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This study aimed to compare effects of clean intermittent catheterization training, which is routinely applied in hospital, and the Roy Adaptation Model-based, Android phone application (RAMTAKE)-supported clean intermittent catheterization training on caregivers’ knowledge/skill, coping/adaptation levels, and urinary tract infection development in children. The research followed a randomized controlled study approach involving 40 patients and caregivers under clean intermittent catheterization care at a university pediatric nephrology clinic between March 2020 and February 2021. Data were collected from the “sociodemographic questionnaire,” “clean intermittent catheterization application knowledge and skill level assessment form,” and “Coping and Adaptation Processing Scale,” and a urinary tract infection follow-up form was used. Forty caregivers performing clean intermittent catheterization were randomly assigned to the control groups and experimental groups. During the first meeting, data collection tools were applied to both groups as a pre-test. RAMTAKE-supported training was given to the experimental group. After discharge, a home visit, phone call, post-test, and repead test were performed. Routine training was given to the control group in the hospital. The post-test and repead test were applied at the same timepoints as the experimental group. Urine culture tests were performed three times with an interval of 1 month after discharge to the children in both groups. Mann–Whitney U, Wilcoxon, Friedman, and Chi-square tests were used to compare data. Knowledge/skill and coping/adaptation levels of caregivers in experimental group were increased. The incidence of urinary tract infections was decreased in experimental group (p < 0.05). Conclusion: RAMTAKE is effective in increasing the knowledge/skills and coping/adaptation level of caregivers who apply clean intermittent catheterization and decreased of urinary tract infections. Trial registration: ClinicalTrials.gov number: NCT04763382, date: February 2021. What is Known: • Urinary tract infection is the most common complication that causes kidney damage in patients when CIC is not applied correctly by caregivers. • To prevent the development of urinary tract infection (ITU), caregivers must have sufficient knowledge/skills for CIC and be adapted to do CIC. What is New: • Our results show that model-based Android phone application-supported CIC training is more effective in increasing the knowledge/skill, coping/adaptation level of caregivers. • Our results show that model-based Android phone application-supported CIC education for caregivers reduces the risk of ITU in children. [ABSTRACT FROM AUTHOR]

Background and Purpose: Clean intermittent catheterization (CIC) nonadherence may lead to renal compromise, incontinence, and frequent urinary tract infections in patients with spinal cord injury and spinal dysraphism. Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice, including patient education. The aim of this concept analysis was to analyze how CIC adherence is conceptualized and synthesize a definition for nursing. Method: Rodgers' evolutionary concept analysis method was used to analyze the concept of CIC adherence in patients and caregivers. We searched databases to identify studies describing CIC adherence and identified common attributes, antecedents, and consequences. A definition was synthesized, and an exemplar was developed to illustrate the concept in practice. Results: Sixteen sources were analyzed. The attributes of CIC adherence were initiation, execution, including prescribed process and prescribed frequency, and persistence. Antecedents included the presence of neurogenic bladder, acceptance, and engagement. Consequences included improved health outcomes and quality of life. Implications for Practice: Adherence to CIC lacks definition in the nursing literature despite implications for research and clinical practice. A unified definition of CIC adherence will facilitate nurses' efforts to plan effective care, anticipate support barriers and opportunities, and develop strategies for improving CIC adherence. [ABSTRACT FROM AUTHOR]

Objective: To explore the data comparing single‐ vs multi‐use catheters for clean intermittent catheterisation (CIC), consider if the widespread use of single‐use catheters is warranted given the cost and environmental impact, and put forth ideas for future consideration. Methods: A primary literature review was performed in PubMed over the past 50 years. Studies that performed comparative analysis of single‐ and multi‐use catheters were included in our review. All studies that reported on primary data were narratively summarised. Results: A total of 11 studies were identified that reported on primary data comparing single‐ and multi‐use catheters. There was no appreciable evidence suggesting reusable multi‐use catheters were inferior to single‐use catheters from an infection or usability standpoint. In addition, the environmental and monetary burden of single‐use catheters is significant. Conclusions: The intermittent catheter landscape in the USA has a complex past: defined by policy, shaped by industry, yet characterised by a paucity of data demonstrating superiority of single‐use over multi‐use catheters. We believe that the aversion to reusable catheters by many patients and healthcare professionals is unwarranted, especially given the cost and environmental impact. Moving forward, better comparative data and more sustainable practices are needed. [ABSTRACT FROM AUTHOR]

Purpose: The study aimed to determine the anxiety levels of caregivers who performed clean intermittent catheterization (CIC) on their children and the factors affecting them. Methods: This descriptive study was conducted between January 6, and May 29, 2023 with caregivers of 42 patients who were followed up by the pediatric nephrology outpatient clinic of a university for CIC. The study data were collected using the "Participant Information Form" and the "State and Trait Anxiety Scale." Results: According to the results, of the children included in the study, 73.8% were female, 64.3% were diagnosed with spina bifida (SB), and 76.2% received CIC applications 4–6 times a day. All the caregivers were mothers, and 76.2% received CIC training from a doctor. However, 78.6% of them found the training insufficient, leading them to rely on self‐experimentation when applying CIC to their own children. None of the caregivers received information or training on the CIC application from nurses, and there were no home visits or telephone counseling provided after the hospital discharge. The mean score for the state anxiety scale among the caregivers was 45.90 ± 10.57, while the mean score for the trait anxiety scale was 46.92 ± 8.43. Significantly higher mean trait anxiety scores were observed among caregivers with chronic diseases who did not receive training on the CIC application (p < 0.05). Additionally, caregivers of children who experienced 3–4 urinary tract infections (UTIs) within the last 3 months also had significantly higher mean trait anxiety scores (p < 0.05). The mean trait anxiety level scores of caregivers of children who had 3–4 UTIs in the last 3 months were significantly higher (p < 0.05). Conclusions: It was concluded that caregivers' lack of training on CIC implementation, having chronic disease, and having frequent UTIs in their children were effective on anxiety levels. [ABSTRACT FROM AUTHOR]

Aims: To confirm the improved performance of the micro‐hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs). Methods: Male self‐catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi‐center, randomized, cross‐over study performed across six European sites. Subjects tested the MHZC, featuring a drainage zone with 120 micro‐holes and a CEC with two eyelets. The study consisted of four study visits (V0–V3), during which endpoints related to catheter performance (urinary flow‐stops, bladder emptying, and intra‐catheter pressure) were measured and two 4‐week test periods at home (T1 and T2) where dipstick hematuria and user perception between catheters were evaluated. Results: Seventy‐three male subjects with non‐neurogenic and neurogenic bladder dysfunction (3:2) were enrolled. On average, catheterizations with the MHZC led to close to mean zero flow‐stops compared to ≥1 flow‐stops with the CEC, during both HCP‐ and self‐led catheterizations (both p < 0.001). Residual urine at first flow‐stop was significantly reduced for the MHZC compared to CEC (p = 0.001 and p = 0.004, for HCP‐ and self‐led catheterizations, respectively). This was substantiated by a significantly smaller pressure peak at first flow‐stop, a proxy for minimized mucosal suction (both HCP‐ and self‐led catheterizations, p < 0.001). After home‐use catheterizations, dipstick hematuria was comparable between catheters, whereas catheterizations were associated with significantly improved perception in favor of MHZC regarding bladder emptying, less blocking sensation, and improved hygienic catheterization compared to the CEC. Conclusion: This study confirmed the evidence of improved bladder emptying with the MHZC compared to a CEC without the need to reposition the catheter. The MHZC therefore offers an enhanced benefit for the dependent CIC user securing complete bladder emptying in an uninterrupted free flow and reducing the need to reposition the catheter during emptying. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore treatment options for chronic urinary retention (CUR) in men, including complications and consequences. Male patients diagnosed with a non-neurogenic, symptomatic and/or high-risk, CUR > 150 mL were included. Data for treatments, complications, and consequences were recorded and incidence rate ratios (IRRs) calculated. We enrolled 177 patients, most initially received a urethral catheter (74%) and some form of catheterization as final treatment (87%), 49 (28%) underwent de-obstructive prostate surgery. Catheterization was more likely to be stopped after surgery (16/49 patients), compared with non-surgical cases (8/128 patients) (IRR 4.18; p < 0.001). Urinary tract infection (IRR 3.68; p < 0.001) and macroscopic hematuria (IRR 5.35; p < 0.001) were more common with catheterization, but post-renal problems were more likely in patients without catheterization (IRR 25.36; p < 0.001). The lowest complication rate was with clean intermittent catheterization. In conclusion, most patients received catheterization for CUR, with clean intermittent catheterization preferred due to its comparatively lower complication risk. De-obstructive prostate surgery increases the chance of stopping catheterization. [ABSTRACT FROM AUTHOR]

Aims: In studies utilizing a 20‐injection‐site paradigm of onabotulinumtoxinA treatment for overactive bladder (OAB), some patients performed clean intermittent catheterization (CIC). An alternative injection paradigm of fewer injections targeting the lower bladder may reduce the need for CIC by maintaining upper bladder function. This study evaluated the efficacy and safety of an unapproved alternative 10‐injection‐site paradigm targeting the lower bladder. Methods: In this phase 4, double‐blind, parallel‐group study, patients with OAB and urinary incontinence (UI) for ≥6 months with ≥3 episodes of urinary urgency incontinence (no more than 1 UI‐free day) and ≥8 micturitions per day over 3 days during screening were randomized 2:1 to onabotulinumtoxinA 100 U or placebo injected at 10 sites in the lower bladder. Results: Of 120 patients, 78 in the onabotulinumtoxinA group and 39 in the placebo group had efficacy assessments. In the double‐blind phase, mean change from baseline at week 12 in daily frequency of UI episodes was greater with onabotulinumtoxinA (−2.9) versus placebo (−0.3) (least squares mean difference [LSMD]: −2.99, p < 0.0001). Achievement of 100% (odds ratio [OR]: 6.15 [95% confidence interval, CI: 0.75–50.37]), ≥75% (OR: 7.25 [2.00–26.29]), and ≥50% improvement (OR: 4.79 [1.87–12.28]) from baseline in UI episodes was greater with onabotulinumtoxinA versus placebo. Reductions from baseline in the daily average number of micturitions (LSMD: −2.24, p < 0.0001), nocturia (LSMD: −0.71, p = 0.0004), and urgency (LSMD: −2.56, p < 0.0001) were greater with onabotulinumtoxinA than with placebo. Treatment benefit was improved or greatly improved in the onabotulinumtoxinA group (74.0% of patients) versus placebo (17.6%) (OR: 13.03 [95% CI: 3.23–52.57]). Mean change from baseline in Incontinence Quality of Life score was greater with onabotulinumtoxinA versus placebo (LSMD: 24.2, p = 0.0012). Two of 78 (2.6%) patients in the onabotulinumtoxinA group used CIC during the double‐blind period; no females used CIC during the double‐blind period. Commonly reported adverse events (≥5%) were urinary tract infection (UTI), dysuria, and productive cough for both groups; rate of UTI was higher with onabotulinumtoxinA versus placebo. Conclusion: In patients treated with onabotulinumtoxinA for OAB with UI, an unapproved alternative injection paradigm targeting the lower bladder demonstrated efficacy over placebo, with a low incidence of CIC. [ABSTRACT FROM AUTHOR]

Objective:: The OT-Balloon Catheter is a novel urethral catheter designed for intermittent balloon catheterization. It has a filter permeable to gases but not liquids, enabling patients to confirm adequate catheterization without the flow of urine. This study examined the characteristics of the filter cap for OT-Balloon Catheter by repeatedly exposing filters to urine samples in 2 different conditions. Methods:: Urine samples were collected from 10 patients who required clean intermittent catheterization and visited Okayama University Hospital in 2023. Filters of the cap for OT-Balloon Catheter were exposed to urine samples for 30 times under 2 conditions, as follows: condition A, filters were rinsed with running water after exposure to urine; condition B, filters were never rinsed throughout the experiment. The permeability of the filters during and after the exposure was examined. The filter surface was also analyzed by stereomicroscopy. Results:: None of the filters were blocked after treatment in condition A. More than 50% of the filters remained permeable after 20 and 30 exposures even in condition B. Long-term storage did not lead to increased rates of blockage. Microscopic examination found minimal urine stains on the surface of filters under condition B. Conclusion:: The filter cap for OT-Balloon Catheter was resistant to blockage and maintained permeability after exposure to urine when adequately rinsed, and also when never rinsed after exposure to most samples. The durable permeability of the filter enables patients to achieve rapid, safe, and easy intermittent balloon catheterization.

Lower urinary tract dysfunction, closely related to bowel dysfunction, means functional abnormalities of the bladder and urethra. Different types of lower urinary tract dysfunction are divided according to symptoms or according to the cause. Treatment is directed to the cause. Neurogenic lower urinary tract dysfunction can cause irreversible damage to the upper urinary tract and changes in the bladder wall long before the clinical picture manifests as urinary leakage. Therefore, it is essential to diagnose the neurogenic defect with the resulting lower urinary tract dysfunction as soon as possible after birth and to treat the condition proactively. The standard therapy for neurogenic lower urinary tract dysfunction is clean intermittent catheterization in combination with an anticholinergic. Non-neurogenic lower urinary tract dysfunction, resulting in sudden, unexpected urge to void, urgency, leakage of urine, sphincter-detrusor dyssynergy and other forms, is often associated with a deterioration in the quality of life and negatively affects the child‘s self-esteem. The child develops different behavioural patterns to delay urination or stop the urgency. With anamnestic data, a diary and a clinical picture, we can easily define the diagnosis and start as soon as possible with non-pharmacological measures, standard and various types of special urotherapy.

Background: Transient increases in postvoid residual urine volume (PVR) requiring clean intermittent catheterization (CIC) have occurred with onabotulinumtoxinA treatment for overactive bladder (OAB). Objective: To evaluate onabotulinumtoxinA safety and the effect of age, gender, and maximum PVR (PVRmax) on CIC initiation in adults with OAB and urinary incontinence (UI). Design, setting, and participants: This was a pooled post hoc analysis of four placebo-controlled, multicenter randomized trials that included adults with idiopathic OAB after first onabotulinumtoxinA treatment (NCT00910845, NCT00910520, NCT01767519, NCT01945489). Patients had at least three urgency UI episodes over 3 d and at least eight micturitions per day, had inadequate management with at least one anticholinergic agent, and were willing to use CIC. Outcome measurements and statistical analysis: We measured the following outcomes: PVRmax within 12 wk after first treatment; CIC incidence; estimated functional capacity; PVR ratio (PVR/estimated functional capacity). Results and limitations: Of 1504 patients, 87.7% were women and 88.8% were White. The mean age was 60.5 yr across 10-yr age groups, baseline PVR was 13.8–35.0 ml, and estimated functional capacity was 293.5–475.7 ml. Mean baseline PVR was 21.3 ml overall versus 34.0 ml in the group that started CIC. The CIC incidence was 6.2% for women (range 1.1–8.4%) and 10.5% for men (range 0–14.6%). Higher CIC rates were observed for PVRmax >350 ml (women 91.9%, men 84.6%) in comparison to PVRmax of 201–350 ml (women 32.5%, men 17.4%) and PVRmax

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare motility disorder with high mortality rate described by Berdon in 1976. We present the first case of Berdon’s syndrome (heterozygous pathogenic variant in the ACTG2 gene) reported in Romania, a female newborn admitted in NICU “Marie S. Curie” Emergency Children’s Hospital Bucharest for intestinal obstruction after birth. Total parenteral nutrition, ileostomy, gastrostomy, clean intermittent bladder catheterisation, evaluation for multivisceral transplantation were performed. She was discharged from our NICU ward at the age of 4 years and 2 months with home total parenteral nutrition administered by her mother in sterile condition, clean intermittent catheterisation for bladder evacuation performed by her mother, monitored monthly for about three years, with normal cardio-respiratory function, no signs of thrombosis, she maintained relatively low platelet count without positive blood culture, good liver and renal function test. Normal neurological and psychomotor development according to age. Her course was complicated by multiorgan failure with death ensuing at the age of 7 years and 10 months.

Purpose: Myelomeningocele is the most severe form of spina bifida. Management of urologic consequences of spina bifida is life long, demanding and costly for both the patient and the public health system. There is a paucity of data in the literature regarding concentration defects and their consequences on this disease. This paper aims to describe retrospectively the effect of early onset clean intermittent catheterization (CIC) in on the severity of urinary concentration defects in myelomeningocele patients with neurogenic bladder in a retrospective observa- tional study. Materials and Methods: In this 10-year retrospective cohort study, children with myelomeningocele were select- ed with the Convenience sampling method. Demographic characteristics, polyuria index ratio (PIR) defined as 24 hour urine output of each patient divided by the maximum normal urine output of the same patient in a healthy state, and nocturnal polyuria index (NPI) were compared between early starters (< 2 years old) or late starters (≥ 2 years old) groups. Results: Seven patients who underwent cystoplasty were excluded and 130 patients (63.8% male, 5.4 ± 3.2 years old, 14.3 ± 2.83 Kg, 28.5% early onset CIC) were investigated. PIR > 1 in inset (1.7 ± 0.2 vs. 2.2 ± 0.5, P = 0.021) and outset (1.5 ± 0.32 vs. 2.5 ± 0.7, P = 0.004) were lower in early starters group than in late starters group. NPI in inset (0.2 ± 0.007 vs. 0.32 ± 0.10, P = 0.018) and outset (0.25 ± 0.15 vs. 0.42 ± 0.095, P = 0.007) were also lower in the early starters group. No further adverse events were reported during the follow-up period. Conclusion: Early onset CIC is more effective than late-onset CIC in preserving the urinary ability of kidneys in myelomeningocele patients. [ABSTRACT FROM AUTHOR]

To review the urological outcomes of proactive versus delayed management of children with a neurogenic bladder (NB). We performed a literature search on EMBASE, MEDLINE, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials between January 1, 2000 to August 21, 2023 for studies investigating the management of spina bifida-associated NB in pediatric patients (0–18 years of age). Proactive management was defined as use of clean intermittent catheterization, and/or anticholinergics at presentation, or based on initial high-risk urodynamic findings by 1 year of age. Delayed management was defined as beginning management after 1 year of age or no intervention. Outcomes included incidence or diagnosis of secondary vesicoureteral reflux (VUR), urinary tract infection (UTI), and renal deterioration, which included renal scarring, loss of differential renal function on a nuclear scan, or a decrease in renal function defined by glomerular filtration rate or serum creatinine estimation. Forest plots were synthesized using the Inverse Variance method with random-effect model. The Risk of Bias was assessed using the ROBINS-I tool. We included 8 observational studies on 652 pediatric patients with spina bifida-associated NB (mean follow-up - 7 years). Proactive management following initial assessment was associated with significantly lower risks of secondary VUR (OR 0.37 [0.19, 0.74], p = 0.004), non-febrile UTI (OR 0.35 [0.19, 0.62], p = 0.0004), and renal deterioration (OR 0.31 [0.20, 0.47], p < 0.00001). Delayed management of NB potentially has 3 times higher risks of secondary VUR, non-febrile UTI, and renal deterioration. However, the evidence is limited by the high risk of bias due to lack of randomization and standardized reporting in observational studies. While further well-defined prospective studies with long-term follow-up should be conducted to confirm this finding, this study supports the EAU/ESPU recommendations for early intervention in children with NB. [Display omitted] [ABSTRACT FROM AUTHOR]

Megacystis Microcolon Intestinal Hypoperistalsis Syndrome (MMIHS) is a rare motility disorder with high mortality rate described by Berdon in 1976. We present the first case of Berdon’s syndrome (heterozygous pathogenic variant in the ACTG2 gene) reported in Romania, a female newborn admitted in NICU “Marie S. Curie” Emergency Children’s Hospital Bucharest for intestinal obstruction after birth. Total parenteral nutrition, ileostomy, gastrostomy, clean intermittent bladder catheterisation, evaluation for multivisceral transplantation were performed. She was discharged from our NICU ward at the age of 4 years and 2 months with home total parenteral nutrition administered by her mother in sterile condition, clean intermittent catheterisation for bladder evacuation performed by her mother, monitored monthly for about three years, with normal cardio-respiratory function, no signs of thrombosis, she maintained relatively low platelet count without positive blood culture, good liver and renal function test. Normal neurological and psychomotor development according to age. Her course was complicated by multiorgan failure with death ensuing at the age of 7 years and 10 months. [ABSTRACT FROM AUTHOR]

Treatment of urethral stricture is a complex reconstructive urology treatment. Previous surgery in the treatment of urethral stricture increases the risk of urinary incontinence. Therefore, this study aimed to assess the outcome of comparing two preservative or nonsurgical methods, clean intermittent catheterization (CIC) or hydraulic urethral dilatation (HUD). Forty-eight patients diagnosed with symptomatic urethral stricture were enrolled in the study. Patients were randomly divided into two groups: Nelaton-based dilatation and HUD treatment. Patients were assessed using patient-reported outcome measure for urethral stricture surgery (USS-PROM) through direct clinical interview and were followed up for 12 months. The rate of urinary infection, the need for surgical intervention, and the patient's quality of life were considered as outcomes of the interventions. SPSS software, version 20.0, was used for statistical analysis. Overall, 23 (47.9%) patients underwent HUD of stricture and Nelaton-based dilatation of stricture was done in 25 (52.1%) patients. We found that surgical intervention was required in four patients in the HUD group, but 15 patients in the CIC group required surgical intervention. Also, the need for surgical intervention and urinary tract infection (UTI) was significantly greater in the CIC group compared with the HUD group. With respect to the patient-reported outcomes, the mean Peeling's voiding picture (Q8) and EQ-VAS score (Q16) in the HUD group (p = .02) were significantly greater than those in the CIC group (p = .02). We obtained excellent results by using an HUD catheter. This safe, simple, well-tolerated, home-based procedure reduced the need for hospital admission to operate for repeat. [ABSTRACT FROM AUTHOR]

Objective: To identify the clinical and urodynamic risk factors associated with the development of recurrent febrile urinary tract infections (FUTIs) in children with neurogenic bladder (NB) who perform clean intermittent catheterization (CIC). Methods: Children with NB receiving CIC were prospectively enrolled from January to December 2019 and followed up prospectively for 2 years. All data were compared between occasional (0–1 FUTI) and recurrent FUTIs (≥2 FUTI) groups. In addition, the risk factors for recurrent FUTIs in children were evaluated. Results: Complete data from 321 children were analyzed. Occasional FUTIs occurred in 223 patients, and 98 patients experienced recurrent FUTIs. Univariate and multivariate analyses, showed late‐initiation and low‐frequency CIC, vesicoureteral reflux (VUR), small bladder capacity and low compliance, and detrusor overactivity were associated with an increased risk of recurrent FUTIs. Children with high‐grade VUR (grades IV‒V) had a higher risk of recurrent FUTIs than those with low‐grade VUR (grades I‒III) (odds ratio [OR]: 26.95 vs. OR: 4.78, p < 0.001). Conclusions: Our study suggests that late‐initiation and low‐frequency CIC, VUR, small bladder capacity and low compliance, and detrusor overactivity were associated with recurrent FUTIs in patients with NB. In addition, high‐grade VUR is a crucial risk factor for recurrent FUTIs. [ABSTRACT FROM AUTHOR]

Background and Aim: Spinal cord injury (SCI) patients have an increased risk of developing urinary tract infections. The method of bladder drainage influences the risk of urinary tract infection (UTI), and most persons with SCI on per urethral continuous catheterization (CC) or clean intermittent catheterization (CIC) develop urinary tract infection. Identification and treatment of severe UTI with appropriate antibiotics as early as possible is associated with better outcomes in SCI patients. The aim of this study was to determine the prevalence and causative organisms of symptomatic urinary tract infection in spinal cord injury patients with different bladder management methods. Materials and Methods: A total of 50 patients with SCI were followed up at a rehabilitation centre from Jan 2020 to Dec 2021 in a prospective descriptive study. The demographic status, clinical and laboratory findings of the patients with SCI were studied and the prevalence and causative organisms of symptomatic UTI in these patients with different bladder management methods were analysed. Results: The commonest organisms isolated were E. coli (31%), Pseudomonas (29%) and Klebsiella (21%). The organisms isolated in the UTI were most sensitive to colistin (82%), followed by 59% being sensitive to both imipenem and tigecycline. Least sensitivity was seen to Piperacillin, Ceftriaxone and Levofloxacin. Maximum UTI episodes were seen in cases with CC followed by CIC. Least UTI episodes were seen in cases where supra-pubic cystostomy was done followed by patients who were self-urinating. Conclusion: Symptomatic UTI in SCI patients is more prevalent in patients with CC and CIC. Such patients should be started as early as possible on antibiotics depending on the antibiotic sensitivity pattern of the organisms isolated.

Purpose: Current guidelines recommend clean intermittent catheterization (CIC) at regular time intervals for patients with spinal cord injuries; however, many patients experience difficulties. Performing time-based CIC outside the home is a significant burden for patients. In this study, we aimed to overcome the limitations of the current guidelines by developing a digital device to monitor bladder urine volume in real-time. Methods: The optode sensor is a near-infrared spectroscopy (NIRS)-based wearable device intended to be attached to the skin of the lower abdomen where the bladder is located. The sensor's primary function is to detect changes in urine volume within the bladder. An in vitro study was conducted using a bladder phantom that mimicked the optical properties of the lower abdomen. To validate the data in the human body at the proof-of-concept level, one volunteer attached the device to the lower abdomen to measure the light intensity between the first voiding and immediately before the second voiding. Results: The degree of attenuation at the maximum test volume was equivalent across experiments, and the optode sensor with multiplex measurements demonstrated robust performance for patient diversity. Moreover, the symmetric feature of the matrix was deemed a potential parameter for identifying the accuracy of sensor localization in a deep-learning model. The validated feasibility of the sensor showed almost the same results as an ultrasound scanner, which is routinely used in the clinical field. Conclusions: The optode sensor of the NIRS-based wearable device can measure the urine volume in the bladder in real-time. [ABSTRACT FROM AUTHOR]

The human bladder has been long thought to be sterile until that, only in the last decade, advances in molecular biology have shown that the human urinary tract is populated with microorganisms. The relationship between the urobiota and the development of urinary tract disorders is now of great interest. Patients with spina bifida (SB) can be born with (or develop over time) neurological deficits due to damaged nerves that originate in the lower part of the spinal cord, including the neurogenic bladder. This condition represents a predisposing factor for urinary tract infections so that the most frequently used approach to treat patients with neurogenic bladder is based on clean intermittent catheterization (CIC). In this study, we analyzed the urobiota composition in a pediatric cohort of patients with SB compared to healthy controls, as well as the urobiota characteristics based on whether patients received CIC or not. [ABSTRACT FROM AUTHOR]

Objective: Febrile urinary tract infections, which commonly occur in spina bifida patients, can cause renal dysfunction. To help prevent febrile urinary tract infection occurrence, a better understanding of any seasonal tendencies would be beneficial. Materials and Methods: Study points evaluated included: (i) with or without febrile urinary tract infections, (ii) type of urinary management in patients with febrile urinary tract infections, (iii) number of febrile urinary tract infection occurrences, and (iv) season associated with episode. Febrile urinary tract infection was defined by medical records specifically ascribing the term and clinical presentations consistent with the diagnosis. We evaluated febrile urinary tract infection incidence per 1 person, risk odds, expected values, and chi-square analysis. Results: This study examined 140 patients (79 males, 61 females). The patient's age at the first visit ranged from 2 days to 43.7 years old (median: 3.0 years old). The observation period was 0.6-43.7 years (median: 11.5 years). (i) Febrile urinary tract infection occurred in 68 cases, (ii) urinary management included: full clean intermittent catheterization: 49 cases, autoaugmented bladder: 15 cases, self-voiding: 8 cases, clean intermittent catheterization+indwelling catheter at night time: 5 cases, self-voiding+clean intermittent catheterization: 4 cases, vesicocutaneostomy: 2 cases, (iii) number of febrile urinary tract infection episodes: 2 times or less: 40 cases, 3-5 times: 20 cases, over 6 times: 8 cases, and (iv) total number of febrile urinary tract infection episodes was 183, with spring: 41, summer: 44, autumn: 37, and winter: 61. Risk odds of the incidence (one season vs. the other season) were spring: 0.870 (P=.425), summer: 0.954 (P=.784), autumn: 0.755 (P=.120), and winter 1.497 (P=.009). Conclusion: There is a significantly high incidence of febrile urinary tract infection in spina bifida patients in winter versus the other seasons. [ABSTRACT FROM AUTHOR]

Introduction: Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. Objective: To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. Methodology: A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. Results: Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62–0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74–0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59–1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66–1.60). Conclusion: We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta‐analyzed due to a lack of information reported. [ABSTRACT FROM AUTHOR]

Background and Aim: Spinal cord injury (SCI) patients have an increased risk of developing urinary tract infections. The method of bladder drainage influences the risk of urinary tract infection (UTI), and most persons with SCI on per urethral continuous catheterization (CC) or clean intermittent catheterization (CIC) develop urinary tract infection. Identification and treatment of severe UTI with appropriate antibiotics as early as possible is associated with better outcomes in SCI patients. The aim of this study was to determine the prevalence and causative organisms of symptomatic urinary tract infection in spinal cord injury patients with different bladder management methods. Materials and Methods: A total of 50 patients with SCI were followed up at a rehabilitation centre from Jan 2020 to Dec 2021 in a prospective descriptive study. The demographic status, clinical and laboratory findings of the patients with SCI were studied and the prevalence and causative organisms of symptomatic UTI in these patients with different bladder management methods were analysed. Results: The commonest organisms isolated were E. coli (31%), Pseudomonas (29%) and Klebsiella (21%). The organisms isolated in the UTI were most sensitive to colistin (82%), followed by 59% being sensitive to both imipenem and tigecycline. Least sensitivity was seen to Piperacillin, Ceftriaxone and Levofloxacin. Maximum UTI episodes were seen in cases with CC followed by CIC. Least UTI episodes were seen in cases where supra-pubic cystostomy was done followed by patients who were self-urinating. Conclusion: Symptomatic UTI in SCI patients is more prevalent in patients with CC and CIC. Such patients should be started as early as possible on antibiotics depending on the antibiotic sensitivity pattern of the organisms isolated. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of a clinically significant catheter-associated urinary tract infection (CAUTI) in patients performing clean intermittent catheterization (CIC) or with an indwelling catheter (IC) can be challenging. Objective: To get an insight into the variation of the used definition, diagnosis and management of CAUTIs by relevant healthcare workers in the Netherlands. Design: An online clinical scenario-based survey. Methods: The survey was built in Limesurvey and distributed to healthcare workers from randomly selected urology departments, rehabilitation departments/centres and general practice offices between January and May 2022. Questions regarding their field of experience, management strategies, used guidelines and two hypothetical cases with clinical scenarios of a possible CAUTI were included. Results: A total of 172 individuals participated, of which 112 completed the survey. In all, 32 individuals who completed the survey partially were also included. Participants consisted of 68 [44 urologists, 22 rehabilitation doctors (RDs) and 2 general practitioners (GPs)] doctors, 60 nurses (46 from the urology department and 14 from rehabilitation centres/departments) and 16 medical assistants (13 from urology department and 3 from GP offices). The majority consulted patients with an IC or on CIC on a daily/weekly or monthly basis. In all, 35 urologists (79.5%), 9 RDs (40.9%), 21 (45.7%) nurses in the urology department and 6 (42.9%) nurses from a rehabilitation department/centre indicated bladder irrigation as a treatment option for prevention/treatment of CAUTIs, treatment of symptoms or treatment of blockage of the catheter. In the clinical scenarios presented, treatment discrepancies were seen between subspecialties and healthcare workers. Various guidelines were named for the definition of CAUTIs. Conclusion: A considerable variation in diagnoses and management of CAUTIs between the healthcare workers involved was seen. Uniformity in diagnosing and managing CAUTIs, to prevent overtreatment and possible resistance to antibiotics, is advised. Suitable multidisciplinary guidelines are preferred. [ABSTRACT FROM AUTHOR]

Objectives: Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. Design and methods: For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Results: Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85years old and male CIC users over 65years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. Conclusion: CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines. [ABSTRACT FROM AUTHOR]

To generate utility decrements for three attributes associated with catheterization for individuals with a spinal cord injury (SCI): the process of catheterization, the physical impact of urinary tract infections (UTIs) and worry associated with hospitalization. Health state vignettes comprising various levels of the three attributes were developed. Two cohorts of respondents, corresponding to people with SCIs and a sample broadly representative of the UK population, were presented with nine vignettes (three vignettes for the mild, moderate and severe health states in addition to a random set of six vignettes). It was assumed no or a nominal decrement was associated with the mild health state. Utility decrements were derived from analysing the data obtained from the online time trade-off (TTO). A proportion of the SCI cohort (n = 57) also completed the EQ-5D-5L questionnaire. Utility decrements were generated using statistical models for the general population (n = 358), the SCI population (n = 48) and the two populations combined (merged model, n = 406). Results from the two cohorts showed minimal differences. For the merged model, SCI status was not statistically significant. All interaction terms, excluding SCI and the severe level of the physical attribute, were not statistically significant. Compared to the mild level, the greatest utility decrement calculated was the severe level of the emotional (worry) attribute (0.09, p <.001) for the SCI population. A significant decrement of 0.02 (p <.001) was calculated for the moderate level of the emotional attribute for all models. The mean utility score for those with SCI having completed the EQ-5D-5L was 0.371. Modest sample size of respondents from the SCI population (n = 48). Worry associated with hospitalization had the greatest impact on patients' health-related quality of life (HRQoL). The catheterization process, such as the lubrication and repositioning of the catheter, also impacted on patients' HRQoL. [ABSTRACT FROM AUTHOR]

Multiple techniques for the creation of continent catheterizable channels have been reported. Several continence mechanisms have been used, including tunneled flap valves, nipple valves, and hydraulic valves. Moreover, several organs have been used, including the appendix, bowel, ureters, and bladders. In this review, we describe various techniques and their outcomes in the adult neuro-urological population. Compared to nipple valves, tunneled flap valves using the appendix and other organs are the most commonly performed procedures but have a higher number of reported complications when compared to nipple valves. Hydraulic valves have been largely abandoned due to disappointing long-term results.

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This study aimed to compare effects of clean intermittent catheterization training, which is routinely applied in hospital, and the Roy Adaptation Model-based, Android phone application (RAMTAKE)-supported clean intermittent catheterization training on caregivers' knowledge/skill, coping/adaptation levels, and urinary tract infection development in children. The research followed a randomized controlled study approach involving 40 patients and caregivers under clean intermittent catheterization care at a university pediatric nephrology clinic between March 2020 and February 2021. Data were collected from the "sociodemographic questionnaire," "clean intermittent catheterization application knowledge and skill level assessment form," and "Coping and Adaptation Processing Scale," and a urinary tract infection follow-up form was used. Forty caregivers performing clean intermittent catheterization were randomly assigned to the control groups and experimental groups. During the first meeting, data collection tools were applied to both groups as a pre-test. RAMTAKE-supported training was given to the experimental group. After discharge, a home visit, phone call, post-test, and repead test were performed. Routine training was given to the control group in the hospital. The post-test and repead test were applied at the same timepoints as the experimental group. Urine culture tests were performed three times with an interval of 1 month after discharge to the children in both groups. Mann-Whitney U, Wilcoxon, Friedman, and Chi-square tests were used to compare data. Knowledge/skill and coping/adaptation levels of caregivers in experimental group were increased. The incidence of urinary tract infections was decreased in experimental group (p < 0.05)., Conclusion: RAMTAKE is effective in increasing the knowledge/skills and coping/adaptation level of caregivers who apply clean intermittent catheterization and decreased of urinary tract infections., Trial Registration: ClinicalTrials.gov number: NCT04763382, date: February 2021., What Is Known: • Urinary tract infection is the most common complication that causes kidney damage in patients when CIC is not applied correctly by caregivers.  • To prevent the development of urinary tract infection (ITU), caregivers must have sufficient knowledge/skills for CIC and be adapted to do CIC., What Is New: • Our results show that model-based Android phone application-supported CIC training is more effective in increasing the knowledge/skill, coping/adaptation level of caregivers. • Our results show that model-based Android phone application-supported CIC education for caregivers reduces the risk of ITU in children., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: The process of caregivers learning to implement clean intermittent catheterization (CIC) affects both children and caregivers negatively. The aim of this study was to examine the experiences of caregivers performing CIC on their children with spina bifida (SB)., Design and Methods: This study was conducted with a qualitative design between June 5 and September 25, 2022, with the caregivers of 17 children. The data were collected using a semi-structured questionnaire and analyzed using a thematic analysis technique. The COREQ guidelines were followed in the study., Results: The data were grouped under fourteen sub-themes: "not knowing CIC, having knowledge about CIC, positive and supportive, negative and compelling, family support, health personnel support, loneliness, sharing responsibility, taking on the role of caregiver, satisfaction, sadness, indecisiveness, limitation of social life, change in social life routine". Caregivers had both positive and negative experiences in this period., Conclusion: Caregivers face various challenges during the implementation of CIC for children with SB. The results reveal the importance of identifying the performance of caregivers. Nurses who are aware of the difficulties faced by caregivers in this period can be actively involved in personalized care-oriented health education, counseling, and support for caregivers., Implications for Clinical Practice: Failure to provide adequate support to caregivers during the CIC application process causes both children and caregivers to be negatively affected in this process. For this reason, protocols or guidelines should be created by nurses in order to reduce the negative experiences of caregivers who apply CIC to their children., Competing Interests: Declaration of competing interest No conflict of interest has been declared by the authors., (Copyright © 2024. Published by Elsevier Inc.)

Multiple techniques for the creation of continent catheterizable channels have been reported. Several continence mechanisms have been used, including tunneled flap valves, nipple valves, and hydraulic valves. Moreover, several organs have been used, including the appendix, bowel, ureters, and bladders. In this review, we describe various techniques and their outcomes in the adult neuro-urological population. Compared to nipple valves, tunneled flap valves using the appendix and other organs are the most commonly performed procedures but have a higher number of reported complications when compared to nipple valves. Hydraulic valves have been largely abandoned due to disappointing long-term results. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy and safety of different modalities of bladder instillation in patients with neurogenic bladder practicing intermittent catheterization. Methods: A systematic review of the literature were conducted using two databases: Medline via PubMed and Scopus. Articles evaluating bladder instillation in patients with neurogenic bladder, who are practicing intermittent catheterization, were collected and assessed for the efficacy and safety of the studied agent by two different reviewers. Results: Among the 1896 studies, eight involving 346 patients with neurogenic bladder, were included in this systematic review according to the PRISMA protocols. Gentamicin, Hyaluronic acid, and Lactobacillus rhamnosus was found to decrease the incidence of urinary tract infections, the former reduced multidrug-resistant organisms. Kanamycin-colistin, showed a drop in the mean incidence of bacteriuria in males only. Trisdine, the only studied antiseptic, significantly reduced bacteriuria. Neomycin, however, showed no efficacy in term of bacteriuria. Regarding safety, when evaluated, no major adverse events were reported with any of the studied modalities. Conclusion: Bladder instillations of either antibiotics, antiseptics, hyaluronic acid, or Lactobacillus rhamnosus GG are efficient and safe in patients having neurogenic bladder, with recurrent urinary tract infections and practicing clean intermittent catheterization, with gentamicin being the most recommended product among the different studied agents. [ABSTRACT FROM AUTHOR]

Objectives: Bladder dysfunction due to spinal cord injury has a significant impact on the overall health and quality of life of an individual. Clean intermittent catheterization is the gold standard for bladder management and is recommended due to having the lowest complication rate. Transitions from intermittent catheterization to other less optimal strategies, such as indwelling catheter, are quite common. However, the research documenting patient perspectives, and epidemiological and demographic factors related to such transition is limited. Methods: Data from patients with spinal cord injury rehabilitated with clean intermittent catheterization were collected. Demographic and epidemiological details of the patients were documented from the inpatient records. Appropriate statistical tests were applied to the values. Results: Among the 45 participants, 68.89% continued clean intermittent catheterization. In those who discontinued clean intermittent catheterization, the median duration of practicing clean intermittent catheterization was 3.5 months. The commonest difficulty among compliant patients was carrying out clean intermittent catheterization in outdoor environments due to the unavailability of toilet facilities. Urinary tract infection was the most common (17.78%) complication noted. Dependence (20.00%) was a major procedural difficulty followed by pain. Adaptations to remain continent in special conditions were diapers and condom catheters. The duration of clean intermittent catheterization practiced influenced discontinuation of clean intermittent catheterization. With an increase in the duration of clean intermittent catheterization practiced after discharge, the risk of discontinuation of clean intermittent catheterization decreased with an adjusted odds ratio of 0.773 (95% confidence interval 0.609–0.982). Conclusions: People with spinal cord injury have many challenging issues in the regulation of bladder function at their level inclusive of procedural difficulties, environmental barriers and medical complications, and understanding of which will help to establish a comprehensive and a holistic program to provide remote/community care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Since 1970 clean intermittent catheterization (CIC) has become the first-line drainage method in patients with neurogenic lower urinary tract dysfunction. MATERIAL AND METHODS: Prospective, observational, cross-sectional non-randomized study. Carried out in 476 people that included: Undergraduate Physicians (UP), Pediatric Residents (PR), Nursing Graduates (NG) and Pediatric Specialists (PS). In two public institutions of the health sector of the State of Oaxaca, Mexico. From January 1, 2015 to January 1, 2020. The statistical analysis was performed with measures of central tendency and frequency table. RESULTS: Of the 45 (PR), 100% were unaware of the (CIC) procedure. In 240 (UP) 99.56% were unaware of the procedure, of the 91 (PS) 90% were unaware of the procedure. Of the 100 (NG), 98% were unaware of the procedure. The 476 respondents had no experience in applying the procedure. DISCUSSION: The (CIC) allows a reduction of infectious complications, protects the upper urinary tract and provides urinary continence for the patient. CONCLUSIONS: The (CIC) is useful to prevent damage to the upper urinary tract. Patients treated with (CIC) present asymptomatic bacteriuria that do not require antimicrobial treatment, only that they are symptomatic. The (CIC) must be taught in the universities that form health resources. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to assess the clean intermittent catheterization (CIC) training and education videos on YouTube. Methods This study was conducted in English language in descriptive type to evaluate the content, reliability, and quality of Internet videos related to CIC training. The search was performed by using term “clean intermittent catheterization” and “intermittent self catheterization” on YouTube in August 2019. The content of the selected videos was analyzed by 2 independent experts in the field. The DISCERN questionnaire was used to analyze the reliability of the video and the global quality score (GQS) was used for the quality of the video. Results When the contents of the 64 videos included in the study were examined, it was found that 41 of them contained useful information and 23 of them contained misleading information. DISCERN scores, video coverage scores, and GQS of videos with useful information were found to be statistically higher than those with misleading information (P

EB is an inherited skin disease that presents with the symptom of skin blisters following trauma, Involvement of the Urogenital system in these people is in the form of meatal stenosis, urinary tract infection and ureteral stricture. We introduce patient with EB and urethral involvement. A 32-year-old man without prenatal problems whose EB skin symptoms started at 6 months of age and urinary symptoms started at 12 years of age. Skin changes on prenatal ultrasound at 18 and 21 weeks of gestation will help in the diagnosis. Follow-up of EB patients with ultrasound will help to identify urogenital complications earlier.

Introduction Men who require intermittent catheterization may be susceptible to balanoposthitis. Benzalkonium chloride is commonly used to disinfect reusable catheters, but the concentration of this solution is critical. Case presentation A 40‐year‐old man presented with fever, pus around the glans and foreskin, and difficult catheterization. On physical examination, his urethral meatus was too narrow to insert a catheter. Suprapubic catheterization and 2 weeks of intravenous and topical treatment cured the ulcer of the glans. However, after restarting catheterization, the ulcer of the glans relapsed, and the patient’s urethral meatus was completely closed. Circumcision and incision of the meatus were performed, and antibiotics were administered. Unexpectedly, restarting catheterization caused recurrent balanoposthitis. Close inquiry revealed that the patient was using a 10% benzalkonium chloride soaking solution for a reusable catheter, which was a toxic concentration. Conclusion The disinfectant concentration should be confirmed when refractory balanoposthitis is encountered in patients who require catheterization.