Electrochemically activated solution as bladder irrigation—An individual curative trial in patients with neurogenic lower urinary tract dysfunction and recurrent urinary infections

Abstract

Aims Driven by increasing awareness of antibiotic stewardship, especially in the vulnerable group of patients with neurogenic lower urinary tract dysfunction (NLUTD), whose frequent need for invasive interventions leads to a high incidence of recurrent urinary tract infections (rUTIs), the goal was to find an alternative to antibiotic treatment. Our intention was for the treatment to be locally administered and well‐tolerated as well as to avoid the risk of antimicrobial resistance. Methods A retrospective analysis of 12 catheterized NLUTD patients was performed within the setting of an individual curative trial. The decision to implement the investigational intervention was made on an individual basis with the aim of eliminating lower urinary tract bacteria before diagnostic procedures or to treat rUTI. Electrochemically activated solution (ECAS) was used as bladder irrigation (BI). The following assessments were undertaken: microbiological analysis of urine, analysis of leukocytes/erythrocytes (per µl urine); microbial resistance and sensitivity to antibiotics before and after therapy; clinical signs and patients' state of health. Results Eradication of bacteria or an increase in microbial sensitivity to antibiotics was observed in 50%–70% of patients. No adverse events were seen. Due to the restrictions of an individual curative trial, the results are limited by the small number of patients and the absence of a control group. Conclusion In NLUTD patients with rUTIs, the use of ECAS BI to eliminate bacteriuria before invasive procedures (e.g., urodynamics, preoperative procedures) or to treat rUTI was shown to be a promising alternative to antibiotic treatment.

The rationale for bladder washouts in children with neurogenic bladder

“…Additionally, these patients were only followed for 6 days post treatment. 28 Nonetheless, the results are promising.…”

“…Importantly, HOCl is effective against biofilms, while antibiotic therapy generally fails to affect biofilms. ECASs are more effective than chlorhexidine on biofilms 28 …”

“…27 More adult trials have shown that non-antibiotic bladder irrigation may have promising effects for treating UTIs. 28 These trials used electrochemically activated solutions (ECAS).…”

“…Altogether, ECAS has been shown to improve sensitivity to antibiotics, eradicate all bladder bacteria in 25% of cases and eradicate the primary pathogen in 50% of cases. 28 T A B L E 1 Comparative bladder irrigation studies. Bladder irrigation with regular saline washouts is currently a mainstay of treatment in children with NB performing CIC.…”

“…Elliot et al Increased exfoliation of uroepithelial cells "The numbers of bacteria were largely unaffected by the irrigations, although in some cases there was a temporary reduction." Richter et al Incidence of post operative bacteriuria was reduced from 100% in control group to 22.5% in the treated group Ramezani et al Improvement in colony forming units and primary outcomes -risk of infection declined by 99%Weyler et al28…”