Catheter Retention Research Articles

Catheter management across patients with hematologic malignancies and catheter-related blood stream infections: a systematic review.

Catheter-related bloodstream infection (CRBSI) can lead to ICU admission in patients with hematologic malignancy (HM). Variability exists in the management of catheters given the need for long-term access and co-existing thrombocytopenia or coagulopathy. We conducted a systematic review to evaluate catheter management in patients with CRBSI. Literature searches were conducted up to December 20, 2021 across MEDLINE, EMBASE, CENTRAL, CINAHL, and PubMed. Observational studies and RCTs of adults (> 16) with HM were included. Our primary outcome was mortality and secondary outcomes included infection recurrence and ICU admission. We identified 23 studies (N = 2026 patients), of which 22 were observational. Across the 12 studies (N = 801) that reported on bacterial organisms, 528 (65.9%) were gram positive, and 273 (34.1%) were gram negative. Catheters were removed in 1266 (62%) and retained in 760 (38%) patients. Removal was associated with a mean 30-day mortality of 13.14% (SD 9.12; 90/685) and reinfection rate of 5.49% (SD 2.88; 22/401) compared to 39.23% (SD 14.58; 122/311) and 10.75% (SD 21.07; 10/93), respectively, if retained. Catheter retention may be associated with a higher risk of mortality and infection recurrence. Further prospective research should assess catheter management in this population, including potential harms associated with retention.

Retrospective Study of the Application Value Analysis of Ultrasound-Guided Technology in Peripheral Deep Venous Catheterization of Neonates.

Objective To investigate the application value analysis of ultrasound-guided technology in peripheral deep venous catheterization of neonates. Method A total of 94 neonates who underwent peripheral deep venous catheterization treatment from March 2020 to August 2021 in our hospital were selected and divided into the study group and the control group according to the simple randomized method, and each group had 47 cases. The control group was performed peripheral deep venous catheterization through X-ray examination, while the study group was performed peripheral deep venous catheterization through ultrasound-guided technology. The catheter placement, catheter retention time and adjustment times, the incidence of complications (limb swelling, pain, fluid leakage, and phlebitis), and the intervention satisfaction of family members were counted. Results The success rate of one-time catheterization in the study group was higher than that in the control group, the operation time was shorter than that in the control group, and the amount of bleeding was less than that in the control group. The indwelling time of catheter in the study group was longer than that in the control group, and the number of adjustments was less than that in the control group. The incidence of complications in the study group was lower than that in the control group. The intervention satisfaction of family members in the study group was higher than that in the control group. Conclusion Peripheral deep venous catheterization in neonates through ultrasound-guided technology can reduce operation time and blood loss and ensure the success rate of one-time catheterization, resulting in a long indwelling time of catheter, low number of adjustments, and low incidence of complications, which has safety and high intervention satisfaction of family members.

Effect of Comprehensive Care Based on Appropriate Chinese Medicine Techniques on Urinary Retention and Bladder Function Recovery after Total Hysterectomy in Patients with Cervical Cancer.

Objective To investigate the effect of comprehensive care based on appropriate Chinese medicine techniques on urinary retention and bladder function recovery after total hysterectomy in patients with cervical cancer. Methods A total of 148 cases admitted after radical hysterectomy for cervical cancer from January 2019 to early September 2019 were used as the observation sample and were divided into control and experimental groups based on a randomized double-blind method. There were 74 cases each. The control group was given comprehensive care, and the experimental group was given comprehensive care based on appropriate Chinese medicine techniques. The intervention period was 2 weeks after surgery. The recovery rate of bladder function and the occurrence of urinary retention were compared between the two groups, and the duration of postoperative retention of urinary catheter, the amount of residual urine, and the feeling of urination were counted. Results The experimental group had better urinary catheter retention time, time to first spontaneous voiding, time to get out of bed, and time to anal discharge than the control group; the experimental group had a higher rate of good bladder function recovery than the control group and better bladder recovery time, residual urine volume, and incidence of urinary retention than the control group; the patients in the experimental group had better UDI-6 scores. Conclusion The implementation of comprehensive care based on appropriate Chinese medicine techniques can relieve patients' difficulty in urination and improve their quality of life.

Clinical Significance of Color Doppler Ultrasound Applied in Patients with Peripherally Inserted Central Venous Catheters before Extubation: A Retrospective Analysis of Real-World Data

Aims and Objectives: By comparing peripherally inserted central venous catheter (PICC)-related complications in real-life patients, we aimed to analyze the significance of color Doppler ultrasound (CDU) applied routinely or once with symptoms of thrombosis before extubation. Methods: For this retrospective study, patient data from January to December 2020 were collected from an intelligent safe platform for infusion, which was embedded in the hospital information system (HIS). After screening by the inclusion and exclusion criteria, venous therapy liaisons were interviewed regarding the PICC procedures and complications of the enrolled patients. Then, the patient medical records were checked to verify the CDU usage and collect the CDU results. Difficulties in extubation and serious complications, including catheter fracture or pulmonary embolism during or after extubation, were also collected. This paper adheres to the RECORD checklist of EQUATOR guidelines. Results: Of the 1455 patients, 489 underwent CDU examination before extubation. Among these, thrombosis was detected in 37 (7.6%) patients and only 1 (0.2%) patient without thrombosis experienced difficulties in extubation. No serious complications were observed in the CDU group. Meanwhile, among the 966 patients in the non-CDU group, three (0.3%) faced difficulties and one patient developed symptoms of pulmonary embolism. Furthermore, among patients with thrombosis in the CDU group, the duration of catheter retention was significantly shorter than that in patients without thrombosis (76.65±42.55 vs. 121.04±45.99 days, P <0.001). Conclusions: After evaluation of their clinical symptoms, patients without symptoms could be directly removed according to conventional procedures, while patients with symptoms should undergo CDU examination before extubation. Relevance to Clinical Practice: When removing the catheter for PICC carriers, it is assessed that the patients have no discomfort symptoms and can be directly extubated without B-ultrasound examination.

Expanded Criteria Same Day Catheter Removal After Holmium Laser Enucleation of the Prostate.

Abstract Introduction and Objectives: Holmium laser enucleation of the prostate (HoLEP) is a highly effective treatment of benign prostatic hyperplasia (BPH). Technical advances and improved hemostatic properties of holmium lasers have allowed for increased efficiency and outcomes. Same day catheter removal after HoLEP was described at our institution in 2020 after a 30-patient pilot trial. We now present an expanded update after widespread adoption at our facility. Methods: We reviewed patients who underwent same day catheter removal after HoLEP between January 1, 2020 and March 21, 2021. Unlike previous trials, there were no limitations to prostate size. Other changes included catheter removal in phase two of recovery when nursing was available rather than the urology clinic. Descriptive statistics are presented of preoperative, operative, and postoperative data. Univariate and multivariate analysis was performed to assess associations with failure of same day void trial. Results: The success rate of same day catheter removal for the 114 identified patients was 87.7%. Mean age was 69.1 ± 8.6 years and prostate volume was 109.2 ± 61.5 cc, 35% were dependent on catheterization for urinary retention preoperatively and 9% were on antiplatelet/anticoagulant therapy. A total of 26.5% of patients with American Society of Anesthesiology score (ASA) 3 or 4 failed catheter removal compared with 3.9% of patients with ASA 1 or 2 (likelihood ratio 9.32, p = 0.002), ASA status lost significance on multivariate analysis (p = 0.076). Effective catheter removal was not significantly associated with age, body mass index, prostate size, catheter dependency, anticoagulation/antiplatelet therapy, American Urologic Association symptom score, prior BPH surgery, or prostate cancer in final pathology report. Conclusion: Regardless of prostate size, same day catheter removal is a safe and reliable method of post-HoLEP patient management. Patients with an ASA 3 or 4 should be counseled regarding potential risks of temporary re-catheterization. Given ongoing nationwide shortages in hospital beds and staffing, same day discharge and catheter removal may allow for wider availability of surgical treatment for BPH.

MP19-15 NEW YORK CITY COVID-19 CONSULTS: AN ALGORITHM FOR SAFE, EFFICIENT, QUALITY CARE

You have accessJournal of UrologyCME1 May 2022MP19-15 NEW YORK CITY COVID-19 CONSULTS: AN ALGORITHM FOR SAFE, EFFICIENT, QUALITY CARE Benjamin Eilender, Joseph Baiocco, Conner Brown, Vannita Simma-Chiang, and Jay A. Motola Benjamin EilenderBenjamin Eilender More articles by this author , Joseph BaioccoJoseph Baiocco More articles by this author , Conner BrownConner Brown More articles by this author , Vannita Simma-ChiangVannita Simma-Chiang More articles by this author , and Jay A. MotolaJay A. Motola More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002552.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: COVID-19 created immense anxiety amongst caregivers and unique strain on healthcare resources which is ongoing. We created a protocol to address this by examining the nature of consults (C) during the pandemic, describe which C needed to be managed in-person, and demonstrated that remote management of many C is appropriate. METHODS: A REDCAP database was used over a six weeks to record urology C at our institution. Data included COVID-status of the patient, reason for C, patient characteristics, and type of intervention required. RESULTS: We received 154 C during the study period. 53% were evaluated in person. 47% were managed remotely. Most common reasons for C were difficult foley catheter placement (21%), obstructing stones(16%), retention (14%) and hematuria (12%). Less common entities included priapism (3%) and Fournier’s gangrene (3%). At the time of C 58% were COVID negative, 30% were COVID positive. After evaluation, 44% of C needed no intervention, 27% required a foley, 8% required bladder irrigation and 4% required stenting or nephrostomy placement. Outcomes of those evaluated remotely did not reflect any issues with the care rendered. Fig 1 represents C requests and Fig 2 interventions. CONCLUSIONS: This study showed a higher percentage of C during COVID-19 requiring intervention compared to pre-COVID literature which we successfully identified. 44% did not require acute in-patient intervention. We have shown there is an important role that remote care can and should play in our specialty. Not all C need hands on intervention and studies such as this will result in a safe and logical algorithm for the management of C. With this approach, it became very apparent that not all C are appropriate. This can lead to enhancing the skill set of other house staff. Lastly, the lack of urgency of a large percentage of what we are consulted for becomes apparent. In the face of demands for decreased work hours amongst house staff, strained resources during the pandemic, and the anxiety of the unknown of this virus, we have been able to redefine how C services are delivered. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e313 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Eilender More articles by this author Joseph Baiocco More articles by this author Conner Brown More articles by this author Vannita Simma-Chiang More articles by this author Jay A. Motola More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Primer and Literature Review on Internal and External Retention Mechanisms for Catheter Fixation.

Although catheters are commonplace in hospital settings, there is scarce literature discussing the internal and external retention mechanisms used to aid in catheter fixation. Additionally, exact definitions and detailed information on internal and external retention mechanisms are almost non-existent in the literature.This article serves three primary purposes. The first purpose is to define internal and external catheter retention mechanisms, describe how they work, and provide examples of each that are routinely used in healthcare settings. The second goal of this paper is to provide a literature review comparing various aspects of the different types of internal and external catheter retention mechanisms discussed in the paper, including performance variance and the advantages and disadvantages of each. The third aim of this article is to provide a brief overview of catheter dislodgment, including the rates at which this occurs, the problems that can arise, and the best treatment option when this does occur.

Frequency and Clinical Features of Candida Bloodstream Infection Originating in the Urinary Tract.

The urinary tract is considered an uncommon source of Candida bloodstream infection (CBSI). We aimed to determine the source of CBSI in hospitalized patients, and to compare clinical and microbiological features of CBSI originating in the urinary tract (U-CBSI) and non-urinary CBSI (NU-CBSI). Of 134 patients with CBSI, 28 (20.8%) met criteria for U-CBSI, 34 (25.3%) had vascular catheter-related CBSI and 21 (15.6%) had a gastrointestinal origin. Compared to NU-CBSI patients, patients with U-CBSI were older with higher rates of dementia. Bladder catheterization for urinary retention and insertion of ureteral stents or nephrostomies were risk factors for U-CBSI. Fifty percent of U-CBSI cases occurred within 48 h of hospital admission, versus 16.9% of NU-CBSI (p < 0.0001). The mortality rate was lowest for CBSI originating in the urinary tract and highest for CBSI of undetermined origin. CBSI of undetermined origin remained associated with higher mortality in a Cox regression model that included age, Candida species, Pitt bacteremia score and neutropenia as explanatory variables. U-CBSI may be increasing in frequency, reflecting extensive use of bladder catheters and urologic procedures in elderly debilitated patients. Distinct clinical features are relevant to the diagnosis, treatment and prevention of U-CBSI.

Extraperitoneal laparoscopic simple prostatectomy with urethra preservation using urethral initiation as the entry point: a practical approach for the treatment of benign prostatic obstruction.

The present study introduces a modified surgical procedure, extraperitoneal laparoscopic simple prostatectomy (LSP) with urethra preservation using urethral initiation as the entry point, and evaluates its feasibility, safety, and efficacy in the treatment of benign prostatic obstruction (BPO). A total of 50 patients with BPO underwent modified LSP from January 2018 to December 2020. The main surgical procedures performed were as follows: transversely incision of prostate surgical capsule at the urethral initiation; creating of the subcapsular plane and the space between urethra and adenoma; removal of lobes with preservation of urethra followed by suturing of capsule. Preoperative, perioperative, follow-up parameters, and complications were recorded and analyzed. Operative time was (106.34 ± 28.00) min and intraoperative blood loss was (98.80 ± 130.58) ml. Continuous bladder irrigation (CBI) was not performed routinely, catheterization duration was (5.26 ± 2.99) days, and postoperative hospital stay was (5.42 ± 1.62) days. Significant improvements were observed in functional outcomes, whereas no retrograde ejaculation, urinary incontinence, and urethral stricture occurred. Urethral rupture was not significantly influenced by operative time, intraoperative blood loss, and prostate volume. However, it prolonged CBI duration, drainage tube retention time, catheterization duration, and postoperative hospital stay. Operative time decreased with an increase in the number of cases, and the surgeon achieved proficiency level after handling 21-25 cases. Extraperitoneal LSP with urethra preservation using urethral initiation as the entry point is a feasible, repeatable, safe, and effective surgical procedure, which is suitable for treating BPO.

Clinical Efficacy and Quality of Life Assessment of Partial Cystectomy and Plasmakinetic Transurethral Resection of Tumor in Bladder Cancer Patients.

ObjectiveBladder cancer is a common malignant tumor of the urinary system, with an incidence ranking the first in the urinary system. Without timely and effective treatment, the tumor may spread to other parts of the body. Traditional partial cystectomy (PC) and plasmakinetic transurethral resection of bladder tumor (PKRBT) are common surgical methods for superficial bladder cancer (SBC). This study aims to clarify the clinical efficacy of bladder carcinoma (BC) patients treated by either PC or PKRBT and their effects on the quality of life (QOL) of patients.MethodsA total of 142 patients with SBC treated in Wenzhou Central Hospital and Bei da huang Industry Group General Hospital from March 2018 to June 2020 were analyzed retrospectively. According to the surgical method, patients undergoing PKRBT were included in the research group (n = 74) while those treated by PC were included in the control group (n = 69). Surgical indicators (intraoperative blood loss, IBL; operating time, OT; bladder irrigation time; catheter retention time; length of hospital stay, LOS), postoperative complication rate, and one-year recurrence rate were compared between the two groups. Besides, the levels of inflammatory factors [tumor necrosis factor (TNF)-α, interleukin (IL)-6, IL-8, IL-10], psychological and emotional scores (Self-Rating Anxiety Scale, SAS; Self-Rating Depression Scale, SDS), and living conditions (Pittsburgh Sleep Quality Index, PSQI) before and after treatment were compared.ResultsCompared with the control group, patients in the research group had 1) less IBL, less time of OT, bladder irrigation and indwelling catheter time, as well as shorter postoperative LOS; 2) lower contents of inflammatory factors TNF-α, IL-6 and IL-8, and higher IL-10; 3) lower SAS and SDS scores and higher PSQI; and 4) fewer postoperative complications and lower one-year recurrence rate.ConclusionCompared with PC, PKRBT contributes to higher efficacy and better postoperative QOL in patients SBC.

Neglected Retained Suprapubic Catheter with Varied Management Options: A Case Series

Supra-pubic catheterization of bladder is used as a short or long term alternative to per-urethtral catheterization. Some catheter materials are more resistant to encrustation than others. If kept indwelling for longer duration, sooner or later all catheters cause complications like urinary tract infection (UTI), trauma, peri-catheter leakage, non-deflation of balloon, encrustations and stone formations resulting into retained catheter. Stone formation over neglected indwelling catheter is not an unusual clinical scenario and its management depends on etiology of catheter retention and complication. This article discusses etiopathogenesis, clinical presentations, diagnosis and varied management options used for the neglected retained supra-pubic catheter in three cases

Systematic Evaluation of the Effect of Bedside Ward Round Checklist on Clinical Outcomes of Critical Patients.

Objective To systematically evaluate the effect of bedside ward round checklists on the clinical outcomes of critical patients and thus provide a scientific and rational basis for decision-making in its clinical application. Methods PubMed, EMBASE, Web of Science, Cochrane Library, CNKI, and Wanfang databases were searched to collect the literature studies about randomized controlled trials (RCTs) and cohort studies involving the effect of bedside ward round checklists on the clinical outcomes of critical patients, and the retrieval time limit was from the establishment of the database to August 2019. After two researchers independently screened the literature studies, extracted the literature data, and evaluated the risk of bias in included studies, meta-analysis was carried out by using Stata 12.0 software. Results Two RCTs and nine cohort studies were included in this study. The results of meta-analysis showed that compared with the ordinary bedside ward round, the application of checklist in bedside ward round could shorten the ICU hospitalization time (standardized mean difference (SMD) = – 0.37, 95% CI (– 0.78, 0.04), P ≤ 0.001) and mechanical ventilation time (SMD = – 0.24, 95% CI (– 0.44, −0.04), P = 0.037) and reduce the incidence of ventilator-associated pneumonia (VAP) (SMD = 0.61, 95% CI (0.38, 0.99), P = 0.057) in critical patients. However, there were no significant differences in central venous catheter (CVC) retention time and incidence and mortality of deep venous thrombosis (DVT) between ordinary ward round and bedside ward round checklist. Conclusion The existing evidence shows that compared with the ordinary ward round, the application of bedside ward round checklists can shorten ICU hospitalization time and mechanical ventilation time and reduce VAP incidence and ICU mortality in critical patients. However, due to the limitations of the quality of the included studies, the above conclusions need to be verified with more high-quality studies.

180. Duration of Therapy and Clinical Outcomes in Adult Oncology Patients with Uncomplicated Coagulase Negative Staphylococcal Bacteremia

BackgroundAlthough they are often considered contaminants, coagulase negative staphylococci (CoNS) can be pathogens especially in immunocompromised patients. National and local guidelines recommend treatment durations of 7 to 14 days, depending on specific clinical scenarios. The objective was to characterize the duration of treatment for CoNS bacteremia and clinical outcomes at our cancer center. MethodsWe conducted a retrospective chart review of adult patients ≥18 years old with ≥1 blood culture with growth of CoNS between 1/1/17 and 12/31/19 at our cancer center. Patients with complicated CoNS bacteremia and polymicrobial infections were excluded.ResultsAmong 128 patients identified during the study period, 98 met inclusion criteria (Figure 1). Most patients (N= 92; 94%) had a hematologic malignancy as the underlying oncologic diagnosis, and 68 (69%) were hematopoietic stem cell transplant recipients. The median total antibiotic duration was 13 days, and median duration from the date of 1st negative blood culture was 12 days; 29 (30%) patients were treated for a total duration of >14 days (Figure 2). The catheter was retained in 67 (68%) and exchanged in 4 (4%) of the cases. Three (3%) patients had recurrence of bacteremia within 30 days of treatment completion, and 8 (8%) patients were transferred to the ICU within 7 days of the index blood culture. The 30-day crude mortality rate was 10%. The most commonly used antibiotic for treatment was vancomycin (N= 95; 97%), and 32 (34%) patients on vancomycin had an increase in serum creatinine of ≥ 50% from baseline. Five (5%) patients discontinued vancomycin due to nephrotoxicity, and 4 (4%) patients required hemodialysis.Figure 1. Results Overview Among 128 patients identified during the study period, 98 met inclusion criteria. Of those included, 36 had one set of blood cultures that were positive for CoNS and 62 patients had at least two sets of blood cultures that were positive for CoNS.Figure 2. Duration of Antibiotic Treatment We evaluated duration of treatment based on total antibiotic duration and duration from date of 1st negative blood culture. The number of patients is noted above each bar.ConclusionAlthough the majority of patients were treated for ≤14 days for uncomplicated CoNS bacteremia, nearly 1/3 of patients were treated for > 14 days. Recurrent bacteremia was uncommon despite catheter retention in most patients. Relatively high rates of vancomycin associated nephrotoxicity highlight opportunities for antimicrobial stewardship to limit duration of vancomycin therapy among cancer patients with uncomplicated CoNS bacteremia. Disclosures All Authors: No reported disclosures

Risk factors for failure of long-term dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement.

To identify the clinical factors resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist for patients with lower urinary tract symptoms and benign prostatic enlargement (BPE). We retrospectively surveyed the patient cohort who had been enrolled in the study of dutasteride add-on treatment to alpha-adrenergic antagonist from December 2009 to November 2011. Treatment failure was defined as receiving surgery for BPE or requiring intermittent catheterization or permanent bladder catheter for urinary retention or huge postvoid residual urine. Clinical parameters before dutasteride treatment were compared between the successful and failed group. Of 92 patients, 23 (25%) were defined as treatment failure at 7-109months (mean: 38months) after dutasteride add-on treatment. In the failed group, the patient' age was younger (71.6 ± 6.8 vs 75.4 ± 8.4, p = 0.033), prostatic volume (PV) was larger (76 ± 41 vs 49 ± 26ml, p = 0.005), voiding efficiency was lower (54 ± 27 vs 68 ± 24%, p = 0.045) and bladder outlet obstruction index was higher (73 ± 30 vs 48 ± 30, p = 0.015). The cox proportional-hazards model indicated that only intravesical prostatic protrusion (IPP) was associated with treatment failure. Non-failure rate at 3years after dutasteride add-on treatment was 89% with patients of IPP < 13mm versus 51% with those of IPP ≥ 13mm (p < 0.001). IPP ≥ 13mm is the risk factor resulting in the failure of dutasteride add-on treatment to alpha-adrenergic antagonist. This kind of information should be provided to the patients early in the clinical practice so that they could consider the necessity of BPE surgery in the long run.

PD18-02 LONG-TERM RATES OF TREATMENT FAILURE FOR AMBULATORY TURP AND PVP: AN ASSESSMENT USING STATE-LEVEL CLAIMS DATA

You have accessJournal of UrologyBenign Prostatic Hyperplasia: Surgical Therapy & New Technology III (PD18)1 Sep 2021PD18-02 LONG-TERM RATES OF TREATMENT FAILURE FOR AMBULATORY TURP AND PVP: AN ASSESSMENT USING STATE-LEVEL CLAIMS DATA Wesley Chou, Daniel Frendl, Ya-Wen Chen, David Chang, and Michelle Kim Wesley ChouWesley Chou More articles by this author , Daniel FrendlDaniel Frendl More articles by this author , Ya-Wen ChenYa-Wen Chen More articles by this author , David ChangDavid Chang More articles by this author , and Michelle KimMichelle Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002007.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: While photoselective vaporization of the prostate (PVP) has become one of the most common ambulatory procedures for BPH, its long-term durability compared to transurethral resection of the prostate (TURP) is not well established. Existing studies often group together heterogenous procedural codes in inpatient and outpatient settings or occur in regions with low PVP uptake. We evaluate state-level outcomes up to 10 years after PVP or TURP, specifically in the ambulatory setting. METHODS: Using the New York Statewide Planning and Research Cooperative System database, we identified men ≥40 years old who underwent index ambulatory BPH procedure, specifically PVP (Common Procedural Terminology [CPT] 52648) or single-stage TURP (CPT 52601) from 2002-2016. The primary endpoint of interest was a composite outcome defined as reoperation or postoperative catheterization for urinary retention ≥60 days from index operation. Kaplan-Meier estimates and multivariate Fine-Gray competing risk models were performed to 10 years, with death as the competing risk. RESULTS: We identified 19,624 men in our cohort with a median age of 69 years (interquartile range [IQR]: 62-76) and a median follow-up of 3.9 years (IQR: 1.9-6.7). PVP was more common than TURP (69% vs. 31%, respectively). At 10 years, unadjusted cumulative rates of composite failure were respectively 21% and 20% for PVP and TURP (p=0.86). Kaplan-Meier estimates found no differences in composite failure (log-rank: p=0.62, Fig. 1). Competing risk models did not show increased hazards of treatment failure for PVP vs. TURP after adjustment for demographic and clinical factors (Table 1). CONCLUSIONS: In a state-wide study, we found no difference in 10-year rates of composite failure after ambulatory PVP or TURP. These results support equivalence of long-term durability in a population where both techniques are commonly performed in the outpatient setting. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e355-e355 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Wesley Chou More articles by this author Daniel Frendl More articles by this author Ya-Wen Chen More articles by this author David Chang More articles by this author Michelle Kim More articles by this author Expand All Advertisement Loading ...

Retrospective observation of the efficacy and safety of prostatic artery embolization combined with transurethral resection of the prostate and simple transurethral resection of the prostate in the treatment of large (> 100mL) benign prostatic hyperplasia.

To retrospectively compare the efficacy and safety of prostatic artery embolization (PAE) combined with transurethral resection of the prostate (TURP) and simple TURP in treating large (> 100mL) benign prostatic hyperplasia (BPH). We retrospectively analyzed the clinical data of 13 and 17 patients with large BPH who underwent TURP and PAE + TURP, respectively, from January 2016 to January 2020. The changes in various indices before and after surgery were compared between the two groups. In the PAE + TURP group, the operation time (OT), intraoperative blood loss (BL), postoperative bladder flushing time (PBFT), and postoperative catheter retention time (PCRT) were lower, and the speed of the excised lesion (SEL) was higher than that in the TURP group (P < 0.05). Following-up for 12months, the prostatic volume (PV), maximum urinary flow rate (Qmax), postvoid residual volume (PVR), International Prostate Symptom Score (IPSS), quality of life (QoL) score, total prostate-specific antigen (T-PSA), and free prostate-specific antigen (F-PSA) in each group improved as compared to before the surgery (P < 0.05), and the above improved indicators, IPSS ratio, and obstructive symptoms in the PAE + TURP group were higher than those in the TURP group (P < 0.05). The incidence of postoperative complications in the PAE + TURP group was lower than that in the TURP group. We obtained the pathological picture of a prostate biopsy after PAE for the first time. Compared to TURP alone, PAE + TURP should be promoted, because of its greater efficacy and safety in treating large BPH and fewer post-surgical complications.

Laparoscopic Cholecystectomy under Spinal Anaesthesia – A Single Center Experience

Traditionally, laparoscopic cholecystectomy is performed under general anaesthesia. However, it can be performed under spinal anaesthesia as the dissection is confined to the gall bladder fossa and cystic triangle and bowel handling is usually minimal. The present study was performed to study the feasibility of performing laparoscopic cholecystectomy under spinal anaesthesia. A prospective observational single center cohort study was conducted with a sample size of 60 patients diagnosed with gall stone disease. Laparoscopic cholecystectomy was performed under spinal anaesthesia using low insufflation pressure of 8-10 mm of Hg. The outcomes studied include intra operative events (hypotension, bradycardia, abdominal pain, shoulder pain and requirement for sedation), reasons for conversion (spinal to general anaesthesia and from laparoscopic to open cholecystectomy), post-operative pain and complications. Females were more commonly affected than males and at a younger age. Three cases were converted from spinal to general anaesthesia. Two cases were converted from laparoscopic to open cholecystectomy. Intra operative analgesia and sedation were required in 10% and 13.3% of patients respectively. In the post operative period majority of the patients did not require any analgesia. Complications like headache (3.3%) and low backache (5%) were managed conservatively. About 5% of patients required urinary catheterization for post operative urine retention. Laparoscopic cholecystectomy can be performed safely under spinal anaesthesia with minimum morbidity. Spinal anaesthesia involves less cost and is better in terms of post operative pain control. The incidence of various post operative complications are less and manageable.

Monopolar Transurethral Resection of Prostate for Benign Prostatic Hyperplasia in Patients With and Without Preoperative Urinary Catheterization: A Prospective Comparative Study

BackgroundA significant proportion of patients undergo surgery for benign prostatic hyperplasia following acute urinary retention. Studies have reported conflicting results of improvement following transurethral surgery in these patients.ObjectiveTo compare perioperative complications and postoperative voiding parameters in patients undergoing monopolar transurethral resection of prostate with and without preoperative Foley catheterization.MethodsA prospective non-randomized study was conducted in patients undergoing monopolar transurethral resection of prostate for symptomatic benign prostatic hyperplasia. Patients were divided into those with Foley catheterization preoperatively (n=52), and those without catheters (n=90). Change in hemoglobin level, the resected volume of prostate, complications and the need for postoperative catheterization were compared. Postoperative symptoms score using International Prostate Symptom Score, maximum flow rate and post-void residual volume were assessed at three months follow up.ResultsThe mean operative duration, length of stay and resected volume were higher in those patients with catheters; however, no significant differences were noted for mean hemoglobin level change and need for postoperative recatheterization. Three patients in each group required recatheterization and, all were catheter-free at one week postoperatively. Complications developed in 16.1% (n=23) with most of them being Clavien I. Patients with catheters had a lower postoperative maximum flow rate than those without it (16.90 vs 19.75 mL/sec). Patients with catheters had a significantly better postoperative quality of life and symptom score.ConclusionMonopolar transurethral resection of prostate in patients with preoperative per-urethral Foley catheter for acute urinary retention had similar postoperative voiding parameters with comparable complication rates to those without a catheter.

Effect of Psychological Intervention Combined with Family Cooperation on the Perioperative Quality of Life and Psychological States of Elderly Patients with Prostate Cancer Treated with Compound Kushen Injection.

Objective The purpose of the study was to investigate the nursing effect of psychological intervention combined with family cooperation on elderly patients with prostate cancer treated with compound kushen injection and put forward effective suggestions. Methods 122 elderly patients with prostate cancer admitted to our hospital from June 2018 to June 2019 were selected and randomly divided into a control group (n = 61) and experimental group (n = 61). The patients in the control group received routine nursing intervention during the perioperative period, while the patients in the experimental group were treated with psychological intervention combined with family cooperation on the basis of routine nursing. The quality of life and psychological states of patients in the two groups were statistically analyzed. Results The evaluation of psychological states at 24 hours before surgery and 24 hours before discharge in the experimental group was significantly better than that in the control group (P < 0.05), with statistical significance. On comparing the basic conditions between the two groups in the perioperative period, the length of hospitalization, length of catheter retention after surgery, and incidence of complications in the experimental group were all significantly better than those in the control group (P < 0.05), with statistical significance. The satisfaction of patients with the nursing process in both groups was recorded and statistically analyzed through questionnaires. The satisfaction with nursing process in the experimental group was significantly higher than that in the control group (P < 0.05), with statistical significance. The quality of life of the patients was followed up at three months after discharge. The quality of life of the experimental group was significantly better than that of the control group (P < 0.05), with statistical significance. Conclusion Psychological intervention combined with family cooperation for the elderly patients with prostate cancer treated with compound kushen injection is beneficial to improve their psychological states, encourage them to face the disease in a more positive manner, effectively improve the quality of life after intervention, ensure the therapeutic effect during perioperative period, increase happiness index, and enhance their satisfaction with the nursing process, which is worthy of clinical application and popularization.

Management of enterococcal central line-associated bloodstream infections in patients with cancer

ObjectiveEnterococcus species are the third most common organisms causing central line-associated bloodstream infections (CLABSIs). The management of enterococcal CLABSI, including the need for and timing of catheter removal, is not well defined. We therefore conducted this study to determine the optimal management of enterococcal CLABSI in cancer patients.MethodsWe reviewed data for 542 patients diagnosed with Enterococcus bacteremia between September 2011 to December 2018. After excluding patients without an indwelling central venous catheter (CVC), polymicrobial bacteremia or with CVC placement less than 48 h from bacteremia onset we classified the remaining 397 patients into 3 groups: Group 1 (G1) consisted of patients with CLABSI with mucosal barrier injury (MBI), Group 2 (G2) included patients with either catheter-related bloodstream infection (CRBSI) as defined in 2009 Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection by the Infectious Diseases Society of America (IDSA) or CLABSI without MBI, and Group 3 (G3) consisted of patients who did not meet the CDC criteria for CLABSI. The impact of early (< 3 days after bacteremia onset) and late (3–7 days) CVC removal was compared. The composite primary outcome included absence of microbiologic recurrence, 90-day infection-related mortality, and 90-day infection-related complications.ResultsAmong patients in G2, CVC removal within 3 days of bacteremia onset was associated with a trend towards a better overall outcome than those whose CVCs were removed later between days 3 to 7 (success rate 88% vs 63%). However, those who had CVCs retained beyond 7 days had a similar successful outcome than those who had CVC removal < 3 days (92% vs. 88%). In G1, catheter retention (removal > 7 days) was associated with a better success rates than catheter removal between 3 and 7 days (93% vs. 67%, p = 0.003). In non-CLABSI cases (G3), CVC retention (withdrawal > 7 days) was significantly associated with a higher success rates compared to early CVC removal (< 3 days) (90% vs. 64%, p = 0.006).ConclusionCatheter management in patients with enterococcal bacteremia is challenging. When CVC removal is clinically indicated in patients with enterococcal CLABSI, earlier removal in less than 3 days may be associated with better outcomes.Based on our data, we cannot make firm conclusions about whether earlier removal (< 3 days) could be associated with better outcomes in patients with Enterococcal CLABSI whose CVC withdrawal is clinically indicated. In contrast, it seemed that catheter retention was associated to higher success outcome rates. Therefore, future studies are needed to clearly assess this aspect.