title: Traditional Chinese medicine therapy reduces the catheter indwelling risk in dementia patients with difficult voiding symptoms.
abstract: BACKGROUND
  Dementia is an international health issue in elder people. Indwelling catheters to address voiding problems in patients with dementia introduce risks of urinary tract infection or urethral trauma. Traditional Chinese medicine (TCM) is widely used to treat difficult voiding symptoms in Taiwan. We investigated the long-term clinical effects of TCM for reducing the risk of indwelling catheterization in dementia patients with difficult voiding symptoms.
  
  
  METHODS
  We used National Health Insurance Research Database to conduct a retrospective study of dementia patients with difficult voiding symptoms between 1997 and 2012 in Taiwan. We collected medical data from the onset of dementia to post-catheter insertion. Cox regression proportional hazards model and cumulative incidence of the urinal catheterization curve were used to determine the association between catheter indwelling risk and TCM use.
  
  
  RESULTS
  Data from 11069 patients with dementia was assessed, and 3982 participants who received medication for relief voiding symptoms were categorized into 2 groups: 2121 (53.3%) were TCM users and 1861 (46.7%) were TCM non-users with a mean follow-up period of 7.25 years. Cox regression demonstrated that using TCM may decrease the need for indwelling catheterization in patients with dementia (adjusted hazards ratio (aHR) =0.58, 95% confidence interval (95% CI): 0.52-0.66) compared to TCM non-users. A relationship between longer TCM use and reduced urinary retention with indwelling catheter use was observed, especially in patients who used TCM for ≥200 days (aHR =0.46, 95% CI: 0.39-0.55). Ji-Sheng-Shen-Qi-Wan (aHR =0.44, 95% CI: 0.21-0.88), Wu-Ling-San (aHR =0.47, 95% CI: 0.16-0.92), Zhi-Bai-Di-Huang-Wan (aHR =0.50, 95% CI: 0.26-0.94), were the most 3 beneficial TCM formulae.
  
  
  CONCLUSIONS
  The results of this study suggest that TCM is associated with a reduced risk of indwelling catheterization in patients with dementia, with enhanced benefits from longer durations of TCM use.
authors.affiliation: Department of Chinese medicine, Taipei City Hospital, Ren-Ai Branch, Taipei City, Taiwan. Electronic address: gigilaskl@gmail.com.
authors.forename: Shun-Ku
authors.initials: SK
authors.lastname: Lin
authors.affiliation: Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan. Electronic address: m7587@adm.cgmh.org.tw.
authors.forename: Po-Hung
authors.initials: PH
authors.lastname: Lin
authors.affiliation: Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. Electronic address: hsurnai@gmail.com.
authors.forename: Ren-Jun
authors.initials: RJ
authors.lastname: Hsu
authors.affiliation: Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan. Electronic address: chuang20110617@yahoo.com.tw.
authors.forename: Heng-Chang
authors.initials: HC
authors.lastname: Chuang
authors.affiliation: Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: mento1218@gmail.com.
authors.forename: Jui-Ming
authors.initials: JM
authors.lastname: Liu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000706:statistics & numerical data; D015331:Cohort Studies; D016208:Databases, Factual; D003704:Dementia / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008516:Medicine, Chinese Traditional / Q000379:methods*; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013624:Taiwan; D013997:Time Factors; D014546:Urinary Catheterization / Q000706:statistics & numerical data*; D016055:Urinary Retention / Q000209:etiology / Q000628:therapy*