Yifan Meng Griffin, Rosalia Misseri, Joshua D Roth, Benjamin M Whittam, Pankaj Dangle, Shelly King, Kirstan K Meldrum, Martin Kaefer, Mark P Cain, Richard C Rink, Konrad M Szymanski
{"title":"使用和废弃可导尿的通道作为排空神经性膀胱的主要方法:一项单一机构队列研究。","authors":"Yifan Meng Griffin, Rosalia Misseri, Joshua D Roth, Benjamin M Whittam, Pankaj Dangle, Shelly King, Kirstan K Meldrum, Martin Kaefer, Mark P Cain, Richard C Rink, Konrad M Szymanski","doi":"10.1097/JU.0000000000004313","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.</p><p><strong>Materials and methods: </strong>People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.</p><p><strong>Results: </strong>561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).</p><p><strong>Conclusions: </strong>Most people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.</p>","PeriodicalId":17471,"journal":{"name":"Journal of Urology","volume":null,"pages":null},"PeriodicalIF":5.9000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Use and disuse of catheterizable channels as the primary method of emptying the neuropathic bladder: a single institutional cohort study.\",\"authors\":\"Yifan Meng Griffin, Rosalia Misseri, Joshua D Roth, Benjamin M Whittam, Pankaj Dangle, Shelly King, Kirstan K Meldrum, Martin Kaefer, Mark P Cain, Richard C Rink, Konrad M Szymanski\",\"doi\":\"10.1097/JU.0000000000004313\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.</p><p><strong>Materials and methods: </strong>People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.</p><p><strong>Results: </strong>561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).</p><p><strong>Conclusions: </strong>Most people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.</p>\",\"PeriodicalId\":17471,\"journal\":{\"name\":\"Journal of Urology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":5.9000,\"publicationDate\":\"2024-11-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Urology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JU.0000000000004313\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Urology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JU.0000000000004313","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Use and disuse of catheterizable channels as the primary method of emptying the neuropathic bladder: a single institutional cohort study.
Purpose: We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors for disuse.
Materials and methods: People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used.
Results: 561 people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. Most common reasons for disuse were non-mechanical (64%). After disuse, 46% underwent incontinent diversion.After correcting for differential follow-up, 89% of people still used their channels at 10 and 81% at 20 years, respectively. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk for disuse compared to self-catheterized channels (p<0.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (p=0.02).For channels disused for non-mechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (p≤0.04). No variables were associated with disuse for mechanical reasons (p≥0.22).
Conclusions: Most people with CCCs use them on long-term follow-up. 1% stopped using them annually. People who never self-catheterized, never attended transition clinic or had RLQ stomas were at higher risk of channel disuse, particularly due to non-mechanical reasons.
期刊介绍:
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing short condensations of the best and most important urology literature worldwide, and practice-oriented reports on significant clinical observations.