Bladder Catheter Removal Research Articles

Urination assessment after the removal of bladder catheter using a novel urination chart.

We investigated the difficulties involved in assessing post prostatectomy voiding according to 20 nurses working in urology and dermatology wards. Problems they encountered included completing a urination (frequency/volume) chart and performing an assessment. We constructed a hourly urination chart for basic nursing education in urinary incontinence. This was used for a 76-year-old male patient with hypertension and diabetes mellitus who underwent a prostatectomy. Urination was recorded for 17 consecutive days after catheter removal. Detailed pathological findings were more distinct in the hourly rather than daily recordings of voluntary micturition. Voluntary micturition appeared 12 h after catheter removal, but it was very scanty. After the onset of urination, frequency and amount of daily voluntary micturition was inversely related to incontinence during the 17 days after catheter removal. We drafted a set of urination recovery stages to enable the analysis of a patient's urination status. Nurses understood its importance and were able to reach a consensus on how to manage patients with postoperative incontinence. We have constructed a practical system for use by specialist urology nurses.

Early Hospital Discharge for Intravesical Ureteroneocystostomy

Inpatient stays of 3 to 5 days are common in the surgical management of vesicoureteral reflux and often include the use of bladder catheters, ureteral stents and perivesical drains. We reviewed our recent experience, in which patients undergoing routine ureteroneocystostomy were often discharged home on postoperative day 1 to determine the safety and efficacy of our management. Between July 1998 and March 2001 patients who underwent intravesical ureteroneocystostomy at 2 major tertiary care institutions were identified. Patients who also underwent simultaneous additional operative procedures, bilateral ureteral duplication or ureteral tapering were excluded from study. Data recorded included patient demographics, the procedure, operative and postoperative pain, nausea and bladder spasm management, hospital stay, post-hospital discharge problems and operative success. Of the 113 patients with complete data available for analysis 101 received ketorolac postoperatively, including 75 females and 26 males with a mean age of 5.01 years (range 6 weeks to 16 years). There were 67 bilateral and 34 unilateral reimplantations. No ureteral stents or perivesical drains were placed. A perioperative urethral Foley catheter was removed on postoperative day 1 in all except 3 cases. Caudal analgesia with 0.25% bupivacaine before or after the operation was given in 91% of cases as a single injection. Epidural catheters were not used. In the ketorolac group average hospitalization was 29.5 hours (range 14 to 72). Of the 101 patients 58% were discharged home within 24 hours (average 21.3) and a further 11% were discharged home within 36 hours (average 27.4). All except 4 patients (4%) were discharged home within 48 hours of surgery. In the 12 patients who did not receive ketorolac average hospital stay was 43.8 hours (p <0.001). Gender did not affect the duration of hospitalization. Patients younger than 1 or older than 5 years old had a longer hospital stay than children between 1 and 5 years old (average 32.8 versus 25.5 hours). All patients received anticholinergics. The 9 complications (8%) involved urinary tract infection in 3 cases, and persistent nausea and vomiting, medication reaction and reoperation for clot evacuation in 1 each. Postoperatively 3 patients had persistent refluxing ureters. Routine surgical repair of vesicoureteral reflux can be successful with early bladder catheter removal and without stents or drains, necessitating only overnight hospitalization in the majority of patients. Ketorolac can be given safely in children with minimal risk and when combined with caudal analgesia it facilitates early discharge home.

Vancomycin-resistant Enterococci: the clinical effect of a common nosocomial pathogen

Enterococcus spp. is now the third most common pathogen among hospitalized patients, accounting for nearly 12% of nosocomial infections. Enterococcus faecalis is the most prevalent enterococcal species (85%–89%), whereas Enterococcus faecium accounts for 10%–15% of enterococcal isolates. Only 5% of E. faecalis isolates are resistant to glycopeptides. E. faecium has also been shown to be resistant to nonglycopeptide compounds, such as penicillins (97%), high-level gentamicin (52.1%), and high-level streptomycin (58.3%). Numerous risk factors for vancomycin-resistant enterococci (VRE) have been identified, including as length of hospital- or ICU-stay, proximity to a hospitalized, colonized VRE, patient severity of illness, renal failure, recent surgery, immunosuppression, and organ recipient status. An important risk factor is prior exposure to antibiotics such as vancomycin, ceftazidime, ciprofloxacin, and metronidazole, as well as the number and duration of recent antibiotics. Interventions to reduce nosocomial VRE cross-transmission have also been studied. Using gowns in addition to gloves diminished the incidence of VRE in one study, but had a negligible effect in a second study. Studies have shown that in many cases (>60%) vancomycin usage is inappropriate. While controlling the use of vancomycin alone has only variably diminished VRE colonization, other efforts such as narrowing the spectrum of antibiotics, antiseptics, and reducing immunosuppression may be salutary. Attempts to eradicate VRE intestinal carriage with enteral agents (bacitracin, tetracycline + rifampin, novobiocin) have been reported but seem to have only a transient effect. Non-antimicrobial interventions such as removal of intravenous or bladder catheters and/or surgical or percutaneous drainage may be beneficial. In addition, the development of new antimicrobial agents such as streptogramins, glycopeptides, everninomicins, and oxazalididones will hopefully play an important role in reducing morbidity from these pathogens.

Minimizing hospital length of stay in children undergoing ureteroneocystostomy

Objectives. Shortening hospital stay yet not compromising quality of care can result in significant cost savings for children undergoing surgical correction of vesicoureteral reflux. Methods. We reviewed the medical records of pediatric patients who underwent ureteroneocystostomy between July 1995 and July 1997. A total of 43 patients, aged 0.2 to 18 years (mean 5.2) who all received identical postoperative care, except for their pain management and the time of bladder catheter removal, were included in the study. Twenty-three were treated with intravenous ketorolac tromethamine (Toradol); the remaining 20 received narcotics in the immediate postoperative period. The bladder catheter was removed in less than 24 hours in 22 children, and greater than 24 hours in 21. Results. Patients who received ketorolac tromethamine for postoperative analgesia had on average shorter hospital length of stays than those treated with narcotics (1.4 versus 2.5 days, respectively; P < 0.001). The average stay for children whose bladder catheter was removed within 24 hours postoperatively was significantly shorter than those whose catheter was removed after a 24-hour period (1.4 versus 2.4 days, respectively; P < 0.001). There were no reimplantation failures. One child presented 2 days postoperatively with anemia, which did not require transfusion. Conclusions. Our review demonstrates that ketorolac tromethamine can be used safely and effectively in children for immediate postoperative analgesia, and that its proper use combined with early catheter removal can reduce the length of hospital stay for pediatric patients undergoing ureteroneocystostomy.

Predicting Bacteremia in Older Patients

To evaluate potential clinical predictors of bacteremia in hospitalized geriatric patients and to propose an individual risk score as an alternative to "subjective" clinical judgment for a more efficient approach in early recognition and treatment of bacteremia. A 16-month prospective study. The University Geriatric Hospital of Geneva, Switzerland. Four hundred thirty-eight patients aged 62 years or older in whom 558 episodes of bacteremia were suspected. The unit of evaluation was the blood culture episode, which was defined as a 48-hour period beginning with the drawing of the first blood for culture. An extensive precoded protocol, including clinical and biological data, was completed by the resident who requested the blood cultures. For each episode, the resident also provided a subjective assessment of the probability of bacteremia. Odds ratios and their variances were used to estimate the relative risks of potential predictors of bacteremia. The performance of a predictive clinical model based on risk score threshold was evaluated by means of a receiver-operating characteristic analysis. Of the 558 potentially bacteremic episodes investigated, 46 (8.2%) yielded positive blood cultures. The bacteremia rate was strongly associated with the type of episode: it reached 15.6% among the community-acquired (CA) episodes (those occurring within 48 hours of hospital admission) and 6.0% only among the hospital-acquired (HA) episodes (those occurring after the first two days of hospitalization). Predictors of bacteremia with highest relative risks included: bladder catheter removal, fever (> or = 38.5 degrees C), rigors, shock, total band count > or = 1500/mm3, and lymphocyte count < or = 1000/mm3. When assessed by episode type, it appeared that bladder catheter removal and rigors were good predictors of bacteremia in HA episodes only, whereas fever (> or = 38.5 degrees C) had a good predictive value in CA episodes only. The performance of the clinical model was two times better than the physician's subjective ability to predict bacteremia when the threshold of the risk score was fixed at two or more predictors per episode. These findings provide means to identify older hospitalized patients at high risk of bacteremia. Although the proposed predictive model will need further validation and more precise evaluation of the potential benefits, it may nevertheless be of some help in early recognition and treatment of bacteremia.

Yeast in the urine: solutions for a budding problem.

The significance of candiduria ranges from simple procurement-related contamination to disseminated candidiasis. Ensuring that a valid urine specimen is collected and carefully assessing patients for risk factors predisposing to disseminated candidiasis permit the stratification of cases into three clinical categories: (1) asymptomatic candiduria in a previously healthy patient; (2) candiduria in a high-risk patient in whom disseminated candidiasis is unlikely; and (3) candiduria in a high-risk patient with a potential for disseminated candidiasis. Strategies for management are tailored to the individual patient. Appropriate management of anatomic genitourinary abnormalities and removal of bladder catheters may result in the resolution of candiduria, although some patients require systemic antifungal therapy. All patients with candiduria should be evaluated for evidence of deep-seated tissue infection or candidemia before therapy is instituted. Fluconazole appears to be a safe and effective agent for the management of candidal urinary tract infection. Both its safety and its ease of administration make it superior to amphotericin B for this purpose.

Transurethral Catheter Removal after Bilateral Orchiectomy for Prostatic Carcinoma Associated with Acute Urinary Retention

In the period 1986-1990 a total of 69 patients with advanced prostate cancer and urinary retention underwent orchiectomy followed by removal of the indwelling catheter during the 3 month/postoperative period. The mean follow-up time was 32 months. Regarding urination after catheter removal the success-rate was 62% (43/69) and 84% of these patients were satisfied with the procedure. For these 43 patients the median time without the catheter was 21.5 months. Eleven patients with success developed a new attack of urinary retention. Bladder catheter removal during 3 months after orchiectomy for patients with advanced prostate cancer and urinary retention is recommended.

Simple procedure for the removal of a non-deflating balloon bladder catheter: two cases.

The occurrence of a non-deflating balloon catheter in the bladder is uncommon (Higgins & Mace, 1984). When all other routine urological methods of deflating the balloon have failed (Pitt, 1970) the aid of the radiologist should be sought so as to perform percutaneous balloon puncture (Rees & Joseph, 1981). We report two patients, who presented to our hospital within 10 days of each other, for whom initial attempts at deflating the balloons had been unsuccessful. A 61-year-old hemiplegic male with a long-term, self-retaining balloon catheter which had become completely obstructed presented to our hospital. Attempts to free the obstruction were unsuccessful and it was therefore decided to remove the catheter.

Bladder and Urethral Dysfunction After Radical Abdominal Hysterectomy: Rehabilitative Treatment

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Bladder and urethral dysfunction after radical abdominal hysterectomy: rehabilitative treatment.

We studied bladder and urethral function prospectively in 64 patients before and after Wertheim's radical hysterectomy. Immediately after surgery, neurogenic bladder dysfunction of various degrees was found in 70% of all patients who presented difficulty of voiding, with high residual urine and/or stress incontinence. All the patients have received an early rehabilitative treatment with kinesitherapy and/or pharmacological therapy after the bladder catheter removal and the urodynamics' results. We have obtained a satisfactory functional recovery of the bladder activity in 91% of the symptomatic patients.

Bladder urethral dysfunction after abdominoperineal resection of the rectum for ano-rectal cancer.

We prospectively studied bladder and urethral function in 44 patients before and after abdominoperineal resection of the rectum for ano-rectal cancer. The patients were investigated with the following examinations: combined cystometry and electromyography, urethral pressure profile measurement, urecholine denervation test, urine culture, urethrogram and residual urine measurement after voiding. Urodynamic results after surgery demonstrated the partial or total denervation of the detrusor muscle with bladder areflexia in the 54% of the cases, the decrease in the urethral pressure profile in the 48% of the cases, and the absence of detrusor sphincter dyssynergia in all cases. Urethrogram results showed a high incidence of bladder dislocation into the presacral space (36%). Urine cultures were frequently positive in 52% of the patients. Most patients (52%) had difficulty in voiding with high residual urine and/or stress incontinence (4.5%). All the patients received an early rehabilitative treatment with kinesitherapy and/or pharmacologic therapy after bladder catheter removal and after urodynamic results. The patients with neurogenic bladder with residual urine volume had satisfactory functional recovery of the activity.