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How to tell if you have a UTI...no symptoms?

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  • #16
    This is an older study, but for what it is worth:

    https://www.ncbi.nlm.nih.gov/pubmed/8900706
    Attached Files

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    • #17
      Note that study was done in 1996...

      (KLD)
      The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

      Comment


      • #18
        From: Evidence Based Guidelines for Best Practice in Urological Health Care, Male external catheters in adults. This is a publications of the European Association of Urology Nurses (EAUN). The publication is date March 2016. https://nurses.uroweb.org/wp-content...omplete_LR.pdf
        7.3.4 Changing interval
        Daily changes of sheaths are recommended for all users when daily hygiene is performed. When the MEC falls off or leakage occurs it should be changed more often and if this recurs the patient should be reassessed.
        It is recommended that the urine bag should be changed at least once a week. In hospitals, the bag is changed every time the MEC is changed due to the risk of cross contamination. Changing the urinary bag should follow local or national policies or standards.


        From: Ostomy Wound Management, journal of the Association for the Advancement of Wound Care
        Issue Number:
        Volume 54 - Issue 12 - December, 2008
        Index:
        Ostomy Wound Manage. 2008;54(12):18-35.
        Diane K. Newman, RNC, MSN, CRNP, FAAN

        https://www.o-wm.com/content/internal-and-external-urinary-catheters-a-primer-clinical-practice
        External Catheters


        (EC) External Catheters (IUC) Intermittent Urinary Cathete
        External catheters are condom-type sheaths applied (usually rolled) over the penis and connected to a drainage bag. They are used primarily for urine collection in men who experience urinary incontinence. The most popular ECs are disposable and must be changed every 24 to 48 hours. Reusable ECs are removed, washed, and reapplied. Although ECs can be an appropriate urine containment option for men, scant research has rendered the role of ECs in hospitalized patients or LTC residents unclear. Most available research53 has involved men in VA medical centers (VAMC) who report that an EC is more comfortable, less painful, and less restrictive on their activities than other devices such as an IUC. This research also indicated that nurses preferred ECs to IUCs. Saint et al53 compared IUCs with ECs in male inpatients in a VAMC. Seventy-five subjects were randomized to receive either an IUC (n = 41) or a condom catheter (n = 34). The incidence of adverse outcomes was 131 per 1,000 patient-days with an IUC and 70 per 1,000 patient-days with a condom catheter. The median time to an adverse event was 7 days in the indwelling and 11 days in the condom group. Adverse outcomes including bacteriuria, symptomatic UTI, or death were lower in men using ECs, particularly in men who did not have dementia. When patient satisfaction with the urinary device was assessed, the patients with an EC were more likely than patients with an IUC to report their device to be comfortable and not painful.

        From:
        Spinal Cord Medicine, Bladder Management for Adults with Spinal Cord Injury, A Clinical Practice Guideline for Health-Care Providers, Consortium for Spinal Cord Medicine, Administrative and financial support provided by Paralyzed Veterans of America, Page 27
        http://www.pva.org/media/pdf/CPGBlad...eme_1AC7B4.pdf,

        Proper use and care of external condom catheter.
        The condom catheter is applied securely to avoid leakage and constriction for 24 hours. To avoid skin maceration and breakdown, the glans is washed daily when the condom is changed, the skin is aired for 20–30 minutes, and the condom is reapplied. To prevent pressure ulcers, alternate legs are used to anchor the tubing.

        Holister makes an external catheter that they call an "extended wear external catheter." Their recommendation is to change it every 24 hours. Then again, I would expect manufacturers of external catheters to recommend changing them every 24 hours, since that sells more catheters.

        In the end, best to ask your urologist.
        Last edited by gjnl; 09-21-2018, 05:25 PM.

        Comment


        • #19
          Originally posted by Brad09 View Post
          So what is the general consensus on re-using condom catheters? Is it ok to take them off a few times a day to intermittent cath and then put back on? Do they need to be replaced daily? What if you have a different leg bag you use at night so you only take the condom catheter on and off once a day, how many days can you use it?

          Also, are any of the answers to these questions backed up by urologists, studies, etc. or is it just whatever an individuals experience has been?
          I'm curious how you get a condom catheter off and back on at all? When I use them they are super sticky and they come off in a stickified tangle. I couldn't picture trying to put one back on, but maybe you're using a different product than I am used to.

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          • #20
            Originally posted by SCI-Nurse View Post
            Note that study was done in 1996...

            (KLD)
            Yes, I mentioned it was an older study.

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            • #21
              So I got my urodynamics appt made and they also scheduled a procedure where they look at the inside of my bladder with a camera to check for anything that may be wrong. I didn't ask for this specifically, I guess it was suggested by my urologist. Is this necessary or typical to have done in addition to the urodynamics? My 20% of both procedures is over $400 so I'm trying to figure out how critical the second procedure is.

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              • #22
                Originally posted by Brad09 View Post
                So I got my urodynamics appt made and they also scheduled a procedure where they look at the inside of my bladder with a camera to check for anything that may be wrong. I didn't ask for this specifically, I guess it was suggested by my urologist. Is this necessary or typical to have done in addition to the urodynamics? My 20% of both procedures is over $400 so I'm trying to figure out how critical the second procedure is.
                According to your profile, you were injured in 2012. I believe a cystoscopy, the second procedure you described above is recommended every 5 years to evaluate the anatomy of the bladder. So, it sounds like it is a reasonable procedure for you to have at this time.

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                • #23
                  Sorry to hijack the thread. I'm having leaking around my sp and very strong smelling urine.Dr ordered a UA and C&S. The results of the C&S are >100,000 cfu/ml Klebsiella pneumoniae ssp, 50,000 to 100,000 cfu/ml Morganella morganii ssp morganii. NP said that was ok no antibiotics ordered.

                  Comment


                  • #24
                    Originally posted by HACKNSACK44 View Post
                    Sorry to hijack the thread. I'm having leaking around my sp and very strong smelling urine.Dr ordered a UA and C&S. The results of the C&S are >100,000 cfu/ml Klebsiella pneumoniae ssp, 50,000 to 100,000 cfu/ml Morganella morganii ssp morganii. NP said that was ok no antibiotics ordered.
                    The nurse practitioner does not understand urinary tract infections in spinal cord injury, especially with a supra pubic catheter in place. Typically you should have physical symptoms potentially fever (although I've never had a fever with a urinary tract infection-I typically have severe autonomia, chilling, sweating, shaking, but temperature usually around 96-97 degrees), flank pain, generally feeling bad. If you are leaking either around the stoma and/or from the urethra, something is going on in your bladder to cause severe spasms. >100,000 cfu of Klebsiella is enough to treat for a urinary tract infection. Some physicians will treat at 50,000-100,000 cfu of a bacteria present because they understand complex urinary tract infections in spinal cord injury.

                    Have stones been ruled out?

                    I would request that the ordering physician review your symptoms and the urinalysis (UA) and culture & sensitivity (C&S) and evaluate the symptoms you are experiencing. You should not have to put up with a leaking supra pubic catheter. If that doesn't happen, consider seeing an infectious disease ID) physician. Over the years, I have had much better luck with ID physicians managing bladder infections than my urologists.

                    Comment


                    • #25
                      Originally posted by gjnl View Post
                      The nurse practitioner does not understand urinary tract infections in spinal cord injury, especially with a supra pubic catheter in place. Typically you should have physical symptoms potentially fever (although I've never had a fever with a urinary tract infection-I typically have severe autonomia, chilling, sweating, shaking, but temperature usually around 96-97 degrees), flank pain, generally feeling bad. If you are leaking either around the stoma and/or from the urethra, something is going on in your bladder to cause severe spasms. >100,000 cfu of Klebsiella is enough to treat for a urinary tract infection. Some physicians will treat at 50,000-100,000 cfu of a bacteria present because they understand complex urinary tract infections in spinal cord injury.

                      Have stones been ruled out?

                      I would request that the ordering physician review your symptoms and the urinalysis (UA) and culture & sensitivity (C&S) and evaluate the symptoms you are experiencing. You should not have to put up with a leaking supra pubic catheter. If that doesn't happen, consider seeing an infectious disease ID) physician. Over the years, I have had much better luck with ID physicians managing bladder infections than my urologists.
                      I never get a fever either. I'm leaking around the stoma but I'm still filing my bag up. In the morning I have atleast 1000ml in my bag but a chux pad soaking wet underneath my butt. The smell is really really bad. The NP works with the ID Dr. When I finished my last round of antibiotics a few months ago I asked the NP to run another UA and C&S and she said we don't recommend that. The leaking never stopped all the way after the last round of antibiotics. It was small amounts it has gotten worse over the past couple weeks. I'm calling the ID Dr. in the morning.

                      Comment


                      • #26
                        Originally posted by HACKNSACK44 View Post
                        I never get a fever either. I'm leaking around the stoma but I'm still filing my bag up. In the morning I have atleast 1000ml in my bag but a chux pad soaking wet underneath my butt. The smell is really really bad. The NP works with the ID Dr. When I finished my last round of antibiotics a few months ago I asked the NP to run another UA and C&S and she said we don't recommend that. The leaking never stopped all the way after the last round of antibiotics. It was small amounts it has gotten worse over the past couple weeks. I'm calling the ID Dr. in the morning.
                        Getting a urinalysis and a culture & sensitivity several days after you finish a course of antibiotics should be standard practice. Even after a 12 to 14 day course of antibiotics, some bacteria may remain and antibiotic treatment may need to be repeated, likely with a different antibiotic.

                        That said, you may want to be evaluated for bladder stones. Stones harbor bacteria and it is hard to get rid of an infection when you have stones.
                        Last edited by gjnl; 10-04-2018, 02:26 PM.

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                        • #27
                          Originally posted by gjnl View Post
                          That said, you may want to be evaluated for bladder stones. Stone harbor bacteria and it is hard to get rid of an infection when you have stones.
                          Got tested for stones in March.

                          IMPRESSION: NO DEFINABLE CALCIFICATIONS ARE PRESENT IN THE RENAL
                          PELVIS OR ALONG THE COURSE OF THE URETERS.
                          THE BOWEL GAS PATTERN IS NORMAL

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                          • #28
                            One last thing to throw in this thread that started last month - If you are getting frequent infections or are highly colonized then you would do well to consult with an infectious disease physician/provider. When you see infectious disease you could talk to them about why you have a high colony count of bacteria. Most infectious disease providers will not want to treat unless you have symptoms.

                            I have also heard that some people go to great lengths at cleaning their environment -bathroom-body- everything. I had a patient who got frequent infections and then when he got his bathroom cleaned on a regular basis his infection rate went down.

                            pbr
                            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                            Comment


                            • #29
                              Are there any articles that discuss complex urinary tract infections in spinal cord injuries? How to handle it.
                              Last edited by HACKNSACK44; 10-09-2018, 11:53 AM.

                              Comment


                              • #30
                                It is discussed in the clinical practice guideline on bladder management in SCI:

                                https://www.pva.org/CMSPages/GetFile...b-9c557bc21b34

                                Have you been evaluated for prostatitis by your urologist?

                                (KLD)
                                The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

                                Comment

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