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.
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Affiliation(s)
| | | | - Hann-Chorng Kuo
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117); Fax: +886-3-8560794
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Patient Support Program and Healthcare Resource Utilization in Patients Using Clean Intermittent Catheterization for Bladder Management. J Wound Ostomy Continence Nurs 2022; 49:470-480. [PMID: 36108231 PMCID: PMC9481293 DOI: 10.1097/won.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary purpose of this study was to evaluate the impact of a patient-centered, chronic care self-management support program of clean intermittent catheterization (CIC) on emergency department (ED) visits and hospitalizations within the first 30 days of starting CIC. Secondary research objectives were to compare reuse of catheters, adherence to healthcare provider–instructed frequency of CIC, and reasons for nonadherence.
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Gharbi M, Gazdovich S, Bazinet A, Cornu JN. Quality of life in neurogenic patients based on different bladder management methods: A review. Prog Urol 2022; 32:784-808. [DOI: 10.1016/j.purol.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/06/2023]
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Brady SS, Bavendam TG, Bradway CK, Conroy B, Dowling-Castronovo A, Epperson CN, Hijaz AK, Hsi RS, Huss K, Kim M, Lazar J, Lee RK, Liu CK, Loizou CN, Miran S, Mody L, Norton JM, Reynolds WS, Sutcliffe S, Zhang N, Hokanson JA. Noncancerous Genitourinary Conditions as a Public Health Priority: Conceptualizing the Hidden Burden. Urology 2022; 166:39-49. [PMID: 34536410 PMCID: PMC8924010 DOI: 10.1016/j.urology.2021.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/07/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To provide a conceptual framework to guide investigations into burdens of noncancerous genitourinary conditions (NCGUCs), which are extensive and poorly understood. METHODS The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop of diverse, interdisciplinary researchers and health professionals to identify known and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden. Following the meeting, a subgroup of attendees (authors of this article) continued to meet to conceptualize burden. RESULTS The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg, romantic partners, family members), organizational/institutional (eg, schools, workplaces), community (eg, public restroom infrastructure), societal (eg, health care and insurance systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects. The framework acknowledges that NCGUCs can be a manifestation of underlying biological dysfunction, while also leading to biological impacts (generation and exacerbation of health conditions, treatment side effects). CONCLUSION NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base to describe the comprehensive burden is needed. Measurement of NCGUC burdens should incorporate multiple levels of well-being and social ecology, a life course perspective, and potential interactions between NCGUCs and genetics, sex, race, and gender. This approach would elucidate accumulated impacts and potential health inequities in experienced burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg, new research and improved treatments) to this important domain of health.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Tamara G Bavendam
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Christine K Bradway
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Britt Conroy
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | | | - Cynthia Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
| | - Adonis K Hijaz
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Karen Huss
- Division of Extramural Science Programs, Symptom Science and Genetics, Self-Management Office, National Institute of Nursing Research, Bethesda, MD
| | - Michelle Kim
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Jason Lazar
- Department of Medicine, SUNY Downstate Health Sciences University, New York, NY
| | - Richard K Lee
- Department of Urology, Weill Cornell Medical College, New York, NY
| | - Christine K Liu
- Section of Geriatrics, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA; Section of Geriatrics, Department of Medicine, Boston University, Boston, MA
| | | | - Saadia Miran
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI and VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Nicole Zhang
- The Valley Foundation School of Nursing, College of Health and Human Sciences, San Jose State University, San Jose, CA
| | - James A Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, WI
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Spinal Cord Injury Patient's Physical and Psychological Care Needs at Home from Patients’ and Caregivers’ Perspectives: A Qualitative Study. ARCHIVES OF NEUROSCIENCE 2022. [DOI: 10.5812/ans-123462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Limited studies have attempted to identify the care needs of patients with spinal cord injury (SCI) and their professional caregivers at home and after discharge from the hospital. However, little information about these needs has led to increased physical and psychological complications and thus a reduced quality of life in SCI patients. Objectives: This study aimed to explain the experiences of patients and their caregivers regarding physical and psychological care needs at home. Method: This qualitative descriptive study was conducted on 24 SCI patients and their professional caregivers using the conventional content analysis. Data were collected through unstructured and semi-structured interviews. Purposeful sampling was continued until data saturation was reached. The conventional content analysis approach proposed by Graneheim and Lundman (continuous comparison) was used to analyze the data. Results: The age range of the participants was 29 - 48 years, with an average age of 37.8 years. Seven of the participants had paraplegia, and three of them had tetraplegia. The results of data analysis led to the extraction of two main categories, including physical and psychological care needs. Conclusions: By identifying the real needs of patients after discharge from the hospital, we emphasize the need to remove barriers to home health care services and provide more financial support to meet patients' needs. Therefore, policymakers are encouraged to use the results of this study to plan at-home patient care services.
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EDITORIAL COMMENT. Urology 2022; 165:79-80. [PMID: 35843701 DOI: 10.1016/j.urology.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Baradaran N, Peng J, Palettas M, Chen Y, DeVivo MJ, Schwab JM. Bladder Management With Chronic Indwelling Catheter is Associated with Elevated Mortality in Patients with Spinal Cord Injury. Urology 2022; 165:72-80. [PMID: 35263641 DOI: 10.1016/j.urology.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database. METHODS Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened. Patients who died within 1 year of injury and had 2 or more changes in method of bladder management, or reported normal volitional void were excluded. Outcome of interest was death from nonpulmonary, nonwound related sepsis (NPNWS). Left truncation cox regression method using age as the time-scale was used to calculate hazard ratios. RESULTS A total of 13,616 patients were included. Comparison was performed between "IndC" group (n = 4872; 36.1%) vs "Other" (n = 8744; 63.9%). After adjusting for age and change in bladder management method, "IndC" is associated with elevated NPNWS mortality (2.10; 95% confidence interval 1.72-2.56, P < .001). Multivariable analysis, adjusting for age at injury, gender, race, education, insurance status, etiology of SCI, injury level, neurologic impairment level, and change in bladder management method, showed IndC was associated with significantly higher risk of death from NPNWS compared to other methods of bladder management. CONCLUSION In a large cohort of SCI patients, bladder management with IndC is predictive of significantly propagated NPNWS related mortality compared to other methods of bladder management. While identifying IndC is an independent mortality risk factor, a better understanding of the underlying mechanisms could inform strategies to improve neurourological care and survival after SCI.
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Affiliation(s)
- Nima Baradaran
- Department of Urology, The Ohio State University, Wexner Medical Center, Columbus, OH.
| | - Juan Peng
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - YuYing Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, Departments of Neurology, Physical Medicine and Rehabilitation, Neuroscience and Center for Brain and Spinal Cord Repair, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH
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Perez NE, Godbole NP, Amin K, Syan R, Gater DR. Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury. J Pers Med 2022; 12:968. [PMID: 35743752 PMCID: PMC9225534 DOI: 10.3390/jpm12060968] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/23/2022] [Accepted: 05/31/2022] [Indexed: 12/14/2022] Open
Abstract
Urinary incontinence is common after spinal cord injury (SCI) due to loss of supraspinal coordination and unabated reflexes in both autonomic and somatic nervous systems; if unchecked, these disturbances can become life-threatening. This manuscript will review normal anatomy and physiology of the urinary system and discuss pathophysiology secondary to SCI. This includes a discussion of autonomic dysreflexia, as well as its diagnosis and management. The kidneys and the ureters, representing the upper urinary tract system, can be at risk related to dyssynergy between the urethral sphincters and high pressures that lead to potential vesicoureteral reflux, urinary tract infections, and calculi associated with neurogenic lower urinary tract dysfunction (NLUTD). Recent guidelines for diagnosis, evaluation, treatment and follow up of the neurogenic bladder will be reviewed and options provided for risk stratification and management. Mechanical, pharmacological, neurolysis and surgical management will be discussed.
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Affiliation(s)
| | | | - Katherine Amin
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Raveen Syan
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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Urinary system complications and long-term treatment compliance in chronic traumatic spinal cord injury patients with neurogenic lower urinary tract dysfunction. Turk J Phys Med Rehabil 2022; 68:278-285. [PMID: 35989971 PMCID: PMC9366489 DOI: 10.5606/tftrd.2022.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives
The aim of this study was to evaluate upper and lower urinary tract complications and the compliance of long-term treatment in patients with spinal cord injury (SCI) by urodynamic examination.
Patients and methods
Between January 1997 and May 2007, a total of 89 patients with SCI (79 males, 19 females; mean age: 39.8±12.2 years; range, 19 to 72 years) who were admitted to physical medicine and rehabilitation clinic were retrospectively analyzed. Demographic, neurological, and urodynamic data of the patients with the diagnosis of neurogenic lower urinary tract dysfunction (NLUTD) in their initial urodynamic examination and without regular follow-up were recorded.
Results
The mean time to the first urodynamic examination was 8.6±5.4 months. Sixty-seven patients who had neurogenic detrusor overactivity (NDO) in their first urodynamic tests were recommended anticholinergics. Clean intermittent catheterization (CIC) was recommended after initial urodynamic examination in all patients. Thirty-nine patients of 67 who had NDO were taking medications, while 28 were not. In the patients who continued anticholinergic treatment, bladder capacity was found to statistically significantly increase, compared to the initial measurement values and detrusor pressures significantly decreased (p<0.001). The compliance rate with CIC and anticholinergic treatment was 79.8% and 58.2%, respectively. Sixteen of the patients had calculus in the urinary system. Forty-two patients had infections more than once a year and used antibiotics.
Conclusion
Neurogenic bladder should be evaluated at the beginning of SCI and, then, followed on a regular basis. Urodynamic tests should be performed immediately after spinal shock and can be repeated, as indicated.
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22
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Krebs J, Wöllner J, Rademacher F, Pannek J. Bladder management in individuals with spinal cord injury or disease during and after primary rehabilitation: a retrospective cohort study. World J Urol 2022; 40:1737-1742. [DOI: 10.1007/s00345-022-04027-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/23/2022] [Indexed: 11/29/2022] Open
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Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective. Low Urin Tract Symptoms 2022; 14:132-139. [PMID: 35233967 DOI: 10.1111/luts.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Effects of hydrophilic coated catheters on urethral trauma, microtrauma and adverse events with intermittent catheterization in patients with bladder dysfunction: a systematic review and meta-analysis. Int Urol Nephrol 2022; 54:1461-1470. [PMID: 35449382 PMCID: PMC9184422 DOI: 10.1007/s11255-022-03172-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/08/2022] [Indexed: 02/08/2023]
Abstract
Background Hydrophilic coated catheters are recommended to reduce the side effects of intermittent catheterization (IC) in patients with bladder dysfunction. However, there is lack of Level one evidence to support the use of this intervention. Search methods Several electronic databases were systematically searched to evaluate complication incidences for hydrophilic coated (HC) and non-hydrophilic catheters (NHC). Results Twelve studies were eligible for inclusion in the review. The meta-analyses exploring microscopic hematuria frequencies (RR = 0.69; 95% CI 0.52–0.90) and urethral stricture frequencies (RR = 0.28; 95% CI 0.13–0.60) showed a lower risk ratio associated with HC in comparison to NHC, whereas gross hematuria was no statistically significant difference in two groups. Subgroup analyses of gross hematuria which was grouped according to "catheterization frequency", "single/multiple catheterization" and "self/other catheterization” were performed and the values of combined RR were also no statistically significant difference. Conclusions Compared with non-hydrophilic catheters, the hydrophilic coated catheters have positive significance in reducing the incidence of urethral microtrauma and the urethral stricture. However, more studies are warranted for evaluating effects of hydrophilic coated catheters on the incidence of gross hematuria. Supplementary Information The online version contains supplementary material available at 10.1007/s11255-022-03172-x.
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Anderson CE, Birkhäuser V, Jordan X, Liechti MD, Luca E, Möhr S, Pannek J, Kessler TM, Brinkhof MW. Urological Management at Discharge from Acute Spinal Cord Injury Rehabilitation: A Descriptive Analysis from a Population-based Prospective Cohort. EUR UROL SUPPL 2022; 38:1-9. [PMID: 35495286 PMCID: PMC9051958 DOI: 10.1016/j.euros.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI). Objective To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation. Design, setting, and participants The population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology. Outcome measurements and statistical analysis Data were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes. Results and limitations At discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0–7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79–85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18–3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52–8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35–42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18–25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26–33%). Urodynamic and renal function data were not collected. Conclusions Our population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research. Patient summary At discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence.
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Affiliation(s)
- Collene E. Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Eugenia Luca
- Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sandra Möhr
- Neuro-Urology, REHAB Basel, Basel, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin W.G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Corresponding author. Swiss Paraplegic Research, Guido A. Zäch Strasse 4, CH-6207 Nottwil, Switzerland. Tel. +41 41 939 65 97; Fax: +41 41 939 66 40.
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Rahman MA, Tharu NS, Gustin SM, Zheng YP, Alam M. Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review. J Clin Med 2022; 11:jcm11061550. [PMID: 35329875 PMCID: PMC8954138 DOI: 10.3390/jcm11061550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most debilitating injuries in the world. Complications after SCI, such as respiratory issues, bowel/bladder incontinency, pressure ulcers, autonomic dysreflexia, spasticity, pain, etc., lead to immense suffering, a remarkable reduction in life expectancy, and even premature death. Traditional rehabilitations for people with SCI are often insignificant or ineffective due to the severity and complexity of the injury. However, the recent development of noninvasive electrical neuromodulation treatments to the spinal cord have shed a ray of hope for these individuals to regain some of their lost functions, a reduction in secondary complications, and an improvement in their life quality. For this review, 250 articles were screened and about 150 were included to summarize the two most promising noninvasive spinal cord electrical stimulation methods of SCI rehabilitation treatment, namely, trans-spinal direct current stimulation (tsDCS) and trans-spinal pulsed current stimulation (tsPCS). Both treatments have demonstrated good success in not only improving the sensorimotor function, but also autonomic functions. Due to the noninvasive nature and lower costs of these treatments, in the coming years, we expect these treatments to be integrated into regular rehabilitation therapies worldwide.
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Affiliation(s)
- Md. Akhlasur Rahman
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- Centre for the Rehabilitation of the Paralysed (CRP), Savar Union 1343, Bangladesh
| | - Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Sylvia M. Gustin
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
| | - Monzurul Alam
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China; (M.A.R.); (N.S.T.); (Y.-P.Z.)
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia;
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, NSW 2031, Australia
- Correspondence: ; Tel.: +852-6213-5054
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Agwu N, Umar A, Oyibo U. Review article: Urethral catheters and catheterization techniques. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Pelosi G, Faleiros F, Pereira MRC, Bimbatti KDF, Tholl AD. Study on the prevalence of neurogenic bladder in Brazilians with traumatic and non-traumatic spinal cord injury. J Spinal Cord Med 2021:1-5. [PMID: 34855564 DOI: 10.1080/10790268.2021.1981715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CONTEXT Considering that SCI is the main cause of neurogenic bladder, in Brazil, studies and statistical data on the number of people with neurogenic bladder are practically non-existent. To ascertain the prevalence of neurogenic bladder among users of SARAH Network hospitals with traumatic and non-traumatic spinal cord injury. METHODS Data collection form from electronic medical records to characterize the sample. The variables were related to sociodemographic data such as age, care unit, and date of admission; and to clinical data, such as main diagnosis, neurogenic bladder diagnosis. In the cases of traumatic spinal cord injury, the ASIA Impairment Scale (AIS) was considered. The statistical tests were Mann-Whitney, for two independent samples, and Pearson's Chi-squared, for the categorical variables. FINDINGS The sample included 954 participants. The prevalence of neurogenic bladder was 94.65%, of which 67% had a traumatic spinal cord injury diagnosis and 69.32% were male. Mean age of the participants was 46.12 years old (SD = 15.78 years). CONCLUSION/CLINICAL RELEVANCE The prevalence of neurogenic bladder found in the sample was 94.65%. The analysis showed that participants with TSCI are more afflicted by lower urinary tract dysfunction than those with NTSCI. TSCI was more prevalent among males and NTSCI was more prevalent among females. This was a pioneering study on the prevalence of neurogenic bladder in SCI in Brazil. However, further studies will be necessary to corroborate the data found here. The development of a database with national data is indispensable to obtain more reliable results that could provide a basis for public healthcare policies for the prevention and rehabilitation of people with SCI in Brazil.
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Affiliation(s)
- Giovana Pelosi
- SARAH Network of Rehabilitation Hospitals, Rio de Janeiro, Brazil.,University of São Paulo, College of Nursing of Ribeirão Preto, Ribeirão Preto, Brazil
| | - Fabiana Faleiros
- University of São Paulo, College of Nursing of Ribeirão Preto, Ribeirão Preto, Brazil
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Siméon H, Rouget B, Bladou F, Bernhard JC, Alezra E, Delleci C, Petit L, Vital JM, Robert G, Capon G. [Urinary drainage of spinal cord injured patients in the acute phase of trauma: A descriptive, retrospective study]. Prog Urol 2021; 32:6-13. [PMID: 34863636 DOI: 10.1016/j.purol.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 08/10/2021] [Accepted: 09/10/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Urinary retention in the acute phase of a spinal cord injury (SCI) requires bladder drainage (BD). International scientific societies recommend early implementation of intermittent catheterisation (IC) to prevent lower urological complications, preserve fertility, the urological future of the patient and improve its quality of life. The aim of our study was to analyze the mode of BD in the acute phase of a trauma in patients with SCI. MATERIALS AND METHODS We retrospectively analyzed the mode of BD of patients with SCI in the acute phase of trauma at the Bordeaux University Hospital from 2013 to 2018. RESULTS The care pathways of 81 patients were analyzed; patients were hospitalized in intensive care unit (ICU) (42%, n=34), in orthopaedic ward (19.8%, n=16) or in ICU and orthopaedic ward (38.2%, n=31). All of them had an indwelling catheter (IUD) inserted before IC was introduced in 56 of them (69%). On hospital discharge, IC was the BD for only 37% of patients, with differences according to the care pathway: 65% of patients leaving ICU were on IC, compared with 11% leaving orthopaedic ward. 80% of patients who had IC in ICU had an IUD installed in orthopaedic ward. CONCLUSION In this study, during the acute phase of a trauma in the majority of SCI patient, IC was introduced only in a minority of patients and the promotion was different within the hospital care pathways. Those results enhanced the need for IC awareness in different hospital units to standardize the best patient care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- H Siméon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France.
| | - B Rouget
- Service de chirurgie urologique, hôpital Robert-Boulin Libourne, Libourne, France
| | - F Bladou
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - J-C Bernhard
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - E Alezra
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - C Delleci
- Service de médecine physique et réadaptation, CHU de Bordeaux, Bordeaux, France
| | - L Petit
- Service de réanimation chirurgicale, CHU de Bordeaux, Bordeaux, France
| | - J-M Vital
- Service de chirurgie orthopédique et de traumatologie, CHU de Bordeaux, Bordeaux, France
| | - G Robert
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
| | - G Capon
- Service de chirurgie urologique et transplantation rénale, CHU de Bordeaux, Bordeaux, France
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Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG, Callender L, Holderbaum L, King T, Jackson A, Tran T, Lin G, Smith AL. Results of the patient report of intermittent catheterization experience (PRICE) study. Neurourol Urodyn 2021; 40:2008-2019. [PMID: 34516673 DOI: 10.1002/nau.24786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients' actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC. METHODS This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). RESULTS Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a "blocking sensation" during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported. DISCUSSION/CONCLUSION Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.
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Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rita G Hamilton
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Leah Holderbaum
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Tamara King
- Shepherd Multispecialty Clinic, Shepherd Center, Inc., Atlanta, Georgia, USA
| | - Angela Jackson
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Thanh Tran
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - George Lin
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Velaer KN, Welk B, Ginsberg D, Myers J, Shem K, Elliott C. Time Burden of Bladder Management in Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:83-91. [PMID: 34456549 DOI: 10.46292/sci20-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background While clean intermittent catheterization (CIC) is the gold standard for bladder management after spinal cord injury (SCI), many individuals with SCI, for reasons not fully understood, choose alternative bladder management. We hypothesized that CIC is associated with an increased time burden in individuals with SCI. Objectives To investigate the time required to perform neurogenic bladder management in individuals with SCI. Methods An electronic nonvalidated questionnaire was designed to determine the self-reported time spent performing bladder management. It was sent to participants in the Neurogenic Bladder Research Group SCI Registry, a national quality of life study of individuals with SCI. Results Eighty-seven individuals responded to the survey. CIC was the most common bladder management (76%). Men and women performing independent CIC had similar average times with each catheterization episode (8.8 vs. 8.5 minutes, p = .864) as did women with a catheterizable stoma compared to women catheterizing per urethra (8.2 minutes, p = .913). Longer catheterization times were associated with cervical spine injury (mean 12.4 minutes per catheterization) and women requiring caregiver assistance (mean 20 minutes per catheterization). In addition, obese/overweight women had longer CIC times than normal weight women (14.5 minutes vs. 7 minutes; p = .036), while catheterization time was similar for all men regardless of body mass index. Individuals with indwelling catheters spent less than a third of the time on bladder management per day compared to those doing CIC (17 vs. 53 minutes per day, p < .001). Conclusion Management of neurogenic bladder after SCI, especially in those performing CIC, is time consuming. This time burden may play a role in long-term bladder management decisions.
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Affiliation(s)
| | - Blayne Welk
- Division of Urology, Western University, Pomona, California
| | - David Ginsberg
- Department of Urology, University of Southern California, Los Angeles, California
| | - Jeremy Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
| | - Christopher Elliott
- Department of Urology, Stanford Hospital and Clinics, Palo Alto, California.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California
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Welk B, Myers JB, Kennelly M, Elliott CS, McKibbon M, Watson J, Gervais K. Using conjoint analysis to measure the importance of psychosocial traits in the choices of bladder management after spinal cord injury. Neurourol Urodyn 2021; 40:1643-1650. [PMID: 34139030 DOI: 10.1002/nau.24730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/06/2021] [Accepted: 06/01/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To conduct a conjoint analysis experiment to better understand the psychosocial priorities related to bladder management in individuals after spinal cord injury (SCI). METHODS We developed a conjoint analysis survey that included 11 psychosocial attributes phrased in the context of bladder management (including attributes for urinary infections, and incontinence). We then performed a multi-center prospective cross-sectional study of adults with existing SCI which consisted of a baseline interview, followed by the online conjoint analysis survey (delivered through Sawtooth software). Hierarchical Bayes random effects regression analysis was used to determine the relative importance of the attributes. RESULTS A total of 345 people complete the study. There was good representation of both men and women, and individuals with cervical and thoracic or lower lesions. The most important attribute was the frequency of urinary infections. Age, sex, and level of SCI were generally not related to the attributes measured in the study. In the subgroup of 256 patients who used a catheter for bladder management, significantly more importance was placed on urinary tract infections, time, fluid intake, and social life among indwelling catheter users compared to intermittent catheter users. CONCLUSIONS Most bladder-related psychosocial priorities are not impacted by a patient's age, sex or level of SCI. Differences in psychosocial priorities between indwelling and intermittent catheter users may represent factors that should be focused on to optimize bladder management after SCI.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Michael Kennelly
- Departments of Urology, Obstetrics, and Gynecology, Carolinas Medical Center, Atrium Health, Charlotte, North Carolina, USA
| | - Christopher S Elliott
- Division of Urology, Department of Urology, Stanford University Medical Center, Santa Clara Valley Medical Center, St Joseph's Hospital, London, Ontario, Canada
| | - Mary McKibbon
- Division of Urology, Department of Urology, Santa Clara Valley Medical Center, Stanford University, Stanford, California, USA
| | | | - Kyle Gervais
- Department of Classical Studies, Western University, London, Ontario, Canada
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Hossain MS, Harvey LA, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Jan S, Liu H, Li Q, Cameron ID, Taylor V, Lindley RI, Billot L, Herbert RD. A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial. Spinal Cord 2021; 59:649-658. [PMID: 32917948 PMCID: PMC8189918 DOI: 10.1038/s41393-020-00546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Randomised controlled trial. OBJECTIVES To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. SETTING Bangladesh. METHODS A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. RESULTS Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. CONCLUSION A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.
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Affiliation(s)
- Mohammad Sohrab Hossain
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT94 1PZ, Northern Ireland
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, University of Copenhagen, Havnevej 25, DK-3100, Hornbæk, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Barker Street, Randwick, 2031, NSW, Australia
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Improved global response outcome after intradetrusor injection of adult muscle-derived cells for the treatment of underactive bladder. Int Urol Nephrol 2021; 53:1331-1338. [PMID: 33840007 DOI: 10.1007/s11255-021-02847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
Abstract
We report on the first regulatory approved clinical trial of a prospective open-label physician-initiated study assessing the safety and efficacy of intradetrusor injected Autologous Muscle Derived Cells (AMDC) treatment for underactive bladder (UAB). 20 non-neurogenic UAB patients were treated. Approximately 50-250 mg of quadriceps femoris muscle was collected using a spirotome 8-gauge needle. The muscle biopsy samples were sent to Cook MyoSite (Pittsburgh, PA) for processing, isolation, and propagation of cells. Research patients received approximately 30 intradetrusor injections of 0.5 mL delivered to the bladder, for a total of 15 mL and 125 million AMDC, performed utilizing a flexible cystoscope under direct vision using topical local anesthesia. Follow-up assessments included adverse events and efficacy via voiding diary and urodynamic testing at 1, 3, 6 and 12 months post-injection. An optional second injection was offered at the end of the 6 months visit. 20 patients received the first injection and all 20 patients requested and received a second injection. Median patient age was 65 years old (range 41-82 years). There were 16 male (80%) and 4 female (20%) patients. Etiology included 7 men (35%) with persistent urinary retention after transurethral resection of the prostate for benign prostatic hyperplasia and 13 patients (65%) with idiopathic chronic urinary retention. At the primary outcome time point of 12 months, 11/19 patients (58%) reported a global response assessment (GRA) ≥ 5, showing slight to marked improvement in their UAB symptoms, compared to 6/20 (30%) patients at 3 months post-injection. No serious procedure or treatment-related adverse events occurred. Noted improvements included: decreased post void residual urine volume, increased voiding efficiency, and decreased catheter use. Intradetrusor-injected AMDC as a treatment for UAB was successfully completed in a 20-patient trial without serious adverse event and with signal of efficacy. Cellular therapy may be a promising novel treatment for catheter-dependent chronic urinary retention. A multicenter controlled trial is needed to further assess the promise of regenerative medicine in the treatment of lower urinary tract dysfunction.
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Angermund A, Inglese G, Goldstine J, Iserloh L, Libutzki B. The burden of illness in initiating intermittent catheterization: an analysis of German health care claims data. BMC Urol 2021; 21:57. [PMID: 33827524 PMCID: PMC8028779 DOI: 10.1186/s12894-021-00814-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intermittent catheterization (IC) is a common medical technique to drain urine from the bladder when this is no longer possible by natural means. The objective of this study was to evaluate the standard of care and the burden of illness in German individuals who perform intermittent catheterization and obtain recommendations for improvement of care. METHODS A descriptive study with a retrospective, longitudinal cohort design was conducted using the InGef research database from the German statutory health insurance claims data system. The study consisted of individuals with initial IC use in 2013-2015. RESULTS Within 3 years 1100 individuals with initial IC were identified in the database (~ 19,000 in the German population). The most common IC indications were urologic diseases, spinal cord injury, Multiple Sclerosis and Spina Bifida. Urinary tract infections (UTI) were the most frequent complication occurring 1 year before index (61%) and in follow-up (year 1 60%; year 2 50%). Resource use in pre-index including hospitalizations (65%), length of stay (12.8 ± 20.0 days), physician visits (general practitioner: 15.2 ± 29.1), prescriptions of antibiotics (71%) and healthcare costs (€17,950) were high. Comorbidities, complications, and healthcare resource use were highest 1 year before index, decreasing from first to second year after index. CONCLUSIONS The data demonstrated that prior to initial catheterization, IC users experienced UTIs and high healthcare utilization. While this demonstrates a potential high burden of illness prior to initial IC, UTIs also decreased over time, suggesting that IC use may have a positive influence. The findings also showed that after the first year of initial catheterization the cost decreased. Further studies are needed to better understand the extent of the burden for IC users compared to non-IC users.
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Affiliation(s)
| | - Gary Inglese
- Hollister Incorporated, 2000 Hollister Drive, Libertyville, IL, 60048-3781, USA
| | - Jimena Goldstine
- Hollister Incorporated, 2000 Hollister Drive, Libertyville, IL, 60048-3781, USA.
| | - Laura Iserloh
- HGC Healthcare Consultants GmbH, Düsseldorf, Germany
| | - Berit Libutzki
- HGC Healthcare Consultants GmbH, Düsseldorf, Germany
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Herrity AN, Aslan SC, Ugiliweneza B, Mohamed AZ, Hubscher CH, Harkema SJ. Improvements in Bladder Function Following Activity-Based Recovery Training With Epidural Stimulation After Chronic Spinal Cord Injury. Front Syst Neurosci 2021; 14:614691. [PMID: 33469421 PMCID: PMC7813989 DOI: 10.3389/fnsys.2020.614691] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. However, as urinary complications continue to impact long-term morbidity in this population, additional therapeutic and rehabilitative approaches are needed that aim to improve function by targeting the recovery of underlying impairments. Several human and animal studies, including our previously published reports, have documented gains in bladder function due to activity-based recovery strategies, such as locomotor training. Furthermore, epidural stimulation of the spinal cord (scES) combined with intense activity-based recovery training has been shown to produce volitional lower extremity movement, standing, as well as improve the regulation of cardiovascular function. In our center, several participants anecdotally reported improvements in bladder function as a result of training with epidural stimulation configured for motor systems. Thus, in this study, the effects of activity-based recovery training in combination with scES were tested on bladder function, resulting in improvements in overall bladder storage parameters relative to a control cohort (no intervention). However, elevated blood pressure elicited during bladder distention, characteristic of autonomic dysreflexia, was not attenuated with training. We then examined, in a separate, large cross-sectional cohort, the interaction between detrusor pressure and blood pressure at maximum capacity, and found that the functional relationship between urinary bladder distention and blood pressure regulation is disrupted. Regardless of one’s bladder emptying method (indwelling suprapubic catheter vs. intermittent catheterization), autonomic instability can play a critical role in the ability to improve bladder storage, with SCI enhancing the vesico-vascular reflex. These results support the role of intersystem stimulation, integrating scES for both bladder and cardiovascular function to further improve bladder storage.
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Affiliation(s)
- April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Sevda C Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville, Louisville, KY, United States
| | - Charles H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
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Xi M, Elterman DS, Welk B, Pakosh M, Chan BCF. Cost‐effectiveness of hydrophilic‐coated urinary catheters for individuals with spinal cord injury: A systematic review. BJUI COMPASS 2020; 2:71-81. [PMID: 35474888 PMCID: PMC8988762 DOI: 10.1002/bco2.63] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/09/2022] Open
Abstract
Objective To identify and critically evaluate the economic evaluations examining the cost‐effectiveness of hydrophilic‐coated vs uncoated catheters for individuals with spinal cord injury. Methods We searched MEDLINE, the Excerpta Medica database (EMBASE), Cochrane Database of Systematic Reviews, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Emcare for studies in English and French. There were no restrictions to the year of publication. Our search strategy included the following key terms: “spinal cord injury,” “catheterization,” and “cost analysis.” Results The search identified 371 studies, of which eight studies met the inclusion criteria. Five studies observed hydrophilic‐coated catheters to be cost‐effective compared to uncoated catheters. Two studies found hydrophilic‐coated catheters to be not cost‐effective compared to uncoated catheters and one study estimated that hydrophilic‐coated catheters reduced the long‐term health‐care costs compared to uncoated catheters. Conclusion The cost‐effectiveness of hydrophilic‐coated catheters was dependent on the comparator used, the consideration of long‐term effects, and the unit cost of treatment. Further studies are needed to explore the short‐term and long‐term effects of hydrophilic‐coated catheter use on urinary tract infections and clarify the impact of hydrophilic‐coated catheter use on long‐term renal function. Overall, our critical evaluation of the literature suggests that the evidence is pointing toward hydrophilic‐coated catheters being cost‐effective, particularly when a societal perspective is applied.
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Affiliation(s)
- Min Xi
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
| | - Dean S. Elterman
- Division of Urology Department of Surgery University Health Network Toronto ON Canada
| | - Blayne Welk
- Department of Surgery Western University London ON Canada
| | - Maureen Pakosh
- Library & Information Services University Health NetworkToronto Rehabilitation Institute Toronto ON Canada
| | - Brian C. F. Chan
- KITE ‐ Toronto Rehabilitation Institute University Health Network Toronto ON Canada
- Institute of Health Policy, Management, and EvaluationUniversity of Toronto ON Canada
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Jacq C, Hubeaux K, Ramanantsitonta J. [Multiple sclerosis and intermittent self-catheterization]. Prog Urol 2020; 31:195-203. [PMID: 33277166 DOI: 10.1016/j.purol.2020.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 10/24/2020] [Accepted: 11/02/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lower urinary tract dysfunctions are frequent in patients with multiple sclerosis (MS). These disorders impair quality of life and can cause urological complications. In cases of urinary retention or incomplete bladder emptying, clean intermittent self-catheterization is the preferred option where possible. OBJECTIVE To identify data concerning the use of intermittent self-catheterization by patients with MS. BIBLIOGRAPHIC SOURCE A review was done using Medline/Pubmed with selection of articles in either English or French. The key words were: « multiple sclerosis and intermittent catheterization, self-catheterization, neuro-urology/urinary guidelines, continent stoma, continent vesicostomy». STUDY SELECTION Studies were selected if they concerned either multiple sclerosis exclusively or with a majority of cases concerning MS. RESULTS Intermittent self-catheterization is recommended and commonly used in patients with MS. Studies are rare in this specific population. Questions still remain about indications and practicalities in this disease. Indications must be individually evaluated according to symptoms and complications. The use of self-catheterization can improve symptomatology or quality of life, however, global urinary management is necessary. Urinary infection is the most frequently reported side effect. The teaching of self-catheterization should take into account physical and cognitive impairment. Due to the developing nature of the pathology, indications and the patients' ability to carry out self-catheterization should be regularly assessed. LIMITATIONS The search was limited to a single bibliographic source and studies are rare. CONCLUSION Further studies are necessary to increase knowledge of self-catheterization specificities in MS patients compared to other neurogenic patients.
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Affiliation(s)
- C Jacq
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France.
| | - K Hubeaux
- Service d'explorations fonctionnelles, site de Perharidy, Fondation Ildys, route de Perharidy, 29680 Roscoff, France
| | - J Ramanantsitonta
- Service de MPR, site d'Auray, Centre hospitalier Bretagne Atlantique, 20, boulevard du Général-Maurice-Guillaudot, BP 70555, 56017 Vannes cedex, France
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Lubba CH, Ouyang A, Jones NS, Bruns TM, Schultz S. Bladder pressure encoding by sacral dorsal root ganglion fibres: implications for decoding. J Neural Eng 2020; 18. [PMID: 33202396 DOI: 10.1088/1741-2552/abcb14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aim at characterising the encoding of bladder pressure (intravesical pressure) by a population of sensory fibres. This research is motivated by the possibility to restore bladder function in elderly patients or after spinal cord injury using implanted devices, so called bioelectronic medicines. For these devices, nerve-based estimation of intravesical pressure can enable a personalized and on-demand stimulation paradigm, which has promise of being more effective and efficient. In this context, a better understanding of the encoding strategies employed by the body might in the future be exploited by informed decoding algorithms that enable a precise and robust bladder-pressure estimation. APPROACH To this end, we apply information theory to microelectrode-array recordings from the cat sacral dorsal root ganglion while filling the bladder, conduct surrogate data studies to augment the data we have, and finally decode pressure in a simple informed approach. MAIN RESULTS We find an encoding scheme by different main bladder neuron types that we divide into three response types (slow tonic, phasic, and derivative fibres). We show that an encoding by different bladder neuron types, each represented by multiple cells, offers reliability through within-type redundancy and high information rates through semi-independence of different types. Our subsequent decoding study shows a more robust decoding from mean responses of homogeneous cell pools. SIGNIFICANCE We have here, for the first time, established a link between an information theoretic analysis of the encoding of intravesical pressure by a population of sensory neurons to an informed decoding paradigm. We show that even a simple adapted decoder can exploit the redundancy in the population to be more robust against cell loss. This work thus paves the way towards principled encoding studies in the periphery and towards a new generation of informed peripheral nerve decoders for bioelectronic medicines.
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Affiliation(s)
- Carl Henning Lubba
- Bioengineering, Imperial College London, Royal School of Mines, Exhibition Road, London, SW7 2AZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Aileen Ouyang
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan, UNITED STATES
| | - Nick S Jones
- Department of Mathematics, Imperial College London, London, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan, UNITED STATES
| | - Simon Schultz
- Imperial College London, London, SW7 2AZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Review of Current Neurogenic Bladder Best Practices and International Guidelines. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00622-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Walter M, Ruiz I, Squair JW, Rios LAS, Averbeck MA, Krassioukov AV. Prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury. Spinal Cord 2020; 59:1018-1025. [PMID: 33051562 PMCID: PMC8397616 DOI: 10.1038/s41393-020-00565-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/22/2020] [Accepted: 10/01/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To identify the prevalence of complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury (SCI). SETTING International and national sporting events. METHODS A total 130 competitive wheelchair athletes living with SCI completed a self-reported questionnaire during international or national sporting events. The questionnaire collected information regarding demographics, injury characteristics, method of bladder emptying, and complications related to intermittent catheterization. RESULTS Overall, 84% (109/130) of wheelchair athletes used intermittent catheterization. Within this group, 77% of athletes (84/109) experienced at least one complication associated with intermittent catheterization. Twenty-seven percent (29/109) sustained urethral injuries and 63% (69/109) had at least one episode of urinary tract infection during the last 12 months. Almost one-fourth of male athletes (22/95, 23%) had a history of inflammation / infection of genital organs associated with intermittent catheterization. CONCLUSIONS Here we report a high prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with SCI. Considering their potential impact on lower urinary tract function, athletic performance, and health, further studies are needed to assess the role of preventative strategies to reduce complications related to intermittent catheterization in wheelchair athletes with SCI. SPONSORSHIP Coloplast Brazil and Instituto Lado a Lado pela Vida (a nongovernmental, nonprofit organization based in São Paulo) and Wellspect provided funding for this study.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ian Ruiz
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Jordan W Squair
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Luis A S Rios
- Department of Urology, IAMSPE Hospital, São Paulo, Brazil.,Videourodynamic Unit, Albert Einstein Hospital, São Paulo, Brazil
| | - Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC, Vancouver, BC, Canada. .,G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada.
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Santiago JE, Cameron AP, Navarrete RA. Addressing Sphincter Dysfunction in the Female with Neurogenic Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Intermittent catheterisation for individuals with disability related to spinal cord injury in Tanzania. Spinal Cord Ser Cases 2020; 6:66. [PMID: 32719337 DOI: 10.1038/s41394-020-0316-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Cross-sectional pilot study on spinal cord injury (SCI) among in- and outpatients. OBJECTIVES To evaluate the challenges faced by individuals with SCI during Clean Intermittent Catheterisation (CIC). SETTING Kilimanjaro Christian Medical Center (KCMC), a tertiary referral hospital in Moshi, Tanzania. METHODS A questionnaire was sent to individuals with SCI who were either admitted to the Orthopedic Rehabilitation Unit or attended the Outpatient clinic between January and April 2018. Inpatients were less than 1 year post-injury and outpatients were one to 3 years post-injury. RESULTS In total, 48 individuals responded: 28 outpatients and 20 inpatients. Among the inpatient group, 80% were performing CIC as compared with 25% of outpatient group. Of the entire cohort, 35.4% reported doing well without catheter-based management. Failure to perform CIC was present in 16.7% of all individuals. CIC-equipment was unavailable in local villages for 58.3% of all patients. The most frequent complications of CIC were urinary tract infections (20.8%) and mild bleeding (14.6%). The majority of individuals (79.2%) reported satisfaction with their situation, regardless of the severity. CONCLUSIONS Some individuals performed CIC upon discharge, but the majority discontinued use, for which unavailability of CIC-equipment was a major determinant. While all individuals reported concerns prior to CIC, only a small minority actually experienced anxiety, pain or shame. Through targeted counselling and enhanced regular follow-up we will likely improve compliance to CIC. SPONSORSHIP We are grateful to the International Network of SCI Nurses in collaboration with Wellspect Health Care for funding this study.
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Sarı İF, Köklü K, Özişler Z, Özel S. A comparison of urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries. J Spinal Cord Med 2020; 43:449-454. [PMID: 30540550 PMCID: PMC7480453 DOI: 10.1080/10790268.2018.1533317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To compare urodynamic findings between patients with complete and incomplete traumatic spinal cord injuries (SCI) and to determine whether it is important to test with urodynamic study in patients with incomplete SCI. Design: Retrospective study Setting: Ankara Physical Medicine and Rehabilitation Training and Research Hospital, Ankara, Turkey Participants: A total of 66 patients with 36 complete and 30 incomplete traumatic SCI were included in the study, from July 2012 to September 2014. Interventions: Urodynamic study Outcome Measures: Maximum cystometric capacity (MCC) , vesicle pressure at MCC, detrusor function (detrusor overactivity or not), bladder complience, bladder storage and emptying disorders, post-void residual volume (PVR) and bladder emptying method were recorded. It was also recorded whether the patients used anticholinergic drugs before urodynamic study. Results: In urodynamic findings MCC, vesicle pressure at MCC, PVR, there was no statistically significant difference between complete and incomplete traumatic SCI patients. Also there was no statistically significant difference in low-compliance of detrusor frequency and bladder storage and emptying disorder frequency. Clean intermittent catheterization (CIC) was the most commonly recommended method after urodynamic studies in both groups of patients with SCI. Conclusions: In urodynamic study findings, there was no statistical difference between complete and incomplete traumatic SCI patients. The present study demonstrate that even if patients with incomplete SCI appear to be functionally better than the patients with complete SCI, urodynamic studies should still be performed in patients with incomplete SCI to identify bladder characteristics and to identify appropriate treatment.
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Affiliation(s)
- İlker Fatih Sarı
- The Department of Physical Medicine and Rehabilitation, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey,Correspondence to: İlker Fatih Sarı, The Department of Physical Medicine and Rehabilitation, Konya Education and Research Hospital, University of Health Sciences, Yazır Mahallesi Turgut Özal Caddesi No:10 Selçuklu/KONYA, Konya, Turkey.
| | - Kurtuluş Köklü
- The Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Zuhal Özişler
- The Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine and Rehabilitation Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sumru Özel
- The Department of Physical Medicine and Rehabilitation, Hitit University Medical School, Çorum, Turkey
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Oh SW, Jung JH, Cho IK, Lee HJ, Kwon SH, Lee BS. Changes in the Trend in Bladder Emptying Methods in Patients With Spinal Cord Injury: A 20-Year Single-Center Retrospective Study. Ann Rehabil Med 2020; 44:228-237. [PMID: 32640782 PMCID: PMC7349040 DOI: 10.5535/arm.19107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/23/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To review trends in bladder emptying methods over a 20-year period in patients with spinal cord injury (SCI) by severity according to the American Spinal Injury Association impairment scale (AIS). METHODS Medical records of patients with SCI from 1994 to 1998 (group 1) and from 2012 to 2016 (group 2) were retrospectively reviewed. We classified bladder emptying methods according to the International Spinal Cord dataset. We grouped patients with normal voiding, bladder reflex triggering, and bladder expression as those using voiding without catheter. RESULTS A total of 667 patients were included in the analysis. The proportion of patients using voiding without catheter and intermittent catheterization decreased from 67.0% to 30.0% and increased from 26.8% to 54.8%, respectively. In patients with AIS-A and AIS-B, the proportion of patients with intermittent catheterization increased from 32.8% to 73.3%. In patients with AIS-D, the proportion of patients using voiding without catheter and intermittent catheterization decreased from 88.5% to 68.9% and increased from 11.5% to 26.8%, respectively. In group 2, among 111 patients with AIS-D using voiding without catheter at admission, 8 (7.2%) switched to intermittent catheterization at discharge due to decreased bladder volume, increased post-voiding residual urine, or incontinence. CONCLUSION Over the past 20 years, trends in bladder emptying methods in patients with SCI changed from voiding without catheter to intermittent catheterization in Korea. This was especially prominent in patients with AIS-A, AIS-B, and AIS-C. Even in patients with AIS-D, the use of intermittent catheterization at hospital discharge increased.
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Affiliation(s)
- Sang-Wook Oh
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Joo Hwan Jung
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - In Kyoung Cho
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Hye Jin Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Seung Hyun Kwon
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Bum Suk Lee
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
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Barriers and facilitators to optimising inpatient bladder management after spinal cord injury. Spinal Cord 2020; 58:1291-1300. [PMID: 32457515 DOI: 10.1038/s41393-020-0487-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative survey. OBJECTIVES Examine clinicians' perspectives on adherence to published evidence-based guidelines and clinician-perceived barriers, and facilitators to optimising inpatient bladder management within one Spinal Cord Injury (SCI) service. SETTING Surgical Hospital (acute care) and SCI Unit (sub-acute, rehabilitation) in Western Australia (WA). METHODS Clinicians reviewed an 'Evidence Matrix' summarising published clinical practice guidelines and recommendations for SCI bladder management. Focus groups examined the extent to which current practice adhered to recommendations and identified perceived barriers and facilitators to optimal management. Data were analysed thematically using a deductive approach. RESULTS Current management closely mirrors published recommendations. Key facilitators included long-standing prioritisation of rapid progression from urethral indwelling (IDC) to a 6 hourly intermittent catheterisation (IC) protocol; regular competency audits of catheterisation technique; and a Spinal Urology Clinical Nurse Consultant (CNC) position. Barriers included limited resources/staffing; restricted access to Neuro-urology consultation; inter-disciplinary communication gaps; and delays in determining and implementing long-term bladder management. CONCLUSIONS Inpatient SCI bladder care in WA closely emulates published evidence, although adherence at other sites may reveal different practices. Bladder management was found to have been facilitated by a strong culture of practice led by Neuro-urologists, informed by evidence and embraced by Senior Clinicians. Further reduction in duration of initial IDC, provision of early and ongoing Neuro-urology consultations as part of standard care, increased interdisciplinary communication and dedicated SCI Urology theatre lists would further optimise management.
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Husmann DA, Viers BR. Neurogenic bladder: management of the severely impaired patient with complete urethral destruction: ileovesicostomy, suprapubic tube drainage or urinary diversion-is one treatment modality better than another? Transl Androl Urol 2020; 9:132-141. [PMID: 32055477 DOI: 10.21037/tau.2019.09.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background Management of the severely impaired patient (pt) with a neurogenic bladder (NGB) and complete urethral destruction employs three therapeutic options; bladder neck closure (BNC) with ileovesicostomy, BNC with suprapubic tube (SPT) placement or in pts with an end-stage bladder, cystectomy with enteric conduit diversion. This paper was performed to test the hypothesis that pts managed with an ileovesicostomy would have the best long-term prognosis. Methods Patients with a NGB and complete urethral destruction managed between 1986-2018 were reviewed. Three treatment populations were assessed, pts treated with BNC with ileovesicostomy, BNC with SPT placement or cystectomy with enteric conduit diversion. A minimal follow-up interval of 2 years was necessary to be entered into the study. The number of uroseptic episodes, development of urolithiasis, the onset of new renal scars, ≥ stage 3 chronic renal failure, or need for additional surgery were recorded. Statistical evaluations used either chi-squared contingency table analysis, Fisher's exact 2-tailed tests, or Kaplan-Meier curve analysis where indicated. P values of <0.05 were considered significant. Results Ten pts were managed by cystectomy, and enteric conduit, 17 by BNC and ileovesicostomy and 21 by BNC and SPT placement, median follow up of 8 yrs (range, 2-30 yrs). No significant differences between the three groups regarding the development of urolithiasis (30%, 3/10 pts; 53%, 9/17 pts; 52%, 11/21 pts; respectively), new onset of renal scarring (30%, 6/20 kidneys; 41%, 14/34 kidneys; 45%, 19/42 kidneys; respectively) or stage 3 chronic renal failure (40%, 4/10 pts; 47%, 8/17 pts; 24%, 5/21 pts; respectively. However, the number of hospitalizations for uroseptic episodes significantly increased in patients managed with an ileal conduit (60%, 6/10 pts) and ileovesicostomy (82%; 14/17 pts) compared to those maintained with a SPT (29%, 6/21 pts) P=0.025 and 0.006, respectively. When evaluating the need for delayed surgical intervention due to either urolithiasis or other complications, a total of 50% (5/10 pts) of the patients managed by an ileal conduit, 88% (15/17 pts) of the ileovesicostomy and 52% (11/21 pts) of the patients with a SPT required additional operations. In essence, significantly more pts undergoing BNC and ileovesicostomy required delayed surgical interventions for complications arising from the surgery compared to patients managed with either a cystectomy and ileal conduit (P=0.0285) or BNC and SPT placement (P=0.0180). Conclusions In severely impaired pts with a NGB and urinary outlet destruction, BNC and ileovesicostomy are associated with a significantly increased incidence of urosepsis and late surgical complications that required operative intervention compared to alternative treatments. This finding has resulted in the abandonment of the ileovesicostomy from our surgical armamentarium.
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Affiliation(s)
| | - Boyd R Viers
- Department of Urology, Mayo Clinic, Rochester, MN, USA
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The impact of catheter‐based bladder drainage method on urinary tract infection risk in spinal cord injury and neurogenic bladder: A systematic review. Neurourol Urodyn 2019; 39:854-862. [DOI: 10.1002/nau.24253] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/26/2019] [Indexed: 01/08/2023]
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Patel DP, Herrick JS, Stoffel JT, Elliott SP, Lenherr SM, Presson AP, Welk B, Jha A, Myers JB. Reasons for cessation of clean intermittent catheterization after spinal cord injury: Results from the Neurogenic Bladder Research Group spinal cord injury registry. Neurourol Urodyn 2019; 39:211-219. [PMID: 31578784 DOI: 10.1002/nau.24172] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/12/2019] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Darshan P Patel
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jennifer S Herrick
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Sara M Lenherr
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology and Biostatistics, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Department of Surgery, University of Western Ontario, London, Ontario, Canada
| | - Amitabh Jha
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah
| | - Jeremy B Myers
- Division of Urology, Department of Surgery, University of Utah, Salt Lake City, Utah
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Nørager R, Bøgebjerg C, Plate I, Lemaitre S. Supporting better adherence among patients engaged in intermittent self-catherisation. ACTA ACUST UNITED AC 2019; 28:90-95. [PMID: 30673330 DOI: 10.12968/bjon.2019.28.2.90] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coloplast has conducted a qualitative study among health professionals working in the field of continence care. Interviews with health professionals working in urology and rehabilitation provided insights into the barriers to, and supporters of, adherent behaviour-suggesting ways in which health professionals can work with patients performing intermittent self-catheterisation (ISC) to support better adherence. This includes individualised training that addresses individual fears, ensures correct understanding of the body and the treatment, and eliminates misconceptions. They can also help patients set realistic ambitions, and give them practical advice that will help them adapt ISC to their daily life. Patients need to know how to handle urinary tract infections, how to cope with contradictory instructions from other sources, and how to identify support resources and accurate information. Specific challenges relating to support for urology patients and rehabilitation patients were also highlighted.
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Affiliation(s)
- Rune Nørager
- Behavioural Psychologist, CEO, Designpsykologi, Denmark
| | | | - Iben Plate
- Head of Clinical Development, Medical Marketing, Coloplast A/S
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