Chronic Catheters Research Articles

Indirect involvement of α2-adrenoceptors in the mechanical antihypersensitivity effect induced by the spinally administered imidazoline I1 receptor ligand LNP599 in a rat model of experimental neuropathy

Here we assess whether neuropathic pain hypersensitivity is attenuated by spinal administration of the imidazoline I1-receptor agonist LNP599 and whether the attenuation involves co-activation of α2-adrenoceptors. Spared nerve injury (SNI) model of neuropathy was used to induce mechanical hypersensitivity in male and female rats with a chronic catheter for intrathecal drug administrations. Mechanical sensitivity and heat nociception were assessed behaviorally in the injured limb. Additionally, GTPγS radioligand binding assay, β-arrestin recruitment and intracellular cAMP levels were used for receptor profiling in vitro. LNP599 (imidazoline I1 receptor agonist) and clonidine (α2-adrenoceptor agonist) produced equal dose-related mechanical antihypersensitivity effects in both sexes. LNP599 attenuated heat nociception preferentially in males, while clonidine reduced heat nociception equally in males and females. Carbophenyline (another imidazoline I1 receptor agonist) had no significant effect on mechanical hypersensitivity or heat nociception in males or females. Mechanical antihypersensitivity and heat antinociception induced by LNP599 in SNI males was prevented by pretreatments with yohimbine or atipamezole (two α2-adrenoceptor antagonists) but not by efaroxan (a mixed imidazoline I1 receptor/α2-adrenoceptor antagonist). In vitro assays indicated that LNP599 does not activate α2A- or other subtypes of α2-adrenoceptors. However, LNP599 was a weak partial agonist for 5-HT2B receptors and bound to sigma-1 and sigma-2 receptors that all are involved in modulation of spinal nociception. The results indicate that the suppression of neuropathic pain hypersensitivity by LNP599 is not due to action on spinal imidazoline I1 receptors, but rather due to indirect activation of spinal α2-adrenoceptors.

Effect of Intravenous Delivery of N,N Dimethyltryptamine on Sleep-Wake States in Rat

Psychedelics, including N, N, Dimethyltryptamine (DMT), are being increasingly explored for therapeutic potential to treat psychiatric disorders such as depression, anxiety, and post-traumatic stress disorder. These and other psychiatric conditions have a bidirectional relationship with sleep patterns but the impact of psychedelics, particularly DMT, on sleep architecture is incompletely understood. Therefore, in this study, we determined the effect of intravenous DMT administration on sleep-wake states in male and female rats. Under surgical isoflurane anesthesia, adult Sprague Dawley rats (n=10, 5 male, 5 female) were instrumented with electrodes to record electroencephalogram (EEG) from across the cortex and electromyogram (EMG) from dorsal nuchal muscles. In addition, a chronic catheter was positioned in jugular vein for the infusion of DMT or 0.9% saline (as vehicle control). Each rat received an intravenous bolus (100 uL/min over 5 min) of either one of two doses of DMT (low dose: 3.75 mg/kg, high dose: 7.5 mg/kg) or 0.9% saline. The DMT and saline infusions were performed 30-minutes after the start of the lights-ON period (8:00 am) after which EEG and EMG data were recorded for 24h across the light and dark cycle. EEG and EMG data were manually scored (SleepSign, Kissei Comtec) in 4-second intervals and classified as wakefulness, slow-wave sleep, or rapid eye movement sleep, then averaged in 3h bins across the 24h recording period. A linear mixed model was used to compare the changes in percent time spent in each state, mean duration per episode for each state, and mean number of episodes for each state, between vehicle control and DMT infusion sessions. There was a statistically significant increase in the time spent in wakefulness in the first 3h bin after DMT infusion (p<0.02 for low dose, p<0.03 for high dose). In the same 3h bin, a significant decrease in slow-wave sleep (p<0.02 for low and high dose DMT) was observed. DMT infusion produced a significant increase in the latency to the onset of rapid eye movement sleep (p<0.01), but no statistical effect was observed on the time spent in rapid eye movement sleep during the light period. Our results with DMT align with previous reports showing an increase in wakefulness after administration of serotonergic psychedelics. Further analysis of neurophysiologic data is needed to understand the neural dynamics associated with DMT-induced increases in wakefulness. Department of Anesthesiology, University of Michigan. RS was partly supported by Magnificent Michigan Summer Undergraduate Research fellowship, University of Michigan. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD).

Although antibiotic prophylaxis (AB) demonstrated a statistically significant reduction in bacteriuria after invasive urodynamics (UDS), no significant decrease in the incidence of urinary tract infections (UTI) has been confirmed. No absolute recommendations on the use of AB in case of relevant potential risk of UTI have been reported, though some categories of patients at increased infective probability after UDS have been recognized. The aim of this study is to report the experts' consensus on the best practice for the use of AB before UDS in the main categories of patients at potential risk of developing UTI. A systematic literature review was performed on AB before UDS in males and females. A panel of experts from the Italian Society of Urodynamics, Continence, Neuro-Urology, and Pelvic Floor (SIUD) assessed the review data and decided by a modified Delphi method on 16 statements proposed and discussed by the panel. The cut-off percentage for the consensus was a ≥70% of positive responses to the survey. The study was a Delphi consensus with experts' opinions, not a clinical trial involving directly patients. The panel group was composed of 57 experts in functional urology and UDS, mainly urologists, likewise gynaecologists, physiatrists, infectivologists, pediatric urologists, and nurses. A positive consensus was achieved on 9/16 (56.25%) of the statements, especially on the need for performing AB before UD in patients with neurogenic bladder and immunosuppression. Urine analysis and urine culture before UDS are mandatory, and in the event of their positivity, UDS should be postponed. A consensus was reached on avoiding AB in menopausal status, diabetes, age, gender, bladder outlet obstruction, high postvoid residual, chronic catheterization, previous urological surgery, lack of urological abnormalities, pelvic organ prolapse, and negative urine analysis. Antibiotic prophylaxis is not recommended for patients without notable risk factors and with a negative urine test due to the potential morbidities that may result from antibiotic administration. However, AB can be used for risk categories such as neurogenic bladder and immunosuppression. The evaluation of urine analysis and urine culture and postponing UDS in cases of positive tests were considered good practices, as well as performing AB in the neurogenic bladder and immunosuppression.

A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer® Polyhexanide 0.02%

IntroductionHistorically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment.Case presentationThese case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms.DiscussionCatheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm.This case report was prepared following the CARE Guidelines (supplementary file 1).

Idiopathic spinal cord herniation—An extremely rare cause of paraparesis: Case report

Abstract Idiopathic spinal cord herniation is a rare disorder, consisting of a ventral displacement of the spinal cord through a dural defect. The resulting adhesion and vascular compromise lead to neurological impairment. We report the case of a 54-year-old male, with a previous urological surgery resulting in chronic vesical catheterization, with a worsening paraparesis associated with anesthesia below T10. The magnetic resonance imaging showed a ventral displacement of the spinal cord at T7/T8 with an enlarged posterior subarachnoid space at that level. A four-level laminotomy was performed followed by spinal cord herniation reduction and closure of the anterior dural defect with a dural replacement. The patient had a partial recovery of his motor deficits regaining his ability to walk with the support of a single crutch. The purpose of this study was to highlight the existence of this extremely rare cause of paraparesis, which is often misdiagnosed.

#3349 METICULOUS CATHETER CARE CAN REDUCE CATHETER-RELATED BLOODSTREAM INFECTIONS SIGNIFICANTLY IN HAEMODIALYSIS PATIENTS – A 5-YEAR SINGLE CENTRE STUDY

Abstract Background and Aims The use of central venous catheters as hemodialysis (HD) vascular access is a leading contributor to a high rate of bloodstream infection. Our dialysis unit in China has followed the China National Infection Control Policy for HD unit as well as developed its own specific dialysis catheter care protocol using the Centre for Disease Control and Prevention (CDC) guidelines as a template. By doing so, our HD unit has achieved a tunneled dialysis catheter (TDC)- related bloodstream infection rate of 0.0229 per 1000 catheter days in the past 5 years. This report, aims to share our experience with the other units. Method We have undertaken a retrospective analysis to determine our catheter-related bloodstream infection (CRBSI) rate. The local Ethics and Research Committee has approved the conduct of the retrospective study. In this study, the definition of a CRBSI is taken from Kidney Disease Outcomes Quality Initiative (KDOQI) Vascular Access-2019 update as 1) clinical manifestations (fever > 37.5°C or rigors or presence of clinical signs of infection); 2) confirmation of bacteremia (blood cultures growing the same organism from the dialysis catheter and a peripheral vein), with either positive semiquantitative (>15CFU/catheter segment), or quantitative (>102 CFU/catheter segment), differential period of catheter culture versus peripheral blood culture (BC) positivity of 2 hours; 3) exclusion of another source of infection. Information including patient demographics, causes of kidney failure, and duration of TDC was obtained. Results The Covidien Palindrome chronic catheters have been used in the majority of our patients during the study period. All tunneled dialysis catheters were placed by the nephrologists under radiological guidance in the Hospital's sterile Digital Subtraction Angiography (DSA) Suite. In the study period (2017-2021), an average of 235 prevalent patients were receiving dialysis in the HD unit. A total of 212 tunneled dialysis catheters have been inserted and managed according to our local dialysis access pathway and catheter care protocol. The TDC days have been calculated by adding all the catheter days until the catheters have been removed or the patients have been transferred out of our HD unit. There was a total of 43,585 catheter days. The average waiting time for arteriovenous fistula (AVF) surgery was two weeks. The mean duration of TDC use was 107.8±14.8 days, range 1-1827 days. The incidence of confirmed tunneled CRBSI was 0.0229/ 1000 catheter days. Conclusion Our local catheter care protocol is similar to the CDC's “scrub-the-hub” protocol. 2% chlorhexidine with 70% alcohol has been used for the scrubbing and disinfection but we have a few additional steps. In our practice, great attention is given to the cleansing of the clamps. 1) Prior to removal of the caps, the clamps are opened and the surroundings are cleaned and disinfected thoroughly. 2) Two nurses are assigned to connect the bloodlines to the hubs, hence the risk of hub contamination is reduced. 3) The point of connection between the hubs and the bloodlines is protected with a gauze dressing in 3 layers during the entire duration of the dialysis. We believe our success with a very low rate of CRBSI has been the result of strict adherence to 1) good and general hygiene, 2) a well-designed dialysis catheter care protocol, 3) good use of a vascular access nurse, 4) short-duration of TDC days, and 5) short waiting time for AVF. Limitations: We may have underestimated the true rate of CRBSI because of the inherent nature of the diagnostic criteria as mentioned above. Although it is unlikely that a blood culture would have been missed before intravenous antibiotics under our hospital's stringent antibiotics stewardship and continuous audit, it is still possible in theory. Finally, a small number of patients has been transferred out to other HD units due to their change of residence, hence the follow up data might be incomplete. However, such patients are very few in number and the long follow up of this study strengthens our findings and conclusion.

Risks of Bladder Cancer in Patients with Childhood Augmentation or Chronic Catheters for Neurogenic Bladder

Risks of Bladder Cancer in Patients with Childhood Augmentation or Chronic Catheters for Neurogenic Bladder

MP52-15 EXTERNAL URETHRAL SPHINCTER BOTULINUM TOXIN INJECTION TO TREAT PSEUDODYSSYNERGIA IN PATIENTS WITH CEREBRAL PALSY

You have accessJournal of UrologyCME1 Apr 2023MP52-15 EXTERNAL URETHRAL SPHINCTER BOTULINUM TOXIN INJECTION TO TREAT PSEUDODYSSYNERGIA IN PATIENTS WITH CEREBRAL PALSY Ryan Haggart, Christopher J Loftus, Molly DeWitt-Foy, Valencia Henry, Joseph Pariser, and Sean Elliott Ryan HaggartRyan Haggart More articles by this author , Christopher J LoftusChristopher J Loftus More articles by this author , Molly DeWitt-FoyMolly DeWitt-Foy More articles by this author , Valencia HenryValencia Henry More articles by this author , Joseph PariserJoseph Pariser More articles by this author , and Sean ElliottSean Elliott More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Cerebral palsy (CP) is an upper motor neuron disorder that typically results in spasticity of striated muscle, which can include the external urinary sphincter. Symptomatic urinary dysfunction in the form of intermittent retention and flooding may result from tonic spasticity of the external urinary sphincter (pseudodyssynergia). Botulinum toxin (BTX) may be injected to the external urinary sphincter to allow for more facile, regular voiding. In the only study examining the use of sphincter BTX injections, a reduction in chronic catheter dependence and urinary tract infection (UTI) rates in the 15 patients studied was reported. The objective of this study is to evaluate urinary outcomes following cystoscopic external urinary sphincter BTX injections in patients with CP. METHODS: In this retrospective cohort study, we reviewed patients with a diagnosis of CP seen in urology clinic from 2016-2022. Patients included were 18 years or older and had undergone a urethral external sphincter BTX injection. Injections were performed with either 100 units or 200 units in 4 cc of saline injected to the anterolateral external urethral sphincter. Data was collected via chart review and entered into a REDCap database. Outcomes included: retention, lower urinary tract symptoms (LUTS), hydronephrosis, and recurrent UTIs recorded as better, no change, or worse based on caregiver or patient feedback and repeat imaging. Urodynamics was performed pre-BTX but often not repeated as many patients are unable to void on command so a proper voiding phase could not be captured. RESULTS: 37 patients met inclusion criteria. The median age was 29 years (IQR 25-39), 57% were male, most (54%) lived at home with or without assistance, and 30% resided in a group home. Prior to BTX, most used a combination of a toilet (59%) and diapers (59%) for bladder management. The most common indication for BTX was retention (92%), followed by LUTS (38%), hydronephrosis (24%), and recurrent UTIs (22%). Post-BTX subjective improvement was seen in 71% (24/34) of patients with retention, 79% (11/14) with LUTS, 75% (6/8) with recurrent UTIs, and 78% (7/9) with hydronephrosis. The majority (68%) of patients underwent repeat injections, typically every 3-6 months. There were no significant complications associated with injections. CONCLUSIONS: External urethral sphincter BTX is a safe, effective option for treating urinary dysfunction in adults with CP. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e708 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Haggart More articles by this author Christopher J Loftus More articles by this author Molly DeWitt-Foy More articles by this author Valencia Henry More articles by this author Joseph Pariser More articles by this author Sean Elliott More articles by this author Expand All Advertisement PDF downloadLoading ...

SEMINAR OF EVALUATION OF THE USE OF CIPROFLOXACIN ANTIBIOTICS IN INFECTION PATIENTS URINARY TRACT (PUT) IN CARE INSTALLATION HOSPITAL GRANDMED LUBUK PAKAM

Urinary Tract Infection (UTI) This is an infectious disease characterized by the growth and multiplication of bacteria in the urinary tract. The most common etiology in more than 80% of uncomplicated UTI cases is Escherichia coli, and less than 50%, Proteus spp, Klebsiella pneumoniae, Enterobacter spp, Pseudomonas aeruginosa, Staphylococcus, and Enterococcus. Candida species are a common cause of urinary tract infection in patients with severe chronic catheterization. The clinical forms of UTI are classified according to age, intensity of inflammatory response, and location of urinary tract infection. Children aged 2 months to 2 years with a UTI require special attention because they are likely to have atypical clinical presentations, invasive urine specimen collection, and kidney injury. This study aims to determine the dosage and composition of the antibiotic ciprofloxacin in patients with urinary tract infections at Grandmed Lubuk Pakam Hospital for the period November-December 2021. The method used is a descriptive assessment because it aims to provide an objective picture or description of the situation. Data collection was carried out retrospectively. Both research by reviewing historical information, as well as data collection by observing the medical records of urinary tract infection patients at Grandmed Lubuk Pakam Hospital in 2021

Urinary Tract Infections: Epidemiology, Mechanisms of Infection, and Treatment

Purpose: The main purpose of this study was to determine the mechanism of infection and the response of preferred antibiotic treatment during this study. Study: This study was conducted from February to March 2022. The approval for this randomized study was taken by the Ethical Committee of the concerned hospital. Written informed consent was signed by all participants. Total of 110 participants who reported problems with UTIs were part of this study. Levofloxacin 750 mg per day for five days and ciprofloxacin 500 mg twice per day for ten days were given to patients for treatment. Results: The total number of patients was 110, 65 (59.09%) males and 45 (40.90%) females having a mean age of 28 ± 5, urinary tract abnormalities were observed in 28 (25.45%) patients including obstruction in 16 (14.54%) patients, stone in 8 (7.27%)cases, the neurogenic bladder was in 4 (3.63%) patients and poly-microbial etiology was in 25 (22.72%) and catheterized patients was 35 (31.81%) in which chronic catheter cases were 15 (13.63%), intermittent catheter cases were 20 (18.18%), and Complicated UTIs was found in 22 (20.02%). 55 patients were treated with levofloxacin 51 (46.36%) reported a positive response and 51 (46.36%) were not cured with a p-value of 0.05. 55 patients were treated with ciprofloxacin of which 48 (43.63%) patients were cured and 7 (6.36%) were not cured with a p-value of 0.05. The number of patients treated with levofloxacin had a higher cured percentage 46.36% than those treated with Ciprofloxacin. Conclusion: Eventually, this study demonstrated that UTIs of all the microorganisms detected during the study can be cured with levofloxacin and ciprofloxacin. While ciprofloxacin was slightly less effective in a few cases than levofloxacin. Keywords: Urinary tract infection (UTIs), Ciprofloxacin, levofloxacin, infection treatment

Impact of Duration of Antibiotic Prophylaxis on Incidence of UTI after OnabotulinumtoxinA Injection

ObjectiveTo assess the impact of duration of antibiotic prophylaxis on incidence of urinary tract infection (UTI) after intravesical OnabotulinumtoxinA (BTX) injection. MethodsA retrospective cohort study of patients with overactive bladder who underwent office BTX injections from 2014 to 2020. UTI incidence within 30 days of BTX was compared between 3 durations of antibiotic prophylaxis: no antibiotic, single day, or multiple day course. Association of UTI with units of BTX, body mass index, history of diabetes, immunosuppression, neurogenic overactive bladder, chronic catheter, or recurrent UTI were investigated. ResultsTwo hundred ninety patients and 896 cycles of BTX injections were included: 877 injections (97.7%) were women, with mean age 61.4 years (range 20-96; SD 13.3). No antibiotic prophylaxis was given to 112 (12.5%) patients, 595 (66%) received a single day, and 189 (21%) received a multiple day regimen (3-7 days). Overall incidence of UTI within 30 days was 11.4%. On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single odds ratio [OR] 0.34; 95% confidence interval [CI] 0.19-0.61; P < .001; multiple OR 0.47; 95% CI 0.24-0.92; P = .029), with no difference between single and multiple day regimens (OR 1.38; 95% CI 0.80-2.38; P = .249). History of recurrent UTI (OR 3.77; 95% CI 2.23-6.39; P < .001) and chronic suprapubic catheter (OR 2.88; 95% CI 1.04-7.95; P = .041) were additional predictors. ConclusionA multiple day regimen of antibiotic prophylaxis was not more effective than a single day in preventing UTI for intravesical BTX injection. Use of any antibiotic prophylaxis was associated with a significantly lower incidence of UTI compared to no antibiotic.

MP02-19 PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO ASSESS THE UTILITY OF URINALYSIS PRIOR TO OFFICE UROLOGY PROCEDURES

You have accessJournal of UrologyCME1 May 2022MP02-19 PROSPECTIVE RANDOMIZED CLINICAL TRIAL TO ASSESS THE UTILITY OF URINALYSIS PRIOR TO OFFICE UROLOGY PROCEDURES Alexa Rose, Aleah Warden, Sara Best, Tudor Borza, Vani Tadakala, E. Jason Abel, Daniel D. Shapiro, David F. Jarrard, and Kyle A. Richards Alexa RoseAlexa Rose More articles by this author , Aleah WardenAleah Warden More articles by this author , Sara BestSara Best More articles by this author , Tudor BorzaTudor Borza More articles by this author , Vani TadakalaVani Tadakala More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , Daniel D. ShapiroDaniel D. Shapiro More articles by this author , David F. JarrardDavid F. Jarrard More articles by this author , and Kyle A. RichardsKyle A. Richards More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI) following office based urology procedures is the most common complication but occurs at a relatively infrequent rate. Due to the volume of office cystoscopy, prostate biopsy, and intravesical bladder cancer therapies (IVT) performed globally, UTI following these procedures is a potential source of significant morbidity to patients and cost to the health systems. Screening urinalysis (UA) is frequently performed prior to these office-based procedures to minimize the risk of UTI. Whether screening UA can reduce the risk of UTI following these procedures is unknown. METHODS: We conducted a multicenter (University of Wisconsin and Madison VA), randomized non-inferiority trial involving patients undergoing office cystoscopy, prostate biopsy, or IVT, in which we compared screening UA vs. no screening UA. Patients were blinded to their randomization arm. We excluded patients with UTI within 1 year, chronic catheter use, and those undergoing stent removals. Both groups completed a questionnaire about their Lower Urinary Tract Symptoms (LUTS) on the day of their procedure, 1-week post-procedure, and 1-month post-procedure. Each follow-up visit we assessed for UTI, hospitalizations, or adverse events. The primary end point was UTI within 30 days of office procedure. UTI was defined as a positive urine culture >10,000 cfu/mL accompanied by symptoms. RESULTS: From 10/2018 to 10/2021, 641 patients were randomly assigned to screening UA (318 patients) or no screening UA (323 patients) of which 157 (24.5%) underwent IVT, 427 (66.6%) underwent cystoscopy, and 57 (8.9%) underwent prostate biopsy. For the entire cohort, the median age was 70 (IQR 63-76), 530 were male (82.7%), 509 (79.4%) had Charlson-comorbidity index > 3, and 621 (97.3%) were white. Prior transurethral urologic procedures (office based or operative) were common in the cohort with 601 (93.8%) patients having undergone a median of 13 (IQR 5-25). History of UTI was present in 115 (17.9%) patients. On the day of the procedure, 48 (11.1%) were noted to have bacteriuria. UTI occurred in five (1.6%, 95% CI 0.7-3.7) patients in the screening UA group and four (1.2%, 95% CI 0.5-3.3) patients in the no screening UA group (OR 0.78, 95% CI 0.21-2.95; p=0.72) which met our predefined non-inferiority difference of 1% between arms. CONCLUSIONS: Omission of pre-procedure urinalysis is not inferior to routine screening urinalysis to prevent post-procedure urinary tract infection in patients undergoing office cystoscopy, intravesical bladder cancer treatment, or prostate biopsy. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e17 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alexa Rose More articles by this author Aleah Warden More articles by this author Sara Best More articles by this author Tudor Borza More articles by this author Vani Tadakala More articles by this author E. Jason Abel More articles by this author Daniel D. Shapiro More articles by this author David F. Jarrard More articles by this author Kyle A. Richards More articles by this author Expand All Advertisement PDF DownloadLoading ...

Changes in Nitric oxide Levels in Basal Forebrain during Sedation with Dexmedetomidine and Sevoflurane

BackgroundPerioperative and critical care settings frequently require periods of prolonged sedation but the effect of sedation on sleep homeostasis is not completely understood. In the ongoing studies in our laboratory, continuous 8 h sedation with dexmedetomidine (DEX) was shown to increase wakefulness (WAKE), decrease slow‐wave sleep (SWS), and nearly eliminate rapid eye movement sleep (REMS) in the post‐sedation period [1]. In contrast, continuous 8 h sedation with sevoflurane (SEVO) did not affect the time spent in WAKE or SWS, but increased REMS in the post‐sedation period [1]. Past studies have shown nitric oxide (NO) in basal forebrain (BF) to be a key modulator of sleep homeostasis. Specifically, NO concentration in BF has been shown to increase with sleep pressure (e.g., during sleep deprivation) and decrease with the reduced sleep need (e.g., during recovery from sleep deprivation). To determine the effect of sedation produced by DEX or SEVO on sleep homeostasis, as inferred from changes in NO levels in BF, we quantified the changes in NO concentration before, during, and after sedation with DEX and SEVO.MethodsAdult male Sprague Dawley rats (N=4 male) were surgically prepared to record electroencephalogram (EEG) and electromyogram and intravenous delivery of DEX via a chronic catheter in jugular vein. In addition, an open flow microperfusion guide cannula was implanted into BF (N=2) or prefrontal cortex (N=2) for collection of perfusates for NO analysis. Prefrontal cortex (PFC) was used as an anatomical control for BF. After at least 15 days of post‐surgical recovery, rats were connected to the EEG recording system and a sampling insert was lowered into BF or PFC to route the perfusate samples directly into a high‐performance liquid chromatograph for online analysis of nitrite and nitrate levels, which are collectively termed as NOx and are considered a surrogate for endogenous NO concentration. The EEG and NOx were recorded during 2 h baseline wake condition, 8 h of sedation with either DEX (0.5‐0.7ug/kg/min) or SEVO (1.5‐3.0%), and 2 h post‐sedation period. Each rat was administered with DEX or SEVO in a counter‐balanced manner and with a washout period of at least 7 days.ResultsThe NOx levels in BF decreased during sedation with DEX (mean ± standard deviation: 0.52 μM ± 0.31 during baseline vs 0.08 μM ± 0.01 during DEX) and SEVO (mean ± standard deviation: 1.58 μM ± 0.16 during baseline vs 0.72 μM ± 0.07 during SEVO). The NOx levels in PFC during sedation with DEX stayed about at the same level as observed during baseline state (2.40 μM ± 1.39 during baseline vs. 3.01 μM ± 0.16 during DEX), but the NOx levels in PFC decreased during sedation with SEVO (1.45 μM ± 1.23 during baseline vs 0.37 μM ± 0.18 during SEVO).ConclusionAlthough these are preliminary data, the decrease in NOx levels in BF after sedation with DEX and SEVO suggest a reduced sleep pressure and is supportive of the changes in sleep homeostasis as described in our previous report.References Parkar A, Liu T, Fryzel A, Groenhout T, Mashour GA and Pal D (2020) Effect of prolonged sedation with dexmedetomidine, midazolam, propofol, or sevoflurane on sleep homeostasis in rat. J Neurosurgical Anesthesiology, Vol 32, No 4, Page 403, Abstract no SNACC‐387.

Chronic bladder catheterization, but not the metabolic chambers, is suitable for collection of precise data on murine diuresis

Chronic bladder catheterization, but not the metabolic chambers, is suitable for collection of precise data on murine diuresis

Factors associated with self-management independence and quality of life for adolescents and young adults with spina bifida engaged in a guideline-based transition clinic.

To determine characteristics associated with self-management independence and quality of life (QOL) among adolescents and young adults with spina bifida (AYASB) engaged in a spina bifida (SB) health care transition clinic. During SB transition visits, Eighty-eight AYASB ages 14-20 completed the Adolescent/Young Adult Self-management and Independence Scale II Self-Report/SB (AMIS II-SR/SB), scores ranging from 1-7 with 7 indicating full independence in activities, and the QUAlity of Life Assessment in Spina bifida for Teens (QUALAS-T), which has two subscales, family/independence (QFI) and bowel/bladder (QBB), with scores ranging from 0-100 with 100 indicating maximal QOL score. Demographic and clinical variables were collected from the electronic medical record. The baseline AMIS II-SR/SB score was 3.3 (SD 1.0). Baseline scores for QUALAS-T QFI and QBB subscales were 73.8 (SD 19.9) and 63.8 (SD 25.8). Older age was associated with a higher baseline AMIS II-SR/SB score (p = 0.017). Over time, AMIS II-SR/SB total significantly improved (p < 0.001), but QFI and QBB did not. AYASB not on chronic intermittent catheterization (CIC) and those using urethral CIC significantly improved in AMIS II-SR/SB total scores (p = 0.001), but those using abdominal channel CIC did not. Baseline bladder management method was associated with self-management improvement for AYASB engaged in a SB-specific transition clinic.

Cortical Acetylcholine Levels Correlate With Neurophysiologic Complexity During Subanesthetic Ketamine and Nitrous Oxide Exposure in Rats.

BACKGROUND:Neurophysiologic complexity has been shown to decrease during states characterized by a depressed level of consciousness, such as sleep or anesthesia. Conversely, neurophysiologic complexity is increased during exposure to serotonergic psychedelics or subanesthetic doses of dissociative anesthetics. However, the neurochemical substrates underlying changes in neurophysiologic complexity are poorly characterized. Cortical acetylcholine appears to relate to cortical activation and changes in states of consciousness, but the relationship between cortical acetylcholine and complexity has not been formally studied. We addressed this gap by analyzing simultaneous changes in cortical acetylcholine (prefrontal and parietal) and neurophysiologic complexity before, during, and after subanesthetic ketamine (10 mg/kg/h) or 50% nitrous oxide.METHODS:Under isoflurane anesthesia, adult Sprague Dawley rats (n = 24, 12 male and 12 female) were implanted with stainless-steel electrodes across the cortex to record monopolar electroencephalogram (0.5–175 Hz; 30 channels) and guide canulae in prefrontal and parietal cortices for local microdialysis quantification of acetylcholine levels. One subgroup of these rats was instrumented with a chronic catheter in jugular vein for ketamine infusion (n = 12, 6 male and 6 female). The electroencephalographic data were analyzed to determine subanesthetic ketamine or nitrous oxide–induced changes in Lempel-Ziv complexity and directed frontoparietal connectivity. Changes in complexity and connectivity were analyzed for correlation with concurrent changes in prefrontal and parietal acetylcholine.RESULTS:Subanesthetic ketamine produced sustained increases in normalized Lempel-Ziv complexity (0.5–175 Hz; P < .001) and high gamma frontoparietal connectivity (125–175 Hz; P < .001). This was accompanied by progressive increases in prefrontal (104%; P < .001) and parietal (159%; P < .001) acetylcholine levels that peaked after 50 minutes of infusion. Nitrous oxide induction produced a transient increase in complexity (P < .05) and high gamma connectivity (P < .001), which was accompanied by increases (P < .001) in prefrontal (56%) and parietal (43%) acetylcholine levels. In contrast, the final 50 minutes of nitrous oxide administration were characterized by a decrease in prefrontal (38%; P < .001) and parietal (45%; P < .001) acetylcholine levels, reduced complexity (P < .001), and comparatively weaker frontoparietal high gamma connectivity (P < .001). Cortical acetylcholine and complexity were correlated with both subanesthetic ketamine (prefrontal: cluster-weighted marginal correlation [CW r] [144] = 0.42, P < .001; parietal: CW r[144] = 0.42, P < .001) and nitrous oxide (prefrontal: CW r[156] = 0.46, P < .001; parietal: CW r[156] = 0.56, P < .001) cohorts.CONCLUSIONS:These data bridge changes in cortical acetylcholine with concurrent changes in neurophysiologic complexity, frontoparietal connectivity, and the level of consciousness.

Characteristics and Outcomes of Patients Receiving Sedation for Voiding Cystourethrography.

BackgroundVoiding cystourethrography (VCUG) is used to diagnose vesicoureteral reflux (VUR); however, it is an invasive procedure and can be psychologically distressing. Procedural sedation is occasionally utilized to alleviate anxiety during VCUG, and some patient populations may get referred more readily for sedation than others. Sedative medications may also impact the results of the test due to their effects on smooth muscle. The goals of this study were to compare patient characteristics between those that were referred for procedural sedation and those that were not and to compare VCUG results between sedated and non-sedated patients.MethodologyWe performed a retrospective cohort study of patients aged 2-18 years undergoing VCUG during a five-year period. Sedated patients were matched with non-sedated patients controlling for referring provider and procedure year. Exclusion criteria included chronic catheterization, same-day surgery, current intensive care admission, and sedation restrictions. A total of 284 patients were included. Demographic information, medical comorbidities, and VCUG results were analyzed.ResultsThere were no significant differences between sedated and non-sedated patients in any demographic variables. Neurologic, developmental, and gastrointestinal comorbidities were more common in sedated patients. On multivariate analysis, having more than one comorbid condition was the only significant predictor of referral for procedural sedation. There were no significant differences in VCUG results between sedated and non-sedated patients.ConclusionsPatients with comorbidities were more likely to receive procedural sedation for VCUG. Procedural sedation did not have a significant impact on test results, suggesting its potential utility in relieving pain and anxiety associated with VCUG.

Abstract 13956: Nalfurafine, an Orally Active, G Protein-Biased Kappa Opioid Receptor Agonist, Increases the Diuretic Response to Loop and Thiazide Diuretics and Limits Electrolyte Losses

Nalfurafine, a G protein-biased kappa opioid receptor (KOR) agonist that produces analgesia and is devoid of CNS adverse effects, is used in Japan to treat pruritis in dialysis patients. Our lab has shown that in rats, IV nalfurafine produces a marked diuresis, antinatriuresis, antikaliuresis, and decrease in blood pressure. Here, we examined the cardiovascular and renal responses to IV and oral nalfurafine in combination with furosemide or hydrochlorothiazide (HCTZ). We hypothesized that combining nalfurafine with these diuretics would increase urine output, given its distinct mechanism of vasopressin inhibition, and limit electrolyte loss. Following chronic catheterization, conscious Sprague-Dawley rats received an isotonic saline infusion, and after stabilization, were administered an IV bolus diuretic alone or in combination with nalfurafine. Mean arterial pressure (MAP), heart rate (HR), and urine output were recorded for 90-min. In a separate study, rats were placed in metabolic cages, and following 2-hour acclimation, were administered drug in a volume load (20 cc/kg) via oral gavage. Hourly urine samples were then collected for five hours. When compared to diuretic treatment alone, IV co-administration with nalfurafine significantly increased total urine output to furosemide and HCTZ while reducing the amount of sodium and potassium excreted (Table 1). Notably, MAP was reduced with nalfurafine/diuretic combination therapy compared to diuretics alone. Similarly, oral co-administration of nalfurafine significantly increased the urine output to HCTZ and reduced the amount of sodium and potassium excreted, whereas combination with furosemide only limited the amount of sodium excreted (Table 1). Together, these findings demonstrate that nalfurafine enhances the diuresis to standard-of-care diuretics without causing an excessive loss of electrolytes, which may offer a new approach to treat several cardiovascular conditions.

Prostatic Abscess: A Review and Update

Prostatic Abscess: A Review and Update

Chronic bladder catheterization for precise urine collection in awake mice

Metabolic chambers are routinely used for urine collection in rodents. In mice, due to small urination volume, evaporation in the metabolic chambers (≈50%) distorts diuresis and urinalysis parameters. We have developed a new technique of bladder catheterization enabling long-term accurate and contamination-free urine collection in awake male and female mice for 30 days or longer.Daily diuresis in catheterized mice was twice higher as compared to metabolic cages. The twofold difference in urine recovery was preserved when the circadian variation of diuresis, the effects of furosemide, desmopressin and water load were estimated using the two techniques. Urine osmolarity, urinalysis, and microbiological parameters evidence higher quality of the catheter-collected urine. Using phenol red, we demonstrate utility of our technique for pharmacokinetic studies. 30 days after the surgery the catheters were patent and had minimal impact on the animals' heath.Bladder catheterization is a useful tool for physiological, pharmacological, and toxicological studies.