Adult Neurogenic Lower Urinary Tract Dysfunction and Intermittent Catheterisation in a Community Setting: Risk Factors Model for Urinary Tract Infections

Abstract

A risk factor model for urinary tract infections in patients with adult neurogenic lower urinary tract dysfunction performing clean intermittent catheterisation was developed; it consists of four domains, namely, (1) general (systemic) conditions in the patient, (2) individual urinary tract conditions in the patient, (3) routine aspects related to the patient, and (4) factors related to intermittent catheters per se. The conceptual model primarily concerns patients with spinal cord injury, spina bifida, multiple sclerosis, or cauda equina where intermittent catheterisation is a normal part of the bladder management. On basis of several literature searches and author consensus in case of lacking evidence, the model intends to provide an overview of the risk factors involved in urinary tract infections, with specific emphasis to describe those that in daily practice can be handled and modified by the clinician and so come to the benefit of the individual catheter user in terms of fewer urinary tract infections.

A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury

“…CIC is often considered the preferred method as it may have the lowest risk of symptomatic UTIs and long-term complications. 1,3,[10][11][12] Successful CIC requires appropriate hand dexterity. 10,11 Furthermore, the cost of catheters can be a barrier that may lead many individuals to re-use catheters.…”

“…10 In those performing intermittent catheterization, there is some evidence that hydrophilic-coated (a polymer coating that reduces friction and inflammation) catheters may reduce UTIs compared to noncoated catheters. 1,2,12…”

Chronic prostatitis effectively managed by transurethral prostatectomy (TURP) in a spinal cord injury male

“…Out of 110 patients, 78 (70%) were referred as cured, 16 (15%) as improved and 16 (15%) with no change. Only one patient's symptoms were quantified under the International Prostate Symptom Score (IPSS), in which improvement suggested, with a score from 27 downgraded to 3 postoperatively [2].…”

“…In addition, the potential complications of neurogenic urinary disorders (reflux, stone formation, incomplete emptying of the bladder), and the methods of urine drainage (intermittent or indwelling catheters, urinary diversion), contribute even more to UTIs. In persons with SCIs, all UTIs are considered as complicated ones and there is different microbiology as compared to the general population [1][2][3].…”

Clinical Pharmacists in Chronic Care

“…The role of dietary patternin RUTI is also not clear. Increasing fluid consumption is often recommended for patients with UTI [301], [307][308][309][310][311][312][313][314] but there has been no clear clinical evidence to support this recommendation [315]. After a first episode of a UTI, 27% of women have a confirmed recurrence within the next 6 months [292].…”