Hypothesis / aims of study
Intermittent catheterization (IC) is the method of choice for managing chronic urinary retention, whether it stems from neurogenic or non-neurogenic causes. Despite its critical role in ensuring patient well-being, the procedure is not without its risks. A primary concern for those performing intermittent self-catheterization (ISC) is the potential for urinary tract infections (UTIs), a common complication that can occur when bacteria is introduced into the bladder during the catheterization process.[1] Furthermore, the presence of mucous and sediment in urine, while nonspecific symptoms, may be associated risk factors for symptomatic UTIs.[2] This study seeks to examine the presence of mucous and sediment among individuals using ISC in relation to UTI incidence.
Study design, materials and methods
Our comprehensive study integrated data from two significant sources: the self-reported experiences of 646 individuals from a geographically diverse cohort across the United States, Canada, the United Kingdom, and France, and baseline data from 209 participants enrolled in the online Continence Care Registry (ConCaReTM).
The larger dataset encompasses detailed cross-sectional surveys from IC patient support programs and product distributors in the participating countries. Individuals from both sources were aged 18 and older, utilized ISC to manage bladder emptying and provided informed consent for their data's use. Standard descriptive statistics were used to evaluate outcomes.
The Continence Care Registry analysis included participants from the United States (63%), Canada (14%), and the United Kingdom (23%), including 130 males, 79 females, and one non-binary individual. This registry-based study follows community-dwelling individuals who perform ISC. Participants can self-enroll on a rolling basis. Online questionnaires used in the study include the Intermittent Self-Catheterization Questionnaire (ISC-Q), EuroQoL-5D, and a modified version of the RAND Medical Outcomes Study Social Support Survey, which offer insights into quality of life, healthcare utilization, and factors influencing catheter choice, enriching the overall study with a nuanced understanding of ISC users' experiences and outcomes.
Results
Results from the cohort of 646 participants performing ISC ranging from less than one month to over four years indicated that 64% had been using catheters for 3 or more years, with 84% catheterizing at least 3 times daily. Among participants who experienced UTIs in the past 12 months, a notable difference in the observation of mucous and sediment in their urine was reported. Individuals who observed mucus in their urine at least once a month reported 39% more UTIs in the past 12 months compared to those who observed mucus in their urine less frequently. Also, subjects who observed sediment in their urine at least once a month reported 35% more UTIs compared to individuals who rarely or never noticed sediment. Moreover, those who consistently observed both mucous and sediment monthly, reported 60% more UTIs in the last year versus those who seldom or never noticed these symptoms (Table 1).
Of those 646 participants, a subgroup of 166 participants with a history of SCI who also reported IC use was further examined. Out of the 166 participants with history of SCI, 63% had been using catheters for over three years, with 95% catheterizing at least three times daily. Among those in the SCI subgroup who experienced a UTI in the last 12 months, 78% more UTIs were observed in the subset of individuals who observed mucous in their urine and 80% more UTIs were noted in the subset of individuals who observed sediment compared to those who seldom or never noticed these symptoms. Remarkably, those within the SCI subgroup who observed both mucous and sediment monthly, 138% (or 2.38 times) reported more UTIs than individuals who rarely or never observed these symptoms (Table 1).
Data from the continence care registry further complements these findings, indicating that 61% of participants self-reported at least one UTI in the past 12 months, with 40% of these individuals experiencing two or more UTIs. At baseline, 19% of participants reported being diagnosed with a UTI in the last 30 days. The most frequently reported symptoms associated with a possible UTI included milky, cloudy, or dark-colored urine (33%), strong-smelling urine (31%), and increased urinary frequency (29%) (Table 2). The results based on this self-reported data may suggest a possible link between the observation of specific urinary symptoms, such as mucous and sediment, and the increased risk of UTIs, and there appears to be a stronger correlation among individuals with SCI using ISC.
Interpretation of results
This study identified a possible association between the occurrence of UTIs and the observation of mucous and sediment in the urine of individuals using ISC. Individuals who observed both mucous and sediment monthly reported experiencing 60% more UTIs compared to those who rarely or never observed these symptoms, highlighting a possible association between these urinary observations and the occurrence of UTIs. This trend became more prevalent in the SCI subgroup. Those with SCI and UTIs in the last year who observed mucous or sediment also experienced 78% and 80% more UTIs, respectively, compared to their counterparts who did not notice these symptoms. Furthermore, SCI participants who observed both symptoms monthly, experienced 138% more UTIs, which may indicate that this subgroup is at higher risk of UTIs, especially when mucus or sediment in urine is observed.
The continence care registry data complements these findings by detailing the most commonly reported symptoms suggestive of UTIs, including changes in urine appearance and smell, and increased frequency of urination. The fact that 19% of participants reported being diagnosed with a UTI in the last 30 days at time of self-report further illustrates the ongoing challenge of UTIs in this population. Small sample sizes as well as reliance on self-reported data were limitations to this study.
Concluding message
The findings from this study suggest that the self-reported observation of mucous and sediment in urine may be associated with an increased risk of UTIs, especially among individuals with SCI using ISC. This highlights the need for healthcare providers to monitor these symptoms closely and possibly adapt ISC practices to mitigate UTI risks. The results also emphasize the importance of educating ISC users about monitoring and reporting changes in their urine, as these could signify the need for further investigations or changes to catheterization techniques.
Furthermore, the continence care registry data provide valuable insight into the broader spectrum of UTI symptoms and their prevalence, offering a comprehensive view of the challenges faced by individuals managing their bladder function through ISC. These insights highlight the complexity of managing ISC, necessitating ongoing support, research, and innovation in continence care to enhance the quality of life for these individuals. Ultimately, this study highlights a possible link between specific urinary symptoms and UTI risk, reinforcing the importance of proactive approaches in continence care.