Urinary Catheter Research Articles

Effects of robotic surgery experience on open radical prostatectomy results: single centre & single surgeon experience

This study aimed to evaluate the effect of robotic surgery experience on open radical prostatectomy (ORP) outcomes. We retrospectively reviewed 100 patients who underwent an ORP for clinically localised prostate cancer (PCa) performed by the same experienced surgeon. The groups included the last 50 patients before (Group 1) and the first 50 patients after (Group 2) robotic surgery experience. A detailed history, peroperative, and oncological data were recorded. Continence status and erectile functions were evaluated before surgery and at 1, 3, 6, and 12 months postoperatively by daily pad count and an International Index of Erectile Function (IIEF) short form and were compared between groups. The demographics and preoperative data were similar. The preoperative and postoperative Gleason score was higher in Group 2 (p = 0.001, 0.033; respectively). The operation time (200 vs. 115 min), estimated blood loss (400 vs. 200 ml), peroperative transfusion rate (46% vs. 8%), drain removal time (4 vs. 3 days), hospital stay (5 vs. 4 days), and urethral catheter removal time (21 vs. 14 days) were significantly lower in Group 2 (p < 0.001). The continence rate was significantly higher in Group 2 in the first month (p = 0.027), but no significant difference was found at 3, 6, and 12 months. Erectile functions (mean IIEF: 9.47 vs. 11.18 at 12th month, p = 0.220) showed no significant difference between the groups in the first year after surgery. In addition to ergonomic benefits, robotic surgery provides a significant surgical procedure experience due to its great visualisation. The most important advantages that robotic surgery adds to our ORP experience were improved early continence; less bleeding and a decreased need for transfusions; and a shorter operation time, hospital stay, and urethral catheter removal time.

Clinical Experience and Video Description of Minimally Invasive Surgery for Benign Prostatic Obstruction using the Schelin Catheter®.

Although designed for in-office use, water vapor thermal therapy (RezumTM) remains a painful procedure, and oral ± intravenous sedation is often required. Schelin Catheter® (ProstaLund AB, Lund, Sweden) is an innovative bladder catheter that delivers local anesthesia to the prostate in a sterile transurethral way. We aimed to evaluate the safety and feasibility of RezumTM for male lower urinary tract symptoms due to benign prostatic obstruction (LUTS/BPO) with local anesthesia delivered with Schelin® catheter, and to report its first step-by-step video description. A total of 15 patients were enrolled, and 14 analyzed. Median pain numeric rating scale at catheter insertion, anesthetic injection, RezumTM insertion, RezumTM treatment, and at 2-h post-operatively were 3(2-5), 3(2-5), 1(0-3), 3.5(2-6), and 0(0), respectively. In 1 patient local anesthesia protocol failed and intravenous sedation was used. All RezumTM therapies were performed successfully. Local anesthesia with Schelin® catheter opens up new possibilities for ultra-minimally invasive surgery for LUTS/BPO.

Outcomes following intradetrusor onabotulinumtoxinA in a national cohort of nursing home residents

AbstractObjectivesTo determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States.Materials and methodsThis is a retrospective cohort study of long‐stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims. Frailty was measured using the Claims‐based Frailty Index and socioeconomic status using the Area Deprivation Index (ADI; higher ADI = increasing social deprivation). The primary outcome was treatment success, defined as repeat onabotulinumtoxinA injection within 1 year of index injection. Secondary outcomes included 30‐day complications and urinary retention, defined as new indwelling urinary catheters identified on the MDS at 3 months.ResultsOnabotulinumtoxinA injections were performed in 1683 NH residents. Mean age was 78.2 years, 74% were female and 22.8% had an indwelling urinary catheter at baseline. A total of 38.4% of residents had ≥1 30‐day complication and 14.6% had a new catheter at 3 months. Repeat injections were performed in 34.3% of residents within 1 year. Repeat injections were more likely among residents who were female [adjusted relative risk (aRR) 1.29; 95% CI 1.08–1.54] and who had a baseline catheter (aRR 1.30; 95% CI 1.11–1.52). Residents who were ≥85 years (aRR 0.78; 95% CI 0.64–0.96) and those in the lowest quartile ADI (aRR 0.75; 95% CI 0.61–0.93) were less likely to undergo repeat injections.ConclusionAmong this population of NH residents, who are by definition frail and comorbid, rates of repeat onabotulinumtoxinA injections are comparable to retrospective analyses of younger adults and independent of frailty and comorbidity. Based on these findings, surgeons should consider the entire clinical picture when evaluating patients for onabotulinumtoxinA injections and should not necessarily exclude those who are frail or comorbid from this potentially quality‐of‐life‐improving therapy.

Assessment of Nurse's Role to Prevent Urinary Tract Infections for Neo-nates with Urinary Catheter

Assessment of Nurse's Role to Prevent Urinary Tract Infections for Neo-nates with Urinary Catheter

Empowering Nursing Practices: Enhancing Patient Care Through Knowledge, Attitude and Practice Towards Urinary Catheterisation in Taicang City.

To assess the knowledge, attitude and practice (KAP) towards unnecessary urinary catheterisation among nurses in Taicang City, China. Cross-sectional study. This study included nurses from our hospital and was conducted between February 2023 and June 2023. A self-administered questionnaire was designed to collect their demographic characteristics and KAP. A total of 233 valid questionnaires were collected. The mean KAP scores were 13.44 ± 1.62 (possible range: 0-17), 45.28 ± 3.87 (possible range: 10-50) and 43.85 ± 5.98 (possible range: 10-50), which indicated moderate knowledge, positive attitude and proactive practice, respectively. The Pearson's correlation analysis showed positive correlations between knowledge and attitude (r = 0.253, p < 0.001), knowledge and practice (r = 0.279, p < 0.001), as well as attitude and practice (r = 0.441, p < 0.001). Partial correlation analysis adjusted for age, gender, department, working experience and experience in treating patients with catheter-associated urinary tract infections also showed positive correlations among KAP. A structural equation modelling showed that both knowledge (β = 0.501, p = 0.047) and attitude (β = 0.691, p < 0.001) had direct effect on practice. This study found moderate knowledge, positive attitude and proactive practice among the participants. Both knowledge and attitude might affect their practice. We wanted to know the knowledge, attitude and behaviour of nurses in Taicang City towards unnecessary catheterisation. Moderate knowledge, positive attitude and proactive practice were found among the participants. The findings would provide evidence for policymakers to develop targeted educational intervention to improve nurses' practice and might improve the outcomes of patients. This study was reported to be adhered to the STROBE guideline. No patient or public contribution. Targeted educational intervention was needed to improve nurses' practice.

Impact of untreated positive urine culture on urinary tract infections after cystoscopy

Cystoscopy is the most commonly performed urological examination during consultation. Various guidelines outline the benefits of performing urine culture before cystoscopy. The main objective of this study was to evaluate the impact of untreated positive urine cultures before cystoscopy on postinterventional urinary tract infection (UTI) rate. The secondary objectives were to identify factors favoring UTI and analyze the correlation between bacteria found before and after cystoscopy. All patients who underwent cystoscopy in our hospital from November 2020 to March 2022 were included. Pregnant women and patients under antibiotic therapy were excluded. A urine culture was collected on the examination day, and the patients filled out a questionnaire one month later, indicating symptom occurrence. The primary outcome was UTI in the month following cystoscopy, defined according French Society for Infectious Diseases (SPILF) criteria by the presence of fever or at least one lower urinary tract symptom (pollakiuria, burning sensation during urination, urgent urination) and a positive uroculture (defined by SPILF criteria). The study included 410 patients. A positive precystoscopy uroculture was noted in 80 (19.5%) patients. Factors significantly associated with UTI were a positive precystoscopy urine culture (11% vs. 1.5%, OR = 7.64 [2.44-23.9]) and the presence of voiding LUTS (8.5% vs. 1.9%, OR = 4.42 [1.39-13.05]). Age, sex, the presence of a urethral catheter, and cystoscopy indication were not significantly associated with UTI. Only one patient, in the positive uroculture group, was hospitalized. For five patients, the microorganism found in the postcystoscopy urine culture was the same as that identified in the precystoscopy urine culture, with the same resistance profile on the antibiograms. The number needed to treat to prevent one UTI is 16. Bacteriuria is associated with a higher UTI rate after cystoscopy. Nevertheless, the benefit of treating a positive uroculture before cystoscopy remains unclear.

Transperineal 3D fusion imaging-guided targeted microwaves ablation for low to intermediate-risk prostate cancer: results of a phase I-II study

Background Targeted microwave ablation (TMA) is a novel modality of focal therapy to treat localized prostate cancer (PCa). We evaluated its short-term functional and oncologic outcomes. Method We performed a single-center, prospective, interventional phase I-II pilot trial (NCT04627896). TMA was performed in 11 patients with a single intracapsular MRI-visible lesion ≤12 mm, International Society of Urological Pathology (ISUP) grade ≤ 2, Prostate Specific Antigen (PSA) < 20 ng/mL, and a 5-mm safety distance from apex and rectum. Patients were treated with a 12 W very low-loss microwaves ablation system, guided by 3D ultrasound/MRI fusion imaging. Follow-up consisted in clinical visits, PSA and validated questionnaires. MRI was scheduled at five months and rebiopsy at six months. The primary endpoints of study were safety and efficacy (absence of tumour in the treated area). Results No severe complications were reported. All patients were discharged the same day of treatment without bladder catheter. No significant changes in PSA or questionnaires scores were reported. At rebiopsy, no cancer was found in five patients (45%); eight patients (73%) had an absence of in-field PCa and nine patients (82%) had an absence of in-field ISUP ≥ 2 PCa. New cancer foci outside the treated area were found in three patients (27%). Limitations of this study were the very limited sample size, the short follow-up, and the lack of a comparator. Conclusions TMA guided by fusion imaging is a safe modality with good ablative efficacy.

Assessment of predictive factors in endoscopic internal urethrotomy for bulbar urethral strictures

IntroductionDirect vision internal urethrotomy (DVIU) is usually the first treatment offered to patients with bulbar urethral strictures (US). Advances in devices and surgical techniques have contributed to reducing associated complications. Despite the favorable success rate of DVIU, various factors predicting better outcomes have been studied, including patient characteristics, stricture features, and procedural aspects. The main aim of our study is to assess predictive factors for success. MethodsWe conducted a retrospective descriptive study of patients who underwent endoscopic internal urethrotomy at our hospital over a 30 year period. Out of 788 DVIU performed, we selected 491 (62.3%) conducted for bulbar US with a minimum follow-up of 12 months. We examined clinical outcomes obtained, and assessed the relationship between different patient characteristics, stricture-related factors and procedural aspects related with clinical success -considered as the avoidance of further interventions for stricture recurrence-. Descriptive statistics were calculated and parametrical and non-parametrical comparative tests were applied. Kaplan-Meier survival analysis was used for evaluating time until recurrence. ResultsMean stricture length was 1.2 cm (SD 0.5), with only 12 patients presenting with more than 1 US in the bulbar area during DVIU. After a median follow-up of 170 months, 67.4% of patients did not experience clinical recurrence. Severe postoperative complications appear in 0.4% of cases, and need for overnight admission was 4.5%. A positive association was observed between clinical recurrence and a history of prior pelvic radiotherapy (OR 2.8, 95%IC 1.3-22.2), active smoking (OR 2.1, 95%IC 1.6-2.4), infectious etiology of stricture (OR 2.3, 95%IC 1.6-8), history of previous urethroplasty (OR 2.5, 95%IC 1.7-3.2), and higher postoperative urinary catheter sizes (OR 1.8 95%IC 1.1-2.9). Median time until recurrence after the first DVIU was 65 months, after the second was 60 months, after the third was 32 months, and after the fourth was 6 months. ConclusionsBulbar US could be safely managed with DVIU. The best clinical success is achieved in non-irradiated, non-smoker patients, without prior urethroplasties. The repetition of the procedure is significantly associated with a shorter time to clinical recurrence.

Does prophylactic tamsulosin use with ERAS protocol provide improvement after colorectal surgery?

IntroductionEarly urinary catheter removal has been incorporated into Enhanced Recovery After Surgery (ERAS) pathways to aid faster recovery and minimize urinary tract infection. However, early catheter removal can result in urinary retention, which may lead to catheter reinsertion and a prolonged hospital stay. Tamsulosin, an alpha-blocking medication, effectively treats urinary retention in both men and women. Our study aims to compare urinary retention rates and short-term outcomes between patients treated with tamsulosin and those who were not. MethodsThis retrospective cohort study included patients who underwent elective abdominopelvic colorectal procedures using the ERAS protocol between September 2020 and October 2023. After April 2022, postoperative 0.4 ​mg tamsulosin treatment was added to the ERAS protocol. Univariate analysis was used to compare demographics and perioperative treatment history. The control and tamsulosin groups were matched in a 2:1 ratio, using propensity scores. The primary outcomes were urinary retention and the length of hospital stay. ResultsThe study included 2072 patients (1215 female, 58.6 ​%), with a mean age of 53.1 (±17.1) years. The initial univariate analysis was followed by propensity score matching, resulting in 344 patients in the tamsulosin group and 688 in the control group. The urinary retention rate was notably lower in patients who received tamsulosin during hospitalization (9.2 ​% vs. 4.7 ​%, p ​= ​0.01). Furthermore, the length of hospital stay was shorter in patients treated with tamsulosin (5 vs. 4.2 p ​< ​0.01). ConclusionPostoperative prophylactic tamsulosin use decreases urinary retention rates and length of stay after colorectal surgery and should be considered complementary to ERAS protocols for improved recovery.

The Impact of Bundled Nursing Interventions Based on Empowerment Theory on Patients with Indwelling Urinary Catheters

The Impact of Bundled Nursing Interventions Based on Empowerment Theory on Patients with Indwelling Urinary Catheters

Influencing Factors of Urinary Tract Stones Complicated by Urinary Tract Infections and the Construction of a Column Chart Prediction Model.

Objective: To analyze the influencing factors of urinary tract stones complicated by urinary tract infections and construct a column chart prediction model. Patients and Methods: From July 2020 to October 2023, 345 patients with urinary tract stones admitted to our hospital were collected as the training set, they were separated into an infection group of 51 cases and a non-infection group of 294 cases on the basis of the presence or absence of concurrent urinary tract infections; 192 patients with urinary tract stones were used as the testing set and were divided into an infection group of 26 cases and a non-infection group of 166 cases on the basis of the presence or absence of concurrent urinary tract infections. Data such as gender, age, and procalcitonin (PCT) were recorded. Multi-variable logistic regression analysis was applied to screen predictive factors, R4.0.2 software was applied to construct a column chart model, the calibration curve and Receiver Operating Characteristic (ROC) curve were applied to evaluate the discrimination and calibration of the column chart model; decision curve analysis curve was applied to evaluate the predictive performance of column chart models. Results: The proportions of female, diabetes mellitus, indwelling time of urinary catheter ≥7 days, the PCT, and urine pH in the infected group were greater than those in the non-infected group (p < 0.05). Female, diabetes mellitus, catheter retention time ≥7 days, high PCT, and high urine pH were independent risk factors for urinary calculi complicated with urinary tract infection (p < 0.05). Training set: C-index was 0.913, Area Under Curve (AUC) was 0.943 [95% Confidence Interval (CI) = 0.912-0.973], sensitivity was 86.36%, and specificity was 89.81%, testing set: C-index was 0.905, AUC was 0.959 (95% CI = 0.928-0.989), sensitivity was 84.65%, and specificity was 95.84%, indicating good discriminability of the line graph model; Hosmer-Lemeshow test showed χ2 = 2.843, 2.894, p = 0.944, 0.941, the calibration curve approached the ideal curve, and the line graph model had good calibration. When the risk threshold for urinary tract stones complicated by urinary tract infections was between 0.08 and 0.86, this column chart model provided clinical net benefits. Conclusion: The column chart prediction model for urinary tract stones complicated by urinary tract infections constructed in this study has high predictive efficiency and clinical practical value, and can provide reference for medical staff.

Impact of Enhanced Recovery After Surgery Protocol Compliance on Outcome After Pancreatic Surgery: Results From a Certified ERAS Center

Objective: The aim was to evaluate the sustainability of the pancreatic Enhanced Recovery After Surgery (ERAS) program and the effect of ERAS items on patient morbidity and hospital stay. Background: The current ERAS guideline recommendations encompass 27 items to improve recovery after pancreatoduodenectomy (PD). Methods: Patients who underwent pancreatic resection at the University Hospital Hamburg-Eppendorf between February 2016 and June 2023 were included. The datasets were retrospectively collected from a central database. The effects of individual ERAS items and compliance on morbidity and hospital stay were assessed by uni- and multivariable analyses. Results: In total, 594 patients who underwent PD (44.8%), distal pancreatectomy (14.6%), total pancreatectomy (17.8%), or other pancreatic resections (22.7%) were included. Of these, 90 patients (15.2%) achieved a high overall ERAS compliance of ≥70%. High compliance was associated with significantly less complications (Clavien–Dindo ≥ 3a), reduced 30-day mortality, and a shorter hospital stay. Early mobilization on the first postoperative day (POD1), restrictive intravenous fluid administration, and timely removal of urinary catheters were significant multivariable predictors for lower morbidity. Early mobilization on POD1 also correlated with reduced morbidity in the subcohort of PD cases. Conclusions: The pancreatic ERAS protocol can be sustainably implemented and applied to both, PD and non-PD cases. A high level of compliance with the ERAS protocol after pancreatic resections correlated with improved outcomes but was achieved by less than one-fifth of patients. Early mobilization on POD1 and restrictive fluid management were key indicators for optimized short-term outcomes.

Individual Pharmacotherapy Management (IPM-II) for Patient and Drug Safety in Polypharmacy via Clinical Electronic Health Record Is Associated with Significant Fall Prevention

Background/Objectives: Falls and fractures are emerging as a near-pandemic and major global health concern, placing an enormous burden on ageing patients and public health economies. Despite the high risk of polypharmacy in the elderly patients, falls are usually attributed to age-related changes. For the “Individual Pharmacotherapy Management (IPM)” established at the University Hospital Halle, the IPM medication adjustments and their association with in-hospital fall prevention were analysed. Methods: On the basis of the most updated digital overall patient view via his inpatient electronic health record (EHR), IPM adapts each drug’s Summary of Product Characteristics to the patient’s condition. A retrospective pre-post intervention study in geriatric traumatology on ≥70 years old patients compared 200 patients before IPM implementation (CG) with 204 patients from the IPM intervention period (IG) for the entire medication list, organ, cardiovascular and vital functions and fall risk parameters. Results: Statistically similar baseline data allowed a comparison of the average 80-year-old patient with a mean of 11.1 ± 4.9 (CG) versus 10.4 ± 3.6 (IG) medications. The IPM adjusted for drug-drug interactions, drug-disease interactions, overdoses, anticholinergic burden, adverse drug reactions, esp. from opioids inducing increased intrasynaptic serotonin, psychotropic drugs and benzodiazepines. IPM was associated with a significant reduction in in-hospital falls from 18 (9%) in CG to 3 (1.5%) in IG, a number needed to treat of 14, relative risk reduction 83%, OR 0.17 [95% CI 0.04; 0.76], p = 0.021 in multivariable regression analysis. Factors associated with falls were antipsychotics, digitoxin, corticosteroids, Würzburg pain drip (combination of tramadol, metamizole, metoclopramide), head injury, cognitive impairment and aspects of the Huhn Fall Risk Scale including urinary catheter. Conclusion: The results indicate medication risks constitute a major iatrogenic cause of falls in this population and support the use of EHR-based IPM in standard care for the prevention of falls in the elderly and for patient and drug safety. In terms of global efforts, IPM contributes to the running WHO and United Nations Decade of Healthy Ageing (2021–2030).

Stimulus responsive wireless sensor integrated smart urine bag for early detection of catheter-associated infections

Urinary catheterization is a routine intervention in intensive care unit (ICU) patients with prolonged immobility. However, extended use of urinary catheters significantly increases the risk of urinary tract infections (UTIs), posing serious healthcare concerns. Early detection of UTIs can effectively prevent disease progression and mitigate additional health complications. Most conventional diagnostic methods rely on periodic urine sample collection and laboratory analysis, which are time-consuming and lack the capacity for continuous, real-time assessment. To address these limitations, we developed a Smart Urinary Bag (SUB) system with an integrated sensor platform designed for real-time monitoring of UTI-associated biomarkers in urine directly within the urinary bag. The sensor platform incorporates two interdigitated electrode (IDE) patterns coated with stimuli-responsive polymers to selectively detect elevations in pH and xanthine oxidase (XOD) levels—two critical biomarkers for urinary infections. These IDEs connect to spiral planar coils, forming sensor tags that enable battery-free, wireless monitoring of urine conditions through near-field inductive coupling with an external reader. The sensor tags, measuring 10 cm × 6 cm, and the coating thickness were optimized using High-Frequency Structure Simulator (HFSS) software to ensure effective wireless readability and sensitivity for practical miniaturization and integration into standard urinary bags. Systematic characterization of the functional coatings confirmed effective compositions that allowed reliable wireless detection of elevated pH (>8) and XOD (>500 U/L) levels in urine, with a response time of less than 3 hours. The sensors maintained stable performance over 14 days under physiologically relevant conditions with high specificity, as verified through tests with both artificial and real urine. As proof of concept, the fully integrated SUB system was tested under simulated patient conditions with varying pH and XOD levels. The platform successfully identified high-risk UTI conditions, enabling timely alerts to healthcare providers for immediate intervention. This platform aims to enhance patient monitoring in ICUs by reducing healthcare provider burden, facilitating early identification of UTI risks, and promoting timely interventions, ultimately reducing antibiotic overuse and addressing the challenge of rising antibiotic-resistant bacterial strains.

The Characterisation of Carbapenem-Resistant Acinetobacter baumannii and Klebsiella pneumoniae in a Teaching Hospital in Malaysia.

Background/Objectives: The emergence and dissemination of carbapenem-resistant organisms, particularly Acinetobacter baumannii and Klebsiella pneumoniae, pose a significant threat to healthcare systems worldwide. This retrospective study aims to characterise carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) strains in a teaching hospital and to determine the risk factors associated with patients' in-hospital mortality. Methods: A total of 90 CRAB and 63 CRKP were included in this study. Carbapenemase genes and MLST types of CRAB and CRKP were determined using specific primers. Risk factors associated with in-hospital mortality were analysed with collected data. Results: All the CRAB strains consisted of OXA carbapenemase genes, with 98% of the strains co-harbouring blaOXA-23-like and blaOXA-51-like carbapenemase genes. Conversely, blaNDM is the predominant carbapenemase gene in CRKP, followed by blaOXA-48-like carbapenemase genes. ST2 and ST20 are the dominant MLST types in CRAB and CRKP, respectively. In CRAB, multivariate analysis identified age, ethnicity, the presence of a mechanical ventilator, and patients who experienced previous exposure to clindamycin in the last 90 days as associated with an increased risk of in-hospital mortality. In contrast, older age, male, ICU admission, and the presence of an indwelling urinary catheter were significantly associated with an increased risk of mortality for patients with CRKP. Conclusions: Both CRAB and CRKP lead to high rates of mortality. The MLST profile showed that the genomic patterns of CRKP were highly diverse, whereas CRAB strains had low genetic diversity. To tackle these challenging pathogens, robust surveillance and an in-depth understanding of molecular epidemiology and genomics studies are needed to tailor infection control strategies and individualise treatment approaches.

Prospective randomized trial of antibiotic prophylaxis for percutaneous renal biopsy.

Infection is a rare complication of percutaneous renal biopsy (RB). However, the questionnaire included in the Kidney Biopsy Guidebook 2020 in Japan revealed that antibiotic prophylaxis (AP) was administered at about 60% of hospitals. The objective of this study was to evaluate whether it is possible to omit AP for RB. Patients aged ≥ 15years were eligible. Three hundred and sixty-four patients were recruited at 6 hospitals. The patients were randomly assigned to receive either a single dose of intravenous cefazolin or no antibiotic prophylaxis. The primary outcome was the percentage of patients that exhibited positive urine cultures 3 or 4days after the RB. The secondary outcomes were the percentage of patients who were diagnosed with pyelonephritis, puncture site infections (PSI), or an infection other than pyelonephritis or PSI within 30days, and cefazolin-induced side effects. With regard to the primary outcome, there was no statistically significant difference between the cefazolin group and the no AP group (2.9% versus 5.1%, p = 0.416). With regard to the secondary outcomes, only one patient (who belonged to no AP group) developed pyelonephritis. This patient underwent urinary catheterization. No PSI occurred. There were no significant intergroup differences in any secondary outcomes. This study revealed the incidence of post-percutaneous RB infections was minimal. Although the outcomes of this study did not lead to the conclusion that it is unnecessary to use AP for RB, the obtained data suggest that the effects of such AP may not be clinically significant.

Accuracy of Screening Tests for the Diagnosis of Urinary Tract Infections in Young Children.

The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs). We included children between 1 and 36 months of age undergoing bladder catheterization for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture result: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition. A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively. Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ∼20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs.

Who changes indwelling urinary catheters in male nursing home residents and where? Results from a nationwide cross-sectional survey in Germany.

We examined the practice and variability of indwelling urinary catheter changes in male nursing home residents. Cross-sectional data from a nationwide survey conducted in a representative sample of German nursing homes in 2023 were analyzed. The professions conducting most transurethral/suprapubic catheter changes in men were identified and proportions for whom respective catheters are changed in nursing homes were determined. Associations between these proportions and nursing home characteristics were investigated via multivariable logistic regressions. Of 1,369 invited facilities, 330 (24.1%) participated. Urologists changed most catheters in 72.8% (transurethral catheters) and 88.3% (suprapubic catheters) of the facilities. The median proportion of men whose catheters were changed in nursing homes was 8.5% (transurethral catheters; interquartile range 0.6%-100.0%) and 1.0% (suprapubic catheters; IQR 0.0%-100.0%). Facilities in which urologists changed most catheters were less likely to have a high proportion (≥90%) of in-home catheter changes compared to the reference group (odds ratio 0.44 [transurethral catheters; 95% confidence interval 0.24-0.82] and 0.30 [suprapubic catheters; 0.12-0.76]). The proportion of men whose catheters were changed in nursing homes varied considerably between facilities and was lower where urologists were involved.

Heterophase CuO/Cu/Fe nanoparticle incorporated polyurethane coating for combating catheter-induced infection

To combat biofilm formation on the surface of medical devices, a new coatings based on polyurethane filled with heterophase nanoparticles CuO/Cu/Fe composition have been developed. Due to the synergistic antibacterial effect of the nanoparticle constituents, the obtained coatings demonstrated exceptional antibacterial activity. Thus the coating containing 5 % wt. or more of the CuO/Cu/Fe nanoparticles was at least 99.99 % against bacteria S. aureus, A. bumannii, K. pneumonia, P. aeruginosa. For this coating, the value of surface energy was maximum, indicating an increase in its hydrophobicity. The operational life of the catheter samples was more than 30 days, which exceeds the operational life of standard urinary catheters. Based on the results obtained, the application of the developed coating is a promising strategy for solving the catheter-associated urinary tract infection problem. Good biocompatibility was determined in vitro using 3T3 fibroblast cell culture, which is highly sensitive to toxic effects. Compared to other strategies of catheter surface modification, the use of polyurethane coating with nanoparticles of complex composition has a number of advantages: high antibacterial activity of nanoparticles due to the synergistic effect of constituents; biocompatibility of the coating provided by the use of biometals; long-term service life due to good adhesion of the coating to the standard silicon Foley catheter. Thus, the proposed coating containing nanoparticles effectively prevents bacterial colonization on catheters or other implants, thereby reducing the risk of postoperative catheter-induced infection.

Holmium laser enucleation of the prostate: Modified urethral mucosa pre-dissected technique versus traditional three-lobe technique-A retrospective study.

The aim of this study is to investigate the effect of modified holmium laser enucleation of the prostrate (HoLEP) on the function of urine control. An analysis was conducted on a cohort of 305 elderly patients in a retrospective study spanning from February 2019 to February 2023. The cohort consisted of 150 patients who underwent modified HoLEP and 155 patients who underwent traditional HoLEP. Factors such as age, length of membranous urethra, prostate volume, BMI, IPSS, Qmax, enucleated weight, enucleation time, post-operative bladder irrigation time, catheterization and hospitalization were compared between both the groups. Multivariable logistic regression was used to identify independent predictors of urinary incontinence, and receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of urethral membrane length in the diagnosis of urinary incontinence. Postoperative Qmax,IPSS, V2 were compared between 2 groups in the 6th month. Groups were compared in terms of age, volume, BMI, IPSS, Qmax and membranous urethral length (MUL). The time of enucleation, bladder irrigation, post-operative catheterization and hospitalization was lower in the modified HoLEP group (p < 0.05). The incidence of urinary incontinence (UI) in the modified group had a statistically significant decrease at 3months (3.3% vs 9.7%, p = 0.025) and 6months (0.6% vs 5.2%, p = 0.048). The median MUL had a significant difference in the 1st month (15.07 vs 12.5mm, p < 0.001). In multivariate regression analysis, older age (OR per SD = 1.102, 95%CI: 1.077-1.136), shortened MUL (OR per SD = 0.776, 95%CI: 0.629-0.957) and increased enucleated prostate weight (OR per SD = 1.29,95%CI: 1.005-1.084) were significantly associated with UI. The ROC curve revealed the threshold value of MUL was 13.5mm, the sensitivity was 76.7%, and the specificity was 98.1%. The modified HoLEP technique is safe and effective on the function of urine control, and is superior to less residual prostate volume and higher maximum urine flow rate after surgery.