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Usefulness of Hydrastis for the prevention of encrustation of long-term indwelling catheters in persons with neurogenic bladder dysfunction: a case series



Virtually every person with a spinal cord injury (SCI) suffers from a neurogenic lower urinary tract dysfunction (NLUTD). In the long term, about 15% of persons with SCI depend on indwelling (suprapubic or transurethral) catheters for bladder management. About 50% of these patients suffer from catheter encrustation and blockage, which may become a vital threat for persons with SCI, as it can lead to septicemia or autonomic dysreflexia. Until today, no prophylaxis of catheter encrustations with an evidence-based proof of efficacy exists.

Case presentation

The homeopathic remedy Hydrastis, made from the goldenseal root, is used for the treatment of thick, mucous urine sediment. In four patients with tetraplegia (three female, one male) who managed NLUTD by suprapubic catheters, recurrent encrustations and catheter blockage occurred despite irrigation and medical treatment. Surgical urinary diversion was envisioned. Applying Hydrastis C30 once weekly as a long-term medication, in three of the four patients, catheter obstructions ceased, with a follow-up for at least 1 year. One patient is awaiting ileal conduit surgery.


According to the results of our case series, the application of Hydrastis seems to be beneficial in the prevention of encrustations of indwelling catheters in patients with SCI. As the treatment was effective and well tolerated, the problem is frequent, and effective solutions are scarce, a prospective trial seems justified.

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  1. 1.

    Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, et al. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol. 2016;69:324–33.

    Article  Google Scholar 

  2. 2.

    Krebs J, Wöllner J, Pannek J. Bladder management in individuals with chronic neurogenic lower urinary tract dysfunction. Spinal Cord. 2016;54:609–13.

    CAS  Article  Google Scholar 

  3. 3.

    Nomura S, Ishido T, Teranishi J, Makiyama K. Long-term analysis of suprapubic cystostomy drainage in patients with neurogenic bladder. Urol Int. 2000;65:185–9.

    CAS  Article  Google Scholar 

  4. 4.

    Feneley RC, Kunin CM, Stickler DJ. An indwelling urinary catheter for the 21st century. BJU Int. 2012;109:1746–9.

    Article  Google Scholar 

  5. 5.

    Vaidyanathan S, Soni BM, Hughes PL, Oo T. Fatal cerebral hemorrhage in a tetraplegic patient due to autonomic dysreflexia triggered by delay in emptying urinary bladder after unsuccessful intermittent catheterization by carer: lessons learned. Int Med Case Rep J. 2018;11:53–8.

    Article  Google Scholar 

  6. 6.

    Sinclair L, Hagen S, Cross S. Washout policies in long-term indwelling urinary catheterization in adults: a short version cochrane review. Neurourol Urodyn. 2011;30:1208–12.

    PubMed  Google Scholar 

  7. 7.

    Jus MS. Hydrastis Canadensis. In: Jus MS, editor. Praktische Materia Medica. 3rd ed. Zug: Homöosana; 2009. p. 938–43.

  8. 8.

    Getliffe KA. Bladder instillations and bladder washouts in the management of catheterized patients. J Adv Nurs. 1996;23:548–54.

    CAS  Article  Google Scholar 

  9. 9.

    Jamal M, Ahmad W, Andleeb S, Jalil F, Imran M, Nawaz MA, et al. Bacterial biofilm and associated infections. J Chin Med Assoc. 2018;81:7–11.

    Article  Google Scholar 

  10. 10.

    Sabbuba NA, Stickler DJ, Long MJ, Dong Z, Short TD, Feneley RJC. Does the valve regulated release of urine from the bladder decrease encrustation and blockage of indwelling catheters by crystalline proteus mirabilis biofilms? J Urol. 2005;173:262–6.

    CAS  Article  Google Scholar 

  11. 11.

    Pannek J, Göcking K, Bersch U. To clamp or not to clamp? Bladder management by suprapubic catheterization in patients with neurogenic bladder dysfunction. World J Urol. 2010;28:637–41.

    Article  Google Scholar 

  12. 12.

    Getliffe KA. The use of bladder wash-outs to reduce urinary catheter encrustation. Br J Urol. 1994;73:696–700.

    CAS  Article  Google Scholar 

  13. 13.

    Stickler DJ, Feneley RCL. The encrustation and blockage of long-term indwelling bladder catheters: a way forward in prevention and control. Spinal Cord. 2010;48:784–90.

    CAS  Article  Google Scholar 

  14. 14.

    Warren JW, Anthony WC, Hoopes JM, Muncie HL. Cephalexin for susceptible bacteriuria in afebrile, long-term catheterized patients. JAMA. 1982;248:454–8.

    CAS  Article  Google Scholar 

  15. 15.

    Laxminarayan R, Duse A, Wattal C, Zaidi AKM, Wertheim HFL, Sumpradit N, et al. Antibiotic resistance-the need for global solutions. Lancet Infect Dis. 2013;13:1057–98.

    Article  Google Scholar 

  16. 16.

    Belfield K, Betts H, Parkinson R, Bayston R. A tolerability and patient acceptability pilot study of a novel antimicrobial urinary catheter for long-term use. Neurourol Urodyn. 2019;38:338–45.

    CAS  Article  Google Scholar 

  17. 17.

    Westfall C, Flores-Mireles AL, Robinson JI, Lynch AJL, Hultgren S, Henderson JP, et al. The widely used antimicrobial Triclosan induces high levels of antibiotic tolerance in vitro and reduces antibiotic efficacy up to 100-fold in iivo. Antimicrob Agents Chemother. 2019;63:e02312–8.

    CAS  Article  Google Scholar 

  18. 18.

    Dinwiddie MT, Terry PD, Chen J. Recent evidence regarding triclosan and cancer risk. Int J Environ Res. Public Health. 2014;11:2209–17.

    Article  Google Scholar 

  19. 19.

    Milo S, Hathaway H, Nzakizwanayo J, Alves DR, Pérez Esteban P, Jones BV, et al. Prevention of encrustation and blockage of urinary catheters by Proteus mirabilis via pH-triggered release of bacteriophage. J Mater Chem B. 2017;5:5403–11.

    CAS  Article  Google Scholar 

  20. 20.

    Wang L, Zhang S, Keatch R, Corner G, Nabi G, Murdoch S, et al. In-vitro antibacterial and anti-encrustation performance of silver-polytetrafluoroethylene nanocomposite coated urinary catheters. J Hosp Infect. 2019;103:55–63.

    CAS  Article  Google Scholar 

  21. 21.

    Chakravarti A, Gangodawila S, Long MJ, Morris NS, Blacklock ARE, Stickler DJ. An electrified catheter to resist encrustation by Proteus mirabilis biofilm. J Urol. 2005;174:1129–32.

    Article  Google Scholar 

  22. 22.

    Smith JM. Indwelling catheter management: from habit-based to evidence-based practice. Ostomy Wound Manag. 2003;49:34–45.

    Google Scholar 

  23. 23.

    Endler PC, Bellavite P, Bonamin L, Jäger T, Mazon S. Replications of fundamental research models in ultra high dilutions 1994 and 2015-update on a bibliometric study. Homeopathy. 2015;104:234–45.

    Article  Google Scholar 

  24. 24.

    Jonas WB, Kaptchuck TJ, Linde K. A critical overview of homeopathy. Ann Intern Med. 2003;138:393–9.

    Article  Google Scholar 

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Correspondence to Jürgen Pannek.

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Pannek, J., Pannek-Rademacher, S. Usefulness of Hydrastis for the prevention of encrustation of long-term indwelling catheters in persons with neurogenic bladder dysfunction: a case series. Spinal Cord Ser Cases 7, 66 (2021).

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