Intravesical electrostimulation in pediatric patients with spinal cord defects.

PURPOSE: Creating a low pressure continent urinary storage mechanism for the pediatric patient with neurogenic bladder is difficult. Current therapy, which is enterocystoplasty with intermittent catheterization, is not an ideal solution. In an effort to optimize storage we used intravesical electrostimulation in patients with spinal cord defects. MATERIALS AND METHODS: A retrospective review of all pediatric patients undergoing bladder stimulation was performed. Parameters reviewed included indication, patient age, initial age adjusted pressure specific bladder volume (less than 30 cm. H2O), initial leak point pressure, number of treatments, number of sessions per treatment, posttreatment age adjusted pressure specific bladder volume, voiding and continence status. RESULTS: Records of all 44 patients treated were reviewed. Indications for treatment included decreasing bladder storage pressures in 24 cases, increased continence between catheterization in 13 and achieving volitional voiding in 7. Patients who became continent had similar age at initiation of treatment, number of treatments, number of sessions, initial leak point pressure and final age adjusted pressure specific bladder volume compared to nonresponders. Nonresponders required surgical intervention to achieve continence with safe storage pressures. Overall, 16% (7 of 44) of patients were continent with safe storage pressures at the completion of treatment and 9% (4 of 44) achieved pretreatment goals. CONCLUSIONS: While some high risk patients were spared surgery due to intravesical electrostimulation, most were not. Spontaneous voiding to completion at safe pressures was not achieved. We were unable to clarify before treatment which patients would benefit from intravesical electrostimulation.

Antibiotic hydrogel coated Foley catheters for prevention of urinary tract infection in a rabbit model.

PURPOSE: We developed an antibiotic liposome (ciprofloxacin liposome) containing hydrogel for external coating of silicone Foley catheters and evaluated its efficacy in a rabbit model. Our goal was to create a catheter that would hinder the development of catheter associated nosocomial urinary tract infections. MATERIALS AND METHODS: We inserted either an untreated, liposomal hydrogel coated or a liposome hydrogel with ciprofloxacin coated 10F silicone Foley catheter into New Zealand White rabbits. We challenged the system with 5x10(6) virulent Escherichia coli at the urethral meatus twice daily for 3 days. Urine cultures were evaluated twice daily for 7 days. When urine cultures became positive, the rabbits were sacrificed and urine, urethral catheter and urethral tissue were cultured. RESULTS: The time to bacteriuria detection in 50% of the specimens was double for hydrogel with ciprofloxacin coated catheters versus untreated and hydrogel coated catheters. A significant (p = 0.04) improvement in average time to positive urine culture from 3.5 to 5.3 days and a 30% decrease in the bacteriuria rate for hydrogel with ciprofloxacin coated catheters were noted compared to untreated catheters. CONCLUSIONS: A significant benefit was realized by coating the extraluminal catheter surface with a ciprofloxacin liposome impregnated hydrogel. We believe this procedure will provide a significant clinical advantage, while reducing health care costs substantially.