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Related Concept Videos

Urinary Bladder01:23

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The urinary bladder is a hollow, muscular sac that temporarily stores urine before it is expelled from the body. It can hold approximately 600 mL of urine prior to micturition. The bladder is retroperitoneal and located behind the pubic symphysis in the pelvic floor.
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Urinary Tract Infection I: Introduction01:26

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Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
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Urinary Tract Infection II: Pathophysiology01:25

Urinary Tract Infection II: Pathophysiology

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The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
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Urinary Tract Infection IV: Nursing Management01:17

Urinary Tract Infection IV: Nursing Management

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In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs...
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Anatomy of the Genitourinary System II: Bladder and Urethra01:19

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The lower urinary system consists of the urinary bladder and urethra, which are essential in storing and expelling urine from the body. Together with the internal and external sphincters, these structures work together to regulate urination effectively.Anatomy of the BladderThe urinary bladder is a muscular, stretchable organ behind the pubic bone and in front of the rectum. In females, the bladder is positioned anterior to the vagina and inferior to the uterus, while in males, it is located...
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Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care01:30

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
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Neomycin-polymyxin or gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic

K H Huen1, F Nik-Ahd2, L Chen3

  • 1Department of Urology, David Geffen School of Medicine at UCLA, 300 Stein Plaza, 3rd Floor, Suite 331, Los Angeles, CA 90095, USA.

Journal of Pediatric Urology
|January 7, 2019
PubMed
Summary
This summary is machine-generated.

Daily antibiotic bladder instillations significantly reduced symptomatic urinary tract infections (UTIs) and related hospital visits for patients with neurogenic bladder (NGB) on clean intermittent catheterization (CIC). This approach may allow for discontinuation of oral antibiotic prophylaxis without increasing antimicrobial resistance.

Keywords:
AntibioticClean intermittent catheterizationIntravesical instillationNeurogenic urinary bladderProphylaxisUrinary tract infection

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Area of Science:

  • Urology
  • Infectious Diseases
  • Pharmacology

Background:

  • Recurrent urinary tract infections (UTIs) are a significant challenge for patients with neurogenic bladder (NGB) undergoing clean intermittent catheterization (CIC).
  • Oral antibiotic prophylaxis is often used but may not fully prevent UTIs or can lead to resistance.
  • Alternative strategies are needed to manage persistent UTIs in this population.

Purpose of the Study:

  • To evaluate the efficacy of daily neomycin-polymyxin or gentamicin bladder instillations in reducing symptomatic UTIs in NGB patients on CIC.
  • To assess the impact of these instillations on emergency department (ED) visits, hospitalizations for UTI, and the need for oral antibiotic prophylaxis.
  • To investigate potential changes in urine microorganism resistance patterns associated with intravesical antibiotic use.

Main Methods:

  • Retrospective review of patients with NGB on CIC and symptomatic UTIs receiving daily intravesical neomycin-polymyxin or gentamicin between 2013 and 2017.
  • Symptomatic UTI defined by positive urine culture (>10,000 CFU/mL) plus clinical symptoms or physician decision.
  • Analysis of UTI rates, ED visits, hospitalizations, oral antibiotic prophylaxis use, and antimicrobial resistance patterns.

Main Results:

  • Intravesical antibiotic instillations reduced symptomatic UTIs by 58% (IRR: 0.42, P < 0.001).
  • Rates of ED visits and inpatient hospitalizations for UTI decreased by 54% (IRR: 0.46, P < 0.001) and 39% (IRR: 0.61, P = 0.043), respectively.
  • Significantly fewer patients required oral antibiotic prophylaxis (OR: 0.12, P = 0.016), with no increase in multidrug or gentamicin resistance observed.

Conclusions:

  • Daily antibiotic bladder instillations offer a feasible and effective alternative for managing persistent UTIs in NGB patients on CIC.
  • This treatment may reduce UTI-related healthcare utilization and the reliance on oral antibiotics.
  • Intravesical antibiotic therapy did not lead to increased antimicrobial resistance in the studied cohort.