Evaluation of 3 methods of bladder irrigation to treat bacteriuria in persons with neurogenic bladder.
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.
Waites
Ken B
KB
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA. waites@path.uab.edu
Canupp
Kay C
KC
Roper
James F
JF
Camp
Susan M
SM
Chen
Yuying
Y
D019342:Acetic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001437:Bacteriuria / Q000188:drug therapy / Q000209:etiology / Q000628:therapy*; D015169:Colony Count, Microbial; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage / Q000627:therapeutic use; D011113:Polymyxins / Q000008:administration & dosage / Q000627:therapeutic use; D012965:Sodium Chloride / Q000008:administration & dosage / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000150:complications*; D007507:Therapeutic Irrigation / Q000379:methods*; D016482:Urinalysis; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D011113:Polymyxins; D012965:Sodium Chloride; D009355:Neomycin; D019342:Acetic Acid