Effect of clean intermittent catherization on lower urinary tract : an experimental study

Objective To investigate the effect of clean intermittent catheterization (CIC) on the lower urinary tract in experimental animals. Patients and Methods: Eight male spinalized cats were subjected to CIC for a period of 6 - 9 weeks. A urine specimen for culture was obtained weekly. A pathological examination of the proximal and distal urethra and the bladder was performed. Results Urinary tract infection was detected in all cats starting from the second week. It responded to antibiotics but recurrence occurred after discontinuing the treatment. One animal died in the 4th week from fibrinopurulent peritonitis caused by necrotizeng ulcerative cystitis. False passage occurred in another cat at the end of the 6th week. It was managed by fixation of a urethral catheter for a week; and CIC was then continued for another two weeks. Pathological examination showed a thickening of the urethral wall that progressed with the duration of CIC. Microscopic examination of the urethra showed epithelial hyperaemia; ulceration and an inflammatory reaction with oedema as well as an inflammatory reaction of the lamina propria. The muscular layer showed progressive hypertrophy with continuing CIC. The bladder wall showed epithelial ulceration; Brunn nests and squamous metaplasia with islands of degenerated cells. Conclusion Recurrent urinary tract infection; local traumatic reactions of the urethral and bladder wall; especially epithelial damage of the mucosa; and false passages are common complications occurring with CIC in the experimental animal. Although the situation in the experimental animal has no relevance in humans; yet; it may throw light on some aspects of possible complications of long-term CIC

Primary noctural enuresis : a clinical urodynamic. evaluation and analysis of therapeutic options

Objective To assess the clinical evaluation; urodynamic data and therapeutic options in patients with primary nocturnal enuresis. Patients and Methods A total of 473 patients aged between 5 and 35 years were evaluated clinically and underwent urine analysis and cultures as well as plain radiography of the abdomen. Intravenous urography was done when indicated. A urodynamic study was done in patients with polysymptomatic enuresis; a failed previous therapy and enuresis in adults. Initially; patients with monosymptomatic enuresis and those who had polysymptomatic enuresis with a stable detrusor function were managed by conditioning therapy using a calendar. When urodynamic studies detected detrusor instability (DI); the patients were initially treated by anti-muscarinics. Results Monosymptomatic enuresis was diagnosed in 329 patients; while the remaining 144 patients had polysymp-tomatic enuresis. Detrusor instability was detected in 36 of the monosymptomatic patients and in 93 of the polysymptomatic patients. Bladder capacities at the first sensation (FS); at normal sensation and at the maximum cystometric capacity (MCC) showed a statistically significant increase in patients with stable detrusor function compared to those with DI. The detrusor pressure (Pdet) was significantly higher at the first sensation and at the MCC in patients with DI than in patients with a stable detrusor. Conditioning therapy showed satis-factory results in 74of the patients with a better outcome in those with monosymptomatic enuresis. Antimuscarinics treated 91 of both monosymptomatic and polysymptomatic enuretics with DI. Conclusion Conditioning therapy using a calendar can offer a good therapeutic modality to most patients with primary nocturnal enuresis with stable detrusor function avoiding the costs and side effects of drugs. Pharmacotherapy should only be used when this conditioning therapy fails. Filling cystometry can detect detrusor instability as a cause of enuresis that helps in the proper choice of antimuscarinics as a primary line of treatment