Catheter Removal Research Articles

Rare case of resistant Achromobacter xylosoxidans-associated meningitis due to intrathecal catheter

Background: Achromobacter xylosoxidans (AX) is an aerobic Gram-negative opportunistic bacteria known to inhabit various environments and is most commonly associated with nosocomial infections in immune-compromised patients. Although rare, AX can cause a variety of neurological infections, such as meningitis, ventriculitis, and osteomyelitis. Intravascular catheters, intrathecal pumps, and contaminated surgical instruments are potential vectors for such patients. Case Description: Here, we present a unique case of multidrug-resistant AX-positive meningitis secondary to infection of a nonfunctional intrathecal narcotic pump. The patient has a complex past medical history leading up to infection, and care was significantly compromised by homelessness and inflammatory bowel disease (IBD). Treatment included catheter removal and antibiotics. Conclusion: Patients who suffer from homelessness or IBD show a possible increased risk of this infection. This case emphasizes the need for increased care regarding these patients, along with describing the complications and timeline when treating this rare type of meningitis.

The prognostic value of cystography-measured bladder capacity on very early continence rates after radical prostatectomy.

To assess the utility and reliability of cost-effective cystography-measured bladder capacity as a prognostic tool for predicting very early continence recovery following radical prostatectomy. Additionally, the study aims to discuss the clinical implications of the findings, including their potential impact on patient management, postoperative rehabilitation strategies, and the development of personalized care pathways for prostate cancer patients. In this prospective monocentric study, we analyzed 223 patients who underwent either robot assisted radical prostatectomy (RARP) or open radical prostatectomy (ORP) between January 2022 and January 2024. Postoperative cystography was routinely performed 5 days after robot-assisted radical prostatectomy and 7 days after open radical prostatectomy. Very early continence rates were determined using a standardized pad-test conducted on the first day following catheter removal. The bladder capacity during cystography was measured and documented for every patient. The correlation between the rate of continence recovery and the bladder capacity was then assessed. To determine other predictive factors for recovery of continence, several parameters were analyzed using multivariate logistic regression analysis, including age, prostate volume, nerve-sparing technique and surgical procedure. Urinary continence rates at day 1 after catheter removal were 73.5% for patients who underwent RARP and 72.6% for patients who underwent ORP. A strong prognostic value of cystography-measured bladder capacity on very early continence rates was reported (p < 0.001), with a cut-off value calculated to be 140 ml of bladder capacity. After adjusting for additional variables such as age, surgical procedure, prostate volume and nerve-sparing technique, multivariate linear model analysis still found a strong correlation between cystography-measured bladder capacity and very early continence rates (p < 0.001). The cystography-measured bladder capacity may be a good predictor of the recovery of post-prostatectomy urinary continence.

Applications of flexible ureteroscope lithotripsy with negative pressure suction and percutaneous nephrolithotomy in the treatment of 2-3cm diameter renal calculi.

Renal calculus, or kidney stone disease, presents a significant healthcare challenge globally, necessitating diverse therapeutic interventions. Percutaneous nephrolithotomy (PCNL) and flexible ureteroscope lithotripsy (FURL) are prominent among these interventions, with PCNL favored for stones > 2cm and FURL for smaller stones and applications of flexible ureteroscope lithotripsy with negative pressure suction for stones 1.5-2.5cm have some benefit. From June 2019 to January 2024, 310 patients undergoing FURL with negative pressure suction or PCNL for 2-3cm renal calculi were retrospectively analyzed. The demographic and clinical data were collected, and outcomes including stone-free rates (SFR), postoperative complications, and surgical parameters were compared. Comparable SFR were observed between FURL and PCNL groups at 1-month follow-up, although PCNL was superior to FURL after immediately post-surgery. FURL exhibited significantly fewer complications overall (5.7% vs. 19.3%, p = 0.044), shorter hospital stays, and lower postoperative pain levels. The surgical parameters favored FURL, showing lower bleeding volumes, shorter catheter removal times, and less hemoglobin decrease postoperatively. Despite similar stone clearance efficacy at 1-month follow-up, FURL demonstrated superior safety and postoperative outcomes compared to PCNL for 2-3cm renal calculi. These findings highlight the potential advantages of FURL in reducing complications, enhancing recovery, and optimizing patient care pathways.

OGC SO23 - Audit on Enhanced Recovery After Surgery (ERAS) in Oesophago-gastric Resections for Cancers

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols, have been designed to guide clinicians in managing patients post-operatively, reducing hospital stay, complications and readmissions. Our trust’s ERAS protocol includes guidance on oral intake initiation, drain, catheter and epidural removal, investigation frequency, medications required on discharge and early mobilization. However, implementation of ERAS protocols in complex oncological surgery can be challenging, due to the multiple factors included and increasing complexity. We aimed to assess the compliance of ERAS implementation in a high volume resectional oesophago-gastric unit, and subsequent impact on morbidity. Method A retrospective review of all patients who underwent oesophago-gastric resections during March-April 2024 was performed. Patients were included if they completed an oesophagectomy, or subtotal/total gastrectomy resection for cancer. Electronic records and medical notes were reviewed and compared to all aspects of the trust’s ERAS protocol. The adherence percentage to the protocol was calculated. Results 20 patients underwent surgery. 85% started their oral diet on time per ERAS protocol. Adherence to ERAS was lowest for epidural (52.6%, 95% within 24-hours of target), catheter (55%, 90% within 24-hours of target), apical (55.6%, 100% within 24-hours of target), basal (53.8%, 85.7% within 24-hours of target), and abdominal drain removals (81.8%, 90.9% within 24-hours of target). All patients mobilized within four days post-op, with 65% achieving daily mobilization. VTE prophylaxis was prescribed for all, and discharge medication adherence ranged from 86.7% to 100%. The mean hospital stay was 9 days post-oesophagectomy, with a 3.2% emergency department return rate. Conclusion Implementation of an ERAS protocol is feasible in complex oesophago-gastric cancer surgery. Effective involvement and training of allied health, specialist pain services and the whole surgical team can decrease morbidity and length of stay in oesophagectomy, while avoiding excess emergency department presentations. Ongoing training and feedback of allied health, pain services, and surgical team at all levels is important to ensure adequate compliance.

A Programmatic Approach to En Bloc Transurethral Enucleation of the Prostate with Bipolar System (TUEB): A Single-Center Retrospective Report.

This study presents a systematic approach for en bloc transurethral enucleation of the prostate utilizing a bipolar system (TUEB), evaluating its effectiveness and safety. Furthermore, the research aims to pinpoint risk factors contributing to early stress urinary incontinence (SUI) after undergoing en bloc TUEB. The en bloc TUEB procedure is visually demonstrated through images and videos. A retrospective analysis was conducted based on the data of 88 patients diagnosed with benign prostatic hyperplasia (BPH) who underwent en bloc TUEB between January 2018 and April 2023. Detailed perioperative and follow-up clinical data were collected and analyzed. Patients were categorized based on the occurrence of SUI, and their clinical characteristics were analyzed. The mean surgical duration was 113.1 ± 50.0 minutes, resulting in an excised prostate gland weighing 58.0 ± 34.3 g and a hemoglobin drop of 14.3 ± 11.2 g/L. The average enucleation rate was 79.00 ± 11.01 %, enucleation efficiency was 0.54 ± 0.26 g/min and prostate specific antigen (PSA) reduction rate was 42.08 ± 22.85 %. There were no major complications during operation. Twenty-three patients (26.13%) developed early SUI after catheter removal, and 74% of them were in remission within 1 month. Importantly, no cases of persistent SUI were observed. Lower urinary tract symptoms (LUTS) duration was significantly different between patients with and without post-operative SUI. Residual urine volume, International Prostate Symptom Score (IPSS) and Quality of Life (QoL) score were significantly improved in BPH patients after surgery (P < 0.05). Twelve months after surgery, only 2 patients (2.27%) had urethral stricture, although it recovered after transurethral dilation. En bloc TUEB is proven to be effective, practical, efficient and safe with minimal complications. This procedure could be standardized and widely adopted. LUTS duration can predict the risk of early SUI.

Robotic surgery versus laparoscopic surgery for rectal cancer: a comparative study on surgical safety and functional outcomes.

This study aims to evaluate the clinical efficacy and functional outcomes of DA Vinci (Xi)-assisted surgery compared to conventional laparoscopic surgery for middle and low rectal cancer, focusing on oncologic cure and functional preservation. Between December 2020 and June 2021, 102 patients with middle and low rectal cancer (tumour lower margin ≤10 cm) were enrolled at the affiliated Hospital of Xuzhou Medical University. Participants were divided into two groups: robot-assisted (n = 51) and laparoscopy-assisted (n = 51). Each group underwent a radical resection using their assigned method. Clinical and functional outcomes were analysed post-surgery. Preoperative data did not differ significantly between groups (P > 0.05). All surgeries were successfully completed without conversion to open surgery. The robotic group experienced significantly less intraoperative blood loss (55.2 ± 29.8 mL vs. 109.5 ± 58.5 mL) and faster recovery in gastrointestinal function (35.1 ± 9.4 h vs. 40.7 ± 1.9 h), diet recovery (2.1 ± 0.8 days vs. 2.9 ± 0.4 days), and catheter removal (2.9 ± 2.7 days vs. 5.3 ± 2.1 days). The robotic group also dissected more lymph nodes (23 ± 6 vs. 15 ± 4). However, they had longer operative times (239.8 ± 29.6 min vs. 141.1 ± 18.5 min) and higher hospital costs. Satisfaction levels regarding defecation, voiding, and sexual functions were notably higher in the robotic group. No significant differences in surgical safety or immediate postoperative outcomes were observed between robotic and laparoscopic approaches. However, robotic surgery demonstrated superior lymph node dissection, anal function preservation, and gastrointestinal recovery, enhancing overall functional outcomes.

Midline vs Peripherally Inserted Central Catheter for Outpatient Parenteral Antimicrobial Therapy.

Little is known about the safety of midline catheters vs peripherally inserted central catheters (PICCs) for outpatient parenteral antimicrobial therapy (OPAT). To compare outcomes from midline catheters vs PICCs for OPAT. This retrospective cohort study included patients who received antimicrobial therapy through a midline catheter or PICC between January 2017 and November 2023 across 69 Michigan hospitals. Because peripherally compatible OPAT was the indication of interest, vancomycin therapy was excluded. Data were analyzed from April to June 2024. Insertion of a midline catheter or PICC for OPAT following hospitalization. The primary outcome was major device complications (ie, catheter-related bloodstream infection or catheter-related venous thromboembolism). Secondary outcomes included minor device complications (eg, catheter dislodgement, occlusion, tip migration, infiltration, superficial thrombophlebitis, or exit site concerns) and device failure, defined as catheter removal following device complication. Cox proportional hazards regression models were fit to device type and outcomes, adjusting for patient and device confounders and device dwell. Of 2824 included patients, 1487 (53.5%) were male, and the median (IQR) age was 66.8 (55.9-77.1) years. Of 2824 devices placed for OPAT, 1999 (70.8%) were midline catheters and 825 (29.2%) were PICCs. The median (IQR) dwell time was 12 (8-17) days for midline catheters and 19 (12-27) days for PICCs (P < .001). A major device complication occurred in 44 patients (1.6%) overall, including 16 (0.8%) with midline catheters and 28 (3.4%) with PICCs (P < .001). OPAT delivered via midline catheters was associated with a lower risk of major complications vs PICCs (adjusted hazard ratio [aHR], 0.46; 95% CI, 0.23-0.91). Risks of minor complications and device failure were similar across device types (minor complications: 206 of 1999 [10.3%] vs 114 of 825 [13.8%]; aHR, 1.07; 95% CI, 0.83-1.38; device failure: 191 of 1999 [9.6%] vs 100 of 825 [12.1%]; aHR, 1.26; 95% CI, 0.96-1.65). For device dwell of 14 or fewer days, midline catheters were associated with a lower risk of major complications (12 of 1324 [0.9%] vs 16 of 304 [5.3%]; aHR, 0.29; 95% CI, 0.12-0.68) and similar risk of failure (151 of 1324 [11.4%] vs 52 of 304 [17.1%]; aHR, 0.79; 95% CI, 0.56-1.12) vs PICCs. For dwell longer than 14 days, no significant difference in rates of major complications (4 of 675 [0.6%] vs 12 of 521 [2.3%]; aHR, 0.42; 95% CI, 0.13-1.40) or device failure (40 of 675 [5.9%] vs 48 of 521 [9.2%]; aHR, 1.02; 95% CI, 0.64-1.61) were observed. In this study, midline catheters appeared to be safe alternatives to PICCs for OPAT, particularly if infusions were planned for 14 or fewer days.

Risk factors, management and outcomes for peritoneal dialysis access damage

Objectives: Peritoneal dialysis (PD) access damage is an uncommon complication of PD. This study aimed to describe the characteristics, management and outcomes of PD access damage. Methods: This retrospective study included patients who suffered from PD access damage between January 2018 and January 2024 at the PD Center of West China Hospital. Patient characteristics and access damage information were collected from medical records. Results: A total of 128 PD patients without PD access damage were included in the control group. A total of 45 patients (51% male; aged 58 ± 14 years) suffered from 49 cases of PD access damage. Multivariate logistic analysis revealed that previous peritonitis [odds ratio (OR) 3.93; 95% confidence interval (CI) 1.56 to 9.94] and assisted PD (OR 4.20; 95% CI 1.25 to 14.12) were risk factors, while catheter belt use (OR 0.16; 95% CI 0.06 to 0.44) and training frequency per year (0.34; 95% CI 0.19 to 0.64) were protective factors against PD access damage. Managements included cutting and repairing (N = 24), transfer set replacement (N = 11), catheter removal (N = 9) and catheter replacement (N = 4). Thirty-nine patients continued with PD after access repair and were followed up for a median of 35 months. The repaired access functioned well during follow-up. Conclusions: In conclusion, to avoid PD access damage, catheter belt and routine retraining are recommended. Once PD access damage is identified, patients should clamp the catheter, take prophylactic antibiotics and resort to the treatment team. The treatment team should evaluate PD access and handle it according to a clinical protocol.

Association between duration of urinary catheterization and post-operative mobilization following elective cesarean section: A retrospective case-control study in Espoo, Finland.

Cesarean section is the most common surgery performed on women. The enhanced recovery recommendations are early urinary catheter removal and early mobilization, as essential elements of post-operative care. This study aimed to analyze the association between these elements and whether limiting the catheter treatment duration affects the timing of post-operative mobilization. This retrospective case-control study compared the mobilization of healthy elective cesarean patients under different instructions on urinary catheter removal: cases with a preset catheter removal time (8-12 hours) and controls with catheter removal based on midwife considerations. Apart from the preset time of catheter removal, the routine post-operative care was given by the same personnel without any advice on patient mobilization. Data on patient demographics, surgery details, post-operative medication, first upright mobilization, the length of hospital stay, and patient satisfaction were analyzed. The study comprised 52 cases and one control for each case (N=104). The mean duration of urinary catheterization was 20.15 ± 6.59 and 11.30 ± 4.20 hours in the control and intervention groups, respectively (p<0.001). A linear regression analysis showed a significant association between the catheter removal time and patient mobilization, when adjusted for maternal background parameters (age, BMI, fear of childbirth diagnosis, prior uterine scar), duration and timing of the surgery, bleeding and post-operative analgesic use (R2=0.444, p<0.001). No difference was detected in the length of hospital stay, or patient satisfaction. Limiting the duration of urinary catheter therapy is associated with shorter time to post-operative mobilization. A prospective randomized trial would provide more detailed information.

Predictive factors of immediate continence after conventional robot-assisted radical prostatectomy: a single-institution retrospective study.

To assess the predictive factors of immediate urinary continence after robot-assisted radical prostatectomy. This study included 282 patients who underwent conventional robot-assisted radical prostatectomy at our institution from April 2019 to March 2024. The primary outcome was immediate urinary continence, defined as the absence of urine leakage immediately after urinary catheter removal on postoperative day 6 or 7. In addition, the immediate urine loss rate, defined as the 24-h urine loss volume divided by the total urine volume after catheter removal, was calculated. The multivariable logistic model was used to assess the possible predictive factors of immediate continence (urine loss rate of 0%). The factors included age, body mass index, Charlson Comorbidity Index, pre-existing lower urinary tract symptoms, presence of an inguinal hernia, prostate volume, membranous urethral length, stratified cancer risk, surgeon's experience, and nerve-sparing procedure. In addition, a multiple linear regression model was established to investigate the associations of the same predictors with immediate urine loss rate (%). We also presented our techniques to achieve immediate continence. The patients' median age was 70 (interquartile range: 63.0-73.0) years. Approximately 39% (n = 111) of patients presented with immediate continence. Age, inguinal hernia, membranous urethral length, and low risk for prostate cancer were associated with immediate continence. These were also statistically significant predictors of immediate urine loss rate. Our study identified factors predicting immediate urinary continence after conventional robot-assisted radical prostatectomy. This information is potentially valuable for preoperative counseling in patients undergoing robot-assisted radical prostatectomy.

The Impact of ERAS and Multidisciplinary Teams on Perioperative Management in Colorectal Cancer.

The Enhanced Recovery After Surgery (ERAS) protocol, a comprehensive multimodal approach, aims to mitigate surgical stress, expedite recovery, and improve postoperative outcomes. Its implementation has notably advanced perioperative care in colorectal cancer surgeries. Integrating ERAS with multidisciplinary collaboration, involving surgery, anesthesia, nursing, and nutrition, may further enhance patient outcomes, making it a significant focus in clinical practice. This study assessed the effectiveness of integrating the ERAS model with multidisciplinary collaboration during the perioperative period in colorectal cancer patients. A total of 117 patients scheduled for elective surgery at Haiyan People's Hospital between August 2023 and April 2024 were randomly assigned to either a control group (n = 59), receiving traditional care, or an experimental group (n = 58), receiving ERAS-based multidisciplinary care. Key outcomes related to postoperative rehabilitation were evaluated. Patients in the ERAS group demonstrated significantly shorter hospital stays, quicker catheter removal, and earlier mobilization compared to the control group (P < 0.0001 for all). Additionally, the ERAS group exhibited reduced postoperative inflammatory responses, as indicated by significantly lower interleukin-6 levels on the first postoperative day (P = 0.0247). The quality of life was significantly higher in the ERAS group (P < 0.05). Furthermore, the ERAS group incurred lower total hospitalization expenses than the control group (P = 0.0011). These findings confirm the benefits of the ERAS protocol in enhancing postoperative recovery in colorectal cancer surgeries. The study highlights the importance of a multidisciplinary approach in optimizing patient outcomes and reducing the burden on hospital resources.

Comparison of Early Versus Late Foley Catheter Removal after TURP- Our Experience

Objective: To compare early versus late catheter removal after Transurethral resection of prostate for benign prostatic hyperplasia in terms of postoperative complications. Study Design: Cross sectional Study. Place and Duration of Study: Urology Department, Armed Forces Institute of Urology, Rawalpindi Pakistan from Jan 2022 to Aug 2022. Methodology: A total of 100 patients undergoing monopolar Transurethral resection of prostate fulfilling the inclusion criteria were included in study after written informed consent. They were randomized in two equal Groups (50 patients each) by lottery method, Group A-catheter removed on day 2 and Group B-catheter removed on day 5, postoperative complications including urinary retention, hematuria, urinary tract infection and urethral stricture were recorded on proforma. Results: Both Groups had no statistically difference in demographic profile. In Group-A, 4(8%) patients had urinary retention and in Group-B, 3(6%) patients had urinary retention (p-value 0.438). The number of patients that had UTI in Group A and Group B were 1(2%) and 7(14%) respectively which was statistically significant (p&lt;0.001). However, hematuria, urethral stricture and epididymo-orchitis were not statistically significant among Groups with p-values of 1.00, 0.24 and 0.36 respectively. Conclusion: Early catheter removal after Transurethral resection of prostate resulted in decreased urinary tract infection rate as compared to delayed catheter removal without any other significant postoperative complications.

Clinical outcomes and the impact of treatment modalities in children with carbapenem-resistant Enterobacteriaceae bloodstream infections: a retrospective cohort study from a tertiary university hospital.

The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections among children represents a significant global concern, leading to elevated mortality rates. The aim of this study was to evaluate the risk factors, outcomes, 30-day mortality rates and contributing factors in children with CRE bloodstream infections (CRE-BSIs). Data regarding demographic characteristics, treatment approaches and outcomes of hospitalized children aged 0-18 years diagnosed with CRE-BSIs between January 2018 and December 2022 were extracted from medical records. Mortality within 30 days of diagnosis and the predictive factors were analysed. A total of 114 children, with a median age of 11 months (range: 6-69.5), were included. All cases of CRE-BSIs were either healthcare associated or hospital acquired and presented with at least one underlying comorbidity. A previous history of CRE colonization or infection rate was 48.2% (55/114). Klebsiella pneumoniae 87.7% (100/114) was the most frequently isolated microorganism, with a 30-day mortality rate of 14% (16/114). Multivariate analysis identified paediatric intensive care unit admission, invasive mechanical ventilation, inotropic support and thrombocytopenia due to CRE-BSIs as the most discriminative predictors for 30-day mortality (P < 0.001). Central venous catheter (CVC) removal was associated with a reduced mortality rate (P = 0.012). High-dose prolonged infusion of MEM-based or polymyxin-based antibiotic combinations did not impact survival. Lower MEM MIC values were associated with improved survival. The mortality rate of CRE-BSI is notably high in childhood. The use of antibiotic combination strategies did not demonstrate a significant impact on 30-day survival; however, the removal of CVCs was found to lower mortality rates.

Peritoneal dialysis-related peritonitis due to Pasteurella multocida in Australia.

Domestic animals are common in Australian households; however, there is little research into the potential risks these animals pose to patients undergoing in-home peritoneal dialysis (PD). Cats and dogs are known to carry many potential pathogens, including Pasteurella multocida. We reviewed the ANZDATA Peritoneal Dialysis Peritonitis Registry for cases of peritonitis due to Pasteurella multocida between 2011 and 2023. Cases identified were younger and more likely to be female compared with the Australian PD population who developed peritonitis due to other organisms. Of the total 32 episodes, 75% were using automated PD with glucose-based solutions. Two cases requiring removal of the PD catheter and transfer to haemodialysis and no deaths were reported. Whilst outcomes were largely favourable, it is likely that many of these cases could have been prevented. Education for people undergoing PD should include information about the potential infectious hazards of domestic animals.

Urethral keratosis caused by vitamin A deficiency: two case reports

BackgroundDysuria in children can have various etiologies, including ureteric stones, phimosis, congenital obstructive posterior urethral membrane, and neurogenic bladders. However, there have been no reports of vitamin A deficiency (VAD) causing dysuria due to urethral keratosis. Here, we report two cases of urethral keratosis caused by a VAD.Case presentationAn 8-year-old boy (Patient 1) and a 6-year-old boy (Patient 2) presented with multiple episodes of dysuria and epididymitis. Both patients had intellectual disabilities and autism, which prevented voiding cystourethrography. Therefore, the patient was admitted for cystoscopy under general anesthesia. Cystoscopy revealed urethral diastolic dysfunction and a large amount of desquamated epithelium obstructing the urethra in both patients, causing urinary obstruction and dysuria. Catheterization was repeated; however, the symptoms recurred after catheter removal. Although the cause of recurrent urinary obstruction could not be initially identified, an ophthalmologist found Bitot’s spots and suggested the possibility of a VAD. Serum vitamin A levels were extremely low in both patients, leading to the diagnosis of urethral keratosis due to VAD. VAD can be attributed to an unbalanced diet resulting from intellectual disabilities or autism. Vitamin A replacement therapy improved both the urethral symptoms and cystoscopic findings.ConclusionDysuria due to VAD is extremely rare, and urethral keratosis as a cause of dysuria is likely the first report of its kind worldwide. VAD may develop due to an unbalanced diet in patients with intellectual disabilities or autism. Therefore, it is essential to consider VAD as a potential cause of dysuria in patients with intellectual disabilities and autism.

Safety and efficacy of transurethral holmium laser enucleation of the prostate versus bipolar transurethral resection of the prostate in the treatment of benign prostatic hyperplasia: a prospective randomized controlled trial.

To evaluate the safety and efficacy of transurethral holmium laser enucleation of the prostate (HoLEP) compared to bipolar transurethral resection of the prostate (bTUR-P) in the treatment of benign prostatic hyperplasia (BPH). A total of 220 BPH patients hospitalized from January 2022 to September 2023 were included in this study. These patients were randomly assigned to HoLEP and bTUR-P groups, with 110 participants in each group. We collected preoperative general information, perioperative data, complications, and postoperative follow-up indicators from both groups of patients. The baseline characteristics of patients in both groups were similar, with no statistical significance (P > 0.05). Compared to the bTUR-P group, the HoLEP group exhibited significantly less intraoperative bleeding (P < 0.001), shorter bladder irrigation time (P = 0.002), shorter catheter retention time (P < 0.001), and reduced postoperative hospitalization (P = 0.002). Additionally, the pain score during urination after catheter removal was significantly lower in the HoLEP group (P < 0.001). Postoperative complications occurred in both groups; however, they were less frequent in the HoLEP group (4 cases), primarily consisting of urinary retention and postoperative bleeding. The bTUR-P group experienced more complications (9 cases). Significant reductions in postoperative residual urine volume (RUV) were observed in both groups (P < 0.001). Both groups also showed significant improvements in Quality of Life (QoL) scores and International Prostate Symptom Scores (IPSS), with the HoLEP group demonstrating a more significant decrease in IPSS (P < 0.001). After comprehensive evaluation, HoLEP was superior to bTUR-P in terms of safety and efficacy. Therefore, HoLEP may be a preferable choice for the treatment of BPH.

Analysis of ERAS protocol adherence and postoperative outcomes after major colorectal surgery in a community hospital

Despite widespread adoption, the efficacy of Enhanced Recovery After Surgery (ERAS) protocols in community hospital settings remains understudied. This retrospective analysis conducted at a high-volume community hospital aimed to evaluate adherence to ERAS protocols and analyze postoperative outcomes following colorectal surgery. A total of 278 adult patients undergoing elective colorectal surgery between January 2022 and January 2024 were included. Data analysis revealed time to first mobilization proved to be satisfactory in accordance with ERAS hospital guidelines (mean 1.0 ​± ​0.05 days, range 0.1–13.8 days), and furthermore demonstrated a strong positive correlation with both time to first bowel function (r ​= ​0.69, p ​< ​0.0001) and length of stay (r ​= ​0.25, p ​< ​0.0001). Time to urinary catheter removal occurred slightly after guideline-directed removal (mean 1.1 ​± ​0.05 days, range 0.5–12.9 days), however did exhibit a significant positive correlation with length of stay (r ​= ​0.33, p ​< ​0.0001). 10.9 ​% of patients experienced a postoperative complication, while the average length of stay across all procedures was 3.1 ​± ​0.17 days (range 0.9–23.3 days), and the overall 30-day readmission rate stood at 10.43 ​%. This study underscores the need for ongoing evaluation and refinement of ERAS protocols in community hospital settings to enhance surgical care and patient satisfaction.

Comparing results of midline catheter and peripherally inserted central catheter in cancer patients under chemotherapy.

Peripherally inserted central catheters (PICC), and peripherally inserted midlines (MC) represent a possible less invasive alternative option to totally implantable vascular access devices (TIVAD) in cancer patients. This study aims to investigate the outcomes of PICC, and MC devices in patients undergoing chemotherapy. A prospective non-concurrent observational study was conducted at the IRCCS Ospedale Policlinico San Martino, Genova (Italy) on 559 cancer patients candidate to chemotherapy bearing PICC, and MC during the period 2019-2022. The primary endpoint was the comparative analysis for failure of the different types of peripheral insertion accesses requiring removal. Secondary outcome measures were age at diagnosis, gender, period of diagnosis, cancer site and type of chemotherapy. The negative binomial regression analysis was applied to estimate catheter removal rate ratios (RR), along with 95% confidence limits (95% CL), in each category of the risk factors. The median follow-up time was 2.6 months (IQR = 1.4-4.6; min-max = 0.03-12.7), and at the end of the study period, a total of 45 catheter failures were detected. A risk reduction of approximately 75% (RR = 0.24; 95% CL = 0.11-0.51) was emphasized for patients with PICC when compared with those with MLC. Type of chemotherapy and cancer site appeared to be important predictive factors for catheter removal risk. For cancer patients undergoing chemotherapy by a non TIVAD, PICC must be preferred to MC because of higher safety and efficacy.

Outcomes of tunnelled cuffed centrally inserted central catheter removal: A retrospective cohort study.

Most children with cancer will require a central venous access device (CVAD) to administer cancer treatment. A commonly used CVAD is a tunnelled cuffed centrally inserted central catheter (TC-CICC). There is little information available to guide best practice when removing this type of CVAD. At our institution, TC-CICCs are removed by using either the traction or dissection methods. This study will describe the outcomes associated with each technique. A retrospective cohort study was undertaken at a quaternary children's hospital in Melbourne, Australia. Data related to characteristics of TC-CICC removal success, post-removal complications and an economic evaluation were carried out. There were 149 patients who underwent traction removal and 100 who had their TC-CICC removed using the dissection technique. In the traction group, 136/149 (91%) patients had their device successfully removed on the first attempt, whereas 99/100 (99%) were removed on the first attempt with dissection. Of the 136 successful traction removals, cuff status was documented in 72 cases. The cuff remained in situ in 46/72 (64%) cases, and six of 72 (8%) patients experienced a complication. There were no documented cases of cuff retention in the dissection group. In the 2019-2020 financial year, the estimated average cost of traction removal was A$387, whereas the estimated average cost of day case surgery was A$2560. This study has highlighted that the traction technique is a safe, efficient and cost-effective approach to TC-CICC removal. Further research is required to understand the patient and family experience of TC-CICC removal.

Central line-associated bloodstream infection outbreak related to Ralstonia pickettii-contaminated saline in a pediatric hematopoietic stem cell transplant center.

Ralstonia pickettii is an aerobic Gram-negative non-fermentative bacillus. It is an opportunistic pathogen that has recently prompted nosocomial outbreaks. Although it has low virulence, it can cause a wide range of invasive diseases in immunosuppressive patients. The characteristics of R. pickettii-related central line-associated bloodstream infection (CLABSI) outbreak in pediatric hematopoietic stem cell transplant (HSCT) recipients are presented in this study. This was a single-center, retrospective analysis conducted at Bahcesehir University Goztepe Medicalpark Hospital . The clinical and laboratory characteristics of twelve children with Ralstonia-related CLABSIs were analyzed. Of the twelve patients with R. pickettii growth, seven were female. The median age was 12.1 (2-17) years. Autologous HSCT was performed in two of the patients and allogeneic HSCT was performed in ten patients for both malignant and non-malignant diseases. In the conditioning regimens, all patients were given myeloablative therapy. Clinical sepsis was the most common presentation. As a result of the investigations, R. pickettii growth was observed in saline solutions. All cases were successfully treated with the appropriate antibiotic regimen and the bacteria was not found in repeat cultures. Catheter removal was required in two patients. Mortality was not observed in any patient as the outcome of the infection episode. The detection and control of the infectious source are critical in pediatric HSCT patients with severe immunosuppression, as medical equipment-related outbreaks can be life-threatening.