Pub Date : 2023-05-25DOI: 10.3389/fruro.2023.1173506
Connie N. Wang, Albert S. Ha, D. Chung
Background There is a lack of understanding of the clinical significance of detrusor contraction duration (DCD) measured on urodynamic studies (UDS). We aimed to identify patient characteristics, presenting symptoms and urodynamic parameters associated with DCD in women. Methods Using a single-institution database of UDS (2015-2019), 405 female patients with measurable detrusor contractions were identified. Baseline characteristics, presenting symptoms and UDS parameters were analyzed. Bladder outlet obstruction (BOO) was characterized using the Blaivas-Groutz nomogram. Wilcox Rank Sum Tests were used for descriptive statistics, and a univariable generalized linear model conforming to a gamma distribution was used. Results Median age was 65 years (IQR 52-75), BMI was 27.5 kg/m2 (IQR 23.9-31.1) and DCD was 90 seconds (IQR 57-124). On univariable analysis, degenerative disc disease (β = -17.9, p = 0.02), pelvic radiation (β = -31.91, p = 0.04), and stress incontinence (β = -14.11, p = 0.03) were associated with reduced DCD. Black race was associated with longer DCD (β = 22.92, p = 0.01). Analysis of UDS parameters revealed a significant increase in DCD per unit increase of bladder capacity (β = 0.08, p<0.001), detrusor pressure (Pdet) at maximum flow (Qmax) (β = 0.96, p<0.001), and maximum Pdet (β = 1.2, p<0.001). In contrast, a significant decrease in DCD was noted per unit increase in Qmax (β = -1.43, p<0.001). Finally, mild (β = 34.4, p<0.001), moderate (β = 72.52, p<0.001), and severe (β = 64.6, p<0.001) BOO were all associated with increased DCD. Conclusions Median DCD in women is 90 seconds. Longer DCD is associated with greater degree of BOO, higher maximum Pdet, Pdet at Qmax, and bladder capacity. Disc disease, irradiation and stress incontinence are associated with reduced DCD. Further studies are needed to evaluate the predictive value of DCD in women.
{"title":"Patient characteristics, symptoms, and urodynamic parameters associated with detrusor contraction duration in women","authors":"Connie N. Wang, Albert S. Ha, D. Chung","doi":"10.3389/fruro.2023.1173506","DOIUrl":"https://doi.org/10.3389/fruro.2023.1173506","url":null,"abstract":"Background There is a lack of understanding of the clinical significance of detrusor contraction duration (DCD) measured on urodynamic studies (UDS). We aimed to identify patient characteristics, presenting symptoms and urodynamic parameters associated with DCD in women. Methods Using a single-institution database of UDS (2015-2019), 405 female patients with measurable detrusor contractions were identified. Baseline characteristics, presenting symptoms and UDS parameters were analyzed. Bladder outlet obstruction (BOO) was characterized using the Blaivas-Groutz nomogram. Wilcox Rank Sum Tests were used for descriptive statistics, and a univariable generalized linear model conforming to a gamma distribution was used. Results Median age was 65 years (IQR 52-75), BMI was 27.5 kg/m2 (IQR 23.9-31.1) and DCD was 90 seconds (IQR 57-124). On univariable analysis, degenerative disc disease (β = -17.9, p = 0.02), pelvic radiation (β = -31.91, p = 0.04), and stress incontinence (β = -14.11, p = 0.03) were associated with reduced DCD. Black race was associated with longer DCD (β = 22.92, p = 0.01). Analysis of UDS parameters revealed a significant increase in DCD per unit increase of bladder capacity (β = 0.08, p<0.001), detrusor pressure (Pdet) at maximum flow (Qmax) (β = 0.96, p<0.001), and maximum Pdet (β = 1.2, p<0.001). In contrast, a significant decrease in DCD was noted per unit increase in Qmax (β = -1.43, p<0.001). Finally, mild (β = 34.4, p<0.001), moderate (β = 72.52, p<0.001), and severe (β = 64.6, p<0.001) BOO were all associated with increased DCD. Conclusions Median DCD in women is 90 seconds. Longer DCD is associated with greater degree of BOO, higher maximum Pdet, Pdet at Qmax, and bladder capacity. Disc disease, irradiation and stress incontinence are associated with reduced DCD. Further studies are needed to evaluate the predictive value of DCD in women.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46179492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-05-17DOI: 10.3389/fruro.2023.1127089
J. Belkora, J. Broering, J. Neuhaus, A. Zargham, Tia Weinberg, J. Witte, Stacey A. Kenfield, Erin L. Van Blarigan, M. Cooperberg, Peter R. Carroll, J. Chan
Introduction A single-arm pre-post pilot study in an academic setting found that pre-consultation decision support was associated with improved patient knowledge among men with early-stage prostate cancer. We now report on exploratory analyses from a controlled study featuring patients from both academic and community settings. Methods We enrolled 58 men to usual care and 61 men to the intervention. We evaluated whether the intervention was associated with patients answering key knowledge items correctly just before their urology visit. Results Just prior to the urology visit, 39/56 or 70% in the intervention group replied correctly to key knowledge items, compared to 31/55 or 56% in the usual care group (p=0.15). At baseline, the intervention group started with 42/60 or 70% correct and the usual care group started with 28/56 or 50% (p=0.03). This imbalance at baseline created a ceiling effect: more men in the usual care group had room to improve on their knowledge scores. Indeed, seven men moved from incorrect to correct in the usual care group, versus 5 in the intervention group; and five men in the intervention group moved from correct to incorrect versus 3 in the usual care group (p=0.44). Discussion In addition to small sample size, reasons for the null findings may include clustering of highly educated participants at the academic site combined with over-representation of academic site participants in the intervention group. We confirmed, from the pilot study, the feasibility of using pre-health student interns as health coaches. Future research should explore whether increasing adoption of telehealth will improve the feasibility of delivering pre-visit decision support in community settings.
{"title":"Controlled trial of decision support for men with early-stage prostate cancer: brief research report of effects on patient knowledge","authors":"J. Belkora, J. Broering, J. Neuhaus, A. Zargham, Tia Weinberg, J. Witte, Stacey A. Kenfield, Erin L. Van Blarigan, M. Cooperberg, Peter R. Carroll, J. Chan","doi":"10.3389/fruro.2023.1127089","DOIUrl":"https://doi.org/10.3389/fruro.2023.1127089","url":null,"abstract":"Introduction A single-arm pre-post pilot study in an academic setting found that pre-consultation decision support was associated with improved patient knowledge among men with early-stage prostate cancer. We now report on exploratory analyses from a controlled study featuring patients from both academic and community settings. Methods We enrolled 58 men to usual care and 61 men to the intervention. We evaluated whether the intervention was associated with patients answering key knowledge items correctly just before their urology visit. Results Just prior to the urology visit, 39/56 or 70% in the intervention group replied correctly to key knowledge items, compared to 31/55 or 56% in the usual care group (p=0.15). At baseline, the intervention group started with 42/60 or 70% correct and the usual care group started with 28/56 or 50% (p=0.03). This imbalance at baseline created a ceiling effect: more men in the usual care group had room to improve on their knowledge scores. Indeed, seven men moved from incorrect to correct in the usual care group, versus 5 in the intervention group; and five men in the intervention group moved from correct to incorrect versus 3 in the usual care group (p=0.44). Discussion In addition to small sample size, reasons for the null findings may include clustering of highly educated participants at the academic site combined with over-representation of academic site participants in the intervention group. We confirmed, from the pilot study, the feasibility of using pre-health student interns as health coaches. Future research should explore whether increasing adoption of telehealth will improve the feasibility of delivering pre-visit decision support in community settings.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48234281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-19DOI: 10.3389/fruro.2023.1154740
C. Costigan, N. Rosenblum
Congenital anomalies of the urinary tract are a major cause of chronic kidney disease in both adults and children. Ureteropelvic junction obstruction, usually detected as urinary tract dilatation in utero, is one of the most common forms of CAKUT. As antenatal ultrasound technology advances and screening becomes more widespread, increasing numbers of infants with this UPJO will be detected. Management of these infants presents a clinical conundrum, as distinguishing mild benign cases from those who may develop severe renal impairment is challenging. Herein we propose that an understanding of normal developmental and pathological mechanisms involved in UPJO is important in the armamentarium for tackling this challenging condition.
{"title":"Understanding ureteropelvic junction obstruction: how far have we come?","authors":"C. Costigan, N. Rosenblum","doi":"10.3389/fruro.2023.1154740","DOIUrl":"https://doi.org/10.3389/fruro.2023.1154740","url":null,"abstract":"Congenital anomalies of the urinary tract are a major cause of chronic kidney disease in both adults and children. Ureteropelvic junction obstruction, usually detected as urinary tract dilatation in utero, is one of the most common forms of CAKUT. As antenatal ultrasound technology advances and screening becomes more widespread, increasing numbers of infants with this UPJO will be detected. Management of these infants presents a clinical conundrum, as distinguishing mild benign cases from those who may develop severe renal impairment is challenging. Herein we propose that an understanding of normal developmental and pathological mechanisms involved in UPJO is important in the armamentarium for tackling this challenging condition.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42864126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-18DOI: 10.3389/fruro.2023.1150795
Darren Ha, Kelly T. Harris, K. Rove
With advances in therapeutic interventions, endourology has become standard of care for the treatment of numerous diseases in the field of pediatric urology. However, there remains a lack of agreement and evidence on the optimal approaches and associated complications of endourological treatment of upper urinary tract conditions in children, namely ureteropelvic junction (UPJ) obstruction, primary obstructive megaureter, and nephrolithiasis. While pyeloplasty remains the first-line surgical treatment for pediatric UPJ obstruction, endoscopic retrograde balloon dilatation (ERBD) and endopyelotomy continue to gain traction as less invasive means of treating obstruction, particularly for failed repairs. Studies report success rates ranging from 76–100% although re-stenosis or need for revision surgery is not uncommon. Endourological options for the surgical management of primary obstructive megaureter include ERBD or endoureterotomy, rather than the open option of ureteroneocystotomy with or without tapering. Both have shown long-term success rates ranging from 70–90%, however, there is emerging evidence that these therapies may be associated with a risk of postoperative vesicoureteral reflux. Meanwhile, for stone disease, shock wave lithotripsy (SWL), flexible ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are mainstays in the pediatric urologist’s armamentarium. Studies have shown that URS and PCNL have comparable stone-free rates, although PCNL can be associated with increased morbidity. Advancements in technology have led to the use of smaller access sheaths without compromising stone-free rates or increasing long-term complications. The use of mini-PCNL in the adult population holds great potential for use in our pediatric patients. The rise of endourology expertise and improved technology makes it an attractive option that could even be considered as a first-line option for the treatment of various urinary tract conditions. Nevertheless, there is a paucity of evidence on outcomes and complications following its use for treatment of upper urinary tract diseases in children. This review aims to summarize and present results of endourological treatments for pediatric UPJ obstruction, primary obstructive megaureter, and nephrolithiasis, as well as highlight advancements in the field of endourology that may increase its utilization in pediatric urology in the future.
{"title":"Endourological treatment of upper tract urinary disease in children","authors":"Darren Ha, Kelly T. Harris, K. Rove","doi":"10.3389/fruro.2023.1150795","DOIUrl":"https://doi.org/10.3389/fruro.2023.1150795","url":null,"abstract":"With advances in therapeutic interventions, endourology has become standard of care for the treatment of numerous diseases in the field of pediatric urology. However, there remains a lack of agreement and evidence on the optimal approaches and associated complications of endourological treatment of upper urinary tract conditions in children, namely ureteropelvic junction (UPJ) obstruction, primary obstructive megaureter, and nephrolithiasis. While pyeloplasty remains the first-line surgical treatment for pediatric UPJ obstruction, endoscopic retrograde balloon dilatation (ERBD) and endopyelotomy continue to gain traction as less invasive means of treating obstruction, particularly for failed repairs. Studies report success rates ranging from 76–100% although re-stenosis or need for revision surgery is not uncommon. Endourological options for the surgical management of primary obstructive megaureter include ERBD or endoureterotomy, rather than the open option of ureteroneocystotomy with or without tapering. Both have shown long-term success rates ranging from 70–90%, however, there is emerging evidence that these therapies may be associated with a risk of postoperative vesicoureteral reflux. Meanwhile, for stone disease, shock wave lithotripsy (SWL), flexible ureteroscopy (URS), and percutaneous nephrolithotomy (PCNL) are mainstays in the pediatric urologist’s armamentarium. Studies have shown that URS and PCNL have comparable stone-free rates, although PCNL can be associated with increased morbidity. Advancements in technology have led to the use of smaller access sheaths without compromising stone-free rates or increasing long-term complications. The use of mini-PCNL in the adult population holds great potential for use in our pediatric patients. The rise of endourology expertise and improved technology makes it an attractive option that could even be considered as a first-line option for the treatment of various urinary tract conditions. Nevertheless, there is a paucity of evidence on outcomes and complications following its use for treatment of upper urinary tract diseases in children. This review aims to summarize and present results of endourological treatments for pediatric UPJ obstruction, primary obstructive megaureter, and nephrolithiasis, as well as highlight advancements in the field of endourology that may increase its utilization in pediatric urology in the future.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45625883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-04-01DOI: 10.3389/fruro.2023.1160122
Raneen Sawaid Kaiyal, R. Cannarella, Shinnosuke Kuroda, N. Parekh, S. Vij, S. Lundy
Introduction Cryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. Although the number of spermatozoa is usually sufficient for intracytoplasmic sperm injection (ICSI), ICSI fails due to poor sperm quality in some cases. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we will offer patients a surgical sperm retrieval via conventional or microdissection testicular sperm extraction (microTESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microTESE at our center. Methods We retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE between 2007- 2021 for failed ICSI with ejaculated sperm or sperm quality deemed to be of insufficient quality for ICSI (e.g., nonmotile sperm). We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR) and ICSI outcomes. Results 28 cryptozoospermic patients were identified. These patients underwent 37 unique microTESE. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had ejaculated sperm with non-suitable quality for ICSI. None had genetic abnormalities. Successful retrieval of motile sperm suitable for ICSI was achieved in in 30 micro TESE procedures (SRR: 81.0%).14 out of 28 patients (50%) who underwent embryo transfer had positive pregnancy result, and 12/28 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). Fibrosis pathology was significantly higher in the negative pregnancy group. There were no postoperative complications noted. Disscussion The use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications.
{"title":"Clinical outcomes of cryptozoospermic patients undergoing surgical sperm retrieval","authors":"Raneen Sawaid Kaiyal, R. Cannarella, Shinnosuke Kuroda, N. Parekh, S. Vij, S. Lundy","doi":"10.3389/fruro.2023.1160122","DOIUrl":"https://doi.org/10.3389/fruro.2023.1160122","url":null,"abstract":"Introduction Cryptozoospermia is defined by the World Health Organization (WHO) as the presence of isolated sperm cell in the ejaculate only identified after an extended microscopic search or after being pelleted. Although the number of spermatozoa is usually sufficient for intracytoplasmic sperm injection (ICSI), ICSI fails due to poor sperm quality in some cases. Contention remains regarding whether testicular sperm offers any advantage in this unique situation. At our tertiary referral center, we will offer patients a surgical sperm retrieval via conventional or microdissection testicular sperm extraction (microTESE) for men with cryptozoospermia and failed ICSI, or where ejaculated specimens are immotile or insufficient for ICSI. In this study, we sought to describe our experience and evaluate the predictors of success in cryptozoospermic patients who had microTESE at our center. Methods We retrospectively reviewed our electronic medical records for all patients with cryptozoospermia who underwent microTESE between 2007- 2021 for failed ICSI with ejaculated sperm or sperm quality deemed to be of insufficient quality for ICSI (e.g., nonmotile sperm). We evaluated demographics, preoperative lab results, pathology results, sperm retrieval rate (SRR) and ICSI outcomes. Results 28 cryptozoospermic patients were identified. These patients underwent 37 unique microTESE. 22 of these men had failed previous ICSI treatment with ejaculated sperm, while the other 6 patients had ejaculated sperm with non-suitable quality for ICSI. None had genetic abnormalities. Successful retrieval of motile sperm suitable for ICSI was achieved in in 30 micro TESE procedures (SRR: 81.0%).14 out of 28 patients (50%) who underwent embryo transfer had positive pregnancy result, and 12/28 patients (42.8%) had successful live birth. The most common pathological pattern was hypospermatogenesis found in 65.3% (17/26). Fibrosis pathology was significantly higher in the negative pregnancy group. There were no postoperative complications noted. Disscussion The use of testicular sperm in cryptozoospermic men with failed prior ICSI using ejaculated sperm has a high rate of pregnancy and live birth. While still controversial, our results suggest that surgical sperm retrieval is a viable option for these men with minimal risk of complications.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42330504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-29DOI: 10.3389/fruro.2023.1089198
K. Roen, Tove Lundberg, P. Hegarty, L. Liao
Introduction Over the past two decades, there has been a shift from concealing diagnoses of sex development from impacted people to the broad principle of age-appropriate disclosure. This change is consistent with children’s rights and with general shifts towards giving children medical information and involving patients in medical decision-making. The present paper examines how health professionals, young people and caregivers with experience in this area talk about the process of telling children about a diagnosis relating to sex development. The focus is on (i) who is given the role of talking with children and young people about their medical condition and care in the context of a diagnosis relating to sex development and (ii) what strategies seem to work, and what dilemmas are encountered, in engaging children and young people in talk about their condition and healthcare. Method Qualitative semi-structured interviews were carried out with 32 health professionals, 28 caregivers and 12 young persons recruited in the UK and Sweden, and thematic analysis was undertaken. Results The analysis identifies strategies and dilemmas in communication and a widespread assumption that it is caregivers’ responsibility to talk with children/young people about the diagnosis. This assumption creates difficulties for all three parties. This paper raises concern about children/young people who, despite a more patient-centred care ethos, are nevertheless growing up with limited opportunities to learn to talk about intersex or differences in sex development with confidence. Discussion Learning to talk about this topic is one step towards shared decision-making in healthcare. A case is made for services to take clearer responsibility for developing a protocol for educating children and young people in ways that involve caregivers. Such a process would include relevant medical information as well as opportunities to explore preferred language and meaning and address concerns of living well with bodily differences.
{"title":"Whose responsibility is it to talk with children and young people about intersex/differences in sex development? Young people’s, caregivers’ and health professionals’ perspectives","authors":"K. Roen, Tove Lundberg, P. Hegarty, L. Liao","doi":"10.3389/fruro.2023.1089198","DOIUrl":"https://doi.org/10.3389/fruro.2023.1089198","url":null,"abstract":"Introduction Over the past two decades, there has been a shift from concealing diagnoses of sex development from impacted people to the broad principle of age-appropriate disclosure. This change is consistent with children’s rights and with general shifts towards giving children medical information and involving patients in medical decision-making. The present paper examines how health professionals, young people and caregivers with experience in this area talk about the process of telling children about a diagnosis relating to sex development. The focus is on (i) who is given the role of talking with children and young people about their medical condition and care in the context of a diagnosis relating to sex development and (ii) what strategies seem to work, and what dilemmas are encountered, in engaging children and young people in talk about their condition and healthcare. Method Qualitative semi-structured interviews were carried out with 32 health professionals, 28 caregivers and 12 young persons recruited in the UK and Sweden, and thematic analysis was undertaken. Results The analysis identifies strategies and dilemmas in communication and a widespread assumption that it is caregivers’ responsibility to talk with children/young people about the diagnosis. This assumption creates difficulties for all three parties. This paper raises concern about children/young people who, despite a more patient-centred care ethos, are nevertheless growing up with limited opportunities to learn to talk about intersex or differences in sex development with confidence. Discussion Learning to talk about this topic is one step towards shared decision-making in healthcare. A case is made for services to take clearer responsibility for developing a protocol for educating children and young people in ways that involve caregivers. Such a process would include relevant medical information as well as opportunities to explore preferred language and meaning and address concerns of living well with bodily differences.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46283157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-28DOI: 10.3389/fruro.2023.1158260
A. Krassioukov, B. Welk, D. Vrijens, S. Islamoska, K. B. Barken, V. Keppenne, M. Wyndaele, M. Walter
The value of disposable, single-use catheters has come under scrutiny in recent years with a growing attention on environmental sustainability. Intermittent catheterization (IC) is a widely available and minimally invasive technique for management of lower urinary tract dysfunction. Effective IC for individuals with neurogenic lower urinary tract dysfunction can promote their independence and improve quality of life. Are there alternative options within IC that could minimize environmental impact without compromising the safety and effectiveness of single-use catheters? How does the future of IC look – environmentally friendly, biodegradable, disposable catheters may be complementary to certified reusable catheters? In the midst of this debate, it is important to emphasize that individuals have the right to choose the best evidence-based treatment available. Here we consider the current landscape for IC with a focus on chronic use in individuals with neurogenic lower urinary tract dysfunction.
{"title":"Intermittent catheterization: A patient-centric approach is key to optimal management of neurogenic lower urinary tract dysfunction","authors":"A. Krassioukov, B. Welk, D. Vrijens, S. Islamoska, K. B. Barken, V. Keppenne, M. Wyndaele, M. Walter","doi":"10.3389/fruro.2023.1158260","DOIUrl":"https://doi.org/10.3389/fruro.2023.1158260","url":null,"abstract":"The value of disposable, single-use catheters has come under scrutiny in recent years with a growing attention on environmental sustainability. Intermittent catheterization (IC) is a widely available and minimally invasive technique for management of lower urinary tract dysfunction. Effective IC for individuals with neurogenic lower urinary tract dysfunction can promote their independence and improve quality of life. Are there alternative options within IC that could minimize environmental impact without compromising the safety and effectiveness of single-use catheters? How does the future of IC look – environmentally friendly, biodegradable, disposable catheters may be complementary to certified reusable catheters? In the midst of this debate, it is important to emphasize that individuals have the right to choose the best evidence-based treatment available. Here we consider the current landscape for IC with a focus on chronic use in individuals with neurogenic lower urinary tract dysfunction.","PeriodicalId":73113,"journal":{"name":"Frontiers in urology","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43231681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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