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Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology
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VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology Spinal-Injured Neuropathic Bladder Antisepsis (SINBA) Trial B. B. Lee, M. J. Haran, L. M. Hunt, J. M. Simpson, O. Marial, S. B. Rutkowski, J. W. Middleton, G. Kotsiou, M. Tudehope and I. D. Cameron Spinal Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia Spinal Cord 2007; 45: 542–550.
Objective: To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI). Study Design: Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up. Setting: In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%) agreed. Methods: Eligible participants were people with SCI with neurogenic bladder and stable bladder management. All regimens were indistinguishable in appearance and taste. The dose of MH used was 1 g twice-daily. The dose of cranberry used was 800 mg twice-daily. The main outcome measure was the time to occurrence of a symptomatic UTI. Results: Multivariate analysis revealed that patients randomized to MH did not have a significantly longer UTI-free period compared to placebo (HR 0.96, 95% CI: 0.68 –1.35, P⫽0.75). Patients randomized to cranberry likewise did not have significantly longer UTI-free period compared to placebo (HR 0.93, 95% CI: 0.67–1.31, P⫽0.70). Conclusion: There is no benefit in the prevention of UTI from the addition of MH or cranberry tablets to the usual regimen of patients with neuropathic bladder following SCI. Editorial Comment: The multivariate analysis accounted for or was adjusted for patient location (inpatient or outpatient) and bladder treatment type (indwelling, urethral or suprapubic catheter, intermittent catheterization or reflex voiding). The authors believe that the results may be generalizable to patients with voiding dysfunction secondary to other spinal pathologies. They add, however, “it is still not known whether different methods of delivery such as rotating schedules of different urinary antiseptics or other combinations or compounds with presumed urinary antisepsis may lead to effective nonantibiotic based preventive regimen for this population group. However, the results from this study should lead to questioning of these management practices.” Alan J. Wein, M.D., Ph.D. (Hon.)
VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology Spinal-Injured Neuropathic Bladder Antisepsis (SINBA) Trial B. B. Lee, M. J. Haran, L. M. Hunt, J. M. Simpson, O. Marial, S. B. Rutkowski, J. W. Middleton, G. Kotsiou, M. Tudehope and I. D. Cameron Spinal Medicine Department, Prince of Wales Hospital, Sydney, New South Wales, Australia Spinal Cord 2007; 45: 542–550.
Objective: To determine whether Methenamine Hippurate (MH) or cranberry tablets prevent urinary tract infections (UTI) in people with neuropathic bladder following spinal cord injury (SCI). Study Design: Double-blind factorial-design randomized controlled trial (RCT) with 2 year recruitment period from November 2000 and 6 month follow-up. Setting: In total, 543 eligible predominantly community dwelling patients were invited to participate in the study, of whom 305 (56%) agreed. Methods: Eligible participants were people with SCI with neurogenic bladder and stable bladder management. All regimens were indistinguishable in appearance and taste. The dose of MH used was 1 g twice-daily. The dose of cranberry used was 800 mg twice-daily. The main outcome measure was the time to occurrence of a symptomatic UTI. Results: Multivariate analysis revealed that patients randomized to MH did not have a significantly longer UTI-free period compared to placebo (HR 0.96, 95% CI: 0.68 –1.35, P⫽0.75). Patients randomized to cranberry likewise did not have significantly longer UTI-free period compared to placebo (HR 0.93, 95% CI: 0.67–1.31, P⫽0.70). Conclusion: There is no benefit in the prevention of UTI from the addition of MH or cranberry tablets to the usual regimen of patients with neuropathic bladder following SCI. Editorial Comment: The multivariate analysis accounted for or was adjusted for patient location (inpatient or outpatient) and bladder treatment type (indwelling, urethral or suprapubic catheter, intermittent catheterization or reflex voiding). The authors believe that the results may be generalizable to patients with voiding dysfunction secondary to other spinal pathologies. They add, however, “it is still not known whether different methods of delivery such as rotating schedules of different urinary antiseptics or other combinations or compounds with presumed urinary antisepsis may lead to effective nonantibiotic based preventive regimen for this population group. However, the results from this study should lead to questioning of these management practices.” Alan J. Wein, M.D., Ph.D. (Hon.)