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Lopez C, Trautner BW, Kulkarni PA. Managing External Urinary Catheters. Infect Dis Clin North Am 2024; 38:343-360. [PMID: 38599895 DOI: 10.1016/j.idc.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
This narrative review explores the use of external urinary catheters. These devices are available in various types and materials for male and female patients. The indications for the use of external urinary catheters include managing incontinence linked to overactive bladder and neurogenic lower urinary tract dysfunction. Contraindications to the use of external urinary catheters include urinary obstruction. Proper skin care and proactive infection control measures are necessary to prevent complications. The collection of a urine specimen for culture requires a standardized technique to prevent contamination. Clinician-led patient education on catheter management plays a important role in ensuring patient comfort and safety.
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Affiliation(s)
- Corina Lopez
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Boulevard, Suite 01Y, Houston, TX 77021, USA; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, USA
| | - Prathit A Kulkarni
- Medical Care Line, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Mailstop: MCL-111, Houston, TX 77030, USA; Department of Medicine, Infectious Diseases Section, Baylor College of Medicine, Houston, TX, USA.
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Qin X, Zhao H, Qin W, Qin X, Shen S, Wang H. Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial. Crit Care 2024; 28:162. [PMID: 38741134 DOI: 10.1186/s13054-024-04947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients. METHODS In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed. RESULTS The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05). CONCLUSION Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.
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Affiliation(s)
- Xingsong Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - He Zhao
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Wei Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Xinglei Qin
- Department of General Surgery, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Songying Shen
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Hongyu Wang
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China.
- Department of Emergency Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, 450053, China.
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Logan K. Understanding the challenges faced by men learning to live with clean intermittent self-catheterisation. Br J Nurs 2024; 33:S4-S8. [PMID: 38722016 DOI: 10.12968/bjon.2024.33.9.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Clean intermittent self-catheterisation (CISC) is considered the preferred option to an indwelling catheter for emptying the bladder in people with a range of voiding dysfunctions. CISC has a lower risk of complications and urinary tract infections. This narrative review of previous qualitative research explores the quality-of-life impacts and highlights the challenges that men face. It will provide nurses who teach CISC with some useful insights into the male experience and the issues of concordance and adherence. This will help to better inform and guide clinical practice in this specialist area of nursing practice.
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Affiliation(s)
- Karen Logan
- Nurse Consultant, Aneurin Bevan University Health Board, The Grange University Hospital, Cwmbran, at the time of writing and is now an Independent Nurse Consultant
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Roesler M, Fato P, Holm A. Catching Up With Clean Intermittent Catheterization: Guide to Products, Tips, and Tricks. NASN Sch Nurse 2024; 39:120-124. [PMID: 37997366 DOI: 10.1177/1942602x231212937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Clean intermittent catheterization (CIC) is the gold standard for the management of urinary retention. Students with special healthcare needs who require CIC can be supported by school nurses who have knowledge and expertise in the management of CIC including an understanding of available products, reinforcement of proper technique, and resources available to promote student independence. This article will discuss the variety and unique features of CIC products and tips to overcoming barriers in bladder management.
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Affiliation(s)
| | | | - Annie Holm
- Kennedy Krieger Institute, Baltimore, MD
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Wang J, Tang X, Zhang X, Meng Z. A case of purple urinary bag syndrome treated with non-antibiotic methods combined with bladder function training. Asian J Surg 2024; 47:2393-2394. [PMID: 38262793 DOI: 10.1016/j.asjsur.2024.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Affiliation(s)
- Junya Wang
- Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaojia Tang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xibin Zhang
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China.
| | - Zhaoxiang Meng
- Department of Rehabilitation Medicine, Clinical Medical College, Yangzhou University, Yangzhou, China.
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Feng ML, Gao L, Gao X. Knotting of the urethral catheter in an adult. Asian J Surg 2024; 47:2496-2497. [PMID: 38296681 DOI: 10.1016/j.asjsur.2024.01.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Mei-Lin Feng
- School of Food and Biological Engineering, Chengdu University, Chengdu, Sichuan, PR China
| | - Linlin Gao
- Faculty of International Studies, Henan Normal University, Xinxiang, Henan, PR China
| | - Xiaoshuai Gao
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
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Kim SW, Nam IC, Kim DR, Lee JS, Kim JJ, Kim BS, Choi GM, Park SE. Safety and efficacy of fluoroscopy-guided urethral catheterization in case of failed blind or cystoscopy-assisted urethral catheterization. Sci Rep 2024; 14:9406. [PMID: 38658695 PMCID: PMC11043067 DOI: 10.1038/s41598-024-60224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
This retrospective study evaluated the safety and efficacy of fluoroscopy-guided urethral catheterization in patients who failed blind or cystoscopy-assisted urethral catheterization. We utilized our institutional database between January 2011 and March 2023, and patients with failed blind or cystoscopy-assisted urethral catheterization and subsequent fluoroscopy-guided urethral catheterization were included. A 5-Fr catheter was inserted into the urethral orifice, and the retrograde urethrography (RGU) was acquired. Subsequently, the operator attempted to pass a hydrophilic guidewire to the urethra. If the guidewire and guiding catheter could be successfully passed into the bladder, but the urethral catheter failed pass due to urethral stricture, the operator determined either attempted again with a reduced catheter diameter or performed balloon dilation according to their preference. Finally, an appropriately sized urethral catheter was selected, and an endhole was created using an 18-gauge needle. The catheter was then inserted over the wire to position the tip in the bladder lumen and ballooned to secure it. We reviewed patients' medical histories, the presence of hematuria, and RGU to determine urethral abnormalities. Procedure-related data were assessed. Study enrolled a total of 179 fluoroscopy-guided urethral catheterizations from 149 patients (all males; mean age, 73.3 ± 13.3 years). A total of 225 urethral strictures were confirmed in 141 patients, while eight patients had no strictures. Urethral rupture was confirmed in 62 patients, and hematuria occurred in 34 patients after blind or cystoscopy-assisted urethral catheterization failed. Technical and clinical success rates were 100%, and procedure-related complications were observed in four patients (2.2%). The mean time from request to urethral catheter insertion was 129.7 ± 127.8 min. The mean total fluoroscopy time was 3.5 ± 2.5 min and the mean total DAP was 25.4 ± 25.1 Gy cm2. Balloon dilation was performed in 77 patients. Total procedure time was 9.2 ± 7.6 min, and the mean procedure time without balloon dilation was 7.1 ± 5.7 min. Fluoroscopy-guided urethral catheterization is a safe and efficient alternative in patients where blind or cystoscopy-assisted urethral catheterization has failed or when cystoscopy-urethral catheterization cannot be performed.
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Affiliation(s)
- Sang Woo Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - In Chul Nam
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea.
| | - Doo Ri Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - Jeong Sub Lee
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - Jeong Jae Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - Bong Su Kim
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - Guk Myung Choi
- Department of Radiology, Jeju National University School of Medicine, Jeju National University Hospital, 15, Aran 13-gil, Jeju, 63241, Republic of Korea
| | - Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, 11 Samjeongja-ro, Seongsan-gu, Changwon, 51472, Republic of Korea
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Maheshwari A, Jha N, Chaturvedula L. Comparison of digital and speculum-guided methods of transcervical Foley catheter insertion in primigravida undergoing cervical ripening at term gestation: a noninferiority randomized clinical trial. Am J Obstet Gynecol MFM 2024; 6:101349. [PMID: 38490333 DOI: 10.1016/j.ajogmf.2024.101349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/29/2024] [Accepted: 03/07/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Foley catheter insertion is frequently used for cervical ripening during the induction of labor. However, the insertion failure, safety, maternal side effects, complications, and satisfaction of digital compared with speculum-guided Foley catheter placement have not been evaluated in a large trial involving primigravida. OBJECTIVE The study aimed to compare the insertion failure rate of digital and speculum-based transcervical Foley catheter placement in primigravida. The co-primary outcome was insertion-associated pain. The secondary outcomes were the time required for successful insertion, maternal satisfaction, and maternal complications within 24 hours of Foley insertion. STUDY DESIGN This randomized, open-label, parallel-arm, noninferiority clinical trial was performed in a large tertiary care university hospital. Primigravida aged >18 years with term gestation (≥37 weeks) were included in this study. Additional inclusion criteria for enrollment in this study were singleton pregnancy with a cephalic presentation, intact membrane, a Bishop score of ≤5, and reassuring preinduction fetal heart rate tracing. All women planned for cervical ripening were assessed for eligibility and were randomized into digital or speculum arms. Foley catheter insertion was performed in a supine lithotomy position. Vaginal and cervical cleaning were performed before insertion. A 22-French Foley balloon catheter was guided digitally or via speculum to position the bulb at the level of the internal os using water-soluble lubricant. Insertion-associated pain was measured using a visual numeric rating scale, and maternal satisfaction was assessed using a set of questions. RESULTS Four hundred and sixty-nine pregnant women were assessed for eligibility, and 446 patients were enrolled and randomized. The median age of the parturients was 24 (19-40) and 24 (18-38) years, respectively. The body mass index, gestational age at randomization, the incidence of postdated pregnancy, and prerandomization Bishop scores were comparable. Insertion failure was observed in 24 (10.8%) and 17 (7.6%) women in digital and speculum arms, respectively (relative risk=1.41 [95% confidence interval, 0.78-2.55]; P=.25). Requirements of >1 attempt (5.4% vs 3.6%) followed by the change in hands (3.6% vs 2.7%) were the most common reasons for insertion failure. The median (interquartile range) visual numeric rating scale was comparable (6 [2-9] vs 5 [2-10]; P=.15). The time taken for successful insertion was similar (58 [12-241] vs 54 [10-281]; P=.30). 9.4% and 10.8% of women required additional methods of cervical ripening. More women in the speculum group (41.7% vs 33.2%; P=.06) felt a medium level of discomfort than the digital group. CONCLUSION Insertion failure and insertion-related pain in the digital approach were comparable to the speculum-guided approach for transcervical Foley catheter insertion in primigravida for cervical ripening. Nevertheless, maternal satisfaction was higher in the digital group because of a lesser level of discomfort.
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Affiliation(s)
- Apurva Maheshwari
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Nivedita Jha
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.
| | - Latha Chaturvedula
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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Sari C, Demirbağ BC. Investigation of anxiety levels in caregivers who perform clean intermittent catheterization on their children and affecting factors. Neurourol Urodyn 2024; 43:738-747. [PMID: 38238988 DOI: 10.1002/nau.25388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/20/2023] [Accepted: 12/21/2023] [Indexed: 03/21/2024]
Abstract
PURPOSE The study aimed to determine the anxiety levels of caregivers who performed clean intermittent catheterization (CIC) on their children and the factors affecting them. METHODS This descriptive study was conducted between January 6, and May 29, 2023 with caregivers of 42 patients who were followed up by the pediatric nephrology outpatient clinic of a university for CIC. The study data were collected using the "Participant Information Form" and the "State and Trait Anxiety Scale." RESULTS According to the results, of the children included in the study, 73.8% were female, 64.3% were diagnosed with spina bifida (SB), and 76.2% received CIC applications 4-6 times a day. All the caregivers were mothers, and 76.2% received CIC training from a doctor. However, 78.6% of them found the training insufficient, leading them to rely on self-experimentation when applying CIC to their own children. None of the caregivers received information or training on the CIC application from nurses, and there were no home visits or telephone counseling provided after the hospital discharge. The mean score for the state anxiety scale among the caregivers was 45.90 ± 10.57, while the mean score for the trait anxiety scale was 46.92 ± 8.43. Significantly higher mean trait anxiety scores were observed among caregivers with chronic diseases who did not receive training on the CIC application (p < 0.05). Additionally, caregivers of children who experienced 3-4 urinary tract infections (UTIs) within the last 3 months also had significantly higher mean trait anxiety scores (p < 0.05). The mean trait anxiety level scores of caregivers of children who had 3-4 UTIs in the last 3 months were significantly higher (p < 0.05). CONCLUSIONS It was concluded that caregivers' lack of training on CIC implementation, having chronic disease, and having frequent UTIs in their children were effective on anxiety levels.
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Affiliation(s)
- Canan Sari
- Department of Health Care Services, Elderly Care Program, Tonya Vocational School, Trabzon University, Trabzon, Turkey
| | - Birsel C Demirbağ
- Faculty of Health Sciences, Public Health Nursing AB, Karadeniz Technical University, Trabzon, Turkey
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Thiruchelvam N, Landauro MH, Biardeau X, Rovsing C, Hahn M, Nascimento OFD, Gardner S, Amarenco G, Bagi P. Improved emptying performance with a new micro-hole zone catheter in adult male intermittent catheter users: A comparative multi-center randomized controlled cross-over study. Neurourol Urodyn 2024; 43:464-478. [PMID: 38196237 DOI: 10.1002/nau.25383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/11/2024]
Abstract
AIMS To confirm the improved performance of the micro-hole zone catheter (MHZC) compared to a conventional eyelet catheter (CEC) in male users of clean intermittent catheterizations (CICs). METHODS Male self-catheterizing subjects, who used hydrophilic sleeved soft/flexible CIC as the only bladder emptying method, were enrolled into a multi-center, randomized, cross-over study performed across six European sites. Subjects tested the MHZC, featuring a drainage zone with 120 micro-holes and a CEC with two eyelets. The study consisted of four study visits (V0-V3), during which endpoints related to catheter performance (urinary flow-stops, bladder emptying, and intra-catheter pressure) were measured and two 4-week test periods at home (T1 and T2) where dipstick hematuria and user perception between catheters were evaluated. RESULTS Seventy-three male subjects with non-neurogenic and neurogenic bladder dysfunction (3:2) were enrolled. On average, catheterizations with the MHZC led to close to mean zero flow-stops compared to ≥1 flow-stops with the CEC, during both HCP- and self-led catheterizations (both p < 0.001). Residual urine at first flow-stop was significantly reduced for the MHZC compared to CEC (p = 0.001 and p = 0.004, for HCP- and self-led catheterizations, respectively). This was substantiated by a significantly smaller pressure peak at first flow-stop, a proxy for minimized mucosal suction (both HCP- and self-led catheterizations, p < 0.001). After home-use catheterizations, dipstick hematuria was comparable between catheters, whereas catheterizations were associated with significantly improved perception in favor of MHZC regarding bladder emptying, less blocking sensation, and improved hygienic catheterization compared to the CEC. CONCLUSION This study confirmed the evidence of improved bladder emptying with the MHZC compared to a CEC without the need to reposition the catheter. The MHZC therefore offers an enhanced benefit for the dependent CIC user securing complete bladder emptying in an uninterrupted free flow and reducing the need to reposition the catheter during emptying.
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Affiliation(s)
- Nikesh Thiruchelvam
- Department of Urology, NHS Foundation Trust, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | | | - Xavier Biardeau
- Centre Hospitalier Universitaire de Lille, Lille Cedex, France
| | | | - Markus Hahn
- ARTIMED Medical Consulting GmbH, Kassel, Germany
| | | | | | | | - Per Bagi
- Department of Urology, Rigshospitalet, København Ø, Denmark
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Awoyomi O, Wang Y, Bakare T, Bradbury A, Episcopia B, Castro-Auvet P, Fornek M, Quale J. Reduction in catheter-associated urinary tract infections following a diagnostic stewardship intervention. Am J Infect Control 2024; 52:255-257. [PMID: 37805028 PMCID: PMC10996837 DOI: 10.1016/j.ajic.2023.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
Catheter-associated urinary tract infections (CAUTIs) are a frequent hospital-acquired infection and public health concern. In an attempt to reduce the number of CAUTIs, an intervention that emphasized the appropriate laboratory evaluation by ordering providers was implemented. This intervention supplemented ongoing standard bundle protocols. Compared to the 16 months before the intervention, there was a significant decrease in the number of CAUTIs during the 12-month intervention period.
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Affiliation(s)
- Olubosede Awoyomi
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Yongsheng Wang
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Temilola Bakare
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Alison Bradbury
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - Briana Episcopia
- Department of Infection Prevention, NYC Health+Hospitals/Kings County, Brooklyn, NY.
| | - Patricia Castro-Auvet
- Department of Infection Prevention, NYC Health+Hospitals/Central Office, New York, NY
| | - Mary Fornek
- Department of Medicine, NYC Health+Hospitals/Kings County, Brooklyn, NY
| | - John Quale
- Department of Infection Prevention, NYC Health+Hospitals/Central Office, New York, NY
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Askew AL, Margulies SL, Agu I, LeCroy KM, Geller E, Wu JM. Patient Removal of Urinary Catheters After Urogynecologic Surgery: A Randomized Controlled Trial. Obstet Gynecol 2024; 143:165-172. [PMID: 37963385 DOI: 10.1097/aog.0000000000005454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/28/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To compare postoperative urinary retention rates in the early postoperative period between home and office catheter removal. Secondary outcomes included pain, difficulty, satisfaction, likelihood to use again, and health care utilization. METHODS We conducted a nonblinded, randomized controlled, noninferiority trial of women undergoing surgery for stress incontinence and prolapse from March 2021 to June 2022. Exclusion criteria were preoperative voiding dysfunction (need for self-catheterization or postvoid residual [PVR] greater than 150 mL), urethral bulking, and need for prolonged postoperative catheterization. Participants discharged with indwelling catheters because of an initial failed void trial were randomized 1:1 to home compared with office removal on postoperative day 3-4. For home removal, participants were instructed to remove the catheter at 7 am and to drink two glasses of water. If they had difficulty voiding 5 hours after catheter removal, they came to the office for a void trial. For office removal, participants returned for a backfill void trial with PVR assessment. Our primary outcome was rate of early postoperative urinary retention , defined as confirmed retention (PVR greater than half the voided volume) after catheter removal. Secondary outcomes were assessed at a 2-week call. Health care utilization (telephone calls and office visits) related to catheter issues was also assessed. At 80% power and α=0.05, we needed 100 participants (50/group) to detect a noninferiority margin of 11%. RESULTS Among 117 participants, the home (n=59) and office (n=58) removal groups were similar in mean age (60 years vs 61 years), mean body mass index (29 vs 30), pelvic organ prolapse quantification system stage 3 or 4, and proportion who underwent hysterectomy or apical suspension. Sling procedures were more common in the office group (45.8% vs 77.6%). For our primary outcome, the rate of early postoperative retention was 11.9% in the home group and 22.4% in the office group ( P =.13). Our predetermined noninferiority margin was greater than the upper bound of our 95% CI; thus, we conclude noninferiority of home removal. For secondary outcomes, the home removal group was more likely to report "no pain" ( P =.02) and "very likely" to use this method again ( P =.004). There were no differences in difficulty or satisfaction between groups. Number of nursing calls was not different ( P =.66); however, number of office visits was higher in the office group (median 0 [interquartile range 0-1] vs 1 [1-1], P <.001). CONCLUSION Postoperative urinary catheter removal by the patient at home was noninferior to office removal when early urinary retention rates were compared. Participants in the home removal group had fewer office visits and reported low pain, low difficulty, and high satisfaction. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , NCT04783012.
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Affiliation(s)
- Amy L Askew
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, University of North Carolina at Chapel Hill, and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
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Ebrahimnejad M, Ghahestani SM. Early Onset Clean Intermittent Catheterization May Decrease Prevalence and Severity of Urinary Concentration Defects in Myelomeningocele Patients with Neurogenic Bladder: A Retrospective Cohort Study. Urol J 2023; 20:408-411. [PMID: 37312599 DOI: 10.22037/uj.v20i.7537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/03/2023] [Indexed: 06/15/2023]
Abstract
PURPOSE Myelomeningocele is the most severe form of spina bifida. Management of urologic consequences of spina bifida is life long, demanding and costly for both the patient and the public health system. There is a paucity of data in the literature regarding concentration defects and their consequences on this disease. This paper aims to describe retrospectively the effect of early onset clean intermittent catheterization (CIC) in on the severity of urinary concentration defects in myelomeningocele patients with neurogenic bladder in a retrospective observational study. MATERIALS AND METHODS In this 10-year retrospective cohort study, children with myelomeningocele were selected with the Convenience sampling method. Demographic characteristics, polyuria index ratio (PIR) defined as 24 hour urine output of each patient divided by the maximum normal urine output of the same patient in a healthy state, and nocturnal polyuria index (NPI) were compared between early starters (< 2 years old) or late starters (≥ 2 years old) groups. RESULTS Seven patients who underwent cystoplasty were excluded and 130 patients (63.8% male, 5.4 ± 3.2 years old, 14.3 ± 2.83 Kg, 28.5% early onset CIC) were investigated. PIR > 1 in inset (1.7 ± 0.2 vs. 2.2 ± 0.5, P = 0.021) and outset (1.5 ± 0.32 vs. 2.5 ± 0.7, P = 0.004) were lower in early starters group than in late starters group. NPI in inset (0.2 ± 0.007 vs. 0.32 ± 0.10, P = 0.018) and outset (0.25 ± 0.15 vs. 0.42 ± 0.095, P = 0.007) were also lower in the early starters group. No further adverse events were reported during the follow-up period. CONCLUSION Early onset CIC is more effective than late-onset CIC in preserving the urinary ability of kidneys in myelomeningocele patients.
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Affiliation(s)
- Mohsen Ebrahimnejad
- Fellow of pediatric urology, Department of pediatric urology, Tehran University of Medical Sciences, Children Medical Center Hospital, Tehran, Iran.
| | - Seyyed Mohammad Ghahestani
- Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Ruan C, Shi S, Shen Z, Guo L, Gong L. Effect of precision management scheme based on the best evidence summary on reducing catheter-associated urinary tract infection. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1333-1342. [PMID: 38044644 PMCID: PMC10929873 DOI: 10.11817/j.issn.1672-7347.2023.230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Catheter-associated urinary tract infection (CAUTI) is an important cause of prolonged hospital stay, which increases economic and medical burden for patients and hospitals, and it is a key focus of hospital infection prevention and control. However, there are currently few studies that convert evidence-based scientific evidence on CAUTI prevention and control into clinical applications and evaluation on its practical effects in combination with standardized infection ratio (SIR), the critical indicator of infection prevention and control. This study aims to establish a precision management plan for reducing the incidence of CAUTI, driven by the findings of a comprehensive evidence summary, to apply this plan across all the nursing units within the entire hospital, followed by a comparative analysis of CAUTI incidence, SIR, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff before and after the implementation of the precision management plan. METHODS Based on a comprehensive review of the best evidence for preventing CAUTI, a precision management plan was meticulously developed through panel discussions and 2 rounds of expert consultations using Delphi technique. Subsequently, a historical control study was conducted to evaluate the plan's effectiveness. A total of 17 658 patients with indwelling urinary catheter in inpatient departments from January to December 2021 comprised the control group. These patients received standard nursing measures for CAUTI. Another 18 753 patients with indwelling urinary catheters in the inpatient departments from January to December 2022 comprised the intervention group, underwent the precision management scheme based on the best available evidence, to enhance CAUTI prevention. The incidence and SIR of CAUTI, the average duration of indwelling urinary catheter for each patient, and the compliance rate on hand hygiene protocols for medical staff were compared between the 2 groups. RESULTS Compared with the control group, the incidence of CAUTI in the intervention group was significantly decreased (0.48‰ vs 1.12‰, χ2=20.814, P<0.001), SIR was decreased in the intervention group (0.55 vs 1.37); the average duration of indwelling urinary catheter for each patient was significantly decreased [(4.33±1.55) d vs (4.43±1.79) d, t=11.941, P<0.001]. The ratio of compliance rate of medical staff with strict hand hygiene protocols higher than 95% in the intervention group was significantly higher than that in the control group (93.3% vs 83.3%, χ2=5.822, P=0.016). CONCLUSIONS The implementation of the precision management plan for reducing CAUTI based on a summary of the best available evidence on CAUTI prevention and control in patients with indwelling urinary catheters has found to be effective. This approach significantly reduces the incidence of CAUTI, reduces the average duration of indwelling urinary catheter, and enhances hand hygiene compliance among medical staff. It provides a scientific and efficient strategy for preventing and controlling CAUTI in the hospital, ultimately saving patients from unnecessary medical expense.
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Affiliation(s)
- Chunhong Ruan
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013.
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
| | - Shuangjiao Shi
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Zhiying Shen
- Department of Hematology, Third Xiangya Hospital, Central South University, Changsha 410013
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
| | - Lanping Guo
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013
- Neurology Intensive Critical Unit, Third Xiangya Hospital, Central South University, Changsha 410013, China
| | - Lina Gong
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha 410013.
- Neurology Intensive Critical Unit, Third Xiangya Hospital, Central South University, Changsha 410013, China.
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15
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Xu M, Zhang W, Sheng L, Hu M, Xu X. Biomimetic urine flow control can preserve bladder function in patients with indwelling catheterization. Medicine (Baltimore) 2023; 102:e36444. [PMID: 38050238 PMCID: PMC10695515 DOI: 10.1097/md.0000000000036444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023] Open
Abstract
For patients with long-term indwelling catheterization, bladder function will be affected. It is necessary to explore whether biomimetic urine flow control (BUFC) can improve bladder function in patients undergoing indwelling catheterization. A retrospective, data-only, cohort study was carried out. The patients admitted to the intensive care unit, who had retained catheter and been continuously using a urodynamic monitoring system for over 30 days were selected. They were divided into 2 groups based on whether they were using BUFC function. The urodynamic monitoring data of the 2 groups were compared and analyzed. A total of 30 patients were included in the final analysis, including 15 in the BUFC group and 15 in the unobstructed group. The Urinary Volume and maximal urinary flow rate of the unobstructed group showed a continuous downward trend, while the BUFC group remained stable, and there was a statistical difference (P < .05) between the 2 groups since day 20. The bladder ultrasound imaging showed that the bladder volume of the BUFC group did not decrease significantly on the 30th day. BUFC technology, which provided by a urodynamic monitoring system, has potential protective effects of the bladder function after indwelling catheterization.
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Affiliation(s)
- Minrong Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Wei Zhang
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Lingxiang Sheng
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Mahong Hu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Xiujuan Xu
- Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
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16
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Taylor Z, Snow Z, Musallam S, Thomas B, Zeltser I. Is Urethral Catheterization Necessary in Retzius-sparing Robot-assisted Radical Prostatectomy? Urology 2023; 182:133-135. [PMID: 37742850 DOI: 10.1016/j.urology.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/03/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE To analyze whether urethral catheter (UC)-free anastomosis during Retzius-sparing radical prostatectomy (RP) results in worsening immediate perioperative and postoperative complications. METHODS We retrospectively reviewed records of patients undergoing robotic-assisted RP with or without indwelling UC placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated. An independent t-test was used to compare continuous variables, and Pearson's chi-square test or Fisher exact test was used to compare categorical variables. RESULTS One hundred fifteen patients underwent robotic prostatectomy from January 2020 to June 2022. Sixty-two patients had both a UC for 12 hours postoperatively and a suprapubic catheter for 6days, while in 53 patients a UC was omitted. There was no significant difference noted between the groups regarding age, body mass index, American Society of Anesthesiology score, prostate-specific antigen, stage, node status, or positive margins. There were no significant differences in the rates of anastomotic leak, ileus, or urethral stricture. Patients had a significantly higher pad-free rate in the suprapubic catheter-only group (P = .04) at 3months. There was no difference in average number of pads used or the number using more than 1 pad/day. CONCLUSION Omission of urethral catheterization during Retzius-sparing RP is safe and doesn't result in an increased risk in perioperative or postoperative complications, but rather appears to be associated with a significantly improved 3-month pad-free rate.
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Affiliation(s)
| | - Zachary Snow
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Sami Musallam
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Brian Thomas
- Main Line Health System, MidLantic Urology, Wynnewood, PA
| | - Ilia Zeltser
- Main Line Health System, MidLantic Urology, Wynnewood, PA
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17
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Landauro MH, Tentor F, Pedersen T, Jacobsen L, Bagi P. Improved Performance With the Micro-Hole Zone Intermittent Catheter: A Combined Analysis of 3 Randomized Controlled Studies Comparing the New Catheter Technology With a Conventional Eyelet Catheter. J Wound Ostomy Continence Nurs 2023; 50:504-511. [PMID: 37966080 PMCID: PMC10681284 DOI: 10.1097/won.0000000000001029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE To assess the performance of a new urinary intermittent catheter (IC) prototype designed with a micro-hole drainage zone compared to a conventional eyelet catheter (CEC) in terms of flow-stop, bladder emptying, and hematuria. DESIGN Randomized controlled crossover studies. SUBJECT AND SETTING The sample comprised 15 male healthy volunteers (HV) and 15 IC users, along with 15 female HV and 15 IC users. The age range was lower for HV participants than for IC users (range: 20-57 years for HV vs 21-82 years for IC users). The study setting was the Department of Urology, located in Rigshospitalet, Copenhagen. METHODS Number of flow-stop incidents, residual urine volume at first flow-stop (RV1), and dipstick hematuria were measured during and after catheterization by a health care professional (HV) and by self-catheterisation (IC-users). Results from the 3 studies were combined for HV and IC users on RV1 and number of flow-stop incidents but separated on sex. For incidents of hematuria, an effect of underlying condition was assumed, and a combined analysis on sex was performed, separating HV and IC users. RESULTS When compared to the micro-hole drainage zone design, catheterizations with CEC resulted in a significantly higher mean RV1 (mean difference: 49 mL in males and 32 mL in females, both P < .001) and average number of flow-stop incidents (8 and 21 times more frequent for males and females, respectively, both P < .001). The likelihood for hematuria was 5.84 higher with CEC than with micro-hole drainage hole design, P = .053, during normal micturition in HV postcatheterization. No serious adverse events were reported. CONCLUSION The micro-hole drainage zone catheter provides IC users fewer premature flow-stops. This design feature reduces modifiable urinary tract infection risk factors, such as residual urine and micro-trauma; additional research is needed to determine its effects on bladder health.
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Affiliation(s)
- Malene Hornbak Landauro
- Correspondence: Malene Hornbak Landauro, PhD, Coloplast A/S, Holtedam 3, 3050 Humlebaek, Denmark ()
| | - Fabio Tentor
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Troels Pedersen
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Jacobsen
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Per Bagi
- Malene Hornbak Landauro, PhD, Coloplast A/S, Humlebæk, Denmark
- Fabio Tentor, PhD, Coloplast A/S, Humlebæk, Denmark
- Troels Pedersen, MS, Coloplast A/S, Humlebæk, Denmark
- Lotte Jacobsen, MS, Coloplast A/S, Humlebæk, Denmark
- Per Bagi, MD, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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18
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Averbeck MA, Kennelly M, Thiruchelvam N, Konstantinidis C, Chartier-Kastler E, Krassioukov A, Landauro M, Jacobsen L, Vaabengaard R, Islamoska S. Risk factors for urinary tract infections associated with lower quality of life among intermittent catheter users. Br J Nurs 2023; 32:S8-S16. [PMID: 37830866 DOI: 10.12968/bjon.2023.32.18.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Evidence shows that intermittent catheterisation (IC) for bladder emptying is linked to urinary tract infections (UTIs) and poor quality of life (QoL). AIM To investigate the association between UTI risk factors and QoL and patient-reported UTIs respectively. METHODS A survey was distributed to IC users from 13 countries. FINDINGS Among 3464 respondents, a significantly poorer QoL was observed when experiencing blood in the urine, residual urine, bowel dysfunction, recurrent UTIs, being female, and applying withdrawal techniques. A lower UTI risk was found when blood was not apparent in urine (RR: 0.63; 95% CI: 0.55-0.71), the bladder was perceived empty (RR: 0.83; 95% CI: 0.72-0.96), not having bowel dysfunction (RR: 0.86; 95% CI: 0.76-0.98), and being male (RR: 0.70; 95% CI: 0.62-0.79). CONCLUSION This study underlines the importance of risk factors and their link to QoL and UTIs, highlighting the need for addressing symptoms before UTIs become problematic.
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Affiliation(s)
| | - Michael Kennelly
- Professor and Director, Atrium Health, Carolinas Medical Center, Charlotte, NC, USA
| | | | | | - Emmanuel Chartier-Kastler
- Professor and Head of Urology, Sorbonne Université, Academic hospital Pitié Salpétrière, Paris, France
| | - Andrei Krassioukov
- Principal Investigator, Professor and Associate Director, International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, The University of British Columbia; GF Strong Rehabilitation Centre, Vancouver Coastal Health Authority; Division of Physical Medicine and Rehabilitation, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Malene Landauro
- Senior Medical Writer, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Lotte Jacobsen
- Principal Biostatistician, Clinical Strategies, Coloplast A/S, Humlebæk, Denmark
| | - Rikke Vaabengaard
- Lead Medical Specialist, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
| | - Sabrina Islamoska
- Senior Evidence Manager, Medical Affairs, Coloplast A/S, Humlebæk, Denmark
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19
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Le Garrec D, Chesnel C, Teng M, Lagnau P, Brouchet M, Chea M, Amarenco G, Hentzen C. [Intermittent catheterization: What are the environmental impacts and how can they be reduced?]. Prog Urol 2023; 33:533-540. [PMID: 37596127 DOI: 10.1016/j.purol.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION If the use of intermittent catheterization has revolutionized the prognosis of neuro-urology patients, it seems necessary to question the ecological cost of single-use catheters, in a process of decarbonization of the health sector. The aim of this work is to identify the environmental impact of intermittent catheterization and potential solutions to reduce it. METHODS A review of the literature on the environmental impact of intermittent catheterizations was conducted. Potential solutions to reduce this impact and possible alternatives were then studied based on data from the literature. RESULTS Only two studies were identified. The first estimated the amount of waste generated by intermittent catheterization in the USA to be between 4400 and 38,964 tons per year. The second study showed a higher overall environmental impact of thermoplastic polyurethane (TPU) catheters than polyvinyl chloride (PVC) catheters and catheters made from polyolefin material. Reuse of catheters would reduce the amount of waste, but the paucity of data does not allow us to determine if the incidence of urinary tract infection would be affected. Alternative micturition methods, in addition to the complications they may cause, require the use of collection bags or pads, which also have an environmental impact. Other treatments for dysuria exist, but the evidence is limited and does not cover all patient populations. CONCLUSION With limited alternatives, it appears essential to develop more environmentally friendly catheters.
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Affiliation(s)
- D Le Garrec
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France.
| | - C Chesnel
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Teng
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - P Lagnau
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Brouchet
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - M Chea
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - G Amarenco
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
| | - C Hentzen
- GRC 01, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, hôpital Tenon, Sorbonne Université, 75020 Paris, France
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20
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Santos-Pérez de la Blanca R, Medina-Polo J, González-Padilla D, Cano-Galán MM, Arrébola-Pajares A, Hernández-Arroyo M, Rodríguez-Antolín A. Evaluation of Quality of Life and Self-reported Complications in Patients With Clean Intermittent Catheterization: An Observational Study. J Wound Ostomy Continence Nurs 2023; 50:400-405. [PMID: 37713351 DOI: 10.1097/won.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
PURPOSE This study sought to determine health-related quality of life and self-reported complications associated with clean intermittent catheterization (CIC). DESIGN Observational, cross-sectional study. SUBJECTS AND SETTING The target population was patients cared for by the urology department at Hospital 12 de Octubre in Madrid, Spain, undergoing CIC for chronic urinary retention of any etiology (neurogenic bladder dysfunction, neobladder, and other). The sample comprised 50 respondents with a mean age of 49 years; a majority (66%, n = 33) were female. Participants performed an average of 4 CICs. METHODS All participants completed the ISC-Q (Intermittent Self-Catheterization Questionnaire) and a questionnaire about CIC-associated complications. Data were collected in February 2019. RESULTS A vast majority of respondents (98%, n = 49) indicated preparation for catheterization was simple, and 76% (n = 38) indicated the catheter was easy to insert. One in 5 (20%, n = 10) considered carrying catheters and supplies inconvenient, though 58% (n = 29) indicated it was easy to dispose of the catheters outside the home. Most respondents (98%, n = 49) indicated they felt self-conscious about their need to self-catheterize, and 16% (n = 8) felt that CIC created limitations when visiting friends and family. The most frequent complication was symptomatic urinary tract infections (UTIs); participants reported an average of 1.7 UTIs in the last year. Additional complications, such as epididymo-orchitis, urethral stenosis, and urethral bleeding, were reported by less than 5% (n = 2) of participants. CONCLUSIONS Participants managed by CIC for chronic urinary retention of any cause reported acceptable levels of satisfaction with the procedure. The reported incidence of complications was low, except for UTIs.
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Affiliation(s)
- Rocío Santos-Pérez de la Blanca
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - José Medina-Polo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Daniel González-Padilla
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - María Mercedes Cano-Galán
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Ana Arrébola-Pajares
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Mario Hernández-Arroyo
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
| | - Alfredo Rodríguez-Antolín
- Rocío Santos-Pérez de la Blanca, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- José Medina-Polo, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Daniel González-Padilla, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- María Mercedes Cano-Galán, Nurse, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Ana Arrébola-Pajares, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Mario Hernández-Arroyo, MD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
- Alfredo Rodríguez-Antolín, PhD, Department of Urology, University Hospital 12 de Octubre Imas12, Madrid, Spain
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Popiel P, Swallow C, Choi JE, Jones K, Xu X, Harmanli O. Assessment of patient satisfaction with home vs office indwelling catheter removal placed for urinary retention after female pelvic floor surgery: a randomized controlled trial. Am J Obstet Gynecol 2023; 229:312.e1-312.e8. [PMID: 37330128 DOI: 10.1016/j.ajog.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 05/10/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Postoperative urinary retention is burdensome for patients. We seek to improve patient satisfaction with the voiding trial process. OBJECTIVE This study aimed to assess patient satisfaction with location of indwelling catheter removal placed for urinary retention after urogynecologic surgery. STUDY DESIGN All adult women who were diagnosed with urinary retention requiring postoperative indwelling catheter insertion after undergoing surgery for urinary incontinence and/or pelvic organ prolapse were eligible for this randomized controlled study. They were randomly assigned to catheter removal at home or in the office. Those who were randomized to home removal were taught how to remove the catheter before discharge, and were discharged home with written instructions, a voiding hat, and 10-mL syringe. All patients had their catheter removed 2 to 4 days after discharge. Those patients who were allocated to home removal were contacted in the afternoon by the office nurse. Subjects who graded their force of urine stream 5, on a scale of 0 to 10, were considered to have safely passed their voiding trial. For patients randomized to the office removal group, the voiding trial consisted of retrograde filling the bladder to maximum they could tolerate up to 300 mL. Urinating >50% of instilled volume was considered successful. Those who were unsuccessful in either group had catheter reinsertion or self-catheterization training in the office. The primary study outcome was patient satisfaction, measured based on patients' response to a question, "How satisfied were you with the overall removal process of the catheter?" A visual analogue scale was created to assess patient satisfaction and 4 secondary outcomes. A sample size of 40 participants per group were needed to detect a 10 mm difference in satisfaction between groups on the visual analogue scale. This calculation provided 80% power and an alpha of 0.05. The final number accounted for 10% loss to follow up. We compared the baseline characteristics, including urodynamic parameters, relevant perioperative indices, and patient satisfaction between the groups. RESULTS Of the 78 women enrolled in the study, 38 (48.7%) removed their catheter at home and 40 (51.3%) had an office visit for catheter removal. Median and interquartile range for age, vaginal parity, and body mass index were 60 (49-72) years, 2 (2-3), and 28 (24-32) kg/m2, respectively, in the overall sample. Groups did not differ significantly in age, vaginal parity, body mass index, previous surgical history, or type of concomitant procedures. Patient satisfaction was comparable between the groups, with a median score (interquartile range) of 95 (87-100) in the home catheter removal group and 95 (80-98) in the office catheter removal group (P=.52). Voiding trial pass rate was similar between women who underwent home (83.8%) vs office (72.5%) catheter removal (P=.23). No participants in either group had to emergently come into the office or hospital due to inadequate voiding afterwards. Within 30 days post operatively, a lower proportion of women in the home catheter removal group (8.3%) had urinary tract infection, compared to patients in the office catheter removal group (26.3%) (P=.04). CONCLUSION In women with urinary retention after urogynecologic surgery, there is no difference in satisfaction concerning the location of indwelling catheter removal when comparing home and office.
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Affiliation(s)
- Patrick Popiel
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY.
| | | | - Jennie Eunsook Choi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Keisha Jones
- Department of Obstetrics and Gynecology, Baystate Medical Center, University of Massachusetts Medical School, Springfield, MA
| | - Xiao Xu
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY; Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
| | - Oz Harmanli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT
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Takahashi R, Sekido N, Matsuoka M, Sengoku A, Nomi M, Matsuyama F, Murata T, Kitta T, Mitsui T. Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan. Low Urin Tract Symptoms 2023; 15:165-172. [PMID: 37300392 DOI: 10.1111/luts.12490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/15/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI). METHODS We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI. RESULTS Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI. CONCLUSIONS There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.
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Affiliation(s)
| | - Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Mihoko Matsuoka
- Department of Rehabilitation Medicine, Aijinkai Rehabilitation Hospital, Osaka, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | - Masashi Nomi
- Department of Urology, Hyogo Prefectural Central Rehabilitation Hospital, Hyogo, Japan
| | | | | | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Hokkaido, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Yamanashi, Japan
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23
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Di Matteo R, Caccamo I, Arcidiacono S, Bertin G, Chiamosa E, Valenti F, Mugone S, De Piaggia A, Daniele A, Clara M, Gatti D, Bolgeo T, Maconi A. [Assessing the impact of bladder ultrasound on catheter-associated urinary tract infections and health-care costs: an observational pre-post study]. Assist Inferm Ric 2023; 42:131-136. [PMID: 37721338 DOI: 10.1702/4095.40917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
. Assessing the impact of bladder ultrasound on catheter-associated urinary tract infections and health-care costs: an observational pre-post study. INTRODUCTION The placement of a urinary catheter is a standard procedure, but it can cause discomfort, increase the risk of infections and costs. Pelvic ultrasound is a non-invasive assessment of the bladder and bladder catheter placement that can be performed by nurses. AIM To assess the appropriateness of urinary catheter placement using bladder ultrasound, to monitor urinary catheter-associated urinary tract infections and costs associated with catheter use. METHODS A single-centre pre-post observational study was conducted from September 2021 to August 2022 in patients aged >18 years requiring urinary monitoring; the first 6 months patients were assessed without the use of bladder ultrasound (control group), while the last 6 months with bladder ultrasound. RESULTS 189 patients were included in the pre-ultrasound group and 175 patients in the post-ultrasound group; the demographic and clinical characteristics of the two groups were comparable. The rate of inappropriate catheterisation was 22.6% in the pre-group, whereas no inappropriate catheterisation was performed in the post-group. There was a 2.2% of absolute reduction in the rate of urinary tract infections (from 8.5% to 6.3%). Costs associated with the use of urinary catheters were reduced by 74.2% (from 173 to 44.8 euros). CONCLUSIONS Bladder ultrasound in clinical practice is feasible and reduced the inappropriate use of bladder catheters, reducing patient risks and healthcare costs.
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Affiliation(s)
- Roberta Di Matteo
- Infrastruttura Ricerca, Formazione e Innovazione, Dipartimento delle Attività Integrate Ricerca e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Irene Caccamo
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Simona Arcidiacono
- S.C. Direzione delle Professioni Sanitarie, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Giovanna Bertin
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Elena Chiamosa
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Francesca Valenti
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Sara Mugone
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Alessia De Piaggia
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Assunta Daniele
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Miriana Clara
- Medicina Interna, Struttura Complessa a Direzione Universitaria S.C.D.U., Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Denise Gatti
- Infrastruttura Ricerca, Formazione e Innovazione, Dipartimento delle Attività Integrate Ricerca e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Tatiana Bolgeo
- Infrastruttura Ricerca, Formazione e Innovazione, Dipartimento delle Attività Integrate Ricerca e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
| | - Antonio Maconi
- Direzione del Dipartimento delle Attività Integrate Ricerca e Innovazione, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italia
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Cunnane EM, Cunnane CV, Allardyce JM, Croghan SM, Walsh MT, Davis NF, Flood HD, Mulvihill JJE. Mechanical and morphological characterisation of porcine urethras for the assessment of paediatric urinary catheter safety. J Mech Behav Biomed Mater 2023; 143:105923. [PMID: 37270901 DOI: 10.1016/j.jmbbm.2023.105923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
Paediatric urinary catheters are often necessary in critical care settings or to address congenital anomalies affecting the urogenital system. Iatrogenic injuries can occur during the placement of such catheters, highlighting the need for a safety device that can function in paediatric settings. Despite successful efforts to develop devices that improve the safety of adult urinary catheters, no such devices are available for use with paediatric catheters. This study investigates the potential for utilising a pressure-controlled safety mechanism to limit the trauma experienced by paediatric patients during inadvertent inflation of a urinary catheter anchoring balloon in the urethra. Firstly, we establish a paediatric model of the human urethra using porcine tissue by characterising the mechanical and morphological properties of porcine tissue at increasing postnatal timepoints (8, 12, 16 and 30 weeks). We identified that porcine urethras harvested from pigs at postnatal week 8 and 12 exhibit morphological properties (diameter and thickness) that are statistically distinct from adult porcine urethras (postnatal week 30). We therefore utilise urethra tissue from postnatal week 8 and 12 pigs as a model to evaluate a pressure-controlled approach to paediatric urinary catheter balloon inflation intended to limit tissue trauma during inadvertent inflation in the urethra. Our results show that limiting catheter system pressure to 150 kPa avoided trauma in all tissue samples. Conversely, all of the tissue samples that underwent traditional uncontrolled urinary catheter inflation experienced complete rupture. The findings of this study pave the way for the development of a safety device for use with paediatric catheters, thereby alleviating the burden of catastrophic trauma and life changing injuries in children due to a preventable iatrogenic urogenital event.
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Affiliation(s)
- Eoghan M Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland.
| | - Connor V Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - Joanna M Allardyce
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Michael T Walsh
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland; Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Hugh D Flood
- Class Medical Limited, Unit 1 D, Annacotty Business Park, Co, Limerick, Ireland
| | - John J E Mulvihill
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
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25
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Gray J, Rachakonda A, Karnon J. Pragmatic review of interventions to prevent catheter-associated urinary tract infections (CAUTIs) in adult inpatients. J Hosp Infect 2023; 136:55-74. [PMID: 37015257 DOI: 10.1016/j.jhin.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common hospital-acquired complications. Insertion of a urinary catheter and the duration of catheterization are the main risk factors, with catheter-associated UTIs (CAUTIs) accounting for 70-80% of hospital-acquired UTIs. Guidance is available regarding the prevention of hospital-acquired CAUTIs; however, how best to operationalize this guidance remains a challenge. AIM To map and summarize the peer-reviewed literature on model-of-care interventions for the prevention of CAUTIs in adult inpatients. METHODS PubMed, CINAHL and SCOPUS were searched for articles that reported UTI, CAUTI or urinary catheter outcomes. Articles were screened systematically, data were extracted systematically, and interventions were classified by intervention type. FINDINGS This review included 70 articles. Interventions were classified as single component (N=19) or multi-component (N=51). Single component interventions included: daily rounds or activities (N=4), protocols and procedure changes (N=6), reminders and order sets (N=5), audit and feedback interventions (N=3), and education with simulation (N=1). Overall, daily catheter reviews and protocol and procedure changes demonstrated the most consistent effects on catheter and CAUTI outcomes. The components of multi-component interventions were categorized to map common elements and identify novel ideas. CONCLUSION A range of potential intervention options with evidence of a positive effect on catheter and CAUTI outcomes was identified. This is intended to provide a 'menu' of intervention options for local decision makers, enabling them to identify interventions that are relevant and feasible in their local setting.
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Affiliation(s)
- J Gray
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
| | - A Rachakonda
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - J Karnon
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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26
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Thompson JM, Gonzalez Ciscar A, Hendry JL. An atraumatic technique for re-inserting the displaced suprapubic catheter using an intravenous cannula and sensor guidewire. Ann R Coll Surg Engl 2023; 105:477-478. [PMID: 36394532 PMCID: PMC10149255 DOI: 10.1308/rcsann.2022.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
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Davis M, Jethani L, Robbins E, Kaner M. Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. Top Spinal Cord Inj Rehabil 2023; 29:94-107. [PMID: 36819923 PMCID: PMC9936901 DOI: 10.46292/sci22-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Background The belief that intermittent catheterization results in fewer infections than indwelling catheters is commonly expressed in the spinal cord injury literature. Some practice guidelines strongly recommend intermittent over indwelling catheterization due to concerns about infections and other complications. However, studies on this topic are of low quality. Guidelines from the Consortium for Spinal Cord Medicine suggest the data regarding infection risk are mixed, and they do not recommend one bladder management method over the other. Objectives To compare risk of bias in studies reporting higher rates of urinary tract infection (UTI) with indwelling catheters to studies that found equal rates of UTI between indwelling and intermittent catheterization, and to describe implications in clinical decision-making. Methods A systematic search of PubMed, CINAHL, Embase, and SCOPUS databases from January 1, 1980, to September 15, 2020, was conducted. Eligible studies compared symptomatic UTI rates between indwelling and intermittent catheterization. We used a risk of bias assessment tool to evaluate each study. Results Twenty-four studies were identified. Only three of these reported significantly higher UTI risk with indwelling catheters, and all three demonstrated a critical risk of bias. More than half of the studies reported differences in UTI risk of less than 20% between the two methods. Studies with larger (nonsignificant) differences favoring intermittent catheterization were more susceptible to bias from confounding. Conclusion The hypothesis that indwelling catheters cause more UTIs than intermittent catheterization is not supported by the scientific literature. Most studies failed to demonstrate a significant difference in UTI risk, and studies with nonsignificant trends favoring intermittent catheterization were more susceptible to bias from confounding. Perceived risk of infection should not influence a patient's choice of catheter type.
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Affiliation(s)
- Matthew Davis
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Lavina Jethani
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Emily Robbins
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
| | - Mahmut Kaner
- Department of Physical Medicine and Rehabilitation, McGovern Medical School, Houston, Texas
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Plata M, Santander J, Zuluaga L, Torres-Sandoval C, Valencia S, Azuero J, Trujillo CG. Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections. World J Urol 2023; 41:491-499. [PMID: 36547679 DOI: 10.1007/s00345-022-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is associated with an increased risk of urinary tract infections (UTI), urethral trauma, urethral stenosis, hematuria, and pain. The first catheters were developed of polyvinyl carbon (PVC). Several types of catheters have been developed to reduce these complications, such as those with hydrophilic coating. OBJECTIVE To conduct a systematic review and meta-analysis to evaluate the effectiveness of hydrophilic coated catheters compared to uncoated catheters on the rate of UTI in patients using CIC. METHODOLOGY A systematic literature search was performed in OVID, Embase, Scopus, Web of Science, PubMed, and CENTRAL databases. Randomized controlled trials (RCTs) or randomized crossover trials comparing UTI and hematuria rates in patients using hydrophilic vs. non-hydrophilic catheters for CIC were identified. The selected trials were evaluated for risk of bias using the "Revised Cochrane risk-of-bias tool for randomized trials (RoB 2)." The results were expressed as a risk ratio (RR) with a 95% confidence interval (CI), under a random-effects model. Data were analyzed using Review Manager 5.4 software. RESULTS Nine studies with a total of 525 patients in CIC were analyzed. Overall, the use of hydrophilic catheters had a lower risk of UTIs compared to uncoated catheters (RR = 0.78; 95% CI 0.62-0.97; I2 = 37%). Five of the studies include patients > 18 years, showing a reduction of UTIs with the use of hydrophilic catheters (RR = 0.83; 95% CI 0.74-0.93; I2 = 0%). There was no difference in UTI development when comparing single-use uncoated vs hydrophilic catheters. However, heterogeneity was high (RR = 0.77; 95% CI 0.59-1.00; I2 = 57%). Regarding hematuria risk reduction, we were unable to identify differences between the use of hydrophilic catheters compared to uncoated catheters (RR = 1.02; 95% CI 0.66-1.60). CONCLUSION We found a risk reduction of UTIs associated with using hydrophilic catheters in adults, with low heterogeneity. Regarding hematuria, significant differences were not proved. We do not find a significant difference in UTI risk reduction in the pediatric population. Urethral trauma presence could not be meta-analyzed due to a lack of information reported.
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Affiliation(s)
- Mauricio Plata
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia.
| | - Jessica Santander
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
- Universidad del Rosario, Bogotá D.C., Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Camilo Torres-Sandoval
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Sergio Valencia
- Department of Radiology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Bogotá D.C., Colombia
| | - Julián Azuero
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
| | - Carlos Gustavo Trujillo
- Department of Urology, Hospital Universitario Fundación Santa Fe de Bogotá and Universidad de los Andes School of Medicine, Carrera 7 No. 118-09, Unidad Renal, Piso 3, 110111, Bogotá D.C., Colombia
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Baradaran N, Peng J, Palettas M, Chen Y, DeVivo MJ, Schwab JM. Bladder Management With Chronic Indwelling Catheter is Associated with Elevated Mortality in Patients with Spinal Cord Injury. Urology 2022; 165:72-80. [PMID: 35263641 DOI: 10.1016/j.urology.2022.01.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the impact of bladder management method, specifically chronic indwelling catheter (IndC), on survival in patients with spinal cord injury (SCI) in Spinal Cord Injury Model System database. METHODS Spinal Cord Injury Model System is a multicenter longitudinal database since 1970 with >40,000 patients with SCI. Adult patients (>18 at the time of injury) were screened. Patients who died within 1 year of injury and had 2 or more changes in method of bladder management, or reported normal volitional void were excluded. Outcome of interest was death from nonpulmonary, nonwound related sepsis (NPNWS). Left truncation cox regression method using age as the time-scale was used to calculate hazard ratios. RESULTS A total of 13,616 patients were included. Comparison was performed between "IndC" group (n = 4872; 36.1%) vs "Other" (n = 8744; 63.9%). After adjusting for age and change in bladder management method, "IndC" is associated with elevated NPNWS mortality (2.10; 95% confidence interval 1.72-2.56, P < .001). Multivariable analysis, adjusting for age at injury, gender, race, education, insurance status, etiology of SCI, injury level, neurologic impairment level, and change in bladder management method, showed IndC was associated with significantly higher risk of death from NPNWS compared to other methods of bladder management. CONCLUSION In a large cohort of SCI patients, bladder management with IndC is predictive of significantly propagated NPNWS related mortality compared to other methods of bladder management. While identifying IndC is an independent mortality risk factor, a better understanding of the underlying mechanisms could inform strategies to improve neurourological care and survival after SCI.
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Affiliation(s)
- Nima Baradaran
- Department of Urology, The Ohio State University, Wexner Medical Center, Columbus, OH.
| | - Juan Peng
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Marilly Palettas
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - YuYing Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL
| | - Jan M Schwab
- Belford Center for Spinal Cord Injury, Departments of Neurology, Physical Medicine and Rehabilitation, Neuroscience and Center for Brain and Spinal Cord Repair, The Neurological Institute, The Ohio State University, Wexner Medical Center, Columbus, OH
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Buckon CE, Koscielniak NJ, Tucker CA, Aiona MD. Mode of Anesthesia and Bladder Management Following Orthopaedic Surgery in Children With Cerebral Palsy: A System Level Analysis. J Pediatr Orthop 2022; 42:e544-e549. [PMID: 35220337 DOI: 10.1097/bpo.0000000000002108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Postoperative urinary retention (POUR) is a surgical complication more prevalent in children with neurodisability and associated with an increase length of hospitalization. Risk factors include pre-existing bladder dysfunction, type and duration of surgery, anesthesia medications, postoperative opioid pain management, and patient demographics. The purpose of this investigation was (1) to determine the frequency of POUR following hip/lower limb orthopaedic procedures in which epidural analgesia was used for pain management; (2) to explore factors influencing postoperative bladder management. METHODS A retrospective analysis of clinical data was performed in an orthopaedic specialty care health care system. A health outcomes network was queried for patients with a diagnoses of cerebral palsy (ICD-9/10 codes) who had one of 57 unique CPT procedure codes corresponding to hip osteotomies or tenotomies from 2011 to 2019. All surgical observations included in analysis required a discrete data element and the confirmation of a secondary proxy. The database was also queried for postoperative medications received and patient demographics of interest. RESULTS A total of 704 surgical procedures met inclusion criteria resulting in a patient population with a mean age of 11 years, 58% male, 53% Caucasian, and 55% classified as quadriplegia [51% Gross Motor Function Classification System (GMFCS) levels IV/V]. Three hundred and thirty-five procedures (48%) involved epidural anesthesia. Sixty-five patients required intermittent catheterization (9.2%) postoperatively following foley catheter removal, of which 23 (3.3%) required recatheterization. The rate of recatheterization was similar regardless of anesthesia mode; 1.8% for general and 1.4% for epidural and was associated with a greater number of pain medications. Epidural anesthesia resulted in significantly longer periods of catheterization. For the total group the time to urinary catheter removal differed significantly among cerebral palsy subtypes, GMFCS Level, race, and ethnicity. Factors identified as significant predictors of the length of catheterization were epidural analgesia, number of pain medications, and osteotomy. CONCLUSIONS The number of postoperative pain medications utilized was more predictive of POUR than the mode of analgesia delivery; however, epidural analgesia and the type of surgical procedure did significantly impact the length of catheterization. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Nikolas J Koscielniak
- Wake Forest School of Medicine, Clinical and Translational Science Institute, Winston-Salem, NC
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Sugarbaker PH, Sabri S, Khan AA, Aljundi MN, Chang G. Two methodologies of the rendezvous procedure to establish ureteral continuity from a delayed ureteral leak following pelvic surgery. Surg Oncol 2022; 40:101697. [PMID: 35030409 DOI: 10.1016/j.suronc.2021.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/17/2021] [Accepted: 12/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Ureteral trauma recognized in the operating theater is managed, for the most part, at the same surgical procedure oftentimes with urologic consultation. A delayed urine leak presents unique problems in that direct access to the site of the leak is not possible except by a reoperative procedure. METHODS In patients who develop delayed urine leakage following cancer surgery, the leakage may be controlled by the collaborative efforts of a urologist and interventional radiologist. Success depends on placement of a nephroureteral stent by the rendezvous procedure. RESULTS The sequence of procedures to reestablish ureteral continuity following a delayed leak are important in the successful placement of a nephroureteral stent. In the first methodology, through a percutaneous nephrostomy, a guidewire is placed in the ureter and down to the ureteral defect. The guidewire is then recovered and advanced into the bladder using a ureteroscope and grasping forceps. A nephroureteral stent is placed over the guidewire to bridge the gap and stent the ureteral defect. In the second methodology, the urologist passed a guidewire into the distal ureter, out of the ureteral defect, and into the free peritoneal space. Under fluoroscopic control, the wire loop must snare the ureteral guidewire and pull it out at the percutaneous nephrostomy. The nephroureteral stent is passed over the ureteral wire into the bladder. CONCLUSIONS Two different methodologies were described to complete the rendezvous procedure. It can be successful a large percentage of the time with a delayed ureteral leakage. Success requires a combined interventional radiology and urologic procedure.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancies, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Saher Sabri
- Department of Interventional Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Arshad A Khan
- Department of Interventional Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Moutasem N Aljundi
- Department of Interventional Radiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - George Chang
- Department of Urology, MedStar Washington Hospital Center, Washington, DC, USA
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Zelnik Yovel D, Glotsman G, Love IY, Darnell N, Rapoport MJ. Indwelling Urinary Catheter and Dementia Are Associated with Enterococcal Urinary Tract Infections in Hospitalized Patients. Isr Med Assoc J 2021; 23:708-713. [PMID: 34811986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The recent increase in enterococcal urinary tract infections (EUTI) and the potential morbidity and mortality associated with inappropriate antimicrobial treatment underscores the need for early risk assessment and institution of appropriate empirical antimicrobial therapy. OBJECTIVES To identify high-risk features associated with hospitalized patients with EUTI. METHODS Demographic, clinical, laboratory, and bacteriological data of 285 patients hospitalized with UTI during 2016 were retrieved from the computerized database of Shamir Medical Center. Patients were divided into two groups: EUTI and non-EUTI (NEUTI), according to the presence or absence of enterococcus in the urine culture. The features of the two groups were compared. RESULTS We obtained 300 urine cultures from 285 patients. Of the total, 80 patients (26.6%) had EUTI and 220 patients (73.3%) had NEUTI. A higher prevalence of urinary multi-bacterial cultures was found in EUTI compared to NEUTI patients (P < 0.01). Higher prevalence of permanent indwelling urinary catheter and dementia were found in hospitalized patients with community-acquired EUTI and nosocomial EUTI respectively (P = 0.02, P = 0.016) compared to patients with NEUTI. CONCLUSIONS Indwelling urinary catheter and dementia are risk factors for EUTI in patients with community and hospital acquired infection, respectively.
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Affiliation(s)
- Dana Zelnik Yovel
- Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Galina Glotsman
- Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Y Love
- Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Darnell
- Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Micha J Rapoport
- Department of Internal Medicine C, Shamir Medical Center (Assaf Harofeh), Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Di Mascio D, Villalain C, Rizzo G, Morales‐Rosello J, Sileo FG, Maruotti GM, Prefumo F, Galindo A, D'Antonio F. Maternal and neonatal outcomes of pregnancies complicated by late fetal growth restriction undergoing induction of labor with dinoprostone compared with cervical balloon: A retrospective, international study. Acta Obstet Gynecol Scand 2021; 100:1313-1321. [PMID: 33792924 DOI: 10.1111/aogs.14135] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The aim of this study was to compare vaginal dinoprostone and mechanical methods for induction of labor (IOL) in pregnancies complicated by late fetal growth restriction. MATERIAL AND METHODS Multicenter, retrospective, cohort study involving six referral centers in Italy and Spain. Inclusion criteria were pregnancies complicated by late fetal growth restriction as defined by Delphi consensus criteria. The primary outcome was the occurrence of uterine tachysystole; secondary outcomes were either cesarean delivery or operative vaginal delivery for non-reassuring fetal status, a composite score of adverse neonatal outcome and admission to neonatal intensive care unit (NICU). Univariate and multivariate logistic regression analysis was used to analyze the data. RESULTS A total of 571 pregnancies complicated by late fetal growth restriction undergoing IOL (391 with dinoprostone and 180 with mechanical methods) were included in the analysis. The incidence of uterine tachysystole (19.2% vs. 5.6%; p = 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. Similarly, the incidence of cesarean delivery or operative delivery for non-reassuring fetal status (25.6% vs. 17.2%; p = 0.027), composite adverse neonatal outcome (26.1% vs. 16.7%; p = 0.013) and NICU admission (16.9% vs. 5.6%; p < 0.001) was higher in women undergoing IOL with dinoprostone than in those undergoing IOL with mechanical methods. At logistic regression analysis, IOL with mechanical methods was associated with a significantly lower risk of uterine tachysystole (odds ratio 0.26, 95% confidence interval 0.13-0.54; p < 0.001). CONCLUSIONS In pregnancies complicated by late fetal growth restriction, IOL with mechanical methods is associated with a lower risk of uterine tachysystole, cesarean delivery or operative delivery for non-reassuring fetal status, and adverse neonatal outcome compared with pharmacological methods.
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Affiliation(s)
- Daniele Di Mascio
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Rome, Italy
| | - Cecilia Villalain
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Giuseppe Rizzo
- Division of Maternal Fetal Medicine, Ospedale Cristo Re, Università di Roma Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First I.M. Sechenov Moscow State Medical University, Moscow, Russia
| | - Jose Morales‐Rosello
- Obstetrics and Gynecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Filomena G Sileo
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe M Maruotti
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Federico Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Alberto Galindo
- Fetal Medicine Unit, Maternal and Child Health and Development Network, Department of Obstetrics and Gynecology, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain
| | - Francesco D'Antonio
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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Wu C, Dong Y, Li Y, Liu H. The efficacy of amniotic membrane-mediated sequential double-barrier therapy for the treatment of postoperative intrauterine adhesions. Medicine (Baltimore) 2021; 100:e25416. [PMID: 33847639 PMCID: PMC8051972 DOI: 10.1097/md.0000000000025416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/10/2021] [Indexed: 01/04/2023] Open
Abstract
To study the efficacy of using amniotic membrane, balloon and intrauterine device (IUD) as barrier therapy to prevent re-adhesion after hysteroscopic adhesiolysis.A total of 45 patients diagnosed with intrauterine adhesions in Changzhou Maternal and Child Health Hospital from June 2014 to December 2017 were included in this retrospective case control study. According to different postoperative isolation barrier methods, the patients were divided into group A (Foley balloon + fresh amniotic membrane Day1 + IUD Day7) (22 cases) and group B (Foley balloon Day1 + IUD Day7) (23 cases). Three months after the surgery, the second hysteroscopy was performed to observe the condition of the uterine cavity and the improvement of menstruation, and to monitor the thickness of the endometrium.The efficacy of hysteroscopic procedure in group A was significantly higher than that of group B (P < .05). After 3 months of treatment, the improvement rate of menstruation was significantly higher in group A than in group B (P < .05). Endometrial thickness in both group A and B was significantly increased compared with that before the surgery (P < .05). The postoperative endometrium of group A was significantly thicker than that of group B (P < .05).Amniotic membrane-mediated sequential double-barrier method is clinically feasible for preventing recurrent intrauterine adhesions.
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Aue-Aungkul A, Kietpeerakool C, Rattanakanokchai S, Galaal K, Temtanakitpaisan T, Ngamjarus C, Lumbiganon P. Postoperative interventions for preventing bladder dysfunction after radical hysterectomy in women with early-stage cervical cancer. Cochrane Database Syst Rev 2021; 1:CD012863. [PMID: 33491176 PMCID: PMC8092645 DOI: 10.1002/14651858.cd012863.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Bladder dysfunction is a common complication following radical hysterectomy, caused by the damage to pelvic autonomic nerves that innervate the muscles of the bladder, urethral sphincter, and pelvic floor fasciae. Bladder dysfunction increases the rates of urinary tract infection, hospital visits or admission, and patient dissatisfaction. In addition, bladder dysfunction can also negatively impact patient quality of life (QoL). Several postoperative interventions have been proposed to prevent bladder dysfunction following radical hysterectomy. To our knowledge, there has been no systematic review evaluating the effectiveness and safety of these interventions for preventing bladder dysfunction following radical hysterectomy in women with cervical cancer. OBJECTIVES To evaluate the effectiveness and safety of postoperative interventions for preventing bladder dysfunction following radical hysterectomy in women with early-stage cervical cancer (stage IA2 to IIA2). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 4) in the Cochrane Library, MEDLINE via Ovid (1946 to April week 2, 2020), and Embase via Ovid (1980 to 2020, week 16). We also checked registers of clinical trials, grey literature, conference reports, and citation lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of any type of postoperative interventions for preventing bladder dysfunction following a radical hysterectomy in women with stage IA2 to IIA2 cervical cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected potentially relevant RCTs, extracted data, assessed risk of bias, compared results, and made judgments on the quality and certainty of the evidence. We resolved any disagreements through discussion or consultation with a third review author. Outcomes of interest consisted of spontaneous voiding recovery one week after the operation, quality of life (QoL), adverse events, post-void residual urine volume one month after the operation, urinary tract infection over the one month following the operation, and subjective urinary symptoms. MAIN RESULTS We identified 1464 records as a result of the search (excluding duplicates). Of the 20 records that potentially met the review criteria, we included five reports of four studies. Most of the studies had unclear risks of selection and reporting biases. Of the four studies, one compared bethanechol versus placebo and three studies compared suprapubic catheterisation with intermittent self-catheterisation. We identified two ongoing studies. Bethanechol versus placebo The study reported no information on the rate of spontaneous voiding recovery at one week following the operation, QoL, adverse events, urinary tract infection in the first month after surgery, and subjective urinary symptoms for this comparison. The volume of post-void residual urine, assessed at one month after surgery, among women receiving bethanechol was lower than those in the placebo group (mean difference (MD) -37.4 mL, 95% confidence interval (CI) -60.35 to -14.45; one study, 39 participants; very-low certainty evidence). Suprapubic catheterisation versus intermittent self-catheterisation The studies reported no information on the rate of spontaneous voiding recovery at one week and post-void residual urine volume at one month following the operation for this comparison. There was no difference in risks of acute complication (risk ratio (RR) 0.77, 95% CI 0.24 to 2.49; one study, 71 participants; very low certainty evidence) and urinary tract infections during the first month after surgery (RR 0.77, 95% CI 0.53 to 1.13; two studies, 95 participants; very- low certainty evidence) between participants who underwent suprapubic catheterisation and those who underwent intermittent self-catheterisation. Available data were insufficient to calculate the relative measures of the effect of interventions on QoL and subjective urinary symptoms. AUTHORS' CONCLUSIONS None of the included studies reported rate of spontaneous voiding recovery one week after surgery, time to a post-void residual volume of urine of 50 mL or less, or post-void residual urine volume at 6 and 12 months after surgery, all of which are important outcomes for assessing postoperative bladder dysfunction. Limited evidence suggested that bethanechol may minimise the risk of bladder dysfunction after radical hysterectomy by lowering post-void residual urine volume. The certainty of this evidence, however, was very low. The effectiveness of different types of postoperative urinary catheterisation (suprapubic and intermittent self-catheterisation) remain unproven.
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Affiliation(s)
- Apiwat Aue-Aungkul
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chumnan Kietpeerakool
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Siwanon Rattanakanokchai
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Khadra Galaal
- Gynaecological Oncology, Princess Alexandra Wing, Royal Cornwall Hospital, Truro, UK
| | - Teerayut Temtanakitpaisan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chetta Ngamjarus
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Pisake Lumbiganon
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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In CB, Lee SJ, Sung TY, Cho CK, Jee YS. Effects of Chlorpheniramine Maleate on Catheter-Related Bladder Discomfort in Patients Undergoing Ureteroscopic Stone Removal: A Randomized Double-Blind Study. Int J Med Sci 2021; 18:1075-1081. [PMID: 33456366 PMCID: PMC7807186 DOI: 10.7150/ijms.53043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/22/2020] [Indexed: 11/12/2022] Open
Abstract
Catheter-related bladder discomfort (CRBD) associated with intraoperative urinary catheterization is a distressing symptom during recovery from anesthesia. Anticholinergics have been used to manage CRBD. Chlorpheniramine maleate (CPM) is a first-generation antihistamine, which also has anticholinergic effects. This study was undertaken to evaluate the efficacy of CPM in preventing CRBD. Seventy-six adults (19-65 years old) with American Society of Anesthesiologists physical status I, II, or III of either sex, undergoing elective ureteroscopic stone removal under general anesthesia were randomized into one of two groups (each n = 38). Group C (control) received a placebo, and group CPM received 8 mg of intravenous CPM before the induction of anesthesia. CRBD was assessed upon arrival in the post-anesthetic care unit at 0, 1, 2, and 6 h. The severity of CRBD was graded as none, mild, moderate, and severe. Tramadol was administered when the severity of CRBD was more than moderate. The incidence rate and overall severity of CRBD did not differ between the groups at any of the time points (р > 0.05). The incidence of moderate CRBD was higher in group C than in group CPM only at 0 h (26.3% vs. 5.3%, р = 0.025). However, fewer patients in the CPM group required rescue tramadol to relieve CRBD after surgery (31.6% vs. 60.5%, р = 0.011). CPM administration before the induction of anesthesia had little effect on the incidence and severity of CRBD after surgery, but it reduced the administration of tramadol required to control CRBD postoperatively.
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Affiliation(s)
- Chi-Bum In
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Seok-Jin Lee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Tae-Yun Sung
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Choon-Kyu Cho
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
| | - Young Seok Jee
- Department of Anesthesiology and Pain Medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Republic of Korea
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Dębska M, Koleśnik A, Kretowicz P, Olędzka A, Rebizant B, Gastoł P, Dębski R. Urethroplasty with balloon catheterization in fetal lower urinary tract obstruction: observational study of 10 fetuses. Ultrasound Obstet Gynecol 2020; 56:916-920. [PMID: 31763721 DOI: 10.1002/uog.21932] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 09/28/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To present the preliminary outcomes of fetal urethroplasty using a coronary angioplasty balloon catheter in lower urinary tract obstruction (LUTO). METHODS We included 10 consecutive male fetuses diagnosed with LUTO caused by presumed isolated posterior urethral valves (PUVs), who underwent urethroplasty with a balloon catheter in our center between 2015 and 2018. During urethroplasty, the fetal urethra was dilated using a balloon catheter (diameter, 0.014 inches; balloon size, 2 × 9 mm) inserted under ultrasonographic guidance via an 18-gauge needle introduced into the fetal bladder. RESULTS Mean gestational age at the time of urethroplasty was 17.8 (range, 16.5-20.4) weeks. All fetuses survived the procedure without any complications and there was no case of preterm prelabor rupture of the membranes. The procedure was successful in 5/10 (50%) fetuses, while in the other five (50%), we were unable to insert the balloon catheter into the urethra. In the five successfully treated cases, mean gestational age at delivery was 38 (range, 36-40) weeks and presence of PUVs was confirmed after birth. All five neonates micturated spontaneously and presented with normal urine output after birth. During the follow-up period, the parameters of kidney function were within normal limits in two neonates, whereas signs of impaired renal function were seen in another two. The other was diagnosed with renal insufficiency and required kidney transplant with bladder sparing at 2 years of age. CONCLUSIONS Urethroplasty with a balloon catheter is a new prenatal treatment option for fetuses with PUVs. By restoring fetal micturition, the procedure can preserve normal urinary bladder and kidney function. Although data on its efficacy and potential to differentiate the etiology of LUTO are sparse, a significant advantage of this method is its safety for the fetus and the mother. Even if the neonates develop renal insufficiency, they may be eligible for kidney transplant with connection to their own bladder, without the need for urostomy. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Dębska
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Koleśnik
- Cardiac Catheterization Laboratory, Children's Memorial Health Institute, Warsaw, Poland
- Department of Perinatal Cardiology and Congenital Anomalies, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Kretowicz
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - A Olędzka
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - B Rebizant
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - P Gastoł
- Department of Pediatric Urology, Children's Memorial Health Institute, Warsaw, Poland
| | - R Dębski
- 2nd Department of Obstetrics and Gynecology, Centre of Postgraduate Medical Education, Warsaw, Poland
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Altman AD, Robert M, Armbrust R, Fawcett WJ, Nihira M, Jones CN, Tamussino K, Sehouli J, Dowdy SC, Nelson G. Guidelines for vulvar and vaginal surgery: Enhanced Recovery After Surgery Society recommendations. Am J Obstet Gynecol 2020; 223:475-485. [PMID: 32717257 DOI: 10.1016/j.ajog.2020.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/17/2020] [Accepted: 07/22/2020] [Indexed: 02/07/2023]
Abstract
This is the first collaborative Enhanced Recovery After Surgery Society guideline for optimal perioperative care for vulvar and vaginal surgeries. An Embase and PubMed database search of publications was performed. Studies on each topic within the Enhanced Recovery After Surgery vulvar and vaginal outline were selected, with emphasis on meta-analyses, randomized controlled trials, and prospective cohort studies. All studies were reviewed and graded according to the Grading of Recommendations, Assessment, Development and Evaluation system. All recommendations on the Enhanced Recovery After Surgery topics are based on the best available evidence. The level of evidence for each item is presented.
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Affiliation(s)
- Alon D Altman
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Magali Robert
- Department of Obstetrics and Gynecology, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Robert Armbrust
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - William J Fawcett
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Mikio Nihira
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Chris N Jones
- Department of Anaesthesia, Royal Surrey County Hospital, Guildford, Surrey, United Kingdom
| | - Karl Tamussino
- Division of Gynecology, Medical University of Graz, Graz, Austria
| | - Jalid Sehouli
- Department of Gynecology with Center for Oncological Surgery, Charité University Medicine of Berlin, European Competence Center for Ovarian Cancer, Berlin, Germany
| | - Sean C Dowdy
- Division of Gynecologic Oncology, Mayo Clinic College of Medicine, Rochester, MN
| | - Gregg Nelson
- Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
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Bratt DG, Berridge C, Young M, Kailavasan M, Taylor J, Biyani CS. A simple novel training model for teaching suprapubic catheter (SPC) exchange. Actas Urol Esp 2020; 44:549-553. [PMID: 32448632 DOI: 10.1016/j.acuro.2020.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/04/2019] [Accepted: 01/19/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. MATERIALS AND METHODS We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp by new urology trainees and validated by expert urologists. A scale reproduction of an abdominal wall was created using a porcine abdominal wall. A segment of small bowel was stitched around a size 16F Foley catheter to form a tract. Abdominal wall tissue was excised cylindrically to create an opening, and the small bowel tract was passed through the abdominal wall and sutured anteriorly, producing a realistic SPC tract: inferiorly, the tract was anastomosed to a porcine urinary bladder. This model was evaluated by 10 expert urologists for content validity with an 8-item 5-point rating scale used to evaluate domains relevant to the simulator. RESULTS The domains were scored between 1 and 5 by 10 expert urologists, 1 being «strongly disagree» and 5 being «strongly agree». The average expert ratings of the domains were then calculated and tabulated following the training course. There was an average global rating of 4.2/5 for the model, with an average usefulness for training score of 4.6/5. CONCLUSION The feedback from experts and trainees (informal) was overwhelmingly positive. On average, our experts reported high satisfaction with their experience using this simulator as a training tool.
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Affiliation(s)
- D G Bratt
- Nottingham University Hospital, Nottingham, Reino Unido
| | - C Berridge
- Leicester General Hospital, Leicester, Reino Unido
| | - M Young
- Leeds Teaching Hospitals, Leeds, Reino Unido
| | - M Kailavasan
- Leicester General Hospital, Leicester, Reino Unido
| | - J Taylor
- Forth Valley Royal Hospital, Larbert, Scotland, Reino Unido
| | - C S Biyani
- Leeds Teaching Hospitals, Leeds, Reino Unido.
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New PW. The evidence supporting single-use intermittent catheters in people with spinal cord injury. Spinal Cord Ser Cases 2020; 6:89. [PMID: 32999268 PMCID: PMC7528086 DOI: 10.1038/s41394-020-00339-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/09/2022] Open
Abstract
Intermittent catheterization (IMC) is the accepted evidence-based best practice for bladder management in people with voiding dysfunction due to neurogenic bladder. The two methods for performing IMC over the decades since this practice was introduced are reuse and single-use catheters. There are perceived advantages and disadvantages of each method of performing IMC. There is considerable evidence that single-use IMC is associated with better health outcomes, including reduced risk of urinary tract infection, urethral trauma, and quality of life. People performing IMC also indicate a preference for single-use, although there are advantages of reuse that need to be acknowledged. Ideally, further research is needed in this area, particularly around the washing and storage of reuse catheters, as well as an adequately powered multicenter RCT comparing reuse with single-use IMC, but there are numerous challenges associated with progressing this research.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia.
- Rehabilitation and Aged Services Program, Department of Medicine, Monash Health, Melbourne, VIC, Australia.
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Sun Y, Ren P, Long X. Role of noble metal-coated catheters for short-term urinary catheterization of adults: a meta-analysis. PLoS One 2020; 15:e0233215. [PMID: 32520937 PMCID: PMC7286480 DOI: 10.1371/journal.pone.0233215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization. METHODS An electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included. RESULTS A total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44-0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41-0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26-0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high. CONCLUSIONS Our review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.
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Affiliation(s)
- Yan Sun
- Department of Encephalopathy Rehabilitation, Zaozhuang Traditional Chinese Medicine Hospital, Zaozhuang, Shandong, P.R. China
| | - Ping Ren
- Drug Distribution Center, Zaozhuang Traditional Chinese Medicine Hospital, Zaozhuang, Shandong, P.R. China
| | - Xuan Long
- Department of Infectious Diseases, Zaozhuang Municipal Hospital, Zaozhuang Shandong, P.R. China
- * E-mail:
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Souders CP, Zhao H, Ackerman AL. Considerations for Bedside Urologic Procedures in Patients With Severe Acute Respiratory Syndrome Coronavirus-2. Urology 2020; 142:26-28. [PMID: 32339561 PMCID: PMC7195357 DOI: 10.1016/j.urology.2020.04.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Indexed: 01/08/2023]
Abstract
Objective To provide guidance when performing bedside urologic procedures on severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) positive patients and offer considerations to maximize the safety of the patients and providers, conserve supplies, and provide optimal management of urologic issues. Methods Urologic trainees and attending physicians at our institution, who are familiar with existing safety recommendations and guidelines regarding the care of infected patients, were queried regarding their experiences to determine an expert consensus on best practices for bedside procedures for SARS-CoV-2 positive patients. Results Our team developed the following general recommendations for urologic interventions on SARS-CoV-2 positive patients: maximize use of telehealth (even for inpatient consults), minimize in-room time, use personal protective equipment appropriately, enlist a colleague to assist, and acquire all supplies that may be needed and maintain them outside the room. Detailed recommendations were also developed for difficult urethral catheterization, bedside cystoscopy, incision and drainage of abscesses, and gross hematuria/clot irrigations. Conclusion As patients hospitalized with SARS-CoV-2 infection are predominantly men over 50 years old, there are significant urologic challenges common in this population that have emerged with this pandemic. While there is tremendous variation in how different regions have been affected, the demographics of SARS-CoV-2 mean that urologists will continue to have a unique role in helping to manage these patients. Here, we summarize recommendations for bedside urologic interventions specific to SARS-CoV-2 positive patients based on experiences from a large metropolitan hospital system. Regulations and requirements may differ on an institutional basis, so these guidelines are intended to augment specific local protocols.
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Affiliation(s)
- Colby P Souders
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Hanson Zhao
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - A Lenore Ackerman
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
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Abstract
PURPOSE OF REVIEW Individual elements in enhanced recovery pathways may be associated with specific complication risks. In this review, we highlight three areas of controversy surrounding complications in enhanced recovery: (1) whether enhanced recovery is associated with increased rates of acute kidney injury, (2) whether NSAID use is associated with anastomotic leaks, and (3) whether early urinary catheter removal is justified following colorectal surgery. RECENT FINDINGS Acute kidney injury has been reported at several institutions following implementation of enhanced recovery pathways highlighting the importance of institutional data tracking. NSAID use has been implicated in anastomotic leak rates for non-elective colorectal procedures, and criteria for its use should be implemented. Early urinary catheter removal has been supported despite increased urinary retention rates in order to decrease urinary tract infections. Enhanced recovery protocols will continue to evolve, and risk profiles associated with individual elements should continue to be evaluated.
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Affiliation(s)
- Robert H Hollis
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Gregory D Kennedy
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Abstract
More than 20% of pregnant women have their labor induced and at least half of them will require cervical ripening due to an unfavorable starting cervical exam. The use of cervical ripening methods has been shown to decrease the risk of cesarean delivery when compared to initiating an induction with oxytocin in women with an unfavorable cervix. However, among the different cervical ripening methods themselves, while there may be differences in time to delivery and differences in the safety profile of different cervical ripening methods, there is no clear evidence that any one cervical ripening method reduces the risk of cesarean compared to another method. The objectives of this manuscript are to discuss the pathophysiology of cervical ripening including the biochemical processes that lead to cervical ripening; to review the different methods of cervical ripening including both mechanical and pharmacologic methods, and to evaluate the evidence and efficacy for different doses, routes, and techniques employed when using various cervical ripening methods.
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Fitzpatrick G, Philbin D, Davis NF. Inadvertent Antegrade Urethral Placement of a Suprapubic Catheter. Ir Med J 2020; 113:26. [PMID: 32407011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Presentation A 55-year-old male patient with neuropathic bladder secondary to multiple sclerosis (MS) presented to the EmergencyDepartment (ED) with abdominal pain and no output from his suprapubic catheter (SPC) that was changed 24 hourspreviously. Diagnosis On examination, the SPC-tip was clearly visible at the external urethral meatus. Treatment The patient was managed by gently deflating the anchoring balloon, exchanging the SPC and a period of observationto ensure adequate catheter drainage. Conclusion Important learning points from this case are to observe urine draining after routine SPC change and to examine thegenitalia when a misplaced SPC is suspected.
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Affiliation(s)
- G Fitzpatrick
- Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Co Dublin
| | - D Philbin
- Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Co Dublin
| | - N F Davis
- Department of Urology, Beaumont Hospital, Dublin 9, Co Dublin
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Skolarus TA, Dauw CA, Fowler KE, Mann JD, Bernstein SJ, Meddings J. Catheter management after benign transurethral prostate surgery: RAND/UCLA Appropriateness Criteria. Am J Manag Care 2019; 25:e366-e372. [PMID: 31860230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To formally assess the appropriateness of different timings of urethral catheter removal after transurethral prostate resection or ablation. Although urethral catheter placement is routine after this common treatment for benign prostatic hyperplasia (BPH), no guidelines inform duration of catheter use. STUDY DESIGN RAND/UCLA Appropriateness Methodology. METHODS Using a standardized, multiround rating process (ie, the RAND/UCLA Appropriateness Methodology), an 11-member multidisciplinary panel reviewed a literature summary and rated clinical scenarios for urethral catheter duration after transurethral prostate surgery for BPH as appropriate (ie, benefits outweigh risks), inappropriate, or of uncertain appropriateness. We examined appropriateness across 4 clinical scenarios (no preexisting catheter, preexisting catheter [including intermittent], difficult catheter placement, significant perforation) and 5 durations (postoperative day [POD] 0, 1, 2, 3-6, or ≥7). RESULTS Urethral catheter removal and first trial of void on POD 1 was rated appropriate for all scenarios except clinically significant perforations. In this case, waiting until POD 3 was deemed the earliest appropriate timing. Waiting 3 or more days to remove the catheter for patients with or without preexisting catheter needs, or for those with difficult catheter placement in the operating room, was rated as inappropriate. CONCLUSIONS We defined clinically relevant guidance statements for the appropriateness of urethral catheter duration after transurethral prostate surgery. Given the lack of guidelines and this robust expert panel approach, these ratings may help clinicians and healthcare systems improve the consistency and quality of care for patients undergoing transurethral surgery for BPH.
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Affiliation(s)
- Ted A Skolarus
- University of Michigan, Taubman Center, Room 3875, 1500 E Medical Center Dr, SPC 5330, Ann Arbor, Michigan 48109.
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Niederhauser A, Züllig S, Marschall J, Schweiger A, John G, Kuster SP, Schwappach DL. Change in staff perspectives on indwelling urinary catheter use after implementation of an intervention bundle in seven Swiss acute care hospitals: results of a before/after survey study. BMJ Open 2019; 9:e028740. [PMID: 31662357 PMCID: PMC6830685 DOI: 10.1136/bmjopen-2018-028740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate changes in staff perspectives towards indwelling urinary catheter (IUC) use after implementation of a 1-year quality improvement project. DESIGN Repeated cross-sectional survey at baseline (October 2016) and 12-month follow-up (October 2017). SETTING Seven acute care hospitals in Switzerland. PARTICIPANTS The survey was targeted at all nursing and medical staff members working at the participating hospitals at the time of survey distribution. A total of 1579 staff members participated in the baseline survey (T0) (49% response rate) and 1527 participated in the follow-up survey (T1) (47% response rate). INTERVENTION A multimodal intervention bundle, consisting of an evidence-based indication list, daily re-evaluation of ongoing catheter need and staff training, was implemented over the course of 9 months. MAIN OUTCOME MEASURES Staff knowledge (15 items), perception of current practices and culture (scale 1-7), self-reported responsibilities (multiple-response question) and determinants of behaviour (scale 1-7) before and after implementation of the intervention bundle. RESULTS The mean number of correctly answered knowledge questions increased significantly between the two survey periods (T0: 10.4, T1: 11.0; p<0.001). Self-reported responsibilities with regard to IUC management by nurses and physicians changed only slightly over time. Perception of current practices and culture in regard to safe urinary catheter use increased significantly (T0: 5.3, T1: 5.5; p<0.001). Significant changes were also observed for determinants of behaviour (T0: 5.3, T1: 5.6; p<0.001). CONCLUSION We found small but significant changes in staff perceptions after implementation of an evidence-based intervention bundle. Efforts now need to be targeted at sustaining and reinforcing these changes, so that restrictive use of IUCs becomes an integral part of the hospital culture.
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Affiliation(s)
| | | | - Jonas Marschall
- Swissnoso National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Alexander Schweiger
- Swissnoso National Center for Infection Control, Bern, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Gregor John
- Department of Internal Medicine, Hopital neuchatelois, Neuchatel, Switzerland
| | - Stefan P Kuster
- Swissnoso National Center for Infection Control, Bern, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital Zurich, Zurich, Switzerland
| | - David Lb Schwappach
- Swiss Patient Safety Foundation, Zurich, Switzerland
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Holroyd S. Intermittent catheterisation: challenges when children move to adult services. Br J Nurs 2019; 28:S20-S22. [PMID: 31597064 DOI: 10.12968/bjon.2019.28.18.s20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sharon Holroyd, Lead Clinical Nurse Specialist, Calderdale and Huddersfield NHS Foundation Trust, outlines approaches to self-catheterisation for children and young people, sharon.holroyd2@cht.nhs.uk.
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Affiliation(s)
- Sharon Holroyd
- Lead Clinical Nurse Specialist, Calderdale and Huddersfield NHS Foundation Trust
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Abstract
Urethral characterization can be difficult for patients and providers alike. This article describes an evidence-based protocol for difficult urethral catheter insertions in male patients.
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Affiliation(s)
- Janelle Warren
- In Loma Linda, Calif., Janelle Warren is an FNP in the inpatient adult urology unit at Loma Linda University Medical Center, and Herbert C. Ruckle is a Roger Barnes chair and professor in the department of urology at Loma Linda University School of Medicine
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Affiliation(s)
- Sharon Holroyd
- Lead Clinical Nurse Specialist, Calderdale Bladder & Bowel Service, CHFT, Halifax
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