Microwave sterilization: a method for home sterilization of urinary catheters

A standard microwave oven has been used to sterilize catheters used for intermittent self-catheterization. Catheters were incubated for 60 minutes in a suspension of microorganisms isolated from the urine of patients with urinary tract infections. Each catheter was removed from the suspension, placed in a paper bag and microwaved for 0 to 30 minutes. A control catheter was not microwaved. We tested 42 strains of microorganisms to determine the minimum microwaving time needed to sterilize the catheters. Representative urinary isolates of Escherichia coli, and Klebsiella, Proteus, Enterobacter, Pseudomonas, Staphylococcus, Streptococcus and Candida species were tested. Mean sterilization time for all strains was 13.0 minutes (standard deviation +/- 5.7 minutes), with a range of 4.0 to 28.6 minutes. Repeat sterilization in the microwave oven did not affect the integrity of the catheter. A water heat sink of constant volume was required. A home microwave oven may be used as a method to sterilize red rubber catheters for reuse. This technique makes aseptic intermittent self-catheterization a practical possibility.     

Microwave: practical cost-effective method for sterilizing urinary catheters in the home

We used a standard microwave oven to sterilize red rubber catheters used for intermittent self-catheterization. Catheters were incubated for sixty minutes in a suspension of microorganisms isolated from the urine of patients with urinary tract infections. For each trial, 6 catheters were removed from their respective suspensions, placed in separate plastic freezer bags, distributed evenly in a microwave oven (avoiding cold spots), and microwaved simultaneously for twelve minutes. A control catheter was not microwaved. Two strains of each microorganism were tested. The urinary isolates were Escherichia coli, Klebsiella sp., Proteus sp., Enterobacter sp., Pseudomonas sp., Streptococcus sp., Staphylococcus sp., and Candida sp. In each experiment, all 6 catheters were sterilized. Repeat sterilization in the microwave oven did not affect the integrity of the catheters or the plastic bags. A water heat sink of constant volume was employed. A home microwave oven may be used as a method to sterilize red rubber catheters for reuse with a recommended time of twelve minutes at full power. This technique makes aseptic intermittent self-catheterization a practical possibility.     

Variability in catheter microwave sterilization techniques in a single clinic population

PURPOSE: We designed a survey to assess the microwave sterilization technique practiced by patients at our clinic who perform clean intermittent catheterization. MATERIALS AND METHODS: A 23-question survey addressing urinary catheter use and home sterilization techniques was mailed to 129 patients. A followup survey was mailed to 47 respondents who reported using a microwave oven to sterilize the catheters to assess the microwave technique further. RESULTS: Of the 129 initial surveys 84 (64%) were returned, while 40 (85%) of the 47 followup questionnaires on microwave sterilization were returned. All patients surveyed have used clean intermittent catheterization for at least 1 year and 75% have used it more than 5 years. Of the respondents 80% perform clean intermittent catheterization 4 to 5 times daily, although sterilization frequency varies from daily to less than once weekly. Of the respondents 71% reported no difficulty with microwave sterilization, although 31 (63%) reported a history of catheter melting during microwaving. Of the respondents 35% reported using a rotation table, all used a heat sink containing 1/2 to 4 cups of water, 39% used 500 to 1,000 W., 37% used greater than 1,000 W., 73% set the microwave for 6 minutes, others set it for 3 to 30 minutes and 98% used a power setting described as high, full, 10 or 100%. CONCLUSIONS: Significant variation exists in the cleaning and sterilizing techniques used by our patients, although they were given uniform written and verbal instructions. It is unclear from the data in the literature how this variation affects sterilization.     

微波联合氯己定用于金属器械快速灭菌的实验研究

目的寻求金属器械快速灭菌的方法 ,满足手术过程中急需器械的灭菌需求。方法将 336件金属手术器械人工染菌后放入微波炉专用塑料盒中 (7件 /盒 ) ,分别加入 0 .5 %氯己定溶液、蒸馏水各 30 0ml加盖 ,置入家用微波炉(2盒 /次 ,14件 ) ,使用高火档 (输出功率 6 5 0W ) ,3、5min分别消毒 2 4次 ,消毒后分别按常规采样做无菌检测 ,观察灭菌效果。结果家用微波炉加蒸馏水作用 3min灭菌合格率为 88.0 9% ,5min灭菌合格率为 95 .2 4 % ;加 0 .5 %氯己定溶液消毒 3min灭菌合格率为 93.4 5 % ,5min灭菌合格率达 10 0 .0 0 %。结论金属器械经家用微波炉 (输出功率为 6 5 0W )与 0 .5 %氯己定溶液协同作用 5min ,即可完全灭菌 ,解决手术过程中急用金属器械的消毒灭菌问题。     

Urinary catheter sterilization with microwave oven

Studies were conducted utilizing a home microwave oven to sterilize catheters commonly used for intermittent self-catherization. Red rubber urinary catheters were inoculated with common clinical uropathogens and were placed in sealed brown paper bags or Ziploc plastic freezer bags and microwaved at full power for various timed intervals. Differences were noted in killing time for some strains or species of bacteria. Twelve minutes at full power appeared to be sufficient time for complete sterilization of most catheters placed in plastic bags. Cold spots were noted in the oven; suggestions are made for placing the bags in certain areas to achieve complete sterilization of contaminated catheters. Repeat sterilization did not affect the integrity of catheters or the plastic bags. A water heat sink of constant volume was employed during the sterilization process. Six catheters could be sterilized at one time. This convenience allows patients reuse of catheters and provides less chances of self-inoculation due to reuse of contaminated catheters for intermittent self-catherization.     

The physical and antimicrobial effects of microwave heating and alcohol immersion on catheters that are reused for clean intermittent catheterisation

INTRODUCTION: Due to worldwide different health insurance policies, patients are often forced to reuse the catheters when performing Clean Intermittent Catheterisation (CIC). We have compared the physical qualities and the antimicrobial effects of two methods of reusing catheters: microwave heating and storage of the catheters in a 70% alcohol solution. The studies were performed during different lengths of time. MATERIALS AND METHODS: Three types of catheters (a standard polyvinylchloride catheter, a special polyvinylchloride catheter with flexible Ergothan tip and a prelubrified catheter), normally intended for single use, were submitted to the effect of a microwave oven (Multitech 215 High Grade and Whirlpool M220 750 W and 1000 W with rotating plate) or preservation in a 70% alcohol solution. To study the effects of microwave heating, a recipient of water was placed in the oven to spread the microwaves and to absorb the heat. The catheters were placed in a resealable plastic bag (Ziploc. To study the effects of preservation in a 70% alcohol solution, the catheters were immerged in the solution for different lengths of time. Thereafter were the physical qualities of the catheters evaluated by using the technique of Differential Scanning Calorimetry (DSC). The antimicrobial effect of the method was evaluated after grafting the catheters with pathogenic E. coli, P. aeruginosa or S. aureus strains. RESULTS: Microwave heating up to 12 minutes at 750 W caused only minimal changes in the physical qualities of all the catheters. However, there was only an antimicrobial effect of the microwave heating on E. coli and not on P. aeruginosa or S. aureus. If the catheter remained longer than 45 minutes in a 70% alcohol solution, the physical qualities of the catheter changed either minimal in the special polyvinylchloride catheter with flexible Ergothan top but changed significantly in the prelubrified catheter). However, already after 5 minutes of immersion in the 70% alcohol solution there was a complete antimicrobial effect on E. coli, P. aeruginosa and S. aureus in all catheters. CONCLUSIONS: It should be recommended to patients on CIC to use a sterile packed and not previously used catheter. In this study we have shown that immersing the catheters in a 70% alcohol solution during 5 minutes can effectively disinfect the catheter without jeopardising the physical qualities. Thereafter, the catheters could be placed in a resealable (e.g. Ziploc bag without being rinsed under water, in order that the few drops of alcohol cause alcohol vapours within the closed plastic bag and maintain the antimicrobial effect.     

A prospective randomized trial of the LoFric hydrophilic coated catheter versus conventional plastic catheter for clean intermittent catheterization

PURPOSE: We compared the incidence of hematuria, pyuria and clinical urinary tract infection in patients who performed intermittent self-catheterization using a hydrophilic coated LoFric (Astra Tech AB, M?lndal, Sweden) or standard plastic catheter. MATERIALS AND METHODS: A total of 62 male patients who performed intermittent self-catheterization to manage neurogenic bladder were randomized into 2 treatment groups at 3 American study sites. Outcome measures included urinary tract infection, microhematuria, pyuria and satisfaction rates. RESULTS: Of the 62 enrolled patients 49 completed the 12-month study. The withdrawal rate was not different in the 2 groups. At the end of the study there was statistically significantly less hematuria in the hydrophilic coated catheter group compared with controls. In addition, there was a significant decrease in the urinary tract infection rate from baseline in the hydrophilic coated catheter group but not in controls. CONCLUSIONS: Use of the hydrophilic coated catheter by patients on intermittent self-catheterization is associated with less hematuria and a significant decrease in the incidence of urinary tract infections. Therefore, it may be preferable for some patients, especially those with a history of difficult catheterization, urethral trauma or a high rate of urinary tract infection.     

Bladder management and risk of bladder stone formation in spinal cord injured patients

PURPOSE: We determined by statistical analysis whether method of management is associated with risk of bladder stone formation in spinal cord injured patients. MATERIALS AND METHODS: A retrospective cohort study was performed of 457 patients admitted to Stoke Mandeville Hospital Spinal Injuries Center between 1985 and 1990 with more than 6 months of followup. Analysis included Cox regression and Poisson regression. RESULTS: Relative to those patients treated with intermittent self-catheterization, the hazard ratio was 10.5 (p <0.0005, 95% confidence interval 4.0-27.5) for patients with suprapubic catheters and it was 12.8 (p <0.0005, 95% confidence interval 5.1-31.9) for those with indwelling urethral catheters. The absolute annual risk of stone formation in patients with a catheter was 4% compared with 0.2% for those on intermittent self-catheterization. However, having formed a stone, the risk of forming a subsequent stone quadrupled to 16% per year. Bladder stones were no more likely to form in patients with suprapubic catheters compared to those with indwelling urethral catheters (hazard ratio 1.2, p = 0.6). CONCLUSIONS: In spinal cord injured patients long-term catheterization is associated with a substantial increased risk of bladder stone formation. This increased risk occurs independently of age, sex and injury level. Degree of injury (complete or incomplete) was considered in the model. Catheter type (suprapubic or urethral) did not change this risk significantly if at all.     

Evaluation of the use of Urocath-Gel catheters for intermittent self-catheterization by male patients using conventional catheters for a long time

STUDY DESIGN: Prospective study of intermittent self-catheterization (CIC) with change from conventional catheter to low-friction Urocath-Gel catheter. OBJECTIVES: To evaluate if such catheters are well accepted and to evaluate their practical use. METHODS: Thirty-nine male patients, between 19 and 74 years old, performing clean intermittent self-catheterization with conventional catheters for a neuropathic bladder for many years were included in this study after written informed consent. Exclusion criteria were clinical urinary tract infection, acute infection of urethra, prostate or epididymis, untreated urethral strictures and false passages or severe urethral bleeding occurring within the last month. During 1 month they changed to the use of the Urocath-Gel catheter. Complications were noted. Satisfaction was evaluated by a visual analogue scale and by questioning. RESULTS: Four patients did not complete the study, two for side effects, two for difficulties with the catheterization technique. Time needed for CIC was not different with both techniques. Difficult introduction or difficult retreat of the catheter were not different in frequency. Impossibility to introduce the catheter was less frequent. Urethritis and urethral bleeding were less frequent than during the use of conventional catheters. Satisfaction was better with the low friction catheters. Negative satisfaction was mainly related to the availability and the use of water to lubricate the catheter, difficulty of manipulation and fear for cost. CONCLUSION: The hydrophilic catheter Urocath-Gel proved as easy to use as conventional catheters but was better tolerated. Satisfaction was better especially in patients who experienced problems with conventional catheters. Some patients were unsatisfied for reasons of practical use or for economical reasons.     

A comparison of prelubricated hydrophilic and non-hydrophilic polyvinyl chloride catheters for urethral catheterization.

OBJECTIVE: To evaluate whether patients performing clean intermittent self-catheterization (CISC) for a short period preferred a prelubricated, hydrophilic, disposable polyvinyl chloride (PVC) catheter or a non-hydrophilic PVC catheter which could be used several times and that had to be lubricated by the patient. PATIENTS AND METHODS: In a prospective cross-over study, 32 patients used each type of catheter for 3 weeks. After each 3-week period, the patients completed a questionnaire to assess comfort and preference, and urine specimens were obtained for culture. RESULTS: There was no significant difference between the groups in the frequency of CISC, discomfort when used, opinion on handling the catheters, preference toward one of the catheters, or of infection. CONCLUSION: Non-hydrophilic PVC catheters may be used safely and with no discomfort to the patient. In addition it may be possible for the healthcare system to save money, as the non-hydrophilic PVC catheters are much cheaper.     

A study on non-sterile intermittent self-catheterization for voiding dysfunction following radical uterine or rectal carcinoma surgery

To determine the effectiveness of non-sterile intermittent self-catheterization, a study was made of 35 patients who had radical surgery of the carcinoma of the uterus or rectum between January, 1978 and October, 1982. These cases were divided into 2 groups; (1) early instituted group of 27 patients who used self-catheterization within 3 months following surgical intervention; (2) late instituted group of 8 patients who received drug treatment for more than 3 months after surgical treatments and then used self-catheterization. After the introduction of self-catheterization, urinary tract infection was evaluated on the basis of the incidence of pyuria defined as more than 5 white blood cells per high magnification field. In 16 of the 35 patients, the incidence of pyuria ranged from 0 to 20 per cent. Regarding prognostic results in the first group the application of self-catheterization, 6 patients had a residual urine ratio ranging from 0 to 20 per cent and were able to void at will. Uroflometry was performed in 9 patients in the first group. In 8 of these patients, UP max values increased 3 months after self-catheterization as compared with those before self-catheterization although their values were still lower than normal. Non-sterile intermittent self-catheterization can shorten the stay in hospital and enable the patient to live a catheter-free life.     

A cross‐sectional study of the catheter management of neurogenic bladder after traumatic spinal cord injury

Aims

This cross‐sectional study describes the catheter management of neurogenic bladder (NGB) in patients with traumatic spinal cord injury (tSCI) with emphasis on the motivations behind transitions between intermittent (IC) and indwelling catheters.

Methods

Patients at the Minneapolis VA with history of tSCI who utilized either intermittent catheterization (IC), urethral (UC) or suprapubic (SP) catheters, participated in a voluntary, anonymous survey regarding their bladder management strategies.

Results

A total of 100 patients participated, 94% were male and 90% Caucasian with median age of 61 years. Patients with current UC or SP were older than those utilizing IC (P = 0.002). The median age at injury and years since SCI were 32 years and 20.5 years, respectively. The median time with current modality was 11 years. A total of 27% of all patients reported at least one transition between catheter type. A total of 14 of 54 patients using IC had prior use of UC or SP, while 12/25 patients using SP and 10/21 patients using UC had prior use of IC. The most common reasons to stop IC included inconvenience, physician recommendation, and dislike of IC. A total of 53% of patients currently using UC or SP reported never using IC. Patients currently using SP were more content with their current catheterization method than those using UC or IC (P = 0.046).

Conclusions

Among patients using catheters for NGB, intermittent catheterization was the most common modality utilized and the transition between intermittent and indwelling catheter was most often influenced by patient preferences and clinician recommendations.     

A three-centre experience of orthotopic neobladder reconstruction after radical cystectomy: initial results

OBJECTIVE: To assess, in a retrospective three-centre series, the initial experience and results of patients undergoing radical cystectomy and orthotopic neobladder reconstruction. PATIENTS AND METHODS: The medical records were retrospectively reviewed for 104 suitable consecutive patients undergoing radical cystectomy and orthotopic neobladder reconstruction between June 1994 and April 2003. The initial histology, operating times, transfusion rates, complications, mortality rates, continence rates, potency rates, and cancer control rates were recorded. RESULTS: The median (range) follow-up was 48 (6-113) months; 90 patients had a reconstruction with a 'Studer' neobladder, 12 with a 'Hautmann W pouch' and two with a 'T pouch' ileal neobladder. There were 24 early complications, and in eight patients re-operation was required; there was one death after surgery. There were 14 late complications and 10 patients required re-operation. The daytime continence rate was 99% and the nocturnal continence rate 78%. Five patients required intermittent self-catheterization. Twenty-two patients died from local and/or distant recurrences, and four from other causes. CONCLUSIONS: Orthotopic neobladder reconstruction provides excellent continence rates, and both acceptable complication and mortality rates. Suitable patients undergoing radical cystectomy should be offered orthotopic neobladder reconstruction.     

Bladder Management in Patients With Pediatric Onset Neurogenic Bladders

Abstract

Our objective was to determine which clean intermittent catheterization (CIC) methods and supplies were used by patients with pediatric onset neurogenic bladders and to relate methodology and materials to reported urinary tract infections. Data were collected via questionnaires distributed by mail and at clinic visits at our university tertiary care outpatient pediatric rehabilitation clinic. Questionnaires were given to 165 patients. Fifty-nine percent were returned (68 patients with myelomeningocele, 27 with pediatric onset spinal cord injury (SCI) and two with other diagnoses). Mean age was 12 years (range 1-27). Fifty-four percent of patients participated in their own CIC. Only two percent used sterile catheterization technique, whereas 98 percent used CIC. A sterile catheter was employed with clean technique by 22 percent. Catheters were reused by 76 percent. Subjects used a wide ranging number of catheters per month, with a median of 5.3. There was no correlation between the number of urinary tract infections (UTIs) per year and the type of catheter used or the use of prophylactic antibiotics. Compared with patients with myelomeningocele, subjects with SCI were significantly more likely to use sterile catheters (p=0.04), >10 catheters per month (p=0.01) and gloves (p<0.001). Subjects who used gloves or more catheters were more likely to experience UTI. These data suggest that clean reused supplies are not related to an increased likelihood of UTI and should be considered a way to lower costs in these populations. (J Spinal Cord Med 1997;20:410-415)     

Does the valve regulated release of urine from the bladder decrease encrustation and blockage of indwelling catheters by crystalline proteus mirabilis biofilms?

PURPOSE: We tested whether valve regulated, intermittent flow of urine from catheterized bladders decreases catheter encrustation. MATERIALS AND METHODS: Laboratory models of the catheterized bladder were infected with Proteus mirabilis. Urine was allowed to drain continuously through the catheters or regulated by valves to drain intermittently at predetermined intervals. The time that catheters required to become blocked was recorded and encrustation was visualized by scanning electron microscopy. RESULTS: When a manual valve was used to drain urine from the bladder at 2-hour intervals 4 times during the day, catheters required significantly longer to become blocked than those on continuous drainage (mean 62.6 vs 35.9 hours, p = 0.039). A similar 1.7-fold increase occurred when urine was drained at 4-hour intervals 3 times daily. Experiments with an automatic valve in which urine was released at 2 or 4-hour intervals through the day and night also showed a significant increase in mean time to blockage compared with continuous drainage (p = 0.001). Scanning electron microscopy confirmed that crystalline biofilm was less extensive on valve regulated catheters. CONCLUSIONS: Valve regulated, intermittent flow of urine through catheters increases the time that catheters require to become blocked with crystalline biofilm. The most beneficial effect was recorded when urine was released from the bladder at 4-hour intervals throughout the day and night by an automatic valve.     

Management of functional bladder neck obstruction in women: use of alpha-blockers and pediatric resectoscope for bladder neck incision

PURPOSE: Functional bladder neck obstruction has been definitively diagnosed in the last few years due to detailed synchronous pressure flow, electromyography and video urodynamics. Clean intermittent self-catheterization and bladder neck incision are the modalities of treatment. To our knowledge the role of alpha-blockers is not yet defined in women. A new technique was developed to perform bladder neck incision using a pediatric resectoscope. MATERIALS AND METHODS: A total of 24 women with obstructive voiding symptoms or retention were evaluated with video pressure flow electromyography, and diagnosed with functional bladder neck obstruction due to high pressure and low flow on silent electromyography and bladder neck appearance on fluoroscopy. Patients were initially treated with clean intermittent self-catheterization and alpha-blockers. Catheterization was stopped when post-void residual was less than 50 ml. and only alpha-blocker therapy was continued. Bladder neck incision was performed in patients who had a poor response to or side effects of alpha-blocker therapy, or when therapy was discontinued due to economic reasons. Clean intermittent self-catheterization was continued in patients who had a poor response to alpha-blockers or refused to undergo bladder neck incision. Bladder neck incision was performed in the initial 2 cases with an adult resectoscope using a Collin's knife and subsequently a pediatric resectoscope (13F). Uroflow and post-void residual measurements were performed in all cases. RESULTS: Of the 24 patients 12 (50%) showed improvement in symptoms, peak flow and post-void residual (p <0.01) with alpha-blocker therapy only. Of the 12 patients who had a poor response to alpha-blockers 6 underwent bladder neck incision subsequently and 6 remained on clean intermittent self-catheterization. All 8 patients treated with bladder neck incision, including 2 who had a good response but discontinued alpha-blocker therapy, had sustained improvement in post-void residual and peak flow (p <0.01) after a mean followup of 3.8 +/- 2.4 years. Grade 1 stress incontinence in 2 adult resectoscope cases responded to conservative treatment. None of the pediatric resectoscope cases had stress incontinence. CONCLUSIONS: Clean intermittent self-catheterization and alpha-blockers are the initial treatment options for functional bladder neck obstruction. The alpha-blockers were successful in 50% of our patients. Bladder neck incision should be offered judiciously with minimal risk of curable stress incontinence. The pediatric resectoscope is useful to make a well controlled incision safely in the female urethra.     

Coated catheters for intermittent catheterization: smooth or sticky?

OBJECTIVE: To evaluate the current range of hydrophilic-coated catheters for intermittent self-catheterization, focusing on the adherence of the catheter to the urethral mucosa at the end of catheterization. PATIENTS AND METHODS: In a prospective randomized study, 61 community-based men tested each of four different hydrophilic-coated catheters available in the UK at the time. Subjects used each of the four test catheters for 1 week in a random order, and were provided with the number and size of catheter they normally used. To assess the products, the subjects: (i) timed seven catheterizations using a stop-watch to determine the time taken from extracting the catheter from the water-filled package, to removing the catheter from the penis, having emptied the bladder; (ii) recorded the severity of 'sticking' on catheter removal on a three-point scale (not at all, a little, a lot); and (iii) completed a product-performance questionnaire. RESULTS: There were no significant differences in ratings of 'sticking' between the 'Easicath' and 'Lofric' (P > 0.05), but there were significant differences between these two products and the 'Aquacath' and the 'Silky', which were found to 'stick' more (P < 0.001). The 'Silky' was reported to stick significantly more than the 'Aquacath' (P < 0.001). CONCLUSIONS: Adherence to the urethral mucosa on catheter removal was a common problem, occurring with all catheters, but two products were significantly more likely to stick than the other two. The clinical importance of 'sticking' and the long-term implications are currently unknown. The relative 'sticking' of uncoated catheters has also not been established.     

Microwave ovens. A safe new method of warming crystalloids

The multiple trauma patient often presents hypothermic. The infusion of warmed parenteral fluids is one of the least invasive methods of core rewarming the hypothermic patient. This study discusses and describes a safe, efficient method of warming normal saline and lactated Ringer's solution by microwave radiation. A 650-watt microwave oven was used to warm single liters of nondextrose containing crystalloid from room temperature (70 F) to 101 F. Total heating time required was 120 seconds. The technique involved midcycle (60 seconds) interruption with agitation and end-cycle agitation. Intra- and extrabag temperatures were confirmed with three separate thermometers. It was concluded that by following the recommended protocol, hospital personnel could be taught this safe method of rapidly warming nondextrose containing crystalloid.     

DDAVP in the Urological Management of the Difficult Neurogenic Bladder in Spinal Cord Injury: Preliminary Report

ABSTRACT

The purpose of this study is to determine the efficacy of desmopressin (DDAVP), a synthetic analogue of antidiuretic hormone, as an alternative therapy in the management of spinal cord injured (SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. Seven SCI patients (three men and four women) were treated with DDAVP after urodynamic evaluation. Despite treatment with anticholinergic agents, urodynamic evaluation demonstrated uninhibited detrusor contractions exceeding 30 cm H₂O pressure at less than 300 ml cystometric capacity in all seven patients. Three patients had been managed with intermittent self-catheterization, but had socially unacceptable short intervals between catheterizations. Two women with incomplete injury were afflicted with significant nocturia (>3 episodes/night). The remaining two patients managed with intermittent self-catheterization were troubled with nocturnal enuresis. The patients received 10 μg intranasal DDAVP once every 24 hours. Prior to DDAVP administration, the four patients who used DDAVP nightly experienced a median of four episodes of nocturia. After one month of DDAVP treatment, two patients had only one episode of nocturia per night and in the other two patients, nocturnal enuresis was completely eliminated. Three patients used daytime DDAVP administration at work to avoid frequent catheterization. The median period between bladder catheterizations increased from 2.5 hours before DDAVP to 6 hours while using DDAVP. Symptomatic improvement persisted during the follow-up period of 6–20 months (mean=12). Side effects were infrequent; only one patient complained of transient headaches. Neither hyponatremia nor serum electrolyte abnormalities occurred. Our preliminary results suggest that DDAVP is safe and effective in the symptomatic management of complicated neurogenic bladder dysfunction in selected SCI patients. (J Am Paraplegia Soc; 17: 165–167)     

Pubovaginal fascial sling for the treatment of complicated stress urinary incontinence

We reviewed retrospectively 67 consecutive women with complicated stress incontinence who underwent a pubovaginal fascial sling procedure by a single surgeon. A detailed micturition questionnaire was completed at the last followup, which ranged from 1 to 8 years, with a mean of 3.5 years. Postoperatively, 82% of the women claimed that they were never incontinent and never wore pads, while 9% were incontinent less often than once per 2 weeks and 9% 9% continued to have troublesome incontinence on a daily basis. Only 2 of these women had persistent stress incontinence; the remainder (5) had urge incontinence. In 6 patients with a neurogenic bladder postoperative urinary retention was expected and they were treated with intermittent self-catheterization. Two patients had urethral obstruction by the sling and required prolonged (probably permanent) intermittent self-catheterization.