BACKGROUND: Bladder dysfunction, notably urinary retention, emerges as a significant complication for cervical cancer patients following radical hysterectomy, predominantly due to nerve damage, severely impacting their postoperative quality of life. The challenges to recovery include insufficient pelvic floor muscle training and the negative effects of prolonged postoperative indwelling urinary catheters. Intermittent catheterization represents the gold standard for neurogenic bladder management, facilitating bladder training, which is an important behavioral therapy aiming to enhance bladder function through the training of the external urethral sphincter and promoting the recovery of the micturition reflex. Nevertheless, gaps remain in current research regarding optimal timing for intermittent catheterization and the evaluation of subjective symptoms of bladder dysfunction.
METHODS: Cervical cancer patients undergoing laparoscopic radical hysterectomy will be recruited to this randomized controlled trial. Participants will be randomly assigned to either early postoperative catheter removal combined with intermittent catheterization group or a control group receiving standard care with indwelling urinary catheters. All these patients will be followed for 3 months after surgery. The study\'s primary endpoint is the comparison of bladder function recovery rates (defined as achieving a Bladder Function Recovery Grade of II or higher) 2 weeks post-surgery. Secondary endpoints include the incidence of urinary tract infections, and changes in urodynamic parameters, and Mesure Du Handicap Urinaire scores within 1 month postoperatively. All analysis will adhere to the intention-to-treat principle.
CONCLUSIONS: The findings from this trial are expected to refine clinical management strategies for enhancing postoperative recovery among cervical cancer patients undergoing radical hysterectomy. By providing robust evidence, this study aims to support patients and their families in informed decision-making regarding postoperative bladder management, potentially reducing the incidence of urinary complications and improving overall quality of life post-surgery.
BACKGROUND: ChiCTR2200064041, registered on 24th September, 2022.

UNASSIGNED: Bladder dysfunction is a common complication following radical hysterectomy, affecting patients\' QOL. Exploring interventions, particularly IC continuity care, is crucial for identifying strategies to enhance postoperative outcomes. This study aimed to assess the impact of continuous intermittent catheterization (IC) care on bladder function recovery and quality of life (QOL) in patients undergoing radical hysterectomy for cervical cancer.
UNASSIGNED: The primary outcome measured was the time to bladder function recovery, with secondary outcomes comprising EORTC QLQ-C30 assessments at 3 and 6 months post-surgery, as well as EORTC QLQ-CX24 evaluations. Meanwhile, urinary complications, readmissions, and outpatient follow-up were also compared.
UNASSIGNED: Among the 128 participants, with 64 in each group, indwelling catheterization durations were similar. However, the IC continuity care group exhibited significantly shorter IC duration and bladder recovery time. This group demonstrated superior QOL, lower occurrence rates post-IC, reduced urethral injuries, and higher readmission and outpatient follow-up rates.
UNASSIGNED: This study underscores continuous IC care emerges as a beneficial intervention, facilitating accelerated bladder function recovery and improved QOL in patients following radical hysterectomy for cervical cancer.

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To identify the clinical and urodynamic risk factors associated with the development of recurrent febrile urinary tract infections (FUTIs) in children with neurogenic bladder (NB) who perform clean intermittent catheterization (CIC).
Children with NB receiving CIC were prospectively enrolled from January to December 2019 and followed up prospectively for 2 years. All data were compared between occasional (0-1 FUTI) and recurrent FUTIs (≥2 FUTI) groups. In addition, the risk factors for recurrent FUTIs in children were evaluated.
Complete data from 321 children were analyzed. Occasional FUTIs occurred in 223 patients, and 98 patients experienced recurrent FUTIs. Univariate and multivariate analyses, showed late-initiation and low-frequency CIC, vesicoureteral reflux (VUR), small bladder capacity and low compliance, and detrusor overactivity were associated with an increased risk of recurrent FUTIs. Children with high-grade VUR (grades IV-V) had a higher risk of recurrent FUTIs than those with low-grade VUR (grades I-III) (odds ratio [OR]: 26.95 vs. OR: 4.78, p < 0.001).
Our study suggests that late-initiation and low-frequency CIC, VUR, small bladder capacity and low compliance, and detrusor overactivity were associated with recurrent FUTIs in patients with NB. In addition, high-grade VUR is a crucial risk factor for recurrent FUTIs.

Clean intermittent catheterization (CIC) is a mainstay in the management of neurogenic bladder.
To assess the effect of CIC on urinary tract infection and upper renal tract function in pediatric patients with neurogenic bladder, and the influence of duration of CIC on these variables.
A retrospective study was performed in 67 pediatric patients with neurogenic bladder who started CIC between 2014 and 2019 at our institution. The febrile urinary tract infection (fUTI) rate, renal pelvis diameter (measured by antero-posterior renal pelvis diameter, APPD), bladder wall thickness (BWT) on ultrasound, and creatinine level at 6 months and 12 months of CIC were compared with baseline in all patients. The grade of vesicoureteral reflux (VUR) at 12 months of CIC were also compared with baseline.
There were no significant differences compared with baseline after 6 months of CIC in the rate of fUTI, APPD, and BWT (p > 0.05); however, all of these parameters significantly improved after 12 months of CIC (p < 0.05). The VUR grade was significantly reduced after 12 months of CIC(p = 0.03). There was no significant change in serum creatinine level with any duration of CIC (both p > 0.05).
Continuing CIC for more than 6 months had a beneficial influence on protecting the upper urinary tract. Complications of CIC, such as recurrent fUTI and lower urinary tract trauma, are more likely to occur in the early stage of CIC due to poor technique by the caregivers and poor patient compliance underscoring the importance of caregiver education. Study limitations include the retrospective nature and small sample size.
CIC for less than 6 months may have limited influence on renal protection; however, a longer duration of CIC (12 months) resulted in significant improvement in outcomes. This study demonstrates the importance of proper caregiver education to establish standardized CIC techniques and to improve CIC quality.

BACKGROUND: Hydrophilic coated catheters are recommended to reduce the side effects of intermittent catheterization (IC) in patients with bladder dysfunction. However, there is lack of Level one evidence to support the use of this intervention.
METHODS: Several electronic databases were systematically searched to evaluate complication incidences for hydrophilic coated (HC) and non-hydrophilic catheters (NHC).
RESULTS: Twelve studies were eligible for inclusion in the review. The meta-analyses exploring microscopic hematuria frequencies (RR = 0.69; 95% CI 0.52-0.90) and urethral stricture frequencies (RR = 0.28; 95% CI 0.13-0.60) showed a lower risk ratio associated with HC in comparison to NHC, whereas gross hematuria was no statistically significant difference in two groups. Subgroup analyses of gross hematuria which was grouped according to \"catheterization frequency\", \"single/multiple catheterization\" and \"self/other catheterization\" were performed and the values of combined RR were also no statistically significant difference.
CONCLUSIONS: Compared with non-hydrophilic catheters, the hydrophilic coated catheters have positive significance in reducing the incidence of urethral microtrauma and the urethral stricture. However, more studies are warranted for evaluating effects of hydrophilic coated catheters on the incidence of gross hematuria.

To investigate the risk factors for recurrent urinary tract infection (UTI) in children with a neurogenic bladder (NB) managed by clean intermittent catheterization.
Over a 5-year period, we retrospectively assessed the risk factors for recurrent UTIs in children (age 9-151 months) who had clean intermittent catheterization. All patients were followed up for more than 12 months and had at least two clinic visits during the study period. Demographic, clinical, and urodynamic parameters were assessed. All data were compared between the recurrent UTI (>1.0 UTI/study-year) and episodic UTI (≤1.0 UTI/study-year) groups.
Of 327 patients, 79 (24.2%) had recurrent UTIs and 248 (75.8%) had episodic UTIs. Univariate and multivariate analyses showed that older age, lumbar level lesions, long duration of NB, presence of vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance were the significant factors for recurrent UTIs. Bladder trabeculation was associated with recurrent UTIs on univariate analysis, but not on multivariate analysis. During the follow-up period, chronic renal insufficiency was diagnosed in 31 (39.2%) and 29 patients (11.7%) in the recurrent and episodic UTI groups (P <.05), respectively.
These results suggest that older age, high level of spinal cord lesions, long duration of NB, vesicoureteral reflux, increased bladder wall thickness, and low bladder compliance may be directly associated with recurrent UTIs in children with NB. Children with NB might have higher susceptibility to chronic renal insufficiency after recurrent UTIs.

To identify patient-reported outcome measures (PROMs) for intermittent self-catheterization (ISC) users, critically assess and summarize the quality of the measurement properties, and describe the application scenarios on each instrument.
PubMed, EMBASE, Medline, PsycINFO, and relevant reference lists were systematically searched through December 2019 (updated May 2020).
Two reviewers independently identified original English language publications that evaluated the psychometric properties of specific PROMs used in ISC patients.
The following data were obtained: author and publication year, content of domains and subscales, number of items, response options, constructs measured, language, and information on measurement properties.
Eleven publications were deemed eligible, including 6 PROMs for measuring patients\' ISC-related quality of life, self-confidence, satisfaction, difficulties, acceptance, and adherence to treatment. The Intermittent Self-Catheterization Questionnaire provided the most detail, and the Intermittent Catheterization Acceptance Test could be evaluated on the most consensus-based standards for the selection of health status measurement instrument properties.
Several tools are available for ISC users, but at present there is no comprehensive, concise, and robust instrument with good psychometric properties. Further research on psychometric properties is needed to verify the remaining properties of existing scales and to develop novel tools for clinicians, researchers, and patients.

We performed a systematic review of randomized controlled trials to assess the incidence of urinary tract infection (UTI) and complications of different urinary drainage methods (indwelling urinary catheterization, suprapubic catheterization, and intermittent catheterization.).
PubMed, EMBASE, and Cochrane Library were systematically searched from their inception to March 2018. We selected randomized controlled trials (RCTs) comparing at least two of the three possible urinary drainage routes after gynecologic surgery. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to rate the quality of evidence.
Fifteen RCTs met eligibility criteria (N = 1607), the meta-analysis indicated that suprapubic drainage was associated with a reduction in the rate of asymptomatic bacteriuria compared with indwelling urinary catheterization [risk ratios (RR) = 0.39, 95% confidence interval (CI): 0.24-0.65, P = 0.0003) but was associated with a higher rate of hematuria (RR = 4.49, 95% CI: 1.16-17.41, P = 0.03). Indwelling urinary catheterization increased the rate of recatheterization compared with suprapubic drainage (RR = 2.95, 95% CI: 1.22-7.11, P = 0.02) and was associated with higher rate of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09-7.14, P = 0.03). No difference was found in other aspects (complication rate and catheter-related pain) among the three drainage routes.
This meta-analysis suggested that suprapubic drainage was superior to indwelling urethral catheterization in reduction of asymptomatic bacteriuria and rate of recatheterization but was associated with higher rate of hematuria. Intermittent catheterization was associated with a reduction in symptomatic UTI compared with indwelling urinary catheterization. More high-quality randomized trials are needed to determine which route is most appropriate for catheterization in patients after gynecologic surgery.

BACKGROUND: Neurogenic bladder (NB) is a common pediatric urological disease caused by a variety of neurological pathologies. Clean intermittent catheterization (CIC) has been the preferred method to empty bladder.
OBJECTIVE: To investigate the effect of CIC on preserving bladder and upper urinary tract function in infants less than 1 year old with NB.
METHODS: A retrospective analysis was conducted on 76 infants with NB. Patients were divided into two groups according to treatment initiation: the early CIC group (ECG) (<1 year old) and the late CIC group (LCG) (>3 years old).
RESULTS: Bladder compliance (BC), safe bladder capacity (SBC) and maximum cystometric capacity (MCC) were significantly higher in the ECG than those in the LCG at 6 years of follow-up respectively (P <  0.05). The frequencies of vesicoureteral reflux (VUR) and urinary tract infection (UTI) in the ECG were significantly lower than those in the LCG (P <  0.05) at 6 years of follow-up. Two and nine patients exhibited mild renal damage in the ECG and LCG, respectively, resulting in a significant difference (P <  0.05) at 6 years of follow-up.
CONCLUSIONS: Early CIC plays an important role in preserving bladder function and preventing UTI and renal deterioration in infants with NB, especially in the first year of life.