Fate of Patients Started on Clean Intermittent Self-Catheterization Therapy 10 Years Ago

Diokno, Ananias C.; Sonda, L. Paul; Hollander, Jay B.; Lapides, Jack

doi:10.1016/s0022-5347(17)52599-9

Cited by 99 publications

(37 citation statements)

References 12 publications

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“…This technique has been successful in a large number of adults and children on follow-up of more than 20 years. 7,8 Indeed, it is reported that clean ISC is more suitable than indwelling catheterization in patients who require long-term bladder drainage as a means of minimizing the histological changes that occur in the bladder mucosa that may predispose and lead to malignant transformation. 9,10 There are 7 reported cases in the published literature of SCC of the bladder due to a variety of reasons in patients using clean ISC (Table 1).…”

Section: Introductionmentioning

confidence: 99%

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

Casey

Cullen

Crotty

et al. 2013

CUAJ

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There are only 7 cases reported in the literature of squamous cell cancer of the bladder in patients performing intermittent selfcatheterization (ISC). We report on an eighth case, and the first case described in a patient with a Mitrofanoff continent appendicovesicostomy. A description of the case and review of the literature are presented. Risk factors for squamous cell cancer include recurrent urinary tract infections, keratinising squamous metaplasia (leukoplakia) and local mucosal trauma from intermittent selfcatheterization. There is no recognized or validated monitoring program for patients performing ISC who may also have these risk factors. Reasonable protocols may include regular urinary cytology and cystoscopy with random or targeted bladder biopsies. Squamous cell cancer may present late in this cohort of patients and is associated with a dismal prognosis. Can Urol Assoc J 2009;3(5):E51-E54 IntroductionSquamous cell cancer (SCC) of the bladder usually occurs secondary to bilharzia in the Middle East, Southeast Asia and South America, where schistosomiasis is endemic and accounts for 59% to 75% of cases. However, in western regions, SCC of the bladder usually constitutes only 1.2% to 4.5% of all bladder cancers, and these cases are usually secondary to prolonged indwelling catheters, especially in spinal cord-injured patients. This association with SCC has been documented for the last 30 years, 1 and a 10% incidence of bladder SCC in patients with an indwelling catheter for ≥10 years has been recognized. 2 SCC of the bladder may also occur secondary to other chronic irritants, such as bacterial infections, foreign bodies (catheters, bladder calculi) and chronic bladder outlet obstruction. More rarely, there are reports of SCC of the bladder following intravesical Bacillus Calmette-Guéri (BCG), 3 systemic cyclophosphamide therapy, 4 and suprapubic catheters. 5 Lapides and colleagues introduced the concept of clean intermittent self-catheterization (ISC) in 1972 as a means of avoiding long-term catheterization or surgery. 6 It was associated with low intravesical pressures, urinary bacterial wall translocation and thus infection, in a variety of neurogenic and non-neurogenic bladder disorders. This technique has been successful in a large number of adults and children on follow-up of more than 20 years. 7,8 Indeed, it is reported that clean ISC is more suitable than indwelling catheterization in patients who require long-term bladder drainage as a means of minimizing the histological changes that occur in the bladder mucosa that may predispose and lead to malignant transformation. 9,10 There are 7 reported cases in the published literature of SCC of the bladder due to a variety of reasons in patients using clean ISC (Table 1). [11][12][13][14] There may be a synergistic association of leukoplakia, persistent bacteriuria, direct catheter trauma and keratinizing squamous metaplasia with progression to SCC in these cases. Squamous metaplasia, which initially may be adaptive and protective, may also...

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Section: Introductionmentioning

confidence: 99%

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

Casey

Cullen

Crotty

et al. 2013

CUAJ

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“…7,8 Prevalences of complications vary in literature 9,10 but remain very acceptable also in the long term. The study presented here was performed to evaluate the use of the prelubricated catheter Urocath gel 1 in male patients who had used conventional catheters for a long time.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the use of Urocath-Gel® catheters for intermittent self-catheterization by male patients using conventional catheters for a long time

Wyndaele

Ridder²,

Everaert

et al. 2000

Spinal Cord

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Study design: Prospective study of intermittent self-catheterization (CIC) with change from conventional catheter to low-friction Urocath-Gel 1 catheter. Objectives: To evaluate if such catheters are well accepted and to evaluate their practical use. Methods: Thirty-nine male patients, between 19 and 74 years old, performing clean intermittent self-catheterization with conventional catheters for a neuropathic bladder for many years were included in this study after written informed consent. Exclusion criteria were clinical urinary tract infection, acute infection of urethra, prostate or epididymis, untreated urethral strictures and false passages or severe urethral bleeding occurring within the last month. During 1 month they changed to the use of the Urocath-Gel 1 catheter. Complications were noted. Satisfaction was evaluated by a visual analogue scale and by questioning. Results: Four patients did not complete the study, two for side e ects, two for di culties with the catheterization technique. Time needed for CIC was not di erent with both techniques. Di cult introduction or di cult retreat of the catheter were not di erent in frequency. Impossibility to introduce the catheter was less frequent. Urethritis and urethral bleeding were less frequent than during the use of conventional catheters. Satisfaction was better with the low friction catheters. Negative satisfaction was mainly related to the availability and the use of water to lubricate the catheter, di culty of manipulation and fear for cost. Conclusion: The hydrophilic catheter Urocath-Gel 1 proved as easy to use as conventional catheters but was better tolerated. Satisfaction was better especially in patients who experienced problems with conventional catheters. Some patients were unsatis®ed for reasons of practical use or for economical reasons. Spinal Cord (2000) 38, 97 ± 99

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“…Table 2 shows that there were no differences in the mean age, the mean duration of postonset, the mean duration of CIC use and the mean time of each catheter usage between those with and without febrile UTI. For long-term management, besides proper daily frequency and technique of CIC/CISC, patients' compliance such as ability to properly perform CISC, mental capability and selfdiscipline, 11 it may be safer that one uses the silicone catheter for a shorter period of time; however, no exact time recommendation can be given so far.…”

Section: Discussionmentioning

confidence: 99%

Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men?

2004

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Study Design: Study of reusable catheter. Objective: To investigate whether a silicone cathether reused over years for clean intermittent catheterization (CIC) was safe for spinal cord injured (SCI) men. Setting: Maharaj Hospital, Chiang Mai, Thailand. Method: A cross-sectional study was obtained from SCI men who had used CIC with a reusable silicone catheter for more than a year. Demographic data, urological management and urinary tract complications focusing on the radiologic status of the urethra were reviewed and analyzed. In addition, two reused and one new catheters were studied under electron microscope for catheter morphology (surface and lumen) and stiffness. Results: There were 28 SCI men included in this study. The average duration of CIC use was 4.8 years and the average time of usage for each catheter was 3 years (range 1-7 years). In all, 26 men previously used indwelling catheterization (ID) during the acute phase. In all, 23 men performed self-catheterization. Regarding urinary complications, three reported urethral bleeding, five had episodes of pus per urethra, five had epididymitis, four had passing stones, 18 had occasional foul smelly urine, 10 developed fever and cloudy urine during the past year. Of 17 patients who had ultrasonography done, four had pathologic findings in kidney and one had bladder calculi. Demographic data, urinary management and complications did not have significant relation to the abnormality of the urethrogram or urinary tract infection. However, where the frequency of CIC was higher, the abnormality of the urethra was lower (Po0.05). All had serum Cr level p1.3 mg/dl. Electron microscopic findings of reused catheters for 2 years revealed encrustation but no obstruction in the lumens and 20% increase in stiffness. Conclusion: The clinical outcome, especially with regard to urethral abnormalities with this reusable silicone catheter is as good as with a disposable one. However, to reuse urinary catheters, one should consider the increasing risk of infection. For SCI patients in developing countries, CIC with a reusable silicone catheter may be a suitable and safe choice if one cleans and applies it properly to reduce infection. In order to answer the question how long a person in a developing country should use the same silicone catheter, further research should be conducted.

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Fate of Patients Started on Clean Intermittent Self-Catheterization Therapy 10 Years Ago

Cited by 99 publications

References 12 publications

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

Intermittent self-catheterization and the risk of squamous cell cancer of the bladder: An emerging clinical entity?

Evaluation of the use of Urocath-Gel® catheters for intermittent self-catheterization by male patients using conventional catheters for a long time

Reused silicone catheter for clean intermittent catheterization (CIC): is it safe for spinal cord-injured (SCI) men?

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