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A condom catheter is an external device used by male patients with urinary incontinence to collect urine. It is indicated for patients with an overactive, neurogenic bladder who use intra-abdominal pressure and reflex voiding to urinate. It is only recommended for patients who have no skin or penile lesions and have urodynamically proven safe intravesical pressures during storage and voiding phases.From: Anxiety masquerading as autonomic dysreflexia [2019], Evaluation and Treatment of the Neurogenic Bladder [2019]
The microbiologic diagnosis of urinary infection is based on the quantitative count of organisms isolated from the urine specimen. Specimens must be collected in a manner to minimize contamination by periurethral or, in women, vaginal secretions, and be forwarded expeditiously to the laboratory for processing. A clean-catch specimen obtained with voiding is adequate for most women. A voided specimen is not feasible for some women, especially with significant functional impairment. In-and-out catheterization should be performed to collect a specimen from these women when there is a clinical indication. Urine specimens obtained from bedpans or diapers are subject to considerable contamination, and are not appropriate. For men, a clean-catch midstream specimen can usually be obtained. When voiding is managed using a condom catheter, a clean catheter and leg bag should be applied and the urine specimen collected immediately after voiding. For subjects with indwelling urethral catheters, the urine specimen should be obtained by aspiration through the sampling port or tubing, and not from the drainage bag.
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
In China, most patients with SCI use a condom catheter for keeping them dry, whether the incontinence is secondary to detrusor overactivity or overflow incontinence.9 When the New York University Medical Center trial was instituted, it was realized, in preparing the protocol for the NIH and IRB, that there was a conflict between routine antimuscarinic usage and achieving neural reinnervation of the bladder after the Xiao procedure. Antimuscarinics are used to block the neural connection between postganglionic nerves and the detrusor, and thereby inhibit detrusor contractions and make the bladder a low-pressure storage tank for CIC. In other words, antimuscarinics, in a way, paralyze the bladder. The Xiao procedure, however, reestablishes neural control of the lower urinary tract via the somatic-autonomic reinnervation. The postganglionic nerve to detrusor connection is the last and most important leg of the somatic-CNS-autonomic reflex arc; if this leg is blocked by continuous antimuscarinics, the newly established reflex pathway created by the surgery would be unable to be activated, and the patient would be unable to initiate a detrusor contraction in order to void. As a result, the New York University study did not allow patients to take antimuscarinics or stay on CIC, and patients with a bladder capacity of greater than 700cc were excluded from the study.7 Most of the patients with disappointing results in the Denmark study were maintained on antimuscarinics and also had volumes well above 700 cc, volumes we believe are too large and too chronically distended to allow for a successful response to reinnervation.23
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Geriatric Neuroanesthesia, 2019
Adequate pain control, attention to temperature control, and avoidance of excessive fluid administration (bladder distension) are also important to ensure patient comfort. During macrostimulation testing, limb positions are dynamic. One must balance between securing lines and monitors while minimizing restraints of attached cables, as well as thermoregulation with exposed extremities. Patients should be encouraged to void before surgery. In our institution, we routinely use a sheath/condom catheter for patient comfort. Good patient communication, repeated reassurance, and verbal encouragement during the procedure is important in maintaining motivation.
Ryan Solinsky, Todd A. Linsenmeyer
A 57-year-old man with a past medical history of T12 AIS A SCI since 1982 presented for urodynamics. The patient had an overactive, neurogenic bladder and used intra-abdominal pressure and reflex voiding to void into an external condom catheter. He had no reported history of AD or altered autonomic control above his neurological level of injury. His relevant home medications included only 0.4 mg of tamsulosin nightly. On presentation, his supine BP was 140/80 mmHg and he appeared anxious about testing. He reported his baseline SBP at home was approximately 130 mmHg, though he noted that his BP was “always increased when I come here” [Urology clinic]. The patient had his bladder filled and SBP was noted to be elevated to 170 mmHg. Bladder filling was stopped, with urodynamics demonstrating no sensation, normal bladder wall compliance, and no bladder contractions. Given his relatively caudal neurological level of injury and the absence of history of rostral altered autonomic function, the suspicion for AD causing this acute hypertension was very low. He was told that testing was complete and he demonstrated notable relief. Approximately one minute later as we were preparing to drain his bladder, a repeat BP measurement revealed that his SBP had decreased to 150 mmHg. His bladder was then drained and his BP was noted to further decrease to 142/90 mmHg.
Dennis J. Bourbeau, Kenneth J. Gustafson, Steven W. Brose
Heterogeneity in subject injury level or completeness is not a concern for effectiveness of GNS to inhibit bladder activity. Previous work has already demonstrated that subject AIS score, injury level, age, and sex do not predict acute effectiveness of GNS to inhibit neurogenic detrusor overactivity.18 The predictive factor is whether subjects retain bladder reflexes below the lesion level. Therefore, any subject with neurogenic detrusor overactivity that is acutely inhibited by GNS would likely have intact spinal reflexes affecting bladder function and would be appropriate for such a clinical study. However, subject heterogeneity should be considered in future clinical trials because there may be variations in subject goals and bladder management strategies that will affect outcome measures, as we found in this study. For example, individuals without bladder sensation might leave the stimulator on continuously, rather than only use GNS when they feel bladder urgency. These subjects may use a condom catheter, instead of intermittent catheterization or voluntary voiding, and not report incontinence but instead report on alternative goals. This study has provided this insight that a future clinical trial will need to be designed to consider the differences in bladder management strategies and how incorporation of GNS might impact those strategies and routines.
Anas Jehad AlSaleh, Ahmad Zaheer Qureshi, Zilal Syamsuddin Abdin, Ahmed Mushabbab AlHabter
There is very limited literature on bladder management on SCI in KSA or in the neighboring countries. Two quality of life surveys were carried out at follow up visits for individuals with SCI who were rehabilitated between 1982 and 2003 in Riyadh region which included 57 males and 50 females.12,13 Most of the male patients were using condom catheter whereas nearly one-fourth of the patients were on CIC at the time of survey.12 The female survey showed that 64% were using CIC and 22% used IFC.13 These surveys did not analyze the bladder management at the time of discharge; which was carried out in our study. There are no similar studies in the neighboring countries of Arabian Peninsula.