Search Results (7)

Neurogenic bladder is a debilitating condition caused by neurological dysfunction that impairs urinary control, often requiring timed intermittent catheterisation. Although effective, intermittent catheterisation is invasive, uncomfortable, and associated with infection risks, reducing patients’ quality of life. SafeBladder is a low-cost wearable device developed to enable real-time, non-invasive bladder volume monitoring using near-infrared spectroscopy (NIRS) and machine learning algorithms. The prototype employs LEDs and photodetectors to measure light attenuation through abdominal tissues. Bladder filling was simulated through experimental tests using stepwise water additions to containers and tissue-mimicking phantoms, including silicone and porcine tissue. Machine learning models, including Linear Regression, Support Vector Regression, and Random Forest, were trained to predict volume from sensor data. The results showed the device is sensitive to volume changes, though ambient light interference affected accuracy, suggesting optimal use under clothing or in low-light conditions. The Random Forest model outperformed others, with a Mean Absolute Error (MAE) of 25 ± 4 mL and $R^2$ of 0.90 in phantom tests. These findings support SafeBladder as a promising, non-invasive solution for bladder monitoring, with clinical potential pending further calibration and validation in real-world settings. Full article

Background/Objectives: Lichen sclerosus is a chronic lymphocyte-mediated inflammatory disorder with a predilection for the anogenital region. It is a common cause of urethral stricture disease in males. The gold standard treatment is considered to be surgical reconstruction; however, there are many patients who are not suitable or not willing to undergo surgery. Cutaneous lichen sclerosus restricted to the foreskin, prepuce or glans is often response to topical corticosteroids; however, the use of intraurethral corticosteroids for urethral involvement has limited research. Methods: We conducted a retrospective cohort study on 18 patients with histologically confirmed lichen sclerosus and associated urethral stricture disease. They were treated with clean intermittent self catheterisation using a hydrophilic catheter coated with 0.05% betamethasone ointment. International Prostate Symptom Score with Quality of Life scores were measured prior to treatment and at follow-up intervals. Results: There was significant improvement in International Prostate Symptom Score and Quality of Life scores at 3 months, 12 months and 24 months, with only 1 patient ceasing treatment due to intolerance. One patient required a single repeat endoscopic dilatation following a period of non-compliance with treatment. Conclusions: Intraurethral corticosteroids with clean-intermittent self-catheterisation is effective and well tolerated for treating lichen sclerosus-associated urethral stricture disease in the short to intermediate term for patients not willing to undergo urethroplasty. Full article

Introduction: Proper bladder drainage is crucial. Children with bladder dysfunction may require alternative methods like clean intermittent catheterisation (CIC). However, CIC can be challenging for individuals with impairments. The Mitrofanoff procedure provides a solution by connecting the appendix to the bladder and creating a stoma on the skin, allowing for continent catheterisation. Minimally invasive techniques, including robotics, have been adopted recently. The aim of this study is to review the existing literature on robotic Mitrofanoff procedures. Materials and Methods: A systematic review on paediatric robotic Mitrofanoff procedures on the PubMed, Cochrane, and Scopus databases was conducted according to the PRISMA Statement. Critical appraisals of the included studies were performed with the Newcastle Ottawa Scale. Results: Six studies were included about the robotic Mitrofanoff procedure. Sex was reported in 50% of the studies. Ages were within the twelve-year age limit, as per the inclusion criteria. The mean operative time was 499.3 (±171.1) min. Four of the six studies reported a length of stay with a median of 6 days (±4; range 1.8–23). The incidence of complications was in line with established benchmarks. Only one study compared the Mitrofanoff procedure to open surgery, finding similar outcomes but longer operating times. Port placement and surgical strategy was described. Conclusions: Robotics can offer potential advantages for the Mitrofanoff procedure, despite its application still being in its early stages. This study emphasises the potential safety and efficacy of the robotic approach and promotes the need for further prospective high-quality studies. Full article

Urinary tract infections (UTIs) are common and troublesome complications of clean intermittent catheterisation (CIC) in individuals suffering from incomplete bladder emptying, which may exacerbate the underlying disease and lead to hospitalisation. Aside from the design of the intermittent catheter and its handling, a recent review highlighted residual urine as one of several UTI risk factors. A new urinary intermittent catheter with multiple micro-holes has been developed for improved bladder emptying. In a controlled crossover study, adult male CIC users were randomised for a health care professional-led catheterisation with the new micro-hole zone catheter (MHZC) and a conventional eyelet catheter (CEC) in two individual test visits to compare the number of flow-stops and the residual urine at the first flow-stop as co-primary endpoints. In 42 male CIC users, the MHZC resulted in significantly fewer flow-stop episodes compared to the CEC (mean 0.17, 95% CI [0.06, 0.45] vs. mean 1.09, 95% CI [0.75, 1.6], respectively; p < 0.001) and significantly less residual urine at the first flow-stop (mean 5.10 mL, SE [1.14] vs. mean 39.40 mL, SE [9.65], respectively; p < 0.001). No adverse events were observed in this study. The results confirm the enhanced performance of the MHZC compared to a CEC, ensuring an uninterrupted free urine flow with no need to reposition the catheter until the bladder is thoroughly empty. Full article

Introduction: Patients with neurogenic lower urinary tract dysfunction (NLUTD) reliant on intermittent self-catheterization for bladder emptying are at an increased risk of recurrent urinary tract infections (rUTI). So far, the most common practice in the prevention of rUTIs is long-term low-dose antibiotic prophylaxis, phytotherapy, and immunomodulation, whereby antibiotic prophylaxis inevitably leads to the emergence of drug-resistant pathogens and difficulty in treating infections. Therefore, non-antibiotic alternatives in the prevention of rUTIs are urgently required. We aim to identify the comparative clinical effectiveness of a non-antibiotic prophylaxis regimen in the prevention of recurrent urinary tract infections in patients with neurogenic bladder dysfunction who practice intermittent self-catheterization. Methods and analysis: In this multi-centre, prospective longitudinal multi-arm observational study, a total of 785 patients practising intermittent self-catheterisation due to NLUTD will be included. After inclusion, non-antibiotic prophylaxis regimens will be instilled with either UroVaxom^® (OM-89) standard regimen, StroVac^® (bacterial lysate vaccine) standard regimen, Angocin^®, D-mannose (oral dose 2 g), bladder irrigation with saline (once per day). The management protocols will be pre-defined, but the selection of the protocol will be at the clinicians’ discretion. Patients will be followed for 12 months from the onset of the prophylaxis protocol. The primary outcome is to identify the incidence of breakthrough infections. The secondary outcomes are adverse events associated with the prophylaxis regimens and the severity of breakthrough infections. Other outcomes include the exploration of change in susceptibility pattern via the optional rectal and perineal swab, as well as health-related quality of life over time (HRQoL), which will be measured in a random subgroup of 30 patients. Ethics and dissemination: Ethical approval for this study has been granted by the ethical review board of the University Medical Centre Rostock (A 2021-0238 from 28 October 2021). The results will be published in a peer-reviewed journal and presented at relevant meetings. Study registration number: German Clinical Trials Register: Number DRKS00029142. Full article

Objective: To determine patient difficulties and concerns when performing IBC (Intermittent Bladder Catheterisation), as well as the evolution of adherence, quality of life, and emotional state of patients one year after starting IBC. Method: A prospective, observational, multicentre study conducted in 20 Spanish hospitals with a one-year follow-up. Data sources were patient records and the King’s Health Questionnaire on quality of life, the Mini-Mental State Examination (MMSE), and the Hospital Anxiety and Depression Scale (HADS). Perceived adherence was measured using the ICAS (Intermittent Catheterization Adherence Scale) and perceived difficulties with IBC were assessed using the ICDQ (Intermittent Catheterization Difficulty Questionnaire). For data analysis, descriptive and bivariate statistics were performed for paired data at three points in time (T1: one month, T2: three months, T3: one year). Results: A total of 134 subjects initially participated in the study (T0), becoming 104 subjects at T1, 91 at T2, and 88 at T3, with a mean age of 39 years (standard deviation = 22.16 years). Actual IBC adherence ranged from 84.8% at T1 to 84.1% at T3. After one year of follow-up, a statistically significant improvement in quality of life (p ≤ 0.05) was observed in all dimensions with the exception of personal relationships. However, there were no changes in the levels of anxiety (p = 0.190) or depression (p = 0.682) at T3 compared to T0. Conclusions: Patients requiring IBC exhibit good treatment adherence, with a significant proportion of them performing self-catheterisation. After one year of IBC, a significant improvement in quality of life was noted, albeit with a significant impact on their daily lives and their personal and social relationships. Patient support programmes could be implemented to improve their ability to cope with difficulties and thus enhance both their quality of life and the maintenance of their adherence. Full article

Intermittent vesical self-catheterisation is a legitimate and safe technique that has been reported since the 1970s as a solution for the treatment and prevention of vesical urinary complications resulting from spinal cord injury. This practice, using clean technology, has been asserting itself as one of the best alternatives for people with neurogenic bladder. However, adherence is not complete due to some barriers imposed to this procedure by the injured, with emphasis on positioning, agility, and visual impairment. The solutions presented today to support self-catheterisation are expensive equipment that does not allow patients with advanced levels of spasticity to have their autonomy. A biomechanical support device was developed to aid self-catheterisation, mainly aimed at women with spasticity, filling the gap in the existing products. Despite the main objective of self-catheterisation, the system’s design made it possible to quantify the strength of the adductors for the sitting position during the execution of the adduction movement, particularly relevant for spastic patients. The device’s production was entirely carried out using the FDM methodology, with 3D printers, and its design and operation were thought to overcome the physical and psychological barriers imposed by the users. The system was first tested with a group of healthy volunteers to obtain a pattern of the adductors force in a sitting position and after with a group of spastic volunteers. The obtained data allows to compare the adductor force data and optimize the system, with particular functionalities for spastic patients, with the implementation of a motorised version and a visualization camera. The system, its developments, and results obtained are present and discussed. Full article