Effect of a Single-Use Sterile Catheter for Each Void on the Frequency of Bacteriuria in Children With Neurogenic Bladder on Intermittent Catheterization for Bladder Emptying

Abstract

ABSTRACT. Objective. The frequency of bacteriuria is high in children with neurogenic bladder on intermittent catheterization for bladder emptying. In an effort to decrease bacteriuria, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. For this, the frequency of bacteriuria was examined in the same patient on single-use sterile catheters and on reused clean catheters.Methods. A prospective, randomized, crossover trial was conducted with 10 patients who were randomized to 4 months of a new, sterile catheter for intermittent catheterization and 4 months of reuse of a clean catheter for intermittent catheterization. Each week, a urine sample was collected and symptoms of infection and medication use were recorded.Results T he majority of children with neurogenic bladder have loss of control over voiding; urinary retention and bladder distention usually occur in the absence of intervention. Obstruction caused by urinary retention may lead to deterioration of the urinary tract. In addition, urinary retention may result in reflux into the upper urinary tract and subsequent renal damage. 1 Several strategies for complete emptying of the bladder on a regular basis have been tried. [2][3][4][5] Intermittent catheterization (IC) of the bladder several times daily is the preferred method of bladder emptying in patients with neurogenic bladder. 6 -10 A disadvantage of IC is the inoculation of bacteria into bladder urine during the course of repeated catheterization. 11 As a result, bacteriuria is frequent in urine samples collected from patients who are on IC. 12 In an effort to decrease bacteriuria and subsequent urinary tract infection (UTI) in this population, investigators compared sterile IC with clean IC. 13,14 They found no significant difference in the number of positive urine cultures in the group on IC and sterile technique compared with a second group on IC and clean technique.For the next step in an effort to decrease bacteriuria in patients who are on IC, we compared the effect of sterile, single-use catheters with reused, clean catheters in patients who are on IC. Our study was the first prospective, randomized, crossover trial of single, sterile versus reused, clean catheters in outpatients with neurogenic bladder attributable to myelomeningocele. METHODS PatientsPatients who had neurogenic bladder and were on IC 4 times per day were enrolled if they lived at home and had a normal renal ultrasound and no reflux on voiding cystourethrogram. The frequency of bacteriuria in our study group is 75%. 12 All patients continued to receive medical care from their primary physician; no therapies were withheld or altered. The urine cultures obtained for the study did not influence the patient's care, because the results were kept on file by a research technologist and were not available to either the patient's physician or the investigator. The protocol was approved by the University of Virginia Human Investigation Committee.Ten patients enrolled and completed study. Two f...

Bladder epithelium is abnormal in patients with neurogenic bladder due to myelomeningocele

“…In addition, we examined whether the method of catheter care was responsible for the high rate of bacteriuria. 4 We found that a single-use, sterile catheter for bladder-emptying did not decrease the frequency of bacteriuria when compared to reused clean catheters.…”

Urinary tract infection and bacteriuria in children performing clean intermittent catheterization with reused catheters

“…In another study in 2001, the same researchers found no difference between the incidence of sUTI whether using a single sterile catheter or using a clean catheter reused for up to five times. 13 However the sample consisted of only 10 patients. In our hospital practice of reusing catheters for 1, 2 or even 3 weeks, the risk for sUTI is potentially increased.…”

Urinary tract infections in patients with myelomeningocele

“…(8) El CIL se utiliza para disminuir la presión intravesical y la administración de agentes anticolinérgicos, para tratar las contracciones inestables del detrusor, con el fin de preservar la función renal, por lo que se recomienda el inicio precoz del tratamiento (11, 12) Para la realización del CIL los padres deben ser entrenados, dado que el mismo requiere de un correcto lavado de manos, del lavado de la región perineal con agua y jabón e insertar un catéter vesical a través de la uretra, advirtiéndoseles que una vez que la salida de orina se detuvo, el paciente debe realizar maniobra de Valsalva o el padre una compresión suave del área suprapúbica antes de remover el catéter (13).…”

“…La desventaja de dicho procedimiento es la posible inoculación de bacterias dentro de la vejiga (13) No se ha encontrado ventajas en la utilización de un catéter estéril para cada vaciamiento vesical, con respecto al CIL, procedimiento en el que se reutilizan los catéteres. Sin embargo, la utilización de catéteres estériles aumenta mucho el costo del tratamiento (13) La efectividad del CIL es menor cuando hay reflujo vesicoureteral , por lo que se agregan anticolinérgicos para disminuir la presión vesical durante el llenado.…”

“…Sin embargo, la utilización de catéteres estériles aumenta mucho el costo del tratamiento (13) La efectividad del CIL es menor cuando hay reflujo vesicoureteral , por lo que se agregan anticolinérgicos para disminuir la presión vesical durante el llenado. Las presiones bajas intravesicales permiten que entre el 30 y el 50% de los reflujos desaparezcan en los 2 a 3 años del inicio del tratamiento (10) Los anticolinérgicos utilizados son: Oxibutinina (0,2-0,6 mg/kg/día en 2 ó 3 dosis) o Tolterodina (0,25 -1 mg 2 veces por día) (14) La Vesicostomía se utiliza en los pacientes menores con vejiga de alto riesgo en los que el tratamiento habitual con CIL y anticolinérgicos fallan en lograr un adecuado drenaje del tracto urinario superior, en episodios reiterados de pielonefritis o cuando sus padres no se adaptan al cateterismo vesical (4, 14).…”