RESUMEN
INTRODUCTION: Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. OBJECTIVE: To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. METHODOLOGY: A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. RESULTS: Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60). CONCLUSION: We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.
Asunto(s)
Cateterismo Uretral Intermitente , Infecciones Urinarias , Niño , Adulto , Humanos , Cateterismo Uretral Intermitente/efectos adversos , Cateterismo Urinario/métodos , Hematuria/etiología , Catéteres/efectos adversos , Infecciones Urinarias/epidemiología , Catéteres Urinarios/efectos adversosRESUMEN
STUDY DESIGN: Cross-sectional study. OBJECTIVES: To identify the prevalence of complications associated with intermittent catheterization in wheelchair athletes with spinal cord injury (SCI). SETTING: International and national sporting events. METHODS: A total 130 competitive wheelchair athletes living with SCI completed a self-reported questionnaire during international or national sporting events. The questionnaire collected information regarding demographics, injury characteristics, method of bladder emptying, and complications related to intermittent catheterization. RESULTS: Overall, 84% (109/130) of wheelchair athletes used intermittent catheterization. Within this group, 77% of athletes (84/109) experienced at least one complication associated with intermittent catheterization. Twenty-seven percent (29/109) sustained urethral injuries and 63% (69/109) had at least one episode of urinary tract infection during the last 12 months. Almost one-fourth of male athletes (22/95, 23%) had a history of inflammation / infection of genital organs associated with intermittent catheterization. CONCLUSIONS: Here we report a high prevalence of self-reported complications associated with intermittent catheterization in wheelchair athletes with SCI. Considering their potential impact on lower urinary tract function, athletic performance, and health, further studies are needed to assess the role of preventative strategies to reduce complications related to intermittent catheterization in wheelchair athletes with SCI. SPONSORSHIP: Coloplast Brazil and Instituto Lado a Lado pela Vida (a nongovernmental, nonprofit organization based in São Paulo) and Wellspect provided funding for this study.
Asunto(s)
Rendimiento Atlético , Cateterismo Uretral Intermitente , Paratletas , Traumatismos de la Médula Espinal , Vejiga Urinaria Neurogénica , Brasil/epidemiología , Estudios Transversales , Humanos , Cateterismo Uretral Intermitente/efectos adversos , Masculino , Prevalencia , Autoinforme , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/epidemiología , Vejiga Urinaria Neurogénica/epidemiología , Vejiga Urinaria Neurogénica/etiologíaRESUMEN
PURPOSE: The purpose of this study was to describe and compare factors that affect urinary tract infection (UTI) rates in people with spina bifida (SB) and neurogenic bladder dysfunction before and following initiation of intermittent catheterization (IC). DESIGN: A quantitative, descriptive, correlational study. SUBJECTS AND SETTING: The study included people who were from Germany, a high-income nation, and Brazil, a middle-income nation. Brazilian participants were recruited from a public rehabilitation hospital in the state of Minas Gerais. German participants were drawn from different regions of the country. The study sample included 200 participants; participants were either individuals diagnosed with SB and neurogenic bladder dysfunction and using IC, or caregivers of persons using IC for bladder management. METHODS: Data were collected through a survey questionnaire developed for urological follow-up of SB patients. A translated and validated version of the form was used to collect data in Germany. To evaluate annual episodes of UTI, we considered the number of symptomatic UTI before and after IC. RESULTS: Participants from Brazil were significantly younger than German patients (median age 9 vs 20 years, P < .001). Brazilians predominately used assisted catheterization (63.0%), whereas most Germans performed self-catheterization (61.0%). Use of IC greatly reduced the incidence of UTI in both groups (mean 2.8 episodes per year before IC vs mean 1.1 episodes after starting IC, P < .001). Women had a higher number of UTI, both before and after IC, but enjoyed greater reduction in UTI after initiating IC than men. Self-catheterization also promoted a greater reduction of UTI than assisted IC (P = .022). CONCLUSIONS: Intermittent catheterization reduced annual episodes of UTI in both samples despite differences in catheterization technique. Patients practicing and performing self-catheterization achieved a greater reduction than those who relied on assisted IC. Comparative studies among additional countries with varying median income levels are needed to better understand the needs of individuals with SB and their families, and to plan and implement safe nursing interventions.
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Infecciones Relacionadas con Catéteres/complicaciones , Cateterismo Uretral Intermitente/efectos adversos , Infecciones Urinarias/etiología , Adolescente , Adulto , Análisis de Varianza , Brasil/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Niño , Preescolar , Femenino , Alemania/epidemiología , Humanos , Lactante , Cateterismo Uretral Intermitente/métodos , Masculino , Meningomielocele/complicaciones , Meningomielocele/terapia , Persona de Mediana Edad , Disrafia Espinal/complicaciones , Disrafia Espinal/terapia , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Vejiga Urinaria Neurogénica/complicaciones , Vejiga Urinaria Neurogénica/terapia , Infecciones Urinarias/epidemiologíaRESUMEN
OBJECTIVE: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. METHOD: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. RESULTS: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. CONCLUSION: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.
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Cateterismo Uretral Intermitente/psicología , Pacientes/psicología , Calidad de Vida/psicología , Determinantes Sociales de la Salud , Catéteres Urinarios/normas , Adolescente , Adulto , Brasil , Femenino , Humanos , Cateterismo Uretral Intermitente/efectos adversos , Cateterismo Uretral Intermitente/métodos , Entrevistas como Asunto/métodos , Masculino , Persona de Mediana Edad , Autocuidado/métodosRESUMEN
ABSTRACT Objective: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. Method: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Results: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. Conclusion: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.
RESUMEN Objetivo: Identificar la influencia de factores de los determinantes sociales de salud en las condiciones de vida de pacientes usuarios de cateterismo urinario intermitente. Método: Investigación descriptiva realizada en centro de Rehabilitación. Participaron 243 pacientes con vejiga neurogénica, usuarios de cateterismo urinario intermitente limpio. Estudio realizado entre marzo de 2012 y octubre de 2015, aplicando entrevista apoyada por instrumento semiestructurado, y análisis por estadística descriptiva. Resultados: La mayoría de los pacientes era de sexo masculino, edad entre 16 y 64 años, solteros, con enseñanza primaria e ingresos familiares entre 2 y 3 salarios mínimos. Los determinantes sociales de salud encontrados estuvieron relacionados a aspectos socioeconómicos, demográficos y condiciones de salud. Conclusión: Los hallazgos señalan una compleja relación entre los determinantes sociales de salud y las condiciones de vida de estos pacientes usuarios de cateterismo urinario intermitente limpio, presentando vulnerabilidad en relación a algunos aspectos de las condiciones de salud.
RESUMO Objetivo: Identificar a influência de fatores dos determinantes sociais de saúde nas condições de vida de pacientes usuários de cateterismo urinário intermitente. Método: Pesquisa descritiva realizada em um Centro de Reabilitação com 243 pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo. O período do estudo foi de março/2012 a outubro/2015, utilizando-se entrevista com apoio de um instrumento semiestruturado e análise por estatística descritiva. Resultados: A maioria dos pacientes era do gênero masculino, idade entre 16 e 64 anos, solteiros, com ensino fundamental e renda familiar mensal de 2 a 3 salários mínimos. Os determinantes sociais de saúde encontrados foram relacionados aos aspectos socioeconômicos, demográficos e condições de saúde. Conclusão: Os achados assinalam para uma complexa relação entre os determinantes sociais de saúde e as condições de vida desses pacientes usuários de cateterismo urinário intermitente limpo, apresentando uma vulnerabilidade com relação a alguns aspectos das condições de saúde.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Pacientes/psicología , Calidad de Vida/psicología , Cateterismo Uretral Intermitente/psicología , Catéteres Urinarios/normas , Determinantes Sociales de la Salud , Autocuidado/métodos , Brasil , Entrevistas como Asunto/métodos , Cateterismo Uretral Intermitente/efectos adversos , Cateterismo Uretral Intermitente/métodos , Persona de Mediana EdadRESUMEN
OBJECTIVE: To report the incidence of urethral stricture and its management in patients with spinal cord injury treated with clean intermittent self-catheterization (CIC). MATERIALS AND METHODS: The clinical records of 333 patients with spinal cord injury treated with CIC since 2001 were identified, and those who developed a urethral stricture during their follow-up, including their treatment and results achieved, were analyzed. RESULTS: The patients had a median age at the time of injury of 27 years, of which only 14 patients (4.2%) developed urethral stricture at a mean duration of self-catheterization of 9 years; 86% of them were treated with urethrotomy, without recurrence through a mean of 1-year follow-up. There are no previous reports of rates of urethral stricture in this type of patients in our institution; the rate found is considerably low, as is the recurrence after urethrotomy, which can be decreased by the continuous self-obturation achieved with catheterization. CONCLUSION: Urethral stricture as a complication of CIC in patients with spinal cord injury has a low incidence and can be effectively treated in those who develop it.
Asunto(s)
Cateterismo Uretral Intermitente/efectos adversos , Autocuidado/efectos adversos , Traumatismos de la Médula Espinal/complicaciones , Estrechez Uretral/epidemiología , Vejiga Urinaria Neurogénica/terapia , Adulto , Vértebras Cervicales , Femenino , Humanos , Incidencia , Vértebras Lumbares , Masculino , México/epidemiología , Recurrencia , Estudios Retrospectivos , Traumatismos de la Médula Espinal/terapia , Vértebras Torácicas , Estrechez Uretral/etiología , Vejiga Urinaria Neurogénica/complicacionesRESUMEN
AIM: To evaluate serum PSA levels of patients with spinal cord injury (SCI) submitted or not to CIC in comparison to those of the general population. METHODS: We retrospectively studied 140 men with SCI admitted in our department from January 2005 to May 2009. Thirty-four SCI patients had PSA levels available, comprising 21 under CIC and 13 without CIC. Patients under CIC performed it 4-6 times a day and mean time of catheterization was 72.4 months (range 30-192). The most common etiology of SCI was fall from height (33%), followed by car/motorcycle crashes (15%). Control group was composed by 670 healthy men that were referred to our service to evaluation of Kidney donation or cancer prostate screening. We used Student's t-test and variance analysis (ANOVA) for age and PSA comparison between the groups. RESULTS: Overall, patients with SCI and controls had similar mean age (54 vs. 57 years old, P = 0.11) and mean PSA level (1.81 vs. 1.95 ng/ml, P = 0.66). SCI patients were divided into with and without CIC. Patients without CIC had similar mean age (60 vs. 57 years old, P = 0.11) and similar PSA values when compared to controls (1.72 vs. 1.95 ng/ml, P = 0.89). Patients under CIC were compared to controls with similar age (50 vs. 47 years, P = 0.0332) and their PSA levels were greater (1.86 vs. 0.79 ng/ml, P = 0.026). CONCLUSION: Clean intermittent catheterization increased PSA levels approximately doubling its value.