Can Bladder Irrigation Reduce the Morbidity of Bladder Stone in Patients with Spinal Cord Injury?

Abstract

Objective: To assess the safety and efficacy of bladder irrigation for reducing the morbidity of bladder stones in patients with neurological lower urinary tract dysfunction (NLUTD). Methods: From June 2012 to July 2013, patients with NLUTD were prospectively randomized and assigned to either a bladder irrigation group or a no bladder irrigation group. Bladder irrigations were performed twice a week by urologists. Patients were followed up at 6 months respectively. Primary outcomes were Incontinence-Specific Quality-of-Life Instrument (I-QoL), the rate incidences of bladder stone. All adverse events were also noted. Results: A total of 80 eligible patients participated and 78 (97.5%) patients (bladder irrigation, n = 39; no bladder irrigation, n = 39) completed 24 weeks of follow-up. Out of the 78 patients, 19 (24.3%) developed bladder stones. All occurred in no bladder irrigation group. In 8 of the 19 patients (42.1%), stones were only detected by cystoscopy. The bladder stones were mostly thin with an eggshell appearance (78.95% for diameter of stone < 5 mm, 84.21% for volume of bladder stone < 0.2 cm3). Bladder stones were removed by vigorous bladder irrigation guided by ultrasound (73.68%) or endoscopic lithotripsy (26.32%). The I-QOL was significantly better in the bladder irrigation group than in no bladder irrigation group at weeks 6, 12, 18, and 24 of follow-up. Conclusion: Bladder irrigation may be more effective and safer than no bladder irrigation for reducing the morbidity of bladder stone in spinal cord injury patients.

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Chen, H. , Xie, K. , Jiang, C. , Yang, X. , Zeng, J. , Huang, M. , Liu, Q. , Huang, J. , Huang, T. , Li, Y. , Liu, J. and Xie, S. (2015) Can Bladder Irrigation Reduce the Morbidity of Bladder Stone in Patients with Spinal Cord Injury?. Open Journal of Urology, 5, 42-47. doi: 10.4236/oju.2015.54007.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] De Vivo, M.J., Fine, P.R., Cutter, G.R., et al. (1985) The Risk of Bladder Calculi in Patients with Spinal Cord Injuries. Archives of Internal Medicine, 145, 428-430.
http://dx.doi.org/10.1001/archinte.145.3.428
[2] Favazza, T., Midha, M., Martin, J., et al. (2004) Factors Influencing Bladder Stone Formation in Patients with Spinal Cord Injury. Journal of Spinal Cord Medicine, 27, 252-254.
[3] Ord, J., Lunn, D. and Reynard, J. (2003) Bladder Management and Risk of Bladder Stone Formation in Spinal Cord Injured Patients. Journal of Urology, 170, 1734-1737.
http://dx.doi.org/10.1097/01.ju.0000091780.59573.fa
[4] Waites, K.B., Canupp, K.C., Roper, J.F., et al. (2006) Evaluation of 3 Methods of Bladder Irrigation to Treat Bacteriuria in Persons with Neurogenic Bladder. Journal of Spinal Cord Medicine, 29, 217-226.
[5] Sinclair, L., Hagen, S., Cross, S., et al. (2011) Washout Policies in Long-Term Indwelling Urinary Catheterization in Adults: A Short Version Cochrane Review. Neurourology and Urodynamics, 30, 1208-1212. http://dx.doi.org/10.1002/nau.21063
[6] McNicoll, D. (2003) Encrusted Urinary Catheters: How Should Nurses Manage Them? Journal of Community Nursing, 17, 10-14.
[7] Moore, K.N., Hunter, K.F., McGinnis, R., et al. (2009) Do Catheter Washouts Extend Patency Time in Long Term Indwelling Urethral Catheters? A Randomized Controlled Trial of Acidic Washout Solution, Normal Saline Washout, or Standard Care. Journal of Wound Ostomy & Continence Nursing, 36, 82-90. http://dx.doi.org/10.1097/01.WON.0000345181.37656.de
[8] Waites, K.B., Canupp, K.C., Roper, J.F., et al. (2006) Evaluation of 3 Methods of Bladder Irrigation to Treat Bacteriuria in Persons with Neurogenic Bladder. Journal of Spinal Cord Medicine, 29, 217-226.
[9] Kennedy, A.P., Brocklehurst, J.C., Robinson, J.M., et al. (1992) Assessment of the Use of Bladder Washouts/Instilla- tions in Patients with Long-Term Indwelling Catheters. British Journal of Urology, 70, 610-615. http://dx.doi.org/10.1111/j.1464-410X.1992.tb15829.x
[10] Muncie Jr., H.L., Hoopes, J.M., Damron, D.J., et al. (1989) Once-Daily Irrigation of Long-Term Urethral Catheters with Normal Saline. Lack of Benefit. Archives of Internal Medicine, 149, 441-443.
http://dx.doi.org/10.1001/archinte.1989.00390020133028
[11] Hansen, R.B., Biering-Sørensen, F. and Kristensen, J.K. (2004) Bladder Emptying over a Period of 10-45 Years after a Traumatic Spinal Cord Injury. Spinal Cord, 42, 631-637.
http://dx.doi.org/10.1038/sj.sc.3101637
[12] Stöhrer, M., Blok, B., Castro-Diaz, D., Chartier-Kastler, E., Del Popolo, G., Kramer, G., et al. (2009) EAU Guidelines on Neurogenic Lower Urinary Tract Dysfunction. European Urology, 56, 81-88.
http://dx.doi.org/10.1016/j.eururo.2009.04.028
[13] Wagner, T.H., Patrick, D.L., Bavendam, T.G., Martin, M.L. and Buesching, D.E. (1996) Quality of Life of Persons with Urinary Incontinence: Development of a New Measure. Urology, 47, 67-71.
http://dx.doi.org/10.1016/S0090-4295(99)80384-7
[14] McGeer, A., Campbell, B., Emori, T.G., et al. (1991) Definitions of Infection for Surveillance in Long-Term Care Facilities. American Journal of Infection Control, 19, 1-7.
http://dx.doi.org/10.1016/0196-6553(91)90154-5
[15] Afsar, S.I., Yemisci, O.U., Cosar, S.N.S. and Cetin, N. (2013) Compliance with Clean Intermittent Catheterization in Spinal Cord Injury Patients: A Long-Term Follow-Up Study. Spinal Cord, 51, 645-649. http://dx.doi.org/10.1038/sc.2013.46
[16] Herr, H.W. (1975) Intermittent Catheterization in Neurogenic Bladder Dysfunction. Journal of Urology, 113, 477-479.
[17] Bartel, P., Krebs, J., Wöllner, J., Göcking, K. and Pannek, J. (2014) Bladder Stones in Patients with Spinal Cord Injury: A Long-Term Study. Spinal Cord, 52, 295-297.
http://dx.doi.org/10.1038/sc.2014.1
[18] Vaidyanathan, S., Hughes, P.L. and Soni, B.M. (2006) A Comparative Study of Ultrasound Examination of Urinary Tract Performed on Spinal Cord Injury Patients with No Urinary Symptoms and Spinal Cord Injury Patients with Symptoms Related to Urinary Tract: Do Findings of Ultrasound Examination Lead to Changes in Clinical Management? Scientific World Journal, 6, 2450-2459. http://dx.doi.org/10.1100/tsw.2006.382
[19] Linsenmeyer, T.A. and Culkin, D. (1999) APS Recommendations for the Urological Evaluation of Patients with Spinal Cord Injury. Journal of Spinal Cord Medicine, 22, 139-142.
[20] Binard, J.E., Persky, L., Lockhart, J.L. and Kelley, B. (1996) Intermittent Catheterization the Right Way! (Volume vs. Time-Directed). Journal of Spinal Cord Medicine, 19, 194-196.
[21] Linsenmeyer, M.A. and Linsenmeyer, T.A. (2004) Accuracy of Bladder Stone Detection Using Abdominal X-Ray after Spinal Cord Injury. Journal of Spinal Cord Medicine, 27, 438-442.
[22] Mobley, H.L. and Warren, J.W. (1987) Urease-Positive Bacteriuria and Obstruction of Long-Term Urinary Catheters. Journal of Clinical Microbiology, 25, 2216-2217.

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