Recurrent Urethral Stricture Disease Managed by Clean Intermittent Self-Catheterization

Newman, L.H.; Stone, Nelson N.; Chircus, J.H.; Kramer, Howard C.

doi:10.1016/s0022-5347(17)39676-3

Cited by 21 publications

(5 citation statements)

References 10 publications

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“…The reported incidence of strictures in long‐term users of hydrophilic or PVC catheters does not differ, being 0–13% for ‘Lofric’[10,11] and 0–19% for PVC [12,13]. Intermittent catheterization is regarded as the preferred method to manage stricture disease after urethrotomy and no complications or differences in stricture recurrence rate have been reported with either red rubber [14], PVC [15] or hydrophilic‐coated catheters [16].…”

Section: Discussionmentioning

confidence: 99%

Coated catheters for intermittent catheterization: smooth or sticky?

Fader¹,

Moore

Cottenden

et al. 2001

BJU International

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Objective To evaluate the current range of hydrophiliccoated catheters for intermittent self-catheterization, focusing on the adherence of the catheter to the urethral mucosa at the end of catheterization. Subjects and methods In a prospective randomized study, 61 community-based men tested each of four different hydrophilic-coated catheters available in the UK at the time. Subjects used each of the four test catheters for 1 week in a random order, and were provided with the number and size of catheter they normally used.To assess the products, the subjects: (i) timed seven catheterizations using a stop-watch to determine the time taken from extracting the catheter from the water-®lled package, to removing the catheter from the penis, having emptied the bladder; (ii) recorded the severity of`sticking' on catheter removal on a threepoint scale (not at all, a little, a lot); and (iii) completed a product-performance questionnaire.Results There were no signi®cant differences in ratings of`sticking' between the`Easicath' and`Lofric' (P>0.05), but there were signi®cant differences between these two products and the`Aquacath' and the`Silky', which were found to`stick' more (P<0.001). The`Silky' was reported to stick signi®cantly more than the`Aquacath' (P<0.001). Conclusions Adherence to the urethral mucosa on catheter removal was a common problem, occurring with all catheters, but two products were signi®cantly more likely to stick than the other two. The clinical importance of`sticking' and the long-term implications are currently unknown. The relative`sticking' of uncoated catheters has also not been established.

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Section: Discussionmentioning

confidence: 99%

Coated catheters for intermittent catheterization: smooth or sticky?

Fader¹,

Moore

Cottenden

et al. 2001

BJU International

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“…9 The hydrophilic catheter which has so far been tested (LoFric) seems to cause less short-term strains 12 and long-term trauma 10,11 and should logically reduce the risk of chronic prostatitis and epididymitis. 9,10 Positive results of self-catheterisaton have also been seen in stricture treatment following urethrotomy 13 including the low-friction variation. 14 Conclusive support for this requires prospective and su ciently large-scale studies over many years, where the optimal properties for the atraumatic performance of the catheters involved are tested and compared.…”

Section: Introductionmentioning

confidence: 99%

The importance of osmolality in hydrophilic urethral catheters: a crossover study

1997

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The longterm use of clean intermittent self catheterisation as an option for bladder management in the care of spinal cord injury patients has shown the possible risk of urethral trauma and chronic infections being developed over time. The basic properties of the catheters being used need to be evaluated. In this crossover study of 14 male spinal cord injury patients, two commercial hydrophilic catheters were compared, as to the maximum friction force during the removal of the catheters after bladder emptying. The friction force, measured by a dynamometer twice daily, showed signi®cant lower values for LoFric (0.87/0.84 N) than for EsiCath/Conveen (1.38/1.27 N). Sticking to the urethral epithelium was reported three times (two patients) with the LoFric catheter, and 42 times (nine patients) with the EasiCath catheter. Osmolality of the outer layer of the catheters was measured using a freezing-point reduction technique. The greater than 10 times higher osmolality (*900 mOsm/kg) of the Lofric catheter may explain the results.Keywords: spinal cord injuries; urethral catheterisation; osmolality of catheters IntroductionIntermittent catheterisation (IC) and clean intermittent catheterisation (CIC) are the results of innovative ideas which have been most prevalent in the medical health and psycho-social life of spinal injury patients during the past 40 years. 1 ± 5 People's doubts surrounding new paradigms should be seen more as a result of tradition than a lack of technology for running conclusive, comparative studies. Nowadays, the technology exists but a decisive routine for starting randomised clinical trials is lacking in more or less the entire spinal injury area. Within the ®eld of neurology, detailed long-term follow-ups of the Lapides method have stated that urethral complications and chronic infections are dependent on the length of the regimen, 6 ± 9 while the hydrophilic CIC catheters could reduce these complications. 10,11 The time seems right for a comparative prospective clinical trial. 9 The hydrophilic catheter which has so far been tested (LoFric) seems to cause less short-term strains 12 and long-term trauma 10,11 and should logically reduce the risk of chronic prostatitis and epididymitis. 9,10 Positive results of self-catheterisaton have also been seen in stricture treatment following urethrotomy 13 including the low-friction variation. 14 Conclusive support for this requires prospective and su ciently large-scale studies over many years, where the optimal properties for the atraumatic performance of the catheters involved are tested and compared.This preparatory clinical study in a crossover design compares the friction during catheter removal between two commercial hydrophilic catheters as part of the spinal injury patient's usual bladder regimen during the post-injury phase.

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“…Second, we recorded important changes in patients' IPSS over the course of the follow‐up. Historic studies on ISD mainly focused on objective urodynamic parameters such as Q max , PVR, or rate of stricture recurrence to assess its clinical effectiveness 9,10 . However, an improvement in these parameters may not necessarily reflect a perceived improvement in micturition by the patient.…”

Section: Discussionmentioning

confidence: 99%

Patient reported outcomes of intermittent self‐dilatation after direct vision internal urethrotomy

Scheipner,

Jankovic,

Jasarevic

et al. 2024

Neurourology and Urodynamics

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PurposeLong‐term results on quality of life (QoL) as well as clinical outcomes of intermittent self‐dilatation (ISD) of the urethra after direct visual internal urethrotomy (DVIU) are scarce. The aim of this study was to prospectively evaluate patient reported outcomes (PROs) on voiding symptoms and QoL in a large cohort of urethral stricture patients performing ISD.MethodsWe identified a total of 121 patients who performed ISD following DVIU between 2008 and 2013. Baseline assessment was conducted for each patient before ISD was started. Follow‐up visits were scheduled in 6‐month intervals. Each assessment included the following questionnaires: International prostate symptom score (IPSS), IPSS quality of life index (IPSS‐QoL), patient global impression of severity (PGI‐S), and patient global impression of improvement (PGI‐I). Additional parameters were maximum urinary flow rate (Qmax), postvoid residual urine, rate of complications, and stricture recurrence. Linear mixed models were used to examine the change over the course of the follow‐up visits to the baseline.ResultsThe median age of the patients was 58 years (interquartile range [IQR]: 43−70). The median follow‐up was 17 months (IQR: 7−30). Mean change from baseline IPSS was −6.1, −5.9, −4.2, and −4.8 points at 6, 24, 36, and 48 months. Mean change from baseline IPSS‐QoL was −1.3, −1.4, −1.6, and −1.8 points, respectively. Mean PGI‐I was 1.7 points at 6, 1.9 points at 24, 1.9 points at 36, and 2.2 points at 48 months after ISD initiation. Mean change of Qmax ranged from 1.7 at 6 to 2.2 mL/s at 48 months. The median complication rate was 3.3% per 6‐month ISD interval. Overall, 11 patients developed stricture recurrence (9%).ConclusionISD after DVIU had no negative impact on patients' QoL (IPSS‐QoL, PGI‐I, PGI‐S). Urodynamic parameters remained stable for up to 48 months with low complications and an acceptable stricture recurrence rate.

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Recurrent Urethral Stricture Disease Managed by Clean Intermittent Self-Catheterization

Cited by 21 publications

References 10 publications

Coated catheters for intermittent catheterization: smooth or sticky?

Coated catheters for intermittent catheterization: smooth or sticky?

The importance of osmolality in hydrophilic urethral catheters: a crossover study

Patient reported outcomes of intermittent self‐dilatation after direct vision internal urethrotomy

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