Long‐Term Urethral Catheterization Increases Risk of Chronic Pyelonephritis and Renal Inflammation

Warren, John W.; Muncie, Herbert L.; Hebel, J. Richard; Hall-Craggs, Mary

doi:10.1111/j.1532-5415.1994.tb06513.x

Cited by 63 publications

(32 citation statements)

References 29 publications

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“…While indwelling trans urethral and suprapubic catheters have been used traditionally, clean intermittent selfcatheterization (CISC) initially reported by Lapides et al 1 has revolutionized the modern management of voiding dysfunction. This revolution occurred because of the significant decrease in urological complications such as renal inflammation and pyelonephritis, 2 bladder and urethral erosions, bladder stones, and cancer, as well as urosepsis 3 compared with chronic indwelling urethral or suprapubic catheters.…”

Section: Introductionmentioning

confidence: 99%

Clean intermittent self‐catheterization: A burden for the patient?

Kessler

Ryu

Burkhard

2008

Neurourology and Urodynamics

101

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Section: Introductionmentioning

confidence: 99%

Clean intermittent self‐catheterization: A burden for the patient?

Kessler

Ryu

Burkhard

2008

Neurourology and Urodynamics

101

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“…[3][4][5] The development of encrustations can cause stent obstruction with impaired urine flow, which can compromise patient care and may lead to pyelonephritis, sepsis, and shock. 6 Various surface modifications to medical devices have been developed to prevent bacterial adhesion, such as silver-coated surfaces, controlled-release antibiotics, and surface modifications to change hydrophobicity or functional groups having antimicrobial activity. [7][8][9][10][11] Heparin coating was proposed to prevent bacterial adhesion over the last three decades, especially in vascular medicine.…”

Section: Introduction Umentioning

confidence: 99%

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Cauda

Fiori

et al. 2008

Journal of Endourology

100

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Purpose:To evaluate the ability of heparin coating to inhibit Double J stent encrustation and compare it with the classic polyurethane Double J stent.Patients and Methods: The study involved five patients with bilateral obstructions, who required bilateral ureteral Double J stent placement. Every patient received a heparin-coated Double J stent and a traditional polyurethane Double J stent for 1 month. After removal, the stents were analyzed using field emission scanning electron microscopy (FESEM), energy dispersive spectroscopy (EDS). and micro-infrared spectrophotometry (Micro-IR). These same techniques were used to analyze the heparin-coated and uncoated stents before insertion. The thickness, extension, and composition of encrustation of the coated and uncoated stents were compared. Moreover, two heparin-coated stents were analyzed with the same techniques after they had been in place for 10 and 12 months.Results: FESEM analysis showed that the difference in encrustation thickness and extension between the two groups was significant. EDS and Micro-IR confirmed that in the heparinized stents the encrustations were not as uniform and compact as those in the uncoated stents. The stents that were left in place long-term were free of encrustations and had no changes in the heparin layer.Conclusions: Heparin coating reduces stent encrustation. Moreover, as no changes were seen in the heparin layer, we concluded that covalent heparin bonding enhances its adhesion to the polyurethane surface and ensures its stability for long periods. The heparin-coated stent appears to be a useful tool for long-term urinary drainage.

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“…Third, P. mirabilis infections can be particularly serious because the combination of stones and infection may result in renal damage, including acute pyelonephritis, bacteremia, and chronic pyelonephritis (38,43). Fourth, P. mirabilis appears to have a large number of conserved surface antigens that do not differ significantly from strain to strain, regardless of whether the bacteria are from feces, urine of asymptomatic individuals, or urine of patients with catheter-associated bacteriuria or acute pyelonephritis (30).…”

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confidence: 99%

Development of an Intranasal Vaccine To Prevent Urinary Tract Infection byProteus mirabilis

Li¹,

Lockatell

Johnson

et al. 2004

Infect Immun

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Proteus mirabilis commonly infects the complicated urinary tract and is associated with urolithiasis. Stone formation is caused by bacterial urease, which hydrolyzes urea to ammonia, causing local pH to rise, and leads to the subsequent precipitation of magnesium ammonium phosphate (struvite) and calcium phosphate (apatite) crystals. To prevent these infections, we vaccinated CBA mice with formalin-killed bacteria or purified mannose-resistant, Proteus-like (MR/P) fimbriae, a surface antigen expressed by P. mirabilis during experimental urinary tract infection, via four routes of immunization: subcutaneous, intranasal, transurethral, and oral. We assessed the efficacy of vaccination using the CBA mouse model of ascending urinary tract infection. Subcutaneous or intranasal immunization with formalin-killed bacteria and intranasal or transurethral immunization with purified MR/P fimbriae significantly protected CBA mice from ascending urinary tract infection by P. mirabilis (P < 0.05). To investigate the potential of MrpH, the MR/P fimbrial tip adhesin, as a vaccine, the mature MrpH peptide (residues 23 to 275, excluding the signal peptide), and the N-terminal receptor-binding domain of MrpH (residues 23 to 157) were overexpressed as C-terminal fusions to maltosebinding protein (MBP) and purified on amylose resins. Intranasal immunization of CBA mice with MBPMrpH (residues 23 to 157) conferred effective protection against urinary tract infection by P. mirabilis (P < 0.002).The urinary tract is a complicated epithelium-lined tube with an opening to the body surface. It is susceptible to infections by exogenous organisms that can colonize the peri-urethral area, enter the bladder via the urethra, and ascend the ureters to the kidneys. In some cases the organisms can enter the bloodstream and cause sepsis. Most urinary tract infections (UTIs) occur in otherwise healthy women with normal urinary tracts, but a significant proportion of UTIs develop in those with complicated urinary tracts, including those that are catheterized or otherwise instrumented or obstructed due to structural abnormalities that prevent the normal flow of urine (42).Proteus mirabilis infects a high proportion of patients with complicated urinary tracts (29, 44). Importantly, once in the urinary tract, the bacterium appears to have a predilection for the kidney (10). Furthermore, this bacterium causes not only cystitis and acute pyelonephritis (9, 11, 13, 38, 41) but also urinary stones (14), further complicating already abnormal urinary tracts.Stone formation is caused by the expression of bacterial urease, which hydrolyzes urea to ammonia, causing local pH to rise, and leads to the subsequent precipitation of magnesium ammonium phosphate (struvite) and calcium phosphate (apatite) crystals (14,31,32). The stones resulting from aggregation of such crystals begin forming at the surface of the epithelium (25), which complicates infection for three reasons. First, the P. mirabilis organisms caught within the interstices of the forming stones are ver...

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Long‐Term Urethral Catheterization Increases Risk of Chronic Pyelonephritis and Renal Inflammation

Abstract: Chronic pyelonephritis and chronic renal inflammation are associated with long-term catheterization.

Cited by 63 publications

References 29 publications

Clean intermittent self‐catheterization: A burden for the patient?

Clean intermittent self‐catheterization: A burden for the patient?

Heparin Coating on Ureteral Double J Stents Prevents Encrustations: An in Vivo Case Study

Development of an Intranasal Vaccine To Prevent Urinary Tract Infection byProteus mirabilis

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