Clean Intermittent Catheterization: Which Patients Benefit From It?
CUA Online Library. Radomski S. 06/24/13; 31282; MP-04.10
Disclosure(s): Radomski- Consultant/Advisory Board for Astellas, Pfizer, Allergan, Lilly and Watson.
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Abstract
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Clean Intermittent Catheterization: Which Patients Benefit From It?
Andrew A. Di Pierdomenico and Sidney B. Radomski MD
Toronto Western Hospital (UHN), Department of Surgery (Division of Urology), University of Toronto
Introduction:
Clean intermittent catheterization (CIC) has been the gold standard for poor bladder emptying due to neurogenic and non-neurogenic causes. CIC theoretically reduces incontinence, urinary tract infections (UTI’s) and lower urinary tract symptoms (LUTS) in the face of poor emptying. However, not all patients utilizing CIC realize symptomatic benefit. Our aim was to determine which patients with poor emptying are most likely able to manage their bladders using CIC with the absence of incontinence, UTI’s and LUTS.
Methods and Materials:
We retrospectively evaluated the medical records of 321 patients between 1995-2011 with neurogenic (n=144) and non-neurogenic (n=177) bladder dysfunction who were started on CIC after urodynamic testing. The median age of the neurogenic group was 48yrs (18-85, STDEV 17.7) and for the non-neurogenic group it was 68yrs (24-90, STDEV 16.6). Success was considered to be no UTI's, and resolution of LUTS and incontinence on CIC. Patients who did not meet these criteria or who stopped CIC for whatever reason were considered failures and the reason recorded. The mean duration of followup was 3.0 – 5.5yrs (95% CI).
Results:
The overall success rate on CIC was 51%. In general men < 65 yrs of age do better on CIC (63% success). The highest success rate was in men and women with retention only (68% and 69% respectively), and men with poor emptying and UTIs (75% success). Patients on CIC that did poorly were women ≥ 65 regardless of the reason for CIC (37% success), all women with incontinence (37% success) and women with non-neurogenic bladder dysfunction and UTI's (43% success). Non-neurogenic male patients and all woman with LUTS did poorly with CIC (29% and 18% success), however, the numbers in these groups were small. In order, the most common reasons for failure on CIC were recurrent UTI's, persistent incontinence and LUTS.
Conclusions:
CIC works best in men and women who are treated solely for urinary retention in the absence of other symptoms. Furthermore, men < 65 are more successful with CIC regardless of the indication. In general, women ≥ 65 who perform CIC for reasons of poor emptying with recurrent UTI's, incontinence and LUTS do poorly. Our data may identify those patients who are likely to do well on CIC and should be offered this treatment.
Andrew A. Di Pierdomenico and Sidney B. Radomski MD
Toronto Western Hospital (UHN), Department of Surgery (Division of Urology), University of Toronto
Introduction:
Clean intermittent catheterization (CIC) has been the gold standard for poor bladder emptying due to neurogenic and non-neurogenic causes. CIC theoretically reduces incontinence, urinary tract infections (UTI’s) and lower urinary tract symptoms (LUTS) in the face of poor emptying. However, not all patients utilizing CIC realize symptomatic benefit. Our aim was to determine which patients with poor emptying are most likely able to manage their bladders using CIC with the absence of incontinence, UTI’s and LUTS.
Methods and Materials:
We retrospectively evaluated the medical records of 321 patients between 1995-2011 with neurogenic (n=144) and non-neurogenic (n=177) bladder dysfunction who were started on CIC after urodynamic testing. The median age of the neurogenic group was 48yrs (18-85, STDEV 17.7) and for the non-neurogenic group it was 68yrs (24-90, STDEV 16.6). Success was considered to be no UTI's, and resolution of LUTS and incontinence on CIC. Patients who did not meet these criteria or who stopped CIC for whatever reason were considered failures and the reason recorded. The mean duration of followup was 3.0 – 5.5yrs (95% CI).
Results:
The overall success rate on CIC was 51%. In general men < 65 yrs of age do better on CIC (63% success). The highest success rate was in men and women with retention only (68% and 69% respectively), and men with poor emptying and UTIs (75% success). Patients on CIC that did poorly were women ≥ 65 regardless of the reason for CIC (37% success), all women with incontinence (37% success) and women with non-neurogenic bladder dysfunction and UTI's (43% success). Non-neurogenic male patients and all woman with LUTS did poorly with CIC (29% and 18% success), however, the numbers in these groups were small. In order, the most common reasons for failure on CIC were recurrent UTI's, persistent incontinence and LUTS.
Conclusions:
CIC works best in men and women who are treated solely for urinary retention in the absence of other symptoms. Furthermore, men < 65 are more successful with CIC regardless of the indication. In general, women ≥ 65 who perform CIC for reasons of poor emptying with recurrent UTI's, incontinence and LUTS do poorly. Our data may identify those patients who are likely to do well on CIC and should be offered this treatment.
Clean Intermittent Catheterization: Which Patients Benefit From It?
Andrew A. Di Pierdomenico and Sidney B. Radomski MD
Toronto Western Hospital (UHN), Department of Surgery (Division of Urology), University of Toronto
Introduction:
Clean intermittent catheterization (CIC) has been the gold standard for poor bladder emptying due to neurogenic and non-neurogenic causes. CIC theoretically reduces incontinence, urinary tract infections (UTI’s) and lower urinary tract symptoms (LUTS) in the face of poor emptying. However, not all patients utilizing CIC realize symptomatic benefit. Our aim was to determine which patients with poor emptying are most likely able to manage their bladders using CIC with the absence of incontinence, UTI’s and LUTS.
Methods and Materials:
We retrospectively evaluated the medical records of 321 patients between 1995-2011 with neurogenic (n=144) and non-neurogenic (n=177) bladder dysfunction who were started on CIC after urodynamic testing. The median age of the neurogenic group was 48yrs (18-85, STDEV 17.7) and for the non-neurogenic group it was 68yrs (24-90, STDEV 16.6). Success was considered to be no UTI's, and resolution of LUTS and incontinence on CIC. Patients who did not meet these criteria or who stopped CIC for whatever reason were considered failures and the reason recorded. The mean duration of followup was 3.0 – 5.5yrs (95% CI).
Results:
The overall success rate on CIC was 51%. In general men < 65 yrs of age do better on CIC (63% success). The highest success rate was in men and women with retention only (68% and 69% respectively), and men with poor emptying and UTIs (75% success). Patients on CIC that did poorly were women ≥ 65 regardless of the reason for CIC (37% success), all women with incontinence (37% success) and women with non-neurogenic bladder dysfunction and UTI's (43% success). Non-neurogenic male patients and all woman with LUTS did poorly with CIC (29% and 18% success), however, the numbers in these groups were small. In order, the most common reasons for failure on CIC were recurrent UTI's, persistent incontinence and LUTS.
Conclusions:
CIC works best in men and women who are treated solely for urinary retention in the absence of other symptoms. Furthermore, men < 65 are more successful with CIC regardless of the indication. In general, women ≥ 65 who perform CIC for reasons of poor emptying with recurrent UTI's, incontinence and LUTS do poorly. Our data may identify those patients who are likely to do well on CIC and should be offered this treatment.
Andrew A. Di Pierdomenico and Sidney B. Radomski MD
Toronto Western Hospital (UHN), Department of Surgery (Division of Urology), University of Toronto
Introduction:
Clean intermittent catheterization (CIC) has been the gold standard for poor bladder emptying due to neurogenic and non-neurogenic causes. CIC theoretically reduces incontinence, urinary tract infections (UTI’s) and lower urinary tract symptoms (LUTS) in the face of poor emptying. However, not all patients utilizing CIC realize symptomatic benefit. Our aim was to determine which patients with poor emptying are most likely able to manage their bladders using CIC with the absence of incontinence, UTI’s and LUTS.
Methods and Materials:
We retrospectively evaluated the medical records of 321 patients between 1995-2011 with neurogenic (n=144) and non-neurogenic (n=177) bladder dysfunction who were started on CIC after urodynamic testing. The median age of the neurogenic group was 48yrs (18-85, STDEV 17.7) and for the non-neurogenic group it was 68yrs (24-90, STDEV 16.6). Success was considered to be no UTI's, and resolution of LUTS and incontinence on CIC. Patients who did not meet these criteria or who stopped CIC for whatever reason were considered failures and the reason recorded. The mean duration of followup was 3.0 – 5.5yrs (95% CI).
Results:
The overall success rate on CIC was 51%. In general men < 65 yrs of age do better on CIC (63% success). The highest success rate was in men and women with retention only (68% and 69% respectively), and men with poor emptying and UTIs (75% success). Patients on CIC that did poorly were women ≥ 65 regardless of the reason for CIC (37% success), all women with incontinence (37% success) and women with non-neurogenic bladder dysfunction and UTI's (43% success). Non-neurogenic male patients and all woman with LUTS did poorly with CIC (29% and 18% success), however, the numbers in these groups were small. In order, the most common reasons for failure on CIC were recurrent UTI's, persistent incontinence and LUTS.
Conclusions:
CIC works best in men and women who are treated solely for urinary retention in the absence of other symptoms. Furthermore, men < 65 are more successful with CIC regardless of the indication. In general, women ≥ 65 who perform CIC for reasons of poor emptying with recurrent UTI's, incontinence and LUTS do poorly. Our data may identify those patients who are likely to do well on CIC and should be offered this treatment.
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