Science Alert: Bladder Function – Important But Not A Given for Everyone

Posted by Maria Åberg Håkansson, March 13, 2018

Find me on:

As a part of our urinary system, the bladder is responsible for many important body functions, such as waste elimination and blood regulation. A functioning bladder should be able to both store and void urine. However, sometimes this functionality is interrupted by damage.

wellspect-science-alert-bladder-and-bowel

Storage problems often lead to urine leakage (incontinence) and voiding problems often lead to urine retention of some kind. Addressing these problems is, however, crucial for urethral health. For example, if urine retention is not treated, it may cause infection, urine leakage, frequent nighttime urination, and discomfort. Inability to empty the bladder may also lead to more severe complications such as renal failure and blood poisoning. Bladder management methods and treatments are important in restoring a dysfunctional bladder. Intermittent catheterization is one important method of overcoming voiding problems. It is useful in different situations and for different people. For example, a recent review of bladder dysfunction in people with Parkinson's disease and multiple system atrophy identifies anticholinergic drugs and intermittent catheterization as useful treatment methods. Furthermore, patients who have had to have their bladder removed (for example due to cancer), and who have received a surgically reconstructed bladder, often have to deal with both incontinence and voiding troubles requiring intermittent catheterization.

Using a catheter is not always hassle-free and urinary tract infections (UTI) are often a burdensome complication that has a major impact on well-being. This is exemplified in the following quotation from a recent paper:

“It obviously makes you feel bad about yourself and it makes you feel like you want to keep away from people, go to bed a bit early. It impacts your relationship with your wife, personally, sexually, because you don’t feel good about yourself, you’ve got an infection and it’s not particularly pleasant.”
Patient report from McClurg et al. Int J Nurs Stud. 2018 Jan 31;81:1-7

It is thus not surprising that many studies suggest that that people who practice intermittent catheterization could potentially benefit from more convenient solutions and interventions that reduce the risk of UTI. So far, solid evidence for efficacy in reducing UTI seems to exist only for hydrophilic-coated catheters for intermittent use. New data suggest that hydrophilic-coated catheters (instead of uncoated catheters) have the potential to increase quality of life throughout a patient's life, and to reduce the number of UTIs by 11% in people with spinal cord injury who practice intermittent catheterization. This is likely to make a real difference, as people with spinal cord injury often need constantly to attend to their bladder and bowel, and chronic UTI is a major barrier to their social participation. In a way, intermittent catheterization can be a game changer, as exemplified in the following quotation:

“[Clean, intermittent self-catheterization] has changed me altogether; it changed my life. In the first week I says ‘this is brilliant, best thing since coloured tellies came out, this is great, I can do what I want to do’. I don’t have a problem with it.”
Patient report from McClurg et al. Int J Nurs Stud. 2018 Jan 31;81:1-7

Download Publication Highlight


Summary of Publications

Urological dysfunction in synucleinopathies: epidemiology, pathophysiology and management.

https://www.ncbi.nlm.nih.gov/pubmed/29124503 

Author and Origin

Sakakibara R, Tateno F, Yamamoto T, Uchiyama T, Yamanishi T.
Japan

Summary

Review presenting epidemiology, pathophysiology, and management of bladder dysfunction in individuals with Parkinson’s disease and multiple system atrophy.

Conclusions

Overactive bladder is common in Parkinson’s disease and multiple system atrophy. Anticholinergics are the firstline treatment but there is also a high prevalence of voiding difficulties which require intermittent catheterization.

Comments and Access

Review of bladder dysfunction in people with Parkinson’s disease and multiple system atrophy, identifying anticholinergics and intermittent catheterization as useful treatments.


Urinary function following radical cystectomy and orthotopic neobladder urinary reconstruction.

https://www.ncbi.nlm.nih.gov/pubmed/29485037 

Author and Origin

Nayak AL, Cagiannos I, Lavallée LT, Morash C, Hickling D, Mallick R, Breau RH.
Canada

Summary

Observational retrospective study of urinary function in 158 patients who underwent radical cystectomy with a neobladder diversion.

Conclusions

The mean age was 63 years and 81.7% were male. Although incontinence is common after surgery, it improves over time. 59% of women and 9% of men used intermittent catheterization 12 months after surgery.

Comments and Access

Study suggesting that intermittent catheter use is more common among women than in men with a neobladder diversion.


Clean intermittent catheterization rates after initial and subsequent treatments with onabotulinumtoxinA for non-neurogenic overactive bladder in real-world clinical settings.

https://www.ncbi.nlm.nih.gov/pubmed/29458265 

Author and Origin

Kennelly M, Green L, Alvandi N, Wehbe S, Smith JJ 3rd, MacDiarmid S, Mangel J, Schwartz M, Aboushwareb T, Murray B.
US

Summary

Observational retrospective study of 299 patients with overactive bladder investigating the rate of voiding dysfunction requiring intermittent catheterization after Botox treatment.

Conclusions

Overall, about 3% of the patients required intermittent catheterization after one or several Botox treatments.

Comments and Access

Study investigating real world use of intermittent catheterization after Botox treatment of overactive bladder.


Participant experiences of clean intermittent self-catheterisation, urinary tract infections and antibiotic use on the ANTIC trial - A qualitative study.

http://www.journalofnursingstudies.com/article/S0020-7489(18)30023-3/fulltext 

Author and Origin

McClurg D, Walker K, Pickard R, Hilton P, Ainsworth H, Leonard K, Suresh S, Nilsson A, Gillespie N.
UK

Summary

Observational interview study of 26 users of intermittent catheterization exploring perceptions around urinary tract infections and use of catheters and antibiotics.

Conclusions

The emotional and practical burden of catheter use and urinary tract infection was considerable. Beliefs were often influenced by healthcare professionals.

Comments and Access

Study suggesting that people who practice intermittent catheterization could potentially benefit from more convenient solutions and interventions to reduce the risk of urinary tract infections. Open access.


Cost-effectiveness of hydrophilic-coated intermittent catheters compared with uncoated catheters in Canada: a public payer perspective.

https://www.ncbi.nlm.nih.gov/pubmed/29458282 

Author and Origin

Welk B, Isaranuwatchai W, Krassioukov A, Torp LH, Elterman D.
Canada

Summary

Cost-effectiveness analysis of hydrophilic-coated intermittent catheters compared with uncoated catheters among individuals with neurogenic bladder dysfunction (NB) due to spinal cord injury.

Conclusions

Choosing hydrophilic instead of uncoated catheters can potentially increase lifetime quality of life (by 0.72 QALYs) and reduce the number of UTIs by 11%. The increase in cost of $48,016 is within general ranges of acceptable costeffectiveness.

Comments and Access

Study suggesting that hydrophilic catheters are cost-effective for intermittent use, as they reduce UTIs at a reasonable additional cost compared to uncoated catheters.
See more details in Publication Highlight.

Download Publication Highlight


Long-term bladder and bowel management after spinal cord injury: a 20-year longitudinal study.

https://www.ncbi.nlm.nih.gov/pubmed/29453362 

Author and Origin

Savic G, Frankel HL, Jamous MA, Soni BM, Charlifue S.
UK

Summary

Observational study of bladder and bowel management in 85 people living with spinal cord injury for more than 40 years.

Conclusions

The mean age was 67 years (mean of 46 years since injury) and 80% were male. Many changed their bladder and/or bowel method. Use of suprapubic and intermittent catheters and use of colostomy and transanal irrigation increased over time.

Comments and Access

Study showing changes over time in bladder and bowel management in people living with spinal cord injury. The reasons behind a change reflect both practical and medical needs. 


Stigma and self-management: an Interpretative Phenomenological Analysis of the impact of chronic recurrent urinary tract infections after spinal cord injury.

https://www.ncbi.nlm.nih.gov/pubmed/29449969 

Author and Origin

Hearn JH, Selvarajah S, Kennedy P, Taylor J.
UK

Summary

Observational interview study exploring 12 people’s experiences with bladder dysfunction and recurrent urinary tract infections (UTIs) secondary to spinal cord injury.

Conclusions

Chronic recurrent UTIs seem to be a major barrier to social participation and they reduce quality of life for people with neurogenic bladder after spinal cord injury.

Comments and Access

Study identifying unmet medical needs for people with neurogenic bladder who suffer from recurrent UTIs.


Prediction of bladder outcomes after ischemic spinal cord injury: A longitudinal cohort study from the European multicenter study about spinal cord injury.

http://dx.doi.org/10.1002/nau.23521 

Author and Origin

Scivoletto G, Pavese C, Bachmann LM, Schubert M, Curt A, Finazzi Agro E, Kessels AG, Kessler TM.
Italy

Summary

Observational study of a subgroup of 85 ischemic spinal cord injury patients from the European Multicenter Study about Spinal Cord Injury (EMSCI).

Conclusions

The mean age was 55 years and 66% of the patients were men. 27% showed complete bladder function recovery one year after ischemia. Bladder recovery seems to be predictable by clinical scores.

Comments and Access

Study on bladder recovery after ischemic spinal cord injury.


Improvements in bladder, bowel and sexual outcomes following task-specific locomotor training in human spinal cord injury.

https://www.ncbi.nlm.nih.gov/pubmed/29385166 

Author and Origin

Hubscher CH, Herrity AN, Williams CS, Montgomery LR, Willhite AM, Angeli CA, Harkema SJ.
US

Summary

A prospective pilot trial investigating how locomotor training affects bladder, bowel and sexual function in 8 persons with spinal cord injury (SCI).

Conclusions

An improvement was seen in bladder, bowel and sexual outcomes after 3 months of locomotor training. This suggests that sensory information can positively benefit neural circuitries controlling urogenital and bowel functions.

Comments and Access

Pilot trial evaluating the effect on bladder, bowel and sexual function after locomotor training in patients with SCI.


This blog post is an extract of the Science Alert from March 2018 (76040-USX-20180306)

Topics: Science Alert, Bladder management