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Clean Intermittent Catheterization (clean + intermittent_catheterization)

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Medical Sciences	100%

Selected Abstracts

Independence in the toilet activity in children and adolescents with myelomeningocele , managing clean intermittent catheterization in a hospital setting

ACTA PAEDIATRICA, Issue 12 2009
M Donlau
Abstract Aim:, The aim of this study was to identify and describe gross motor, fine motor, executive and time-processing obstacles for independence in children with myelomeningocele who are treated with Clean Intermittent Catheterization and to relate their opinions about their performance in the toilet activity, and their medical records, to the observed outcome. Methods:, In a hospital setting, 22 children with myelomeningocele were observed using a structured information form while performing their toilet activity, and tested for time processing ability with the Ka-Tid instrument. Results:, Only five children were independent, despite the fact that 12 of 22 children were completely satisfied with their toilet activity. Neither the degree of motor impairment, nor sex or age had any significant impact on performing the toilet activity. The ability to remain focused on the toilet activity proved to have no relation to age or learning disabilities. The medical records for the children were only able to classify approximately three quarters correctly with respect to independence. The only measurement that could suggest anything in relation to a maintained focus was time processing ability. Conclusion:, The children were unaware of their abilities and limitations. Time processing ability and observations are important factors to assess independence. [source]

Self-sterilizing catheters with titanium dioxide photocatalyst thin films for clean intermittent catheterization: Basis and study of clinical use

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2007
Yuki Sekiguchi
Objective: Clean intermittent catheterization (CIC) requires a large number of disposable catheters or a large amount of water and disinfectant. We made titanium dioxide (TiO2)-coated catheters for CIC using technology we have developed previously, and examined the photocatalytic antibacterial effect of this catheter using only light energy and the safety of this type of catheter for practical clinical use. Methods: TiO2 -coated catheters were filled with bacterial cell suspensions and illuminated with a 15-W black-light lamp for testing antibacterial potency. Next, we soaked control toxic materials (zinc diethyldithiocarbamate) and the tips of TiO2 -coated catheters in M05 medium, and evaluated cell toxicity from the numbers of V79 colonies in these dilutions. Then, bodyweight curves and histological tissue changes were observed over a period of time in mouse-transplanted TiO2 -coated catheters and control catheters. Finally, we investigated the use of these TiO2 -coated catheters in 18 patients by questionnaire and bacterial culture of TiO2 -coated catheters and control catheters. Results: The survival rate of Escherichia coli in the liquid inside the TiO2 catheter decreased to a negligible level within 60 min under ultraviolet (UV)-A illumination. The survival rate of Staphylococcus aureus, Pseudomonas aeruginosa and Serratia marcescens also decreased to a negligible level within 60 min. V79 cells showed no cytotoxicity of this catheter, and there was no difference in bodyweight or foreign body reaction between mouse-transplanted TiO2 -coated catheters and control catheters. In a preliminary clinical analysis of 18 patients who voluntarily used this catheter, the rate of positive bacterial culture of the tips of TiO2 -coated catheters was 20% versus 60% for conventional catheters after 4 weeks of use. Conclusion: TiO2 -coated silicone catheters were easily sterilized under certain light sources and were shown to be safe in an experiment using cultured cells and in animal experiments. Sterilizing catheters with TiO2 photocatalyst thin films are expected to be used clinically for clean intermittent catheterization after proper modification based on this study. [source]

Urodynamic findings in children with cerebral palsy

INTERNATIONAL JOURNAL OF UROLOGY, Issue 8 2005
M IHSAN KARAMAN
Abstract Aim: More than one-third of children with cerebral palsy are expected to present with dysfunctional voiding symptoms. The voiding dysfunction symptoms of the cerebral palsy patients in the present study were documented. Methods: Of the study group, 16 were girls and 20 were boys (mean age: 8.2 years). Children with cerebral palsy were evaluated with urodynamics consisting of flow rate, filling and voiding cystometry, and electromyography findings of the external urethral sphincter to determine lower urinary tract functions. Treatment protocols were based on the urodynamic findings. Anticholinergic agents to reduce uninhibited contractions and to increase bladder capacity were used as a treatment. Clean intermittent catheterization and behavioral modification were used for incomplete emptying. Results: Of the children, 24 (66.6%) were found to have dysfunctional voiding symptoms. Daytime urinary incontinence (47.2%) and difficulty urinating (44.4%) were the most common symptoms. Urodynamic findings showed that neurogenic detrusor overactivity (involuntary contractions during bladder filling) with a low bladder capacity was present in 17 (47.2%) children, whereas detrusor,sphincter dyssynergia was present in four patients (11%). The mean bladder capacity of patients with a neurogenic bladder was 52.2% of the expected capacity. Conclusions: The present study concluded that voiding dysfunction was seen in more than half of the children with cerebral palsy, which is a similar result to other published studies. We propose that a rational plan of management of these patients depends on the evaluation of the lower urinary tract dysfunction with urodynamic studies. These children benefit from earlier referral for assessment and treatment. [source]

Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapse

INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009
Kumiko Kato
Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source]

Long-term functional outcomes in patients with various types of orthotopic intestinal neobladder

INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2008
Hideaki Miyake
Objectives: To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB). Methods: Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively. Results: Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups. Conclusions: Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based. [source]

Self-sterilizing catheters with titanium dioxide photocatalyst thin films for clean intermittent catheterization: Basis and study of clinical use

Appendicovesicostomy for pubescent patients with neurogenic bladder using umbilicus as a stomal site

INTERNATIONAL JOURNAL OF UROLOGY, Issue 5 2002
Akiko Uda
Abstract We experienced two cases of neurogenic bladder in which clean intermittent catheterization (CIC) had been performed since early childhood. In both cases, CIC had not provided adequate voiding control and incontinence persisted. According to the Mitrofanoff Principle, we used the appendix as a catheterizable conduit, which was constructed to the umbilicus. [source]

Long-term results of Burch colposuspension

INTERNATIONAL JOURNAL OF UROLOGY, Issue 4 2000
Haluk Akpinar
Abstract Background: We aimed to determine the long-term results of Burch colposuspension. Methods: Patients who had undergone Burch colposuspension due to stress urinary incontinence (SUI) in our department between 1991 and 1995 were asked to participate in the study by telephone or mail. Fifty of 78 patients (64%) responded and these formed the study group. Patients were evaluated by a detailed questionnaire, pelvic examination, uroflowmetry and postvoid residual urine determination. Provocative stress test and urodynamic evaluations were performed in those who claimed leakage. Additionally, follow-up charts were retrospectively reviewed from the patients' files. Results: Mean follow-up time was 50.6 months. The subjective cure rate was 52% and the surgical success rate was 84%. The patient satisfaction rate in terms of incontinence was 86%. No correlation was found between pre-operative patient characteristics (i.e. age, number of vaginal deliveries and pregnancies, menopause, previous anti-incontinence surgery and presence of detrusor instability) and outcome of surgery. Although no patient was performing clean intermittent catheterization in the long term, two patients had significant residual urine and obstructive flows. Three patients had severe pelvic prolapse that required surgical correction. Conclusions: Our results indicate that Burch colposuspension operation is an effective and durable choice of treatment with low complication rates for the treatment of SUI. [source]

Management of Low Compliant Bladder in Spinal Cord Injured Patients

LUTS, Issue 2 2010
Won Hee PARK
Low bladder compliance means an abnormal volume and pressure relationship, and an incremental rise in bladder pressure during the bladder filling. It is well known that at the time bladder capacity decreases, intravesical pressure increases, and the risk of upper deterioration increases. Hypocompliance is usually thought to be the range from 1.0 to 20.0 mL/cmH2O. Though the exact cause of hypocompliance is not known, it may be caused by changes in the elastic and viscoelastic properties of the bladder, changes in detrusor muscle tone, or combinations of the two. Management aims at increasing bladder capacity with low intravesical pressure. The main is a medical therapy with antimuscarinics combined with clean intermittent catheterization. The results are sometimes unsatisfactory. Various drugs or agents through the mouth or the bladder, including oxybutynin, new antimuscarinics, capsaicin and resiniferatoxin were tried. Among them botulinum toxin-A is promising. Some patients eventually required surgical intervention in spite of the aggressive medical therapy. Finally most patients undergo the surgical treatment including autoaugmentation, diversion, and augmentation cystoplasty. Among them augmentation cystoplasty still seems the only clearly verified treatment method. [source]

Study of Botulinum Toxin A in Neurogenic Bladder Due to Spina Bifida in Children

ANZ JOURNAL OF SURGERY, Issue 4 2010
Aniruddh V. Deshpande
Abstract Background:, We report results of a pilot study investigating the safety and efficacy of Botulinum A toxin on urinary incontinence and bladder function in children with neurogenic bladder. Methods:, This was a prospective, non-randomized clinical trial. Seven children with median age of 16 years with spina bifida who had high storage pressures, poor bladder compliance and had failed treatment with anticholinergic medications were offered a single intra-detrusor injection of Botulinum A toxin. All subjects were on clean intermittent catheterization before and during the study. Follow-up videourodynamic studies were performed at 1 month, between 3 and 6 months, and at 9 months. Data were collected on safety and on subjective outcomes through validated questionnaires filled out by patients at each visit. Results:, In majority of the patients (5/7), the injection produced an increase in bladder compliance (P < 0.05) and an improvement in incontinence (P < 0.05) at 1-month follow-up. However, in two patients whose baseline bladder capacity was markedly reduced (<200 mL), the improvement was very minimal. The beneficial effects in bladder compliance and incontinence dissipated by 9 months. The changes in subjective outcomes (incontinence and satisfaction scores) did not parallel the changes in urodynamics through the study period. No side effects of Botulinum toxin were seen. Conclusion:, Botulinum A toxin injection produces beneficial urodynamics and clinical effects. These beneficial effects last for approximately 9 months. There is a poor correlation between improvement in the urodynamics and the subjective outcomes. Botulinum A toxin injection is a safe alternative treatment for patients with spina bifida and a neurogenic bladder. [source]

Experience with non-cycled artificial urinary sphincters

BJU INTERNATIONAL, Issue 7 2004
C.D.A. Herndon
Papers in this section review experience with artificial urinary sphincters, hypospadias, and the exstrophy/epispadias complex. Also, in keeping with a significant theme of urological trauma in this issue of the journal, authors from Mansoura evaluate the late renal functional and morphological evaluation of high-grade renal injuries in children after conservative treatment. OBJECTIVE To report our experience in children and adolescents with a non-cycled artificial urinary sphincter. While some children with the AUS can void, others require clean intermittent catheterization (CIC) through the sphincter or an alternative site for catheterization; in some of the latter we have either not cycled (pumped) an activated AUS or the AUS has failed, and there is concern about ischaemia in some adults with a non-cycled AUS. PATIENTS AND METHODS In all, 143 patients who had an AUS placed between 1980 and 2002 were reviewed retrospectively; 15 (10 boys and five girls) no longer cycled (pumped) their AUS. The mean age at AUS insertion was 11 years and the mean (range) follow-up after insertion was 10.4 (1.64,22.2) years. The diagnoses included myelomeningocele in 11, sacral agenesis in three and cloaca in one. Nine patients have an activated functioning AUS and in six the AUS does not function; in the first nine the sphincter has not routinely been cycled (pumped) for a mean (range) of 1.6 (0.6,2.9) years. In the other six with a nonfunctioning AUS the mean (range) observation period is 6.4 (1.5,10) years since the system has not functioned. RESULTS All patients were completely continent, including the six with a nonfunctioning AUS. After inserting the AUS, two patients voided in combination with CIC (one each urethral and abdominal stoma) and 13 emptied by CIC (nine abdominal stoma, four urethral). There was a mechanical complication in eight patients; three had the AUS repaired and are dry, and five are dry with no repair. In one patient the AUS was never activated. To date there has been no erosion of the cuff in any of the 15 patients with a non-cycled AUS. CONCLUSION The AUS remains an extremely reliable procedure to achieve continence in children and young adults. It is versatile and can be combined with other procedures that provide an alternative means for catheterization. While some have noted the need to routinely cycle the AUS to prevent erosion, this has not been our experience in these 15 patients. [source]

Expanded PTFE bladder neck slings for incontinence in children: the long-term outcome

BJU INTERNATIONAL, Issue 1 2004
P. Godbole
OBJECTIVE To assess the long-term outcome of circumferential expanded PTFE (Gore-texTM, WL Gore Associates, Scotland) bladder neck slings for achieving urethral continence in children with a neuropathic bladder. PATIENTS AND METHODS The records were reviewed of 19 children undergoing bladder reconstruction (most with a neuropathic bladder) who had a Gore-tex sling placed circumferentially at the bladder neck, over a 5-year period. Of these, seven had spina bifida; two each spinal dysraphism, surgery for anorectal anomalies and an idiopathic neuropathic bladder; five who developed a neuropathic bladder from other causes, and one born with bladder exstrophy. All children had an uncompliant bladder with a low urethral leak-point pressure on preoperative urodynamics. In all children conventional clean intermittent catheterization and pharmacotherapy had failed. Four had had previous augmentation surgery while 15 had concomitant bladder augmentation and formation of a Mitrofanoff stoma. The main outcome measure was achieving dryness. The original intention of the procedure was also to maintain urethral catheterization. RESULTS Full details of the follow-up were available in 17 patients. Despite initial good short-term results, at a median follow up of 7 years, in 14 patients the sling had to be removed because of erosion, often with transient urethral leakage before the bladder neck subsequently closed. A bladder calculus was associated with each case of erosion except one. CONCLUSION Although in the short term this technique had favourable results, it was not a useful technique in the long term. [source]

Long-term results of orthotopic neobladder reconstruction after radical cystectomy

BJU INTERNATIONAL, Issue 6 2003
J.N. Kulkarni
Objective To assess, in a retrospective study, the long-term results of neobladder reconstruction after radical cystectomy, as this is the standard of care for muscle-invasive bladder cancer. Patients and methods Data were retrieved for all patients with muscle-invasive transitional cell carcinoma of the bladder treated by radical cystectomy and orthotopic neobladder substitution between 1988 and 1998. All perioperative and long-term complications were recorded. The voiding pattern, frequency of micturition and continence were assessed, and a complete urodynamic profile recorded. Results In all, 102 patients underwent radical cystectomy with orthotopic neobladder reconstruction in the study period; their mean (range) follow-up was 73 (36,144) months. Neobladder substitution was with an ileocaecal segment in 35 patients, sigmoid colon in 34 and ileum in 33. Early complications occurred in 32 patients (31%) although open surgical intervention was required in only nine (9%). The death rate after surgery was 3.9%. Late complications occurred in 31 patients (30%) and were primarily caused by uretero-enteric and vesico-urethral strictures (9% each). Most patients had daytime (89%) and night-time (78%) continence. The mean maximum pouch capacity (mL) and pouch pressure at capacity (cmH2O) were 562.5 and 23 (ileocaecal), 542 and 17.8 (sigmoid) and 504 and 19.1 (ileal), respectively; the mean postvoid residual was 29, 44 and 23 mL, respectively. Nine patients with ileocaecal neobladders, and 20 and seven with sigmoid and ileal neobladders, required clean intermittent catheterization. Twenty-four patients had recurrence of disease, of whom 20 died. Conclusions Orthotopic neobladder reconstruction requires complex surgery but has an acceptable early and late complication rate in properly selected patients. It provides satisfactory continence without compromising cure rates. [source]

The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children

BJU INTERNATIONAL, Issue 9 2002
H.G. Pohl
Objective,To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. Patients and methods,The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6,14.5, and seven males, mean age 8 years, range 5,20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. Results,Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. Conclusion,CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively. [source]

Independence in the toilet activity in children and adolescents with myelomeningocele , managing clean intermittent catheterization in a hospital setting