Bladder Scan Research Articles

Weakly supervised learning-based 3D bladder reconstruction from 2D ultrasound images for bladder volume measurement.

Accurate measurement of bladder volume is necessary to maintain the consistency of the patient's anatomy in radiation therapy for pelvic tumors. As the diversity of the bladder shape, traditional methods for bladder volume measurement from 2D ultrasound have been found to produce inaccurate results. To improve the accuracy of bladder volume measurement from 2D ultrasound images for patients with pelvic tumors. The bladder ultrasound images from 130 patients with pelvic cancer were collected retrospectively. All data were split into a training set (80 patients), a validation set (20 patients), and a test set (30 patients). A total of 12 transabdominal ultrasound images for one patient were captured by automatically rotating the ultrasonic probe with an angle step of 15°. An incomplete 3D ultrasound volume was synthesized by arranging these 2D ultrasound images in 3D space according to the acquisition angles. With this as input, a weakly supervised learning-based 3D bladder reconstruction neural network model was built to predict the complete 3D bladder. The key point is that we designed a novel loss function, including the supervised loss of bladder segmentation in the ultrasound images at known angles and the compactness loss of the 3D bladder. Bladder volume was calculated by counting the number of voxels belonging to the 3D bladder. The dice similarity coefficient (DSC) was used to evaluate the accuracy of bladder segmentation, and the relative standard deviation (RSD) was used to evaluate the calculation accuracy of bladder volume with that of computed tomography (CT) images as the gold standard. The results showed that the mean DSC was up to 0.94 and the mean absolute RSD can be reduced to 6.3% when using 12 ultrasound images of one patient. Further, the mean DSC also was up to 0.90 and the mean absolute RSD can be reduced to 9.0% even if only two ultrasound images were used (i.e., the angle step is 90°). Compared with the commercial algorithm in bladder scanners, which has a mean absolute RSD of 13.6%, our proposed method showed a considerably huge improvement. The proposed weakly supervised learning-based 3D bladder reconstruction method can greatly improve the accuracy of bladder volume measurement. It has great potential to be used in bladder volume measurement devices in the future.

Patients’ experiences of urinary retention and bladder care – A qualitative study in orthopaedic care

BackgroundUrinary retention is a common complication associated with hip surgery. There are easily available, evidence-based clinical practice guidelines prescribing how to prevent both urinary retention and other voiding issues, by means of bladder monitoring and risk assessments. A detected lack of adherence to such guidelines increases risks for unnecessary suffering among patients but a greater understanding of patients’ experiences can benefit tailored interventions to address quality and safety gaps in orthopaedic nursing and rehabilitation. PurposeThe aim was to describe patients’ experiences of urinary retention, bladder issues, and bladder care in orthopaedic care due to hip surgery. MethodThis was a qualitative study with a descriptive design: content analysis with an inductive approach was applied to interviews (n = 32) and survey free-text responses (n = 122) across 17 orthopaedic units in Sweden. ResultsThe patients had received no or limited details for the recurrent bladder care interventions (such as bladder scans and prompted voiding) while at the hospital. They relied on the staff for safe procedures but were left to themselves to manage and comprehend prevailing bladder issues. Despite the patients’ experiences of bladder issues or the risk of urinary retention postoperatively, the link to hip surgery remained unknown to the patients, leaving them searching for self-management strategies and further care. ConclusionsPatients’ perspectives on bladder care, urinary retention and bladder issues can serve as a means for increased understanding of procedures and issues, reinforcing improved implementation of guidelines, including person-centred information. Safer bladder procedures imply further patient engagement, highlighted in guidelines.

(445) A Full Bladder Is Not Needed To Grade Male Stress Incontinence For Prosthesis Patient Selection

Abstract Introduction Stress urinary incontinence (SUI) resulting from prostate surgery can have devastating consequences in men’s quality of life. Patient selection is crucial for successful treatment of SUI with urethral sling or artificial urinary sphincter (AUS). The ideal SUI evaluation tool for determining severity and guiding surgical treatment remains unknown. The Male Stress Incontinence Grading Scale (MSIGS) uses a standing cough test to provide a simple, non-invasive assessment of post-prostatectomy SUI severity, and can facilitate procedure selection. However, uncertainty remains as to whether MSIGS underestimates SUI severity if performed with insufficiently full bladder, increasing the risk of treatment failure. Objective We present our sling and AUS outcomes using the MSIGS for selection. We assessed bladder fullness with random bladder scans (BS) at the time of evaluation to determine if emptier bladder carries increased risk of failure. Methods We conducted a retrospective chart review of male patients undergoing sling and AUS placement. MSIGS and BS were documented at initial evaluation. Additional collected data included age, pads per day (PPD) pre- and post-surgery, post-operative MSIGS, and need for revision or conversion. Success and failure groups were defined as the post-operative use of ≤1 PPD or >1 PPD, respectively. Descriptive and comparative statistics were performed using SAS software. Results From April 2017 to September 2021, 40 male patients underwent sling and 43 naïve AUS placement. Average age was 71.9 for slings and 70.3 for AUS. 80/83 had prior prostatic surgery. Average follow up was 12.5 months. 34/40 slings had complete SUI resolution or reduction of pad use to no more than one PPD vs 40/43 of AUS (85 vs 93%, p=0.4). 4 sling patients (10%) had persistence or recurrence of SUI, of whichone patient underwent AUS placement. MSIGS scores were similar between sling success (83% patients grade 0, 3% grade 1, 14% grade 2) and failure groups (67% grade 0, 33% grade 1). 73% of AUS patient mostly had MSIGS scores 3 or 4. BS was available for 35 sling and 25 AUS patients. Average was 18.5cc in the sling failure group (range 17-161) and 38cc in the sling success, (17-161), with 32% of success patients having a BS of 0cc, and 80% of <60cc. Average BS for AUS patients was 45cc (14-224). 10 patients with BS 0 and 7 patients with BS<30cc demonstrated MSIGS 4 on exam. Conclusions MSIGS is a non-invasive, reliable test to assess SUI severity. Our preliminary data suggests that a full bladder at time of assessment is not necessary to accurately select patients for male sling vs AUS, with high rate of success and patient satisfaction. Disclosure No

PO-2269 Bladder filling verification with bladder scan for prostate radiotherapy: how reproducible we are?

PO-2269 Bladder filling verification with bladder scan for prostate radiotherapy: how reproducible we are?

MP06-09 NOVEL ALGORITHM FOR INDWELLING URINARY CATHETER REMOVAL: A PILOT STUDY

You have accessJournal of UrologyCME1 Apr 2023MP06-09 NOVEL ALGORITHM FOR INDWELLING URINARY CATHETER REMOVAL: A PILOT STUDY Emmett H Kennady, Kathleen Rea, Priyanka R Kumar, Dayna Monaghan, David E Rapp, Haerin Beller, and Emmett Kennady Emmett H KennadyEmmett H Kennady More articles by this author , Kathleen ReaKathleen Rea More articles by this author , Priyanka R KumarPriyanka R Kumar More articles by this author , Dayna MonaghanDayna Monaghan More articles by this author , David E RappDavid E Rapp More articles by this author , Haerin BellerHaerin Beller More articles by this author , and Emmett KennadyEmmett Kennady More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003217.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indwelling urinary catheter (IUC) complications including catheter-associated urinary tract infection (CAUTI) are a major source of patient morbidity associated with increased mortality and healthcare costs. Although urinary retention following IUC removal can lead to complications including CAUTI, no well-established algorithms exist for management following IUC removal. The objective of this study was to evaluate the impact of a comprehensive IUC removal algorithm. We hypothesized that a protocol driven approach to urinary retention would be superior to routine care. METHODS: A data-driven IUC removal algorithm was developed by a multidisciplinary team (Figure 1). This was made available via Epic order-set. All patients cared for in the neurosciences units in the first 3 months following implementation (April – July 2022) were evaluated. Patients were stratified by use of the algorithm. RESULTS: A total of 450 patients were evaluated during the study period. Following best of fit matching for length of stay, there were 189 patients in each cohort. There were largely no differences in baseline characteristics between algorithm and no algorithm groups, respectively (age 64 vs 64, p=0.455; BMI 28.58 vs 28.49; p=0.243). There were no CAUTIs in either group. Although the algorithm group had a significantly higher number of in-and-out catheterizations (430 vs 360; p=0.010) and bladder scans performed (826 vs 572; p=0.003), this led to a significant reduction in the proportion of patients discharged with indwelling catheters (4.3% vs 16.9%; p<0.001). There was no difference in the median time with IUC between groups (1.29 vs 1.09 days; p=0.435). There was only one consult for urinary retention in the algorithm group compared to five in the no-algorithm group (p=0.10). CONCLUSIONS: Implementation of a urinary retention algorithm following IUC removal is associated with a decrease in the number of patients discharged with an IUC. Furthermore, this algorithm may increase non-urologic clinicians’ independence in managing urinary retention. This novel algorithm was feasible and effective in a neuroscience patient population and these data warrant broader application. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e56 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emmett H Kennady More articles by this author Kathleen Rea More articles by this author Priyanka R Kumar More articles by this author Dayna Monaghan More articles by this author David E Rapp More articles by this author Haerin Beller More articles by this author Emmett Kennady More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving the quality and safety of radiology reporting: A prospective audit of discrepancies among consultant radiologists

AbstractObjectivesTo examine discrepancy rates over multiple annual cycles in reporting by consultant radiologists for the interpretation of acute Computerized Tomography (CT) examinations.MethodsA prospective audit with peer review and second reading of acute CT scans was implemented in one radiology department in the UK. A longitudinal audit over 5 years was performed to determine the discrepancy rate of acute and emergency CT scans conducted on weekends. The examinations comprised CT head, thorax, abdomen and pelvis, CT Kidneys, Ureters, and Bladder (CT KUB), and CT angiography scans. Discrepancies were scored as no discrepancy (zero), minor discrepancy (one), moderate discrepancy (two), or significant discrepancy (three). Seventeen consultants took part in the audit as primary reporters and second readers. All consultants were on‐call radiologists, and the allocation of cases was randomized depending on the on‐call rota. Results were reported annually to one consultant radiologist.ResultsA significant discrepancy rate of 1.2% (p = 0.026) was found for consultant radiologists, interpreting acute CT examinations based on 2951 s read CT scans.ConclusionsTo the best of our knowledge, this is the first study to establish significant discrepancy rates among consultant radiologists, interpreting acute CT examinations over time.

Accuracy of Bladder Scanner in Measuring Bladder Volumes in Postpartum Women.

Ultrasound bladder scanners may provide a less invasive method to measure postpartum urinary volume, but their accuracy must be validated. The objective of this study was to evaluate the accuracy of a bladder scanner in measuring bladder volumes in postpartum women. The secondary objective was to evaluate the effect of obesity on scanner accuracy. This prospective cohort study included women older than 18 years who gave birth vaginally at term gestation. After delivery, we obtained 3 sequential measurements of the bladder volume using an ultrasound bladder scanner. We then measured true bladder volume by transurethral catheterization. The primary outcome was the absolute difference between the bladder scanner volume and the catheterized volume. A Wilcoxon signed-rank test was used to compare absolute median difference between the bladder scan volume and true catheter volume. Repeated-measures analysis of variance and linear regression were used to evaluate the effect of obesity on the accuracy of the bladder scanner. We enrolled 70 patients (61.4% nulliparous, 38.6% multiparous). One delivery was vacuum-assisted, 4 were forceps-assisted, and 65 were spontaneous vaginal. The median age was 34 years, and median body mass index was 30.5. Median difference between bladder scanner and catheter volume was 42.7 mL (P < 0.001), with the scanner underestimating true volume 82.9% of the time. The scanner was less accurate in patients with a body mass index ≥ 30 (P = 0.001). The bladder scanner is less accurate than catheterized urine volume. However, the median difference between the bladder scanner and the catheterized volume is 42.7 mL, making it suitable for clinical use. Accuracy deteriorates in obese patients.

Routine Use of Bladder Scans After Primary Total Joint Arthroplasty is Not Necessary: Results of a Protocol Change

BackgroundPostoperative urinary retention is a common concern after total joint arthroplasty (TJA) and can cause discomfort, incontinence and, if left untreated, myogenic changes to the bladder. However, overdiagnosis of postoperative urinary retention by bladder scans may lead to unnecessary interventions and delayed discharges. The purpose of this study was to compare the safety of two bladder management protocols following TJA. MethodsFrom January 3, 2022 to April 29, 2022, 519 consecutive patients operated on by thirteen surgeons underwent routine postoperative bladder scanning (standard protocol). From February 28, 2022 to April 29, 2022, a new protocol was introduced by three surgeons in 209 consecutive patients using a specific algorithm (selective protocol) so that only symptomatic patients had bladder scans. The primary outcome of interest was catheterization rate. Chi-square and Students t-tests were used for analyses. There were 37.7% of patients in the selective group who received scans. ResultsTimes to catheterization, readmissions, emergency department visits, and straight catheterization rates (15.0 versus 14.8% P = .999) were similar. More scans in the selective group resulted in intervention (39.2 versus 15.0%, P < .001). Prevoid volumes were higher in the selective protocol (608 versus 448 mL, P < .001). Postvoid volumes were similar (233 versus 223 mL, P = .497). There was one readmission for a urinary tract infection in the standard group and no urinary-related readmissions in the selective group. ConclusionThe selective protocol had a higher rate of same day discharge, fewer bladder scans, and did not lead to increased rates of urinary-related complications. These findings suggest that selective bladder scanning for symptomatic patients can be safely instituted for TJA patients.

Bladder Scanners in Personal Care Homes

&#x0D; For older adults with incontinence in a personal care home setting, using a bladder scanner to assist traditional urinary incontinence care may reduce the amount of daytime urine loss and use of incontinence pads without increasing caregivers’ care burden.&#x0D; Adding a bladder scanner to urinary incontinence care may not impact patient quality of life, mental state, depression, physical function, and level of motivation.&#x0D; These findings were based on 2 studies, 1 of which lacked a control group and did not directly measure the effect of adding a bladder scanner to urinary incontinence care on patients’ urine loss. This may limit our confidence in the findings.&#x0D; We did not find any studies that reported on the effect of using bladder scanners in the personal care setting on rates of catheterization, emergency department visits, urinary tract infections, or other harms. We also did not identify any cost-effectiveness studies or evidence-based guidelines that met inclusion criteria for this report.&#x0D;

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation.

Introduction: Urinary dysfunction has a strong impact clinically, socially, and economically. Although the development of acute urinary dysfunction in hospitalized patients with cancer is common in clinical practice, its occurrence and management strategies are scant in the literature. It has been reported as one of the more common medical complications in patients with cancer undergoing acute inpatient rehabilitation. This study assessed the frequency of and risk factors for acute urinary dysfunction among these patients and identified the interventions used for management. Methods: This is a retrospective study of consecutive patients admitted to a National Cancer Institute Comprehensive Cancer Center's acute inpatient rehabilitation service from 9/1/2020 through 3/15/2021. We excluded patients that were readmissions during the study time frame. We collected patients' demographic, clinical, and functional data. We defined acute urinary dysfunction as the development of any new urinary symptom(s) or diagnosis, which involved additional work-up and/or management after admission to the acute inpatient rehabilitation service. Results: Of the 176 total patients included in this study, 47 (27%; 95% confidence interval [CI], 20-34) patients had acute urinary dysfunction. The most frequent diagnoses were urinary tract infection (32%) and neurogenic bladder (26%). The most common tests were urine cultures (32%) and urinalyses (30%). The most commonly prescribed medications were antibiotics (32%) and alpha-1 blockers (15%). Other most frequent interventions included timed voiding (34%) and intermittent catheterization with bladder scans (28%). Acute urinary dysfunction was associated with an increased length of stay on the inpatient rehabilitation service (odds ratio [OR], 1.13; 95% CI, 1.06-1.20; P<.001), surgery during the index admission (OR, 2.50; 95% CI, 1.21-5.16; P=.014), and fecal incontinence (OR, 6.41; 95% CI, 1.83-22.44; P=.004). Conclusion: Acute urinary dysfunction was noted to be a substantial problem in this cohort. This is an overlooked dimension of inpatient cancer rehabilitation that deserves more attention. Patients at risk for acute urinary dysfunction may benefit from close monitoring for medical management and rehabilitation interventions to maximize functional independence with bladder care. More research regarding acute urinary dysfunction types and management approaches in post-acute care settings for patients with cancer is justified.

Validation of acoustic voided volume measure: a pilot prospective study.

We evaluated the accuracy and reliability of a new smartphone-based acoustic voided volume (VV) measurement application compared to VV estimation based on the measurement of urine volume in a bladder by ultrasound bladder scan. A total of 53 subjects from 01/2021 to 09/2021 were prospectively enrolled. Bladder scan-based VV estimation is based on the difference in the volume of urine in a bladder measured before urination and volume measured after urination. The acoustic VV measurement is based on smartphone-based acoustic VV measurement mobile application. VV estimates for the same void were compared between two techniques. Urinary measures were obtained from 49 male subjects resulting in a total of 245 measurements for analysis. VV measures were compared using Pearson's correlation coefficient (PCC), evaluation of observed versus predicted VV measures using linear regression fit indices, and Bland-Altman method. VV between the two techniques revealed strong correlation (PCC 0.811, p < 0.001). Means of the number of measurements per patient and inpatient days for measurements analyzed are 5 and 2.7, respectively. In 245 measurements, VV measured by bladder scan is 238.69 ± 122.32mL, VV measured by mobile application is 254.69 ± 119.28mL, and their difference of two measurements is 16 ± 74.29mL. Through the comparison with VV estimated by ultrasound bladder scan, which is a technology to measure the urine volume in a bladder, it was confirmed that the smartphone-based acoustic VV measurement application proudP® is accurate.

A case of blunt abdominal trauma resulting in significant bladder injury (AAST grade IV)

Introduction: Bladder injuries are uncommon and its diagnosis is often missed. However, in patients presenting with blunt abdominal trauma, bladder, and other lower urinary tract injuries must be ruled out using adequate investigations. Case Report: A 33-year-old male presented to the Emergency Department 24 hours after a fall, complaining of lower abdominal pain and inability to void. Examination revealed a mildly distended abdomen with no signs of peritonism. A random bladder scan showed a volume of 583 mL. Basic investigations showed the patient to be in acute kidney injury (AKI) stage III with a creatinine of 350 mmol/L. Clinical findings were suggestive of a bladder injury. However, due to the rarity of such cases, clinicians reviewing the patient did not think of a bladder injury as one of the differential diagnoses. Instead of also requesting for a computed tomography (CT) cystography, only a trauma CT abdomen and pelvis with contrast was requested which demonstrated an intraperitoneal bladder injury. The patient was taken to theater for an emergency laparotomy and repair of a 4 cm bladder laceration. According to the American Association for the Surgery of Trauma (AAST) classification, the patient had a Grade IV bladder injury. A cystogram performed 4 weeks after the surgery showed no urine leak and the urethral catheter was removed. Fortunately, no harm was brought to the patient. Conclusion: Intraperitoneal bladder injuries, if missed, can be associated with serious morbidities and even increase the risk of mortality.

Defining the Reliability of Bladder Scan in Obese Patients with Postoperative Urinary Retention

Introduction: Postoperative urinary retention (POUR) is a common problem. Patients are prophylactically catheterized to prevent detrusor damage and pain from bladder distention. This may result in unnecessary catheterization. Bladder scans are used to check for POUR before a patient is catheterized. There is a paucity of data pertaining to its reliability in postoperative obese patients. Methods: We prospectively collected data in postoperative patients in the surgical ward. Only postoperative patients were included. Patients were catheterized based on the clinical judgement of the treating physician. The nurses collected 5 bladder scan readings using a portable bladder scanner before catheterizing a patient and recording the volumes collected. The mean of bladder scan readings was compared with the volume collected during catheterization. Intraclass correlation coefficient (ICC) was used to judge reliability. Results: We collected data in 95 patients, and 62 (27 women, 35 men) were included in the final analysis. ICC in all subjects was 0.76 (95% CI, 0.63-0.85), indicating good reliability. ICC for 17 (27.9%) patients with a BMI >30 kg/m2 (Class I obesity), and 9 (14.8%) patients with a BMI >35 kg/m2 (Class II obesity) was 0.75 (95% CI, 0.61-0.84) in both the groups, suggesting good reliability with respect to correlation between the average of bladder scan measurements and volume collected during catheterization. Conclusion: The bladder scan is a reliable measure of urine volume and correlates well with catheterization volume. This holds true even in patients with obesity, both class I and II. This study emphasizes the reliability of bladder scan use before catheterization in postoperative patients irrespective of the BMI.

A co-created nurse-driven catheterisation protocol can reduce bladder distension in acute hip fracture patients - results from a longitudinal observational study

BackgroundUrinary retention is common in elderly patients undergoing acute hip fracture surgery. Avoiding overfilling the urinary bladder is important to avoid detrusor muscle damage and associated motility problems. The aim of this study was to analyse associations between the co-creation of a nurse-driven urinary catheterisation protocol and the incidence of bladder distension in patients undergoing hip fracture surgery.MethodsThis is a single-centre implementation intervention with a retrospective longitudinal observation design, using five measures points, spanning from June 2015 to March 2020. The intervention was theory driven and the participants, together with the facilitators and researcher, co-created a nurse-driven urinary catheterisation protocol. Data were retrieved from the hip fracture register. Uni- and multivariable logistic regressions were used for analyses of changes in bladder distension and urinary volume of ≥500 ml over the years.ResultsA total of 3078 patients were included over a five-year period. The implementation intervention was associated with a reduction in the proportion of patients with bladder distension of 31.5% (95% confidence interval 26.0–37.0), from year 1 to year 5. The multivariable analysis indicated a 39% yearly reduction in bladder distension, OR 0.61 (95% confidence interval 0.57–0.64, p < 0001). There was a reduction in the proportion of patients with a bladder volume of ≥500 ml of 42.8% (95% confidence interval 36.2–49.4), from year 1 to year 5. The multivariable analysis found a 41% yearly reduction in patients with a bladder volume of ≥500 ml, OR 0.59 (95% confidence interval 0.55–0.64, p < 0.0001). The intervention was associated with improved documentation of both catheter indications and removal plans.ConclusionThe use of predefined catheter indications and a tighter bladder scanning schedule were associated with a reduction in the incidence of both bladder distension and urine volume ≥ 500 ml in hip fracture patients. Registered nurses can play an active role in the facilitation of timely and appropriate catheter treatment in patients with hip fractures.Trial registrationClinical Trial Registry ISRCTN 17022695 registered retrospectively on 23 December 2021, in the end of the study, after data collection.

Prevention of Postpartum Urinary Retention with Peppermint Oil Vapor

Urinary retention in the postpartum period (PPUR) is one of the health problems commonly handled using catheterization and antibiotic prophylaxis. This study aimed to look at the influence of peppermint oil on PPUR prevention. This quasi-experimental study with a control group design included 60 postpartum subjects (29 in the control group and 31 in the intervention group) with vaginal delivery (ages 17-50 years). The intervention group obtained treatment by giving 2 mL of peppermint oil, while the controlled group used mineral water in the closet before subjects sat on it for 5-10 minutes and voided. The bladder condition was further checked subjectively and manually by palpation before and after the exposure to peppermint oil (distention or no distention). The relationships between variables were analyzed using the Fisher Exact statistical test, obtaining no significant effect of peppermint oil administration variables on PPUR prevention (p = 0.495, CI 95%). PPUR is related to oxidative stress, tissue inflammation, and nerve impulse blocks. Peppermint oil is estimated to be one of the modalities in preventing health problems through antioxidant, anti-inflammatory, and antispasmodic effects. Further research is needed to validate the effect of peppermint oil on PPUR prevention. In addition, support of screening information on the condition of the bladder objectively using a bladder scanner is also needed to measure the post-void residual volume (PVRV). This study showed that peppermint oil on PPUR prevention has no significant effect and may require further investigation.

Reducing Indwelling Urinary Catheter Utilization Results in Reduction of Associated Urinary Tract Infections

<h3>Background</h3> Catheter Associated Urinary tract infections (CAUTIs) are the fifth most common type of healthcare-associated infection (HAI), resulting in increased morbidity/mortality. The most important risk factor for developing a CAUTI is prolonged use of indwelling urinary catheters (IUCs). One of the strategies to prevent a CAUTI is to reduce IUC utilization. During the 12-month period from July 2019 through June 2020, the CAUTI Standard Infection Ratio (SIR) for our Medical Center was 1.86 with 21 observed cases. The Standard Utilization Ratio (SUR) was 0.89. <h3>Methods</h3> A Plan Do Study Act (PDSA) cycle was used in this performance improvement project. In order to address high CAUTI incidences, a multi-disciplinary performance improvement task force composed of nursing directors, physicians, infection prevention, and the supply chain was initiated in August 2020. The Chief Medical Officer, Chief Nursing Officer and Chief Operating Officer highlighted the gravity of the situation at every team meeting. One action taken was the initiation of the "Holy Moley Remove That Foley" campaign. The purpose of the campaign was to review appropriateness of IUCs during daily multi-disciplinary rounds using "IUC appropriateness checklist" and complete the "IUC insertion checklist" prior each IUC insertion house-wide including the Emergency Department. Bladder scans were encouraged to assess for retention and to follow a nurse driven protocol to use external urinary devices. The hospital's education department provided education and ongoing competency evaluations during this campaign. <h3>Results</h3> The actions above resulted in SIR of 0.58, SUR of 0.71 and 7 incidences during July 2020 through June 2021. This is a statistically significant SIR reduction with two-tailed t test, p value of 0.0049. <h3>Conclusions</h3> By engaging a multi-disciplinary team that includes non-nursing departments, a significant reduction in CAUTIs was achieved. This project highlights that the involvement of several disciplines is needed to prevent HAIs.

Status of hospital infection prevention practices in Thailand in the era of COVID-19: Results from a national survey

BackgroundA 2014 study assessed infection prevention (IP) practices in Thai hospitals for catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), and ventilator-associated pneumonia (VAP). This study compares current IP practices to results obtained in 2014. MethodsBetween February 1, 2021 and August 31, 2021, we resurveyed Thai hospitals regarding practices to prevent CAUTI, CLABSI, and VAP. We also assessed COVID-19 impact and healthcare worker burnout and coping strategies. We distributed 100 surveys to a convenience sample of infection preventionists. ResultsResponse rate: 100%. One-third (31%) of hospitals reported excellent leadership support for infection control (ie, responses of “good” or “excellent” to one survey question). Some prevention practices increased between 2014 vs 2021 (CAUTI: catheter reminder/stop-order/nurse-initiated discontinuation [50.0% vs 70.0%, P < .001]; condom catheters [36.3% vs 51.0%, P = .01]; ultrasound bladder scanner [4.7% vs 12.0%, P = .03]; CLABSI: chlorhexidine gluconate insertion site antisepsis [73.6% vs 85.0%, P = .03]; maximum sterile barrier precautions [63.2% vs 80.0%, P = .003]; VAP: selective digestive tract decontamination [26.9% vs 40.0%, P = .02]). Antimicrobial catheter use decreased since 2014 (10.4% vs 3.0%, P < .001). Many other practices remain suboptimal. COVID-19 challenges: staff shortages (71%), financial hardships (67%). Only 46% of infection preventionists felt safe working during COVID-19. ConclusionsMore national strategic support is needed for IP programs to prevent CAUTI, CLABSI, VAP and healthcare worker well-being in Thailand during the COVID-19 pandemic.

MP30-12 VALIDATION OF MOBILE APPLICATION MEASURING VOIDED VOLUME: A PILOT PROSPECTIVE STUDY

You have accessJournal of UrologyCME1 May 2022MP30-12 VALIDATION OF MOBILE APPLICATION MEASURING VOIDED VOLUME: A PILOT PROSPECTIVE STUDY Hwanik Kim, Jin Hyuck Kim, Changhee Ye, Gyoohwan Jung, Jung Kwon Kim, Hakmin Lee, Seong Jin Jeong, and Sangchul Lee Hwanik KimHwanik Kim More articles by this author , Jin Hyuck KimJin Hyuck Kim More articles by this author , Changhee YeChanghee Ye More articles by this author , Gyoohwan JungGyoohwan Jung More articles by this author , Jung Kwon KimJung Kwon Kim More articles by this author , Hakmin LeeHakmin Lee More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , and Sangchul LeeSangchul Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Comparing urine flow tests performed at the clinic with the actual urination at home, there can be a mental burden and straining of urine that can affect the test results. The need for a comfortable, convenient, and even portable, home-based device has led to the development of novel uroflowmetry technology. This study aimed to evaluate the accuracy and reliability of a new smartphone-based acoustic voiding volume measurement application compared to conventional ultrasound bladder volume scanner. METHODS: A total of 12 subjects from September 2020 to March 2021 were prospectively enrolled with informed consent to compare novel acoustic voiding volume measurement to conventional ultrasound bladder volume scanner. 2 subjects were excluded their measurement do not meet our standard of sound quality (i.e. voiding in environment with very loud fan noise, voiding to the wall, door slams). Finally, 10 patients with 50 voiding measurements were included for analysis. The value measured before urination by bladder scanner (A), the value measured after urination by bladder scanner (B), and the value of voided volume measured by smartphone-based acoustic voiding volume measurement mobile application (C) were compared between the 2 techniques. Reliability and accuracy of the voided volume results were compared using Pearson correlation coefficient, and student t-test, respectively. RESULTS: 10 healthy volunteers were included in the study. Median age was 53.5. Median values of uroflowmetry proflile are as follows: Qmax: 16.3mL/s, Voided volume: 256.8mL, and postvoid residual urine: 7.5mL. Voided volume between the 2 techniques revealed strong visual correlation (r=0.71, p=0.02). When compared to conventional uroflowmetry. When analyzed separately for each individual, each participant showed stronger correlation (range: 0 59-1.00). CONCLUSIONS: The acoustic voiding volume measurement application can take over the role of traditional bladder scan resulted from our validation. Through comparison of bladder scan measurements before and after urination, it was confirmed that the urine volume measurement using the smartphone PRIVY application was accurate. PRIVY application can be a breakthrough that can lower the barriers to entry to health management of patients' urination. Further large-scale studies will further increase the credibility of our results. Source of Funding: N/A © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e482 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hwanik Kim More articles by this author Jin Hyuck Kim More articles by this author Changhee Ye More articles by this author Gyoohwan Jung More articles by this author Jung Kwon Kim More articles by this author Hakmin Lee More articles by this author Seong Jin Jeong More articles by this author Sangchul Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...

The efficacy of force of stream assessment for post-operative catheter management: a retrospective cohort study.

Postoperative urinary retention is common after urogynecologic procedures. Our objective is to determine the efficacy of force of stream (FOS) assessment without a visual analog scale for postoperative catheter management. We conducted a retrospective cohort study of 110 women undergoing an inpatient gynecologic procedure. They were asked to subjectively assess FOS after surgery without a visual analog scale. If it was 50% or better than the usual preoperative void, they were discharged home without a catheter. If < 50%, the catheter was replaced and the patients were sent home and asked to follow up in 3 to 5days for another void trial. Average age was 56.9 ± 10.2years; 63.6% underwent surgery for pelvic organ prolapse, 23.6% underwent sling for urinary incontinence, and 12.7% underwent a combination of both. Force of stream was > 50% in 93.6% of the patients; 6.4% had force of stream < 50% and hence were discharged home with a Foley catheter. Only two patients (1.8%) were discharged without a Foley catheter and returned to the emergency department for signs of urinary retention. Sensitivity, specificity, positive and negative predictive values were 77.8%, 100%, 100% and 98.1%, respectively. The subjective assessment of flow of stream is a reliable and safe method to assess postoperative voiding. Given it is less invasive than backfilling the bladder and easier than using a bladder scan, it should be the primary method to assess postoperative voiding.

Post‐void residual volume after uroflowmetry measured using both ultrasound and bladder scanner by urologic nurses

Post‐void residual volume after uroflowmetry measured using both ultrasound and bladder scanner by urologic nurses