Irrigation of continent catheterizable ileal pouches: tap water can replace sterile solutions because it is safe, easy, and economical.
BACKGROUND
Continent catheterizable ileal pouches require regular irrigations to reduce the risk of bacteriuria and urinary tract infections (UTIs).


OBJECTIVE
Our aim was to compare the UTI rate, patient friendliness, and costs of standard sterile irrigation versus irrigation with tap water.


METHODS
Twenty-three patients participated in a prospective randomized two-arm crossover single-center trial. Aseptic intermittent self-catheterization (ISC) combined with sterile sodium chloride (NaCl) 0.9% irrigation was compared with clean ISC and irrigation with tap water (H(2)O) during two study periods of 90 d each.


METHODS
Patients underwent daily pouch irrigations with NaCl 0.9% solution or tap water.


METHODS
Urine nitrite dipstick tests were evaluated daily; urine culture (UC) and patient friendliness were evaluated monthly. Costs were documented.


CONCLUSIONS
A total of 3916 study days with nitrite testing and irrigation were analyzed, 1876 (48%) in the NaCl arm and 2040 (52%) in the H(2)O arm. In the NaCl arm, 418 study days (22%) with nitrite-positive dipsticks were recorded, 219 d (11%) in the H(2)O arm, significantly fewer (p=0.01). Of the 149 UCs, 96 (64%) were positive, 48 in each arm, revealing a total of 16 different germs. All patients preferred the H(2)O method. Monthly costs were up to 20 times lower in the H(2)O arm.


CONCLUSIONS
Pouch irrigation with sterile NaCl 0.9% solution and tap water had comparable rates of positive UC. Irrigation with tap water significantly lowered the incidence of nitrite-positive study days and was substantially less costly and more patient friendly than NaCl irrigation. We therefore recommend the use of tap water (or bottled water) instead of sterile NaCl 0.9% solution for daily irrigation of continent catheterizable ileal pouches.


BACKGROUND
Australian New Zealand Clinical Trials Registry, ACTRN12610000618055, http://www.ANZCTR.org.au/ACTRN12610000618055.aspx.
Department of Urology, University of Bern, Switzerland.
Frédéric D
FD
Birkhäuser
Pascal
P
Zehnder
Beat
B
Roth
Leander
L
Schürch
Katharina
K
Ochsner
Rita
R
Willener
George N
GN
Thalmann
Fiona C
FC
Burkhard
Urs E
UE
Studer
D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage; D039021:Colonic Pouches; D017046:Cost Savings; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D007097:Imines; D008297:Male; D008875:Middle Aged; D009573:Nitrites / Q000652:urine; D017060:Patient Satisfaction; D011725:Pyridines / Q000008:administration & dosage; D012307:Risk Factors; D012648:Self Care / Q000191:economics / Q000379:methods; D012965:Sodium Chloride; D007507:Therapeutic Irrigation / Q000191:economics / Q000379:methods*; D014546:Urinary Catheterization / Q000191:economics / Q000379:methods*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000652:urine; D014881:Water Supply
D000890:Anti-Infective Agents; D007097:Imines; D009573:Nitrites; D011725:Pyridines; D012965:Sodium Chloride; C034213:octenidine