Duration Of Catheterization Research Articles

The effects of early enteral feeding, fortification, and rapid feeding advancement in extremely low birth weight infants.

Preterm infants are at risk for necrotizing enterocolitis (NEC) and sepsis. Optimal strategies of preterm feeding to achieve full enteral feeding early with minimal duration of central lines without increasing the risk of NEC remain uncertain. We aimed to evaluate if new enteral feeding strategies reflecting early initiation, fortification, and more rapid advancement is beneficial without increasing the risk of NEC. We performed a retrospective cohort study including 122 infants born with birth weight<1000g during Period 1 (old feeding protocol, n=61) and Period 2 (new feeding protocol, n=61) to compare the incidence of NEC, late-onset sepsis, the duration of central line, and the growth outcomes before and after the implementation of feeding strategies to reflect early initiation of feeding within 12h of life, early fortification at 60mL/kg/day, and more rapid feeding advancement up to 30mL/kg/day. Median time to reach full enteral feeds was decreased from 9 to 6days (p<0.001). The duration of central venous catheters was also improved from median 7 to 5days (p<0.001). The incidence of NEC was not different (11.5% in Period 1 vs. 8.2% in Period 2, p=0.54). 14 infants (23%) had late-onset sepsis in Period 1 vs. 8 infants (13.1%) in Period 2 (p=0.16). The growth outcome was comparable between the two periods (p=0.47). Earlier initiation of enteral feeding and fortification, and more rapid advancement were safely introduced with significantly shorter duration of central lines without increasing the incidence of NEC.

P-346. Candida auris: Colonization, Risk Factors and Antifungal Susceptibility at a Tertiary Healthcare Setting

Abstract Background Candida auris, a multidrug-resistant nosocomial pathogen, has emerged globally as a major threat to healthcare settings, and several hospital outbreaks continue to be reported. We attempted to study the risk factors associated with C. auris colonization and its antifungal susceptibility at a tertiary healthcare center. 1.Distribution of Candida auris isolates Methods A prospective observational study was conducted over 18 months. Patients were screened for Candida auris colonization by axillary, groin swabs, and urine cultures within 48 hours of admission. Patients with extended hospital stays, exhibiting clinical isolates positive for C. auris, were also included. Baseline characteristics and risk factors were assessed. In patients with positive C. auris isolates, samples from inanimate surfaces, hands of healthcare workers and patient care attendants were also screened for C. auris colonization. Antifungal susceptibility testing was done for all isolates. Results Ninety-nine patients (59% males) were included with a mean age of 43.1±18.06 years. There were 34 Candida auris isolates from 20 patients. Sixteen patients (80%) were colonized, and four (20%) had candidemia. Median duration of urinary catheterization (9 vs 3 days [p=0.01]) and prior antifungal exposure(p=0.04) were significant risk factors for C.auris colonization. Seventy-eight samples from bed rails, monitors, healthcare workers, and patient-care attendants showed no growth of C.auris. Antifungal susceptibility testing showed 87.5% and 37.5% of isolates were resistant to Fluconazole and Amphotericin B respectively, while all isolates were susceptible to Micafungin and Caspofungin. Conclusion Prior outbreaks of Candida auris at our medical ICU prompted the need for early identification, effective contact precautions, and decolonization to prevent fatal invasive infections. Patients with long-term urinary catheters in situ, prior exposure to antifungals, and prolonged hospital stay were found to be at risk for C.auris colonization, warranting further studies to implement routine screening in these high-risk groups. Disclosures All Authors: No reported disclosures

P-1078. Gentamicin-releasing polydopamine catheter coating to prevent urinary catheter-related infections

Abstract Background Catheter-associated urinary infections (CAUTIs) are among the most common healthcare-associated infections in the United States. The risk of CAUTI corresponds to the duration of catheterization; prolonged catheter uses impacts patient morbidity, mortality, and healthcare costs. Pseudomonas aeruginosa is a leading cause of CAUTI and is particularly adept at forming surface-associated biofilms that are difficult to treat. In the present study, we developed a catheter coating using polydopamine (PD) to embed gentamicin on the surface. Bacterial Viability of PAO1 when exposed to PD-gentamicin coating Colony-forming unit (CFU) count of PAO1 exposed to concentration series of PD-only and PD-Gent well plate coating. Methods Coating synthesis: PD-antibacterial coating was synthesized using dopamine hydrochloride salt and antibiotic drugs (i.e., gentamicin) in an alkaline buffer in the presence of polyvinyl chloride (PVC) tubing. A similar procedure was used for the well-plate study using 150 µL of solution per well, followed by heating at 60 °C. Biofilm Quantification: PAO1 was added to a 96-well plate or tubes and incubated statically for 24 h. Biofilms were stained with 0.1% crystal violet, solubilized with 33% glacial acetic acid, and measured at OD590 nm. Cell viability: Colony forming units were measured using 10-fold serial dilutions on TSA agar. Biofilm formation of PAO1 after incubation with PD-gentamicin coating in PVC tubes PAO1 biofilm concentration changes with changing the PD to gentamicin ratio during coating synthesis. Results PD-gentamicin coated tubes and 96-well plates showed elimination of PAO1 viability at PD concentrations of 0.25 mg/mL and above but had little bactericidal effect at lower concentrations (Fig. 1). There was no reduction in viability in PAO1 exposed to PD or gentamicin alone. PAO1 biofilm was reduced in the median PD-gentamicin concentrations 0.1-0.5 mg/mL, but this effect was lost at the extremes of concentration (Fig. 2). Conclusion The PD-gentamicin coating eliminated PAO1 viability and reduced biofilm at PD concentration 0.25 mg/mL. Similar results were observed in 96-well plates and PVC tubes, suggesting versatility in the adherence of the coating material. Additional studies are needed to assess the duration of these effects over time. Disclosures All Authors: No reported disclosures

Experience with the implementation of central venous catheters by medical oncologists in a non-surgical setting

Totally implantable central venous catheters (CVCs) are widely used in the management of patients with malignant diseases. Conventionally, port implantations were carried out by general surgeons and vascular radiologists. In recent years, the medical staff of the Medical Oncology department at the Central University Hospital of Asturias (HUCA) has developed a simplified methodology for the routine implantation of these devices. The aim of this study was to review our experience of CVCs and analyze the outcomes regarding catheter duration, complications, and cost comparison with respect to conventional port implantation by vascular radiologists. An observational epidemiological study was conducted, analyzing the methodology performed in a non-surgical, outpatient setting utilizing the Seldinger technique, without fluoroscopic control. A thorax X-ray was performed after each procedure and no prophylactic antibiotics were required. From January 2015 to March 2019, five hundred port systems were implanted, with a median age of 62 years (range 18–81), male 286/female 214. Most patients had a digestive tumor (79.4%). The right jugular vein was the most accessed in 345 patients (69%), followed by right subclavian in 144 (29%). Complications were observed in 49 patients (9.8%), immediate in 16 (3.2%), and late in 33 (6.6%). Thirty-nine devices were removed (7.8%). The cost incurred for port implantations by medical oncologists was lower (994.38 € cheaper for each device) compared to those implanted by vascular radiologists. Our experience suggests that implantation of port devices by medical oncologist in a non-surgical environment is safe and cost saving regarding conventional procedures.

Comparison of the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery in patients with early-stage non-small cell lung cancer

Objective: To compare the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery (VATS) in patients with early-stage non-small cell lung cancer (NSCLC). Methods: We performed a retrospective chart review of patients with early-stage NSCLC who underwent subxiphoid uniportal video-assisted thoracic surgery (SA-VATS) or intercostal uniportal VATS (IA-VATS) at Shidong Hospital in Shanghai from November 2020 to May 2023. Perioperative conditions including surgical duration, intraoperative blood loss, postoperative catheterization duration, time to first off-bed activities, and number of lymph node dissected were compared between the groups. Degree of pain, preoperative and postoperative lung function, prognosis, and incidence of complications were also compared between the groups. Results: Records of a total of 128 patients were included. Of them, 72 patients underwent SA-VATS and 56 patients underwent IA-VATS. The duration of SA-VATS was longer, while the intraoperative blood loss and catheterization times were lower compared to those of IA-VATS (P&lt;0.05). Visual analogue scale (VAS) score of patients after SA-VATS was significantly lower than after IA-VATS (P&lt;0.05). There was no significant difference in forced expiratory volume in one second (FEV1) between the two groups before the surgery, and one- and 12 months after the surgery (P&gt;0.05). The prognosis and the incidence of complications were comparable in the two groups after the surgery (P&gt;0.05). Conclusions: Compared with IA-VATS, SA-VATS is associated with lower intraoperative blood loss, shorter postoperative catheterization and time to first off-bed activities, and less postoperative pain in surgical treatment for early-stage NSCLC. However, there was no significant difference in prognosis and complications between the two approaches. doi: https://doi.org/10.12669/pjms.41.2.11096 How to cite this: Fu Z, Wang L, Hu W, Zhou Y, Zhou Q. Comparison of the efficacy of subxiphoid and intercostal uniportal video-assisted thoracoscopic surgery in patients with early-stage non-small cell lung cancer. Pak J Med Sci. 2025;41(2):359-365. doi: https://doi.org/10.12669/pjms.41.2.11096 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comparative study of HoLEP in elderly patients with indwelling catheters: a retrospective dual-center study.

This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70-130] vs. 90 [65-120] mL and 6 [5-7] vs. 3 [2-4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1-3] vs. 1 [1-2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

A nomogram for predicting central venous catheter-related infections in maintenance hemodialysis: A 4-year single-center study.

To develop and validate a nomogram model for predicting central venous catheter-related infections (CRI) in patients with maintenance hemodialysis (MHD). MHD patients with central venous catheters (CVCs) visiting the outpatient hemodialysis (HD) center of Xuzhou Medical University Affiliated Hospital from January 2020 to December 2023 were retrospectively selected through a HD monitoring system. Patient data were collected, and the patients were divided into training and validation sets in a 7:3 ratio. The training set was used to establish the model, which was verified using the validation set. Multiple logistic regression analysis was performed to identify risk factors for central venous CRI and develop a nomogram prediction model. A total of 300 MHD patients were enrolled. Multivariate analysis showed that catheter duration, catheter site, catheter reinsertion, history of catheter infection, diabetes, and albumin <35 g/L were risk factors for central venous CRI. The area under the receiver operating characteristic (ROC) curve (AUC) for the training set was 0.902 (95% confidence interval (CI) = 0.862-0.941), with a sensitivity of 85.7%, specificity of 80%, and a Youden index of 65.7%, and that for the validation set was 0.826 (95% CI = 0.726-0.905), with a sensitivity of 80.5%, specificity of 77.9%, and a Youden index of 58.4%. The model demonstrated good discrimination and calibration (Hosmer-Lemeshow goodness-of-fit test statistics: training set: χ2 = 4.709, p = 0.788; validation set: χ2 = 7.171, p = 0.518). This study identified six risk factors associated with central venous CRI in MHD patients. This predictive model demonstrates good prognostic performance and can be used by clinicians to screen for high-risk patients with central venous CRI, thereby enabling the early implementation of risk management strategies.

Assessing infection related to short-term central venous catheters in the perioperative setting

Central venous catheter (CVC) cannulation can be accompanied by serious complications. The appearance of catheter-related infections is associated with high morbimortality. The aim of this study is to evaluate the incidences of colonization and central line-associated bloodstream infections (CLABSI) in short-term CVCs in the elective surgery setting, as well as to analyze the related risk factors. Prospective observational study including patients undergoing elective surgery with a CVC inserted perioperatively. Patients with current infection, taking preoperative antibiotics, those planning to have CVC for longer than 14 days, those under 18 years old, and those refusing to participate were excluded. Patients without cultures at the moment of CVC retrieval were not included. 200 patients were included, with a mean catheter duration of 6.8 ± 3.1 days, and a total duration of 1,358 days. Incidence of colonized catheters was 6% (8.84/1000 catheter-days), and 3.5% had CLABSI (5.15/1000 catheter-days). Catheter duration was longer in patients whose CVCs had been removed due to suspected infection (p < 0.0001). The risk factors for catheter colonization were a history of oncological disease (p = 0.022), ischemic heart disease (p = 0.019), as well as jugular venous catheterization (p = 0.019). No relationship was detected between colonization and operator experience (p = 0.050), ultrasound-guided cannulation (p = 0.565), or number of attempts (p = 0.379). The risk factors for CLABSI were: age over 60 years (p = 0.041) and oncological disease (p = 0.021). CLABSI was neither related to operator experience (p = 0.178), ultrasound-guided cannulation (p = 0.373), or number of attempts (p = 0.379). Although CVCs were in place for a short time and in a controlled setting, we observed high incidences of colonization and CLABSI. The risk of catheter colonization depends on other factors rather than catheter duration.

Effect of Older Age on Postoperative Urinary Retention After Prolapse Surgery.

Postoperative urinary retention (POUR) is common after reconstructive pelvic surgery. Little is known about the relationship between older age (≥70 years) and POUR after pelvic organ prolapse surgery. We aimed to investigate the relationship between age ≥70 years and POUR. Secondarily, we aimed to determine if duration of urinary catheterization differed by age in women with POUR. This was a secondary analysis of a dual-center retrospective study on perioperative adverse events in biologic females aged ≥61 years undergoing prolapse surgery. The primary outcome was POUR, defined as a failed retrograde voiding trial requiring bladder catheterization. The secondary outcome was duration of temporary bladder catheterization. We developed a stepwise multivariable logistic regression model, which included relevant variables with P < 0.10 on univariate analyses and a forced age variable. In this cohort of 2,665 women, mean ± standard deviation age was 71.2 ± 6.7 years, and 54.6% were ≥70 years, POUR occurred in 830 (31.1%) patients. Women with POUR had a lower body mass index and were more likely to have undergone a vaginal prolapse surgery and concomitant hysterectomy/incontinence procedure (P < 0.05). They had higher estimated blood loss (75 vs 50 mL, P < 0.001). On multivariable logistic regression, age ≥70 years was not associated with POUR (adjusted odds ratio 1.02, 95% CI [0.83-1.26]). Age ≥70 years was associated with longer duration of catheterization (5 vs 4 days, P < 0.01). Age was not associated with POUR when controlling for other clinical factors (body mass index, surgical approach, concomitant hysterectomy/incontinence surgery, and estimated blood loss). These factors may affect POUR in older women and should be considered in perioperative management.

Holmium Laser Enucleation of the Prostate (HoLEP) Versus Transurethral Resection of the Prostate (TURP) in Elderly Patients: Insights Into Recovery, Complications, and Risk Factors.

We compared the safety and efficacy of holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) in elderly men (aged ≥75 years) with benign prostatic hyperplasia (BPH). A retrospective analysis of 151 patients (HoLEP: 72; TURP: 79) was conducted. Preoperative and postoperative parameters, including prostate size, International Prostate Symptom Score (IPSS), catheterization duration, hospital stay, and perioperative complications (incontinence and dysuria), were analyzed. HoLEP significantly reduced catheterization (22 hours vs. 50 hours) and hospitalization times (one day vs. three days) compared to TURP (p < 0.01). However, HoLEP was associated with longer operation times (81.89 min vs. 67.95 min; p < 0.01) and higher rates of dysuria (65.3% vs. 27.8%) and transient incontinence (27.8% vs. 8.9%; p < 0.001). HoLEP offers significant perioperative benefits over TURP, particularly in shortening recovery times; however, further investigation is required to address the higher rates of dysuria and incontinence. Although the retrospective design and surgeon experience constitute limitations, these findings underscore the need for prospective studies. The results support personalized surgical decision-making, emphasizing patient-specific factors such as body mass index (BMI). These insights may help refine perioperative management and improve collaborative decision-making to enhance outcomes in elderly patients with BPH.

Urethral instrumentation in men with artificial urinary sphincter: a national survey among Brazilian urologists.

Urethral instrumentation (UI) in patients with an artificial urinary sphincter (AUS) demands technical considerations and poses a risk of urethral erosion, leading to serious clinical and legal consequences. We conducted a national survey to evaluate the knowledge and experience of Brazilian urologists with UI in these patients. This study used an electronic survey distributed to members of the Brazilian Society of Urology. The survey included 19 multiple-choice questions assessing sociodemographic characteristics, practice patterns, AUS training, knowledge of AUS components and functionality, experience with UI in AUS patients, and interest in further training. Urologists were classified as 'competent' in AUS manipulation if they had prior experience and confidence in performing UI. Among 536 participants (median age 47years [39-55]), 72.8% reported involvement in urological emergencies, with 89.9% indicating inadequate AUS training during residency. Only 29.7% had occasional or regular involvement with AUS surgeries. Of the participants, 53.4% had performed UI in men with an AUS. Prior UI had been attempted by healthcare staff in 36.2% of cases. Only 46.8% reported knowledge of AUS components and 45.1% felt competent in deactivating it. Regarding urethral catheterization, 47.2% knew the safe catheter diameter, and 20.9% identified safe catheterization duration. Overall, 45.1% self-declared competence in UI, yet many gave incorrect answers on catheter size and duration. Competence strongly correlated with knowledge of AUS components, regular implant involvement, and prior experience. Most (89.3%) expressed interest in additional training for UI. This study highlights significant gaps in training and knowledge among Brazilian urologists regarding UI in AUS patients. These deficiencies underscore the potential for enhanced education to improve patient outcomes and reduce AUS-associated complications in Brazil and possibly broader internationalcontexts.

The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia.

Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] vs 2 [2-2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.

Comparison of the prophylactic effect of cefazolin injection versus oral levofloxacin as prophylactic antibiotic in TURP surgery: a randomized clinical trial

IntroductionUse of antibiotic prophylaxis before transurethral resection of the prostate (TURP) is highly recommended. However, there is no agreement on the use of a single antibiotic for this purpose. This study aimed to compare the prophylactic effect of cefazolin injection with oral levofloxacin on postoperative complications in TURP surgery.Trial designBody temperature and urine culture results were obtained two and five days after surgery. Drugs’ side effects as well as surgery and catheterization time were also recorded.MethodsIn an analytical-comparative trial, the participants were randomly divided into two groups to receive cefazolin or levofloxacin before the surgery.ResultsThe duration of surgery (min) and catheterization (days) were 41.5 ± 11.7 and 4.7 ± 1.8 for levofloxacin-treated group and 43.9 ± 11.9 and 4.7 ± 1.8 for cefazolin-treated group, respectively. The number of positive urine cultures, 2 and 5 days post-surgery were 12 and 14 for levofloxacin-treated group and 9 and 12 for cefazolin-treated group, respectively. Furthermore, both groups reported one fever two days after surgery and had no fever after 5 days. In total, no significant difference was observed between the two groups. Additionally, no correlation was observed between the demographic data (i.e. age, BMI and prostate volume) and the postoperative complications (i.e. fever and urinary culture tests), except between age and urinary culture 2 days after the surgery.ConclusionConsidering the lack of significant differences between the two groups, the use of oral levofloxacin is suggested as an easy to take and cost-effective alternative to injection of cefazolin before TURP surgery.Trial registrationIranian registry of clinical trials, IRCT registration number IRCT20160514027893N4, available through www.irct.ir, Registration date: 2024-03-13 (Retrospectively registered).

Evolution of the medium-term functional outcomes of holmium laser prostate enucleation (HoLEP).

The boom in surgery for benign prostatic hyperplasia using Holmium laser enucleation (HoLEP) has reduced length of hospitalization, catheterization duration and the risk of bleeding, with comparable results to the old gold standard. The aim of this study is to evaluate the evolution of medium-term functional results after HoLEP. Retrospective monocentric observational study in patients who underwent HoLEP surgery from 2014 to 2019. We analyzed our post-operative functional results (scores USP, IPSS, QdV and Qmax) at short and medium term. The results were compared to preoperative data. At last consultation was performed at least one year after the procedure. A total of 338 patients underwent HoLEP surgery during this period. The mean follow-up time at the last consultation was 3.5 years. At the last consultation, the USP was 0.5 for the dysuria score (a 2.7-point improvement) (p<0.001), 1.6 points for the overactive bladder score (a 3.9-point improvement) (p<0.001), 0.5 for the stress urinary incontinence score (a 0.1-point improvement) (p=0.67). Among the patients, 2% had severe urinary incontinence (Stress urinary incontinence USP ≥ 7). The average IPSS at the last consultation was 3.7, an improvement of 16 points compared with the pre-operative score (p<0.001), and the average QoL was 1, a improvement of 4.3 (p<0.001). Surgical treatment of benign prostatic hyperplasia using HoLEP appears to be an efficient technique at medium term with a 2% rate of severe stress urinary incontinence. Overactive bladder is corrected from the 6th month postoperatively.

The Influence of Invasive Candida Infections on Prognosis and Analysis of Their Risk Factors After Liver Transplantation

PurposeThis study aimed to investigate the incidence, timing, risk factors, and impacts of invasive Candida infections (ICIs) within 3 months after liver transplantation (LT) on LT recipients’ prognosis. MethodsPatients undergoing LT from January 2015 to December 2022 in a tertiary university hospital were investigated the incidence, onset, and risk factors of ICIs and the effects of ICIs on the outcome of LT recipients using statistical methods. FindingsThe mean age of involved 389 LT recipients was 47.3 ± 10.5 years, with 322 (82.8%) being men. The incidence of ICIs was 3.3% (13/389), and the median time between LT and onset of ICIs was 5.0 days. The univariate analysis of predictors of ICIs identified that massive blood loss, prolonged duration of central line and urethral catheter, and prophylactic antifungal therapy were related to post-LT ICI risk. Multivariate logistic regression analysis adjusted for men and age identified that intraoperative blood loss ≥5000 mL (odds ratio [OR] = 7.005, 95% CI: 2.084–23.542, P = 0.002) and central line duration >14 days (OR = 5.270, 95% CI: 1.556–17.854, P = 0.008) were independently associated with the development of post-LT ICIs. Post-LT prophylactic antifungal therapy >3 days reduced ICIs (OR = 0.103, 95% CI: 0.021–0.501, P = 0.005). Regarding clinical outcomes, patients with ICIs were more likely to stay in the intensive care unit for 7 days or longer compared with those without ICIs (OR = 6.910, 95% CI: 1.737−27.493, P = 0.006). ICIs had no impact on hospitalization stay and 1-month all-cause mortality after LT. ImplicationsICIs are frequent and occur early after LT. Predictors of post-LT ICIs were massive intraoperative blood loss and prolonged duration of the central line. However, post-LT prophylactic antifungal therapy reduced ICIs. Patients with ICIs stayed longer in the intensive care unit than those without ICIs.

Enhancing Pain Management and Psychological Recovery in Earthquake Victims: The Role of Continuous Regional Analgesic Techniques Assessed by QoR-15.

After the earthquakes in Turkey, many citizens were injured, and a long ongoing process requiring physiological and psychological treatments began. The aim of this study was to observe the pain and psychological changes in earthquake victims in light of the QoR-15 score. After approval by the local ethics committee (Decision No. 2023-194), earthquake victims with catheters in trauma and reconstructive surgery were retrospectively evaluated. Demographic and catheterization data were collected. Baseline, 24 h, 72 h QoR-15 (Quality of Recovery-15), and VAS (Visual Analog Scala) scores were compared for changes over time. A total of 40 catheters were placed in 29 patients (after the exclusion of children, 36 catheters were evaluated in 26 (15 w/11 m) patients). The mean age of the patients was 35.57 ± 13.69 years, and the duration of catheterization was 8 (4.25-12.75) days. An infusion of 0.1% bupivacaine 0.5-1 mg/kg/24 h was started routinely. The QoR-15 scores of the patients at baseline, 24 h, and 72 h were 80.45 ± 17.76, 95.27 ± 15.16, and 101.06 ± 15.52, respectively (p < 0.001). The VAS scores of the patients at baseline, 24 h, and 72 h were 4.61 ± 1.41, 1.79 ± 1.36, and 0.76 ± 0.86, respectively (p < 0.001). In this study, a significant improvement in QoR-15 and VAS scores was achieved as a result of catheter insertion in earthquake victims. Considering that post-traumatic injuries require repeated surgeries and that pain aggravates the existing psychological state, it can be said that catheterization is beneficial.

Comparative efficacy and safety of 180W XPS vs. 120 W HPS GreenLight laser therapy for benign prostatic hyperplasia: a systematic review and meta-analysis.

To compare the surgical and functional outcomes of the 120 W HPS and 180 W XPS GreenLight laser vaporization systems in the treatment of benign prostatic hyperplasia (BPH). In January 2024, a comprehensive search across PubMed, Cochrane Library, and EMBASE was conducted following PRISMA guidelines, registered under PROSPERO (CRD42024531176). Studies comparing 120 W and 180 W GreenLight lasers in BPH treatment were assessed for clinical outcomes. Eight studies were included. The 180 W XPS system improved operation time (MD: 12.70, 95% CI [5.29-20.11], p=0.0008), lasing duration (MD: 10.09, 95% CI [0.85-19.33], p=0.03), and catheterization duration (MD: 0.43, 95% CI [0.12-0.74], p=0.007). No significant differences in energy consumption, energy density, or length of hospital stay were found. Functional outcomes such as International Prostate Symptom Score and maximum urinary flow rate showed no significant differences, except in quality of life (MD: 0.43, 95% CI [0.06-0.80], p=0.02) and prostate-specific antigen levels (MD: -0.77, 95% CI [-1.28 to -0.25], p=0.003). The 180 W system exhibited a lower rate of overall (OR: 1.52, 95% CI [1.14-2.04], p=0.005) and minor complications (OR: 1.84, 95% CI [1.27-2.66], p=0.001), with no significant differences in major complications or other adverse events. The 180 W XPS system demonstrates enhanced efficiency and reduced complication rates, offering a favorable option for BPH treatment, particularly for larger prostates. Future studies should focus on randomized trials to confirm these findings and assess long-term outcomes.

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.

Biochemical recurrence after open radical prostatectomy in a single-center cohort with a minimum follow-up of 10 years

Purpose: To investigate the long-term oncological outcomes and report biochemical recurrence (BCR)-free survival for men who underwent open radical prostatectomy at a single center. Materials and methods: A total of 360 patients who underwent open radical prostatectomy at our institution between 2003 and 2011 were included in this study. The BCR-free survival rates were calculated by Kaplan-Meier method and log-rank analysis. Multivariable Cox regression models were used to test the effect of other factors such as age, preoperative prostate-specific antigen (PSA), Gleason score, and surgical margins on BCR. Results: Median patient age was 65.4 years, with a median preoperative PSA level of 6.21 ng/ml. Operating time had a median duration of 155.1 minutes, ranging from 104 to 301 minutes. Nerve-sparing surgery was achievable in 48.1% of patients, including 34.2% undergoing bilateral procedures and 13.9% unilateral. In terms of surgical precision and outcomes, the overall rate of positive surgical margins was 23.6%, which decreased significantly to 11.1% in patients with localized prostate cancer. Lymph node involvement occurred in 3.6% of cases. Postoperative care statistics revealed a median catheterization duration of 9.1 days (range: 4–30 days) and a low rate of significant complications (4.4%). The early continence rate in a standardized pad test was 80.6%. At a median follow-up of 150.5 months, the 5-year and 10-year BCR-free survival rates for the entire cohort were 91.4% and 77.5%, respectively. The 10-year BCR-free survival rates were 84.8%, 81.5%, and 68.5% for low-, intermediate-, and high-risk patients, respectively. Furthermore, the 10-year BCR-free survival rates were 78.8% and 62.8% for localized and locally advanced prostate cancer, respectively. Preoperative PSA &gt;20 ng/ml, postoperative Gleason sum ≥3 + 4, and positive surgical margins were associated with increased risk of BCR on multivariable Cox regression analysis. Conclusion: Our long-term oncological results match or exceed those previously published in similar contemporary cohorts with long follow-up.

Aetiology and Prognostic Significance of Postoperative Urinary Tract Infections in Patients with Cervical Cancer.

This study aimed to investigate the risk factors for urinary tract infections (UTIs) in patients with cervical cancer (CC) following radical surgery, and analyse the etiological distribution and prognostic implications of these infections. A retrospective analysis was conducted on the clinical data of 168 patients with CC who underwent radical surgery at our hospital between January 2021 and December 2023. Postoperative UTI incidence and associated risk factors were analysed. Postoperative urine samples were collected under sterile conditions for pathogen culture to analyse pathogen distribution. Patients were classified into poor and good prognosis groups based on their health status within one month of treatment. The relationship between pathogen distribution and prognosis in patients with CC and postoperative UTIs was analysed. The incidence of postoperative UTIs was 35.12% (59 cases). Among these patients, 84 pathogen strains were detected in urine samples, including 54 of gram-negative bacteria, 26 of gram-positive bacteria, and four of fungi. The single-factor analysis identified age, diabetic status, menopausal status, tumour diameter, surgical duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as potential risk factors. The multifactorial analysis confirmed age, diabetic status, operation duration, intraoperative blood loss volume, duration of ureteral catheterisation, and postoperative urinary retention as independent risk factors. The distribution of Klebsiella pneumoniae (K. pneumoniae) significantly differed between the study groups, while other pathogens showed no significant difference. UTIs in patients with CC post-radical surgery are primarily caused by gram-negative bacteria, mainly Escherichia coli and K. pneumoniae. K. pneumoniae is predominant in patients with a poor prognosis, while Enterococcus spp. is the most common gram-positive bacterium observed.