Update on voiding dysfunction managed with suprapubic catheterization

Neurogenic Bladder Physiology, Pathogenesis, and Management after Spinal Cord Injury

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.

Suprapubic catheter encasement by bladder stone

Complications of suprapubic catheterization including acute urinary retention present often to the emergency department. Patients with chronic indwelling catheters are at increased risk of bladder calculi and recurrent infections, especially without appropriate follow up care. We describe a case of suprapubic catheter failure secondary to complete circumferential encrustation of the distal catheter tip by a bladder calculus. This case demonstrates the need for thorough evaluation of any case of catheter dysfunction and for careful consideration of bladder calculi in those patients at risk.

Rectourethral Fistula Induced by Localised Prostate Cancer Treatment: Surgical and Functional Outcomes of Transperineal Repair with Gracilis Muscle Flap Interposition

BACKGROUND

Transperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects.

OBJECTIVE

To assess surgical and functional outcomes of this treatment of RUF.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020.

SURGICAL PROCEDURE

The standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures.

MEASUREMENTS

Fistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark's score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality.

RESULTS AND LIMITATIONS

The median (interquartile range) follow-up was 27 (8-47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark's score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations.

CONCLUSIONS

The present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate.

PATIENT SUMMARY

We performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes. TAKE HOME  MESSAGE: Transperineal repair of rectourethral fistula with gracilis muscle flap interposition is a safe surgery with a high success rate. Urinary continence is a serious issue, but patients may be reassured as to the impact on digestive continence, lower extremity functionality, and scar aesthetics.

A rare complication of suprapubic catheterisation with obstruction and significant migration into a ureter

Suprapubic catheter insertion is frequently indicated for patients with a neurogenic bladder. It's an effective and safe way to drain the bladder and can be managed in a community setting by a trained health professional. Here we report a rare case of a 73-year-old male-presenting with a two-day history of frank haematuria secondary to a recent suprapubic catheter change. Imaging confirmed an obstruction of the right ureteric orifice due to migration of the catheter into the ureter. Once the catheter was withdrawn into the correct location his haematuria and acute renal injury resolved and was discharged the following day.

What Do Nurses Prefer? A Cross-sectional Study of Catheter Preference After Pelvic Organ Prolapse Surgery

PURPOSE

The purpose of this study was to determine nursing preferences regarding catheter type (transurethral indwelling catheters vs intermittent catheterization vs suprapubic tube drainage) when caring for patients in hospital after pelvic organ prolapse surgery.

DESIGN

Cross-sectional survey study.

SUBJECTS AND SETTING

Registered nurses practicing in academic and community hospitals across North America (the United States and Canada).

METHODS

Three hundred fifty-four RNs who routinely care for patients after pelvic organ prolapse surgery from centers across North America were sent an electronic survey between February 2018 and March 2019. The survey comprised 24 questions that collected information on the participants' demographics and their experience with using different catheters in a hospital setting, along with knowledge of and preference for the different catheter types. Descriptive statistics were used to determine catheter preferences of respondents in addition to their catheter rankings according to catheter-related outcomes.

RESULTS

One hundred sixty nurses completed the survey, representing a 45% response rate. More than half (63.1%, n = 101) of respondents stated a preference for transurethral indwelling catheters, 23.1% (n = 37) preferred suprapubic tubes, and 10.6% (n = 17) preferred intermittent catheterization. Transurethral indwelling catheters were ranked by nurses as the best catheter type for ease of use and pain/discomfort for patients. Intermittent catheterization was ranked by nurses as the best for lowest malfunction rates and return of bladder function. Suprapubic tubes were ranked by nurses as best for lowest infection rates.

CONCLUSIONS

This study has demonstrated that nurses practicing in inpatient care units have a strong preference for transurethral indwelling catheters over intermittent catheterization and suprapubic tubes when caring for patients after pelvic organ prolapse surgery.

Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury

The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.