Neurological patients need evidence‐based urological care

Wyndaele, Jean‐Jacques; Bruschini, Homero; Madersbacher, H.; Moore, Katherine; Pontari, Michel A.; Wein, Alan J.

doi:10.1002/nau.20866

Cited by 15 publications

(12 citation statements)

References 63 publications

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“…Incidence fi gures for UTI vary widely in the literature, owing to different defi nition criteria, various methods used for evaluation, different CIC techniques used, different frequencies of urine analysis, the administration of prophylaxis, the group of patients studied and probably other factors as well. A review of the literature shows that most studies do not provide a high level of evidence [ 3,4 ] .…”

Section: Introductionmentioning

confidence: 99%

Clean intermittent catheterization and urinary tract infection: review and guide for future research

et al. 2012

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What ' s known on the subject? and What does the study add? Clean intermittent catheterization (CIC) is considered the method of choice for bladder emptying when neurological or non-neurological causes make normal voiding impossible or incomplete. The outcome is overall good, also in the long-term. There is neither one best technique nor one best material, as both depend greatly on patients ' individual anatomic, social and economic possibilities. The most frequent complication is urinary tract infection (UTI). Studies differ in the defi nition criteria for UTI, methods for evaluation, CIC techniques, frequency of urine analysis, prophylaxis and patients studied.The study provides a literature review and shows that most studies do not have a high level of evidence. There are various risk factors for UTI and phenotyping them helps to assess prognosis by considering what can happen if treatment is not initiated. The study concludes, that the role of biofi lms in CIC deserves more attention and that diagnosis should be made on urine sample obtained with catheterization, because symptoms are often less reliable. It also concludes that treatment in those who catheterize for a long time is only necessary for symptomatic infections. The study identifi es the following areas for further research: prevention of UTI in patients performing CIC; the use of special catheter types; and the role of frequency of catheterization, prophylactic antibiotics and preservation of natural defence mechanisms in the lower urinary tract. OBJECTIVE• To review the factors related to urinary tract infection (UTI), the most prevalent complication in patients who perform clean intermittent catheterization (CIC). METHODS• We conducted a literature search then a group discussion to gather relevant information on aspects of UTI to guide future research and to help provide clearer recommendations for the prevention of UTI in patients performing CIC. RESULTS• UTI is a major complication of CIC, the incidence of which varies widely in the literature owing to differences in methodology and defi nitions.• Phenotyping the risk factors for UTI helps to assess prognosis by considering what can happen if treatment is not initiated. The role of biofi lms in CIC deserves more attention.• Diagnosis is made using the urine sample obtained by catheterization. Because of neurological or other defi ciencies in patients performing CIC, symptoms are less reliable. Thorough evaluation for the source of signs and symptoms should be made before attributing them to UTI.• There have been many different proposals for the prevention of UTI in patients performing CIC, but most need more research. The role of the type of catheter is unclear but further exploration of special catheter types might be worthwhile.• Treatment in those who perform CIC for a long time is best reserved for symptomatic infections. CONCLUSIONS• Several mechanisms are relevant in UTI related to CIC.• As UTI is prevalent, more research into its prevention is needed.

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Section: Introductionmentioning

confidence: 99%

Clean intermittent catheterization and urinary tract infection: review and guide for future research

et al. 2012

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“…The pressure value at which urine is lost is considered to be an important risk factor for upper urinary tract deterioration in patients with NLUTD. Incontinence pressures greater than 40 cm H 2 O are considered to significantly increase this risk 20. In our study, we assimilated this incontinence pressure with the maximum detrusor pressure during the IDCs in the filling phase (P detmaxIDC ).…”

Section: Discussionmentioning

confidence: 99%

Never say never, but tread lightly through vena cava filters

Gilchrist

2009

Cathet Cardio Intervent

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“…Infobox 1; [18]). Das liegt sicher weniger an der fehlenden Evidenz der Unterschiede zwischen verschiedenen therapeutischen Optionen als am Fehlen evidenzbasierter Daten [45]. Die vorliegenden Studien sind häufig zu klein, schlecht vergleichbar und methodisch schwach.…”

Section: Dauerkatheterismusunclassified

Die Bedeutung des Katheterismus in der Neurourologie

Böthig

Burgdörfer

2012

Urologe

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Together with comprehension and therapy of neurogenic failure of the storage function of the urinary bladder, intermittent catheterization as a pressure-free voiding method without residual urine, represents a major principle of therapy in lower urinary tract dysfunction. Aseptic intermittent catheterization is recommended in Germany and Europe and seems to be acceptable even in long-term application with low complication rates. It is a precondition that patients are seen for clinical and urodynamic reevaluation at risk-adapted time intervals. The major focus is on early recognition and avoidance of threatening complications. The most important preventive measures are the motivation and compliance of the well-educated patient and the use of careful catheterization techniques with individually optimized catheters.Although aseptic intermittent catheterization has been used effectively for many years there is still a lack of randomized controlled studies for some important questions of details and an optimal catheter has still to be defined. Furthermore, valid conclusions based on well-conducted studies on the self-estimated quality of life of patients with intermittent catheterization, especially those with catheterization by attendant, are urgently needed. Intermittent catheterization is never a ready-made solution but always an individually tailored treatment for patients with lower urinary tract dysfunction.

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Neurological patients need evidence‐based urological care

Abstract: In each of these subjects, research items are suggested which can help to improve the care in this patient group.

Cited by 15 publications

References 63 publications

Clean intermittent catheterization and urinary tract infection: review and guide for future research

Clean intermittent catheterization and urinary tract infection: review and guide for future research

Never say never, but tread lightly through vena cava filters

Die Bedeutung des Katheterismus in der Neurourologie

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