Vesicostomy button: how is it placed, in whom, and how is quality of life affected?

ABSTRACT Purpose The vesicostomy button has been shown to be a safe and effective bladder management strategy for short- or medium-term use when CIC cannot be instituted. This study reports our use with the vesicostomy button, highlighting the pros and cons of its use and complications. We then compared the quality or life in patients with vesicostomy button to those performing clean intermittent catheterization. Materials and Methods Retrospective chart review was conducted on children who had a vesicostomy button placed between 2011 and 2015. Placement was through existing vesicostomy, open or endoscopically. We then evaluated placement procedure and complications. A validated quality of life questionnaire was given to patients with vesicostomy button and to a matched cohort of patients performing clean intermittent catheterization. Results Thirteen children have had a vesicostomy button placed at our institution in the 4 year period, ages 7 months to 18 years. Indications for placement included neurogenic bladder (5), non-neurogenic neurogenic bladder (3), and valve bladders (5). Five out of 7 placed via existing vesicostomy had leakage around button. None of the endoscopically placed buttons had leakage. Complications were minor including UTI (3), wound infection (1), and button malfunction/leakage (3). QOL was equal and preserved in patients living with vesicostomy buttons when compared to CIC. Conclusion The vesicostomy button is an acceptable alternative to traditional vesicostomy and CIC. The morbidity of the button is quite low. Endoscopic insertion is the optimal technique. QOL is equivalent in patients with vesicostomy button and those who perform CIC.

Social Determinants of Health in the lives of urinary catheter users / Determinantes Sociales de Salud en la vida de usuarios de cateterismo urinario / Determinantes Sociais de Saúde na vida de usuários de cateterismo urinário

ABSTRACT Objective: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. Method: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Results: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. Conclusion: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

RESUMEN Objetivo: Identificar la influencia de factores de los determinantes sociales de salud en las condiciones de vida de pacientes usuarios de cateterismo urinario intermitente. Método: Investigación descriptiva realizada en centro de Rehabilitación. Participaron 243 pacientes con vejiga neurogénica, usuarios de cateterismo urinario intermitente limpio. Estudio realizado entre marzo de 2012 y octubre de 2015, aplicando entrevista apoyada por instrumento semiestructurado, y análisis por estadística descriptiva. Resultados: La mayoría de los pacientes era de sexo masculino, edad entre 16 y 64 años, solteros, con enseñanza primaria e ingresos familiares entre 2 y 3 salarios mínimos. Los determinantes sociales de salud encontrados estuvieron relacionados a aspectos socioeconómicos, demográficos y condiciones de salud. Conclusión: Los hallazgos señalan una compleja relación entre los determinantes sociales de salud y las condiciones de vida de estos pacientes usuarios de cateterismo urinario intermitente limpio, presentando vulnerabilidad en relación a algunos aspectos de las condiciones de salud.

RESUMO Objetivo: Identificar a influência de fatores dos determinantes sociais de saúde nas condições de vida de pacientes usuários de cateterismo urinário intermitente. Método: Pesquisa descritiva realizada em um Centro de Reabilitação com 243 pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo. O período do estudo foi de março/2012 a outubro/2015, utilizando-se entrevista com apoio de um instrumento semiestruturado e análise por estatística descritiva. Resultados: A maioria dos pacientes era do gênero masculino, idade entre 16 e 64 anos, solteiros, com ensino fundamental e renda familiar mensal de 2 a 3 salários mínimos. Os determinantes sociais de saúde encontrados foram relacionados aos aspectos socioeconômicos, demográficos e condições de saúde. Conclusão: Os achados assinalam para uma complexa relação entre os determinantes sociais de saúde e as condições de vida desses pacientes usuários de cateterismo urinário intermitente limpo, apresentando uma vulnerabilidade com relação a alguns aspectos das condições de saúde.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

ABSTRACT Objective To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. Material and Methods Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content). Results The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. Conclusion The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

The Ochoa urofacial syndrome: recognize the peculiar smile and avoid severe urological and renal complications / Síndrome urofacial de Ochoa: reconheça o sorriso peculiar e evite complicações urológicas e renais graves

Ochoa syndrome is rare and its major clinical problems frequently unrecognized. We describe facial characteristics of six patients to help health professional recognize the inverted smile that these patients present and refer them to proper treatment. Patients’ medical records were reviewed and patients’ urological status clinically reassessed. At last evaluation patients’ mean age was 15.5 years, and age ranged from 12 to 32 years. Mean follow-up was 35 months (12 to 60). Initial symptoms were urinary tract infections in four patients (67%) associated with enuresis and incontinence in three of them (50%). One patient had only urinary tract infection and two lower urinary tract symptoms without infections. Initial treatment consisted of clean intermittent catheterization with anticholinergics for all patients. Four patients (67%) were submitted to bladder augmentation. Two patients had end-stage renal disease during follow-up, one received kidney transplantation and one patient remained on the waiting list for a renal transplantation. Familial consanguinity was present in only one case. This significant condition is rare, but it must be recognized by pediatricians, nephrologists and urologists in order to institute early aggressive urological treatment.

A síndrome de Ochoa é rara, e seus principais problemas clínicos são frequentemente não reconhecidos. Descrevem-se aqui características faciais de seis pacientes para auxiliar profissionais de saúde a reconhecer o sorriso invertido que eles apresentam e encaminhá-los para o tratamento adequado. Os prontuários médicos foram revisados e a condição urológica dos pacientes foi reavaliada clinicamente. A média de idade na última avaliação foi de 15,5 anos, variando de 12 a 32 anos. O seguimento médio foi de 35 meses (12 a 60). Os sintomas iniciais foram infecções do trato urinário em quatro pacientes (67%) associadas com enurese e incontinência urinária em três deles (50%). Um paciente apresentou infecções do trato urinário isoladamente e dois apresentaram sintomas do trato urinário inferior, porém sem infecções. O tratamento inicial consistiu em cateterismo intermitente limpo, com anticolinérgicos em todos os pacientes. Reconstrução urinária foi realizada em quatro pacientes (67%) por meio de ampliação vesical. Dois pacientes apresentaram doença renal em estágio terminal no seguimento, um recebeu transplante renal e outro manteve-se em lista de espera para transplante renal. Consanguinidade familiar esteve presente em apenas um caso. Essa condição significativa é rara, porém deve ser reconhecida por pediatras, nefrologistas e urologistas, a fim de instituir tratamento urológico agressivo precoce.