BLADDER IRRIGATION FOLLOWING AUGMENTATION: ADHERENCE AND FACTORS AFFECTING ADHERENCE
Matthieu Peycelon, MD, Konrad M. SZYMANSKI, MD, MPH, M. Francesca MONN, MD, MPH, Amr K. SALAMA, MD, Hillary B. RISK, NP, Mark P. CAIN, MD, Rosalia MISSERI, MD.
Riley Children Hospital; Indiana University, School of Medicine, INDIANAPOLIS, IN, USA.
Background. Patients with bladder augmentation (BA) are routinely counselled to irrigate their bladders daily to prevent urinary tract infection (UTI) and bladder calculi. However, reports of adherence with this regimen are lacking. This cross-sectional study aims to evaluate the adherence rate for a bladder irrigation protocol and to identify risk factors for poor adherence.
Methods. Adults with spina bifida (SB) and BA, using clean intermittent catheterization (CIC) that were actively followed at the Multidisciplinary SB Adult Clinic were identified (2017-2019). All patients or caregivers were taught the importance of and the technique for the institution's bladder irrigation protocol prior to and after BA. Patients were reminded about the protocol at every follow-up appointment. Instructions included daily irrigation with at least 120 mL of saline or until clear of mucus. Patients' demographics (age, gender, functional level, mobility, presence of a caregiver in clinics) and surgical details (type of BA, age at surgery, length of follow-up, catheterizable channel, position of stoma, bladder neck surgery, presence of a MACE or VP shunt, number of stone surgeries) were obtained from the medical record. Patients reported other variables in a standardized clinic questionnaire. Answers were confirmed by health care providers. These included who performs CIC, size of catheter, frequency of CIC, use of overnight catheterization, difficulties with CIC, number of UTIs, and continence per urethra and per catheterizable channel. Adherence to bladder irrigation was also assessed in the questionnaire. "Strict adherence" was defined as bladder irrigation performed >= 6 times/week with >= 120 mL of saline. For statistical analysis, a more lenient definition of "higher adherence" was used: bladder irrigation >= 2 times/week with at least 60 mL. "Lower adherence" was defined as <= 1 time/week or with less than 60 mL. Risk factors for "lower adherence" were assessed with non-parametric tests.
Results. Adherence was assessed in 87 eligible patients (60.9% females; mean age of 28.8 ± 8.2 years). No patient (0.0%) reported "strict adherence" to bladder irrigation. Sixty-two patients (71.3%) reported "higher adherence" and 25 patients (28.7%) reported "lower adherence". Nine patients (10.3%) in the "lower adherence" group did not irrigate at all. Patients with previous bladder stone surgery were more likely to be more adherent with bladder irrigation (78.8% versus 66.7%) (p = 0.14). "Higher adherence" was more often reported by adults with a
catheterizable channel (79.7% versus 61.1%) (p = 0.27). "Higher adherence" was not associated with any other variables screened.
Conclusions. Adherence to a bladder irrigation protocol in adults with SB and BA is poor. While a history of bladder stones and the presence of a catheterizable channel seem to affect adherence, it remains unclear why some patients are more likely than others to irrigate their bladders. Future work will focus on methods to improve adherence.
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