Science Alert: We are all equal, but some are more equal than others? Gender-specific differences in bladder management

Posted by Maria Åberg Håkansson, February 5, 2019

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We are all human beings but let’s face it, our anatomy is not the same. Men and women experience gender-specific challenges when it comes to urological complications and there are differences that need to be taken into account when addressing these problems. 

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Women

For many women, urinary tract infection (UTI) is a recurring nightmare. For example, about 50% of all women experience at least one UTI during their lifetime and the risk that women suffer a UTI is 3-4 times greater than for men. Women are more predisposed to UTI for anatomical reasons, such as a short urethra (the longer male urethra facilitates bacteria washout) and close proximity to other bacterial reservoirs in the rectum and vagina.

A new randomized controlled study shows that the solution may be easier than we think. Researchers found that an increased fluid intake can decrease occurrence of UTI. In fact, in women who raised their daily fluid intake from 1.1 to 1.7 liters per day, urine production went up, number of voidings increased (from 5-6 to 8 times per day), and the incidence of UTI was reduced by almost half (3.2 vs 1.7 events per year). There was also an increase in time between UTIs (84 vs 142 days) in those with increased fluid intake.

Another way to avoid UTI is to consider catheter choice following for example gynecological surgery. A new meta-analysis looked at 15 trials and concluded that there is a 279% higher risk of symptomatic UTI associated with indwelling catheter use compared to intermittent catheter use. Intermittent catheterization has also shown to provide benefits when considered after radical hysterectomy.

Men

In men there is a different story. Just as among women, many suffer from lower urinary tract symptoms, but the profile is different. Men’s urinary problems are often linked to voiding problems related to an enlarged prostate and/or stricture disease. Nocturia (the need to void at night) has been reported as the single most common symptom among men with lower urinary tract symptoms.

A new study has explored the use of intermittent catheterization/dilatation therapy following stricture surgery. It seems that this therapy can provide quality of life gains without adding too much inconvenience.

When it comes to intermittent catheterization in men, recently published real world evidence suggests that specific catheter features can improve satisfaction and adherence to the therapy. Ultimately, this means that the catheter you choose can be a decisive factor for obtaining optimal clinical outcomes and minimal complications with intermittent catheterization. 

Read the Publication Highlight

 

Summary of Publications: women


Title

Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial.
https://www.ncbi.nlm.nih.gov/pubmed/30285042   

Author and Origin

Hooton TM, Vecchio M, Iroz A, Tack I, Dornic Q, Seksek I, Lotan Y.
USA

Summary

Randomized controlled trial in 140 women comparing low vs. high fluid intake and the impact on urinary tract infection (UTI) rate.

Conclusions

An increased fluid intake was associated with a decrease in UTIs (3.2 vs 1.7 events/year) and antibiotic use (3.6 vs. 1.9 times/year), as well as an increase in time between UTIs (84 vs 142 days). 

Comments and Access

Study showing evidence that increased fluid intake can reduce UTI rate among healthy adult women. 


Title

The incidence of urinary tract infection of different routes of catheterization following gynecologic surgery: a systematic review and meta-analysis of randomized controlled trials.
https://www.ncbi.nlm.nih.gov/pubmed/30374534 

Author and Origin

Li M, Yao L, Han C, Li H, Xun Y, Yan P, Wang M, He W, Lu C, Yang K.
China

Summary

Meta-analysis of randomized controlled trials comparing incidence of urinary tract infection (UTI) and complications of different urinary drainage methods.

Conclusions

15 trials were included and indwelling catheterization was associated with a 279% higher risk of symptomatic UTI compared with intermittent catheterization (RR = 2.79, 95% CI: 1.09-7.14, P = 0.03).  

Comments and Access

Meta-analysis verifying the benefits of intermittent vs indwelling catheter use to avoid risk of UTI.


 

Title

Evaluation of a Program of Clean Intermittent Catheterization for Underactive Bladder After Radical Hysterectomy.
https://www.ncbi.nlm.nih.gov/pubmed/30275745  

Author and Origin

Hikita K, Honda M, Kimura Y, Kawamoto B, Tsounapi P, Morizane S, Takenaka A.
Japan

Summary

Observational retrospective study of lower urinary tract dysfunction (LUTD) after radical hysterectomy and treatment of underactive bladder (UAB) in 41 patients.

Conclusions

Treatment protocol included treatment with antihypertensive drugs, scheduled voiding (6 times/day), and intermittent catheterization after each voiding. Mean time on catheter use was 25 weeks and 95% could successfully stop using it.   

Comments and Access

Study showing benefits of treating UAB after radical hysterectomy with drugs and intermittent catheterization. Open access.

 

Summary of Publications: men


Title

Assessment of quality of life in patients of urethral stricture on clean intermittent catheterization following direct vision internal urethrotomy.
https://doi.org/10.4103/UA.UA_34_17 

Author and Origin

Jhanwar A, Sokhal AK, Singh K, Sankhwar S, Saini DK.
India

Summary

Observational prospective study of quality of life issues for 97 patients who underwent stricture surgery and then intermittent catheterization and dilatation for stricture treatment. 

Conclusions

Patients with urethral stricture who are undergoing intermittent catheterization and dilatation experience moderate difficulty and pain, and low inconvenience. Patients who were compliant reported no stricture recurrence during a 6-month follow-up.

Comments and Access

Study suggesting low inconvenience and quality of life improvements for those who practice intermittent catheterization and dilatation following stricture surgery.  


Title

User perception of a new hydrophilic‐coated male urinary catheter for intermittent use.
https://doi.org/10.1002/nop2.193 

Author and Origin

Koeter I, Stensröd G, Hunsbedt Nilsen A, Lund R, Haslam C, De Sèze M, Sriram R, Heesakkers J, the LoFric Origo study group.

Summary

Observational, prospective study of adherence and satisfaction in 365 intermittent catheter users using LoFric Origo.  

Conclusions

General high satisfaction was reported and LoFric Origo was found to fulfill patient‐preferred catheter requirements associated with convenience, ease of insertion and use, and infection prevention. 

Comments and Access

Real world evidence supporting use of LoFric Origo to ensure patient satisfaction, adherence, and ultimately good clinical outcomes and minimal complications with intermittent catheterization.   

Read the Publication Highlight 


This blog post is an extract of the Science Alert from November 2018 (76040-USX-20181113)

Topics: Science Alert, Bladder management