CASE STUDY: The Impact of Urinary Symptoms and the Urine Microbiome in an individual that has changed from Intermittent to Suprapubic catheter
1Rounds A, 1Ljungberg I, 2Groah S
1Medstar Health Research Institute, Washington, DC, USA; 2Medstar National Rehabilitation Hospital, Washington, DC, USA
Purpose/Background: The purpose of this study was to determine what changes occur in urinary symptom perception, inflammatory biomarkers, DNA concentration, and microbiome as a result of a change in bladder management. People with SCI are at a high risk of genitourinary complications including bladder and kidney infections1,2, bladder cancer3, and many more due to the neurogenic bladder (NB) that accompanies the neurologic injury. Urinary tract infections (UTI) have been and remain the most common complication and costly secondary health condition leading to re-hospitalization in people with SCI.2 Best practice suggests if UTIs persist that a less demanding (suprapubic) bladder management technique should be considered.4 We will present prospective data on urinary symptoms and urine microbiome on a patient who changed from managing his bladder with intermittent catherization to suprapubic catherization.
Timeline: A male participant with SCI who was enrolled in a funded research project assessing urinary symptoms utilizing the new Urinary Symptom Questionnaire for Neuropathic Bladder (USQ-NB) unexpectedly changed bladder management methods. This provided a unique opportunity to continue to collect USQ-NB and urine microbiome data after the change from intermittent to suprapubic to explore if any changes had occurred in his urinary symptoms, bladder inflammatory markers, and DNA due to a change in the type of catheter. Data was collected prospectively 6 months with intermittent catheter use and 6 months with the suprapubic catheter use.
USQ-NB: Our research team developed a new Urinary Symptom Questionnaire for individuals with neuropathic bladder (USQ-NB) due to SCI, focusing on the signs and symptoms of (or possibly preceding) UTI in terms of frequency, severity, and impact..5 This survey was administered on a weekly basis through the patients e-mail. Urine was collected on a monthly basis to analyze the urine for inflammatory biomarkers, DNA concentration and microbiome.
Results: Of the 29 symptoms of the USQ-NB the participant averaged 10 symptoms per week for the first 6 months when using an intermittent catheter. Asymptomatic baseline urinalysis and culture showed Leukocyte esterase (LE) at 2, White blood cell count (WBC) was 20-40, and >100,000 cfu/ml Enterococcus Faecalis. With the use of a suprapubic catheter we anticipate a reduction of symptoms and lower levels of LE and WBC.
Discussion/Conclusions: This case study not only looks at the change in symptoms and microbiome changes when using an intermittent catheter and the change to a suprapubic catheter. But it captures whether what is used for best practice to reduce urinary symptoms and UTIs is in fact, decreasing due to the change in catheter used. This is a stepping stone in determining the gold standard for clinicians to use for individuals with SCI that have chronic UTIs.
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