Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder.

Academic Article

Abstract

  • BACKGROUND/OBJECTIVE: We conducted a randomized, double-blind comparison of twice daily bladder irrigation using 1 of 3 different solutions in community-residing persons with neurogenic bladder who used indwelling catheters to evaluate efficacy in treatment of bacteriuria. METHODS: Eighty-nine persons with bacteriuria were randomized to irrigate their bladders twice daily for 8 weeks with 30 mL of (a) sterile saline, (b) acetic acid, or (c) neomycin-polymyxin solution. Urinalysis, cultures, and antimicrobial susceptibility tests were performed at baseline and weeks 2, 4, and 8 to determine the extent to which each of the solutions affected numbers and types of bacteria, urinary pH, urinary leukocytes, and generation of antimicrobial-resistant organisms. RESULTS: Bladder irrigation was well tolerated with the exception of 3 participants who had bladder spasms. None of the 3 irrigants had a detectable effect on the degree of bacteriuria or pyuria in 52 persons who completed the study protocol. A significant increase in urinary pH occurred in all 3 groups. No significant development of resistance to oral antimicrobials beyond what was observed at baseline was detected. CONCLUSIONS: Bladder irrigation was generally well tolerated for 8 weeks. No advantages were detected for neomycin-polymyxin or acetic acid over saline in terms of reducing the urinary bacterial load and inflammation. We cannot recommend bladder irrigation as a means of treatment for bacteriuria in persons with neurogenic bladder.
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    Keywords

  • Acetic Acid, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Bacteriuria, Colony Count, Microbial, Double-Blind Method, Female, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Neomycin, Polymyxins, Sodium Chloride, Spinal Cord Injuries, Therapeutic Irrigation, Urinalysis, Urinary Bladder, Neurogenic
  • Author List

  • Waites KB; Canupp KC; Roper JF; Camp SM; Chen Y
  • Start Page

  • 217
  • End Page

  • 226
  • Volume

  • 29
  • Issue

  • 3