Continuous Catheterization Research Articles

Transvaginal double-layer parallel in-situ suturing for early complex vesicovaginal fistula repair: Case report.

Complex vesicovaginal fistulas (VVFs) with large defects pose significant surgical challenges. Traditional repair methods often require extensive tissue separation and multilayer suturing, risking local blood supply and healing. This study introduces a novel modified transvaginal repair technique that simplifies the procedure while preserving tissue vascularity. It employs double-layer parallel in situ suturing for early repair of complex VVF. A 50-year-old woman was admitted with continuous vaginal urine leakage for 4 days following trauma. Speculum examination revealed a 3-cm longitudinal oval laceration at the 11 o'clock position in the dorsal lithotomy site, with continuous fluid leakage through the fistula. Self-inflicted complex VVF. The patient underwent prophylactic placement of bilateral double-J stents and continuous catheterization, followed by surgical repair using a modified transvaginal technique involving double-layer parallel in situ suturing. Postoperative evaluations showed successful healing with no urinary leakage. The vaginal sutures were removed on day 24, and follow-up at 1 year confirmed no recurrence of the fistula or lower urinary tract symptoms, significantly improving the patient's quality of life. The modified transvaginal repair technique using double-layer parallel in situ suturing is a simple and effective approach for early repair of complex VVF, highlighting its potential for broader clinical application. Future studies with larger cohorts are needed to validate these findings.

Predictors and Outcome of Surgical Repair of Obstetric Fistula at a Private Hospital of Dhaka City

Background: Obstetric fistula remains a significant public health issue in low-resource settings, with high prevalence in countries like Bangladesh. The condition often results from prolonged, obstructed labor, compounded by socio-cultural factors such as early marriage, financial constraints, and lack of access to skilled birth attendants. This study aimed to explore the socio-demographic characteristics and surgical outcomes of women undergoing fistula repair at a private hospital in Dhaka, Bangladesh. Methods: This observational descriptive study included 62 women who underwent obstetric fistula repair between September 2010 and September 2012. Data were collected on socio-demographic characteristics, fistula details, and surgical outcomes through a structured booklet completed at various stages of patient care. Surgical success, complications, and post-operative outcomes were analyzed to identify factors influencing recovery and success rates. Result: The study found that 100% of participants were married at an early age, with significant financial barriers reported by all. A majority (87.10%) had home deliveries attended by unskilled birth attendants. Surgical repair was successful in 88.71% of cases, with a small proportion (11.29%) of unsuccessful repairs. Residual stress incontinence was noted in 4.84% of participants. The mean hospital stay was 17.52 days, with 95.16% of participants requiring continuous catheterization for 7 to 10 days. Conclusion: The high success rate of surgical repairs is promising, but the persistence of socio-cultural barriers and residual complications highlights the need for improved access to maternal healthcare and enhanced post-operative care. Addressing these issues is critical for reducing the burden of obstetric fistula and improving outcomes for affected women.

Indwelling catheter vs intermittent catheterization: is there a difference in UTI susceptibility?

BackgroundPatients with neurogenic lower urinary tract dysfunction (NLUTD) often rely on some type of catheterization for bladder emptying. Intermittent catheterization (IC) is considered the gold standard and is preferred over continuous catheterization, since it is considered to cause fewer urinary tract infections (UTIs) than indwelling catheterization. The main objective of our study was to describe UTI prevalence (at visit) and incidence (within the last 12 months) and urine culture characteristics between patients using an indwelling catheter versus (vs) those performing IC.MethodsIn this cross-sectional study, we prospectively evaluated from 02/2020 to 01/2021 patients with NLUTD undergoing urine cultures for prophylactic reasons or due to UTI symptoms. At visit, all patients underwent a standardized interview on current UTI symptoms as well as UTI history and antibiotic consumption within the past year. Patients using an indwelling catheter (n = 206) or IC (n = 299) were included in the analysis. The main outcome was between-group differences regarding UTI characteristics.ResultsPatients using an indwelling catheter were older (indwelling catheter vs IC: median 66 (Q1-Q3: 55—77) vs 55 (42—67) years of age) and showed a higher Charlson comorbidity index (indwelling catheter vs IC: median 4 (Q1-Q3: 2–6) vs 2 (1–4) (both p < 0·001).A total of 40 patients from both groups were diagnosed with a UTI at visit (indwelling catheters vs IC: 8% (16/206) vs 8% (24/299); p = 0·782), and the number of UTIs within the past 12 months was not significantly different between groups. Overall, Escherichia coli (21%), Enterococcus faecalis (17%), and Klebsiella spp. (12%) were the most frequently detected bacteria.ConclusionsIn this cohort of patients with NLUTD, we did not find relevant differences in UTI frequency between groups. These results suggest that UTI-related concerns should not be given undue emphasis when counseling patients for catheter-related bladder emptying methods.

Intermittent vs continuous catheterization for postpartum urinary retention: A multicenter randomized controlled trial

Postpartum urinary retention (PUR) is a common complication in the immediate postpartum period. Yet, there is no consensus regarding optimal management. To compare between two catheterization strategies for the treatment of PUR. A multi-center prospective randomized controlled trial was conducted at four university-affiliated medical centers between January 2020 and June 2022. Individuals with PUR (bladder volume>150 mL) up to 6 hours following vaginal or Cesarean delivery were randomly allocated to one of two protocols: intermittent catheterization (IC) every 6 h, up to 4 times, or continuous catheterization (CC) with an indwelling urinary catheter for 24 h. If PUR was not resolved after 24 hours, an indwelling catheter was inserted for an additional 24 h in both groups. The primary endpoint was the mean time to PUR resolution. The secondary endpoints included post-catheter urinary tract infection rate and length of hospital stay. Satisfaction rate was estimated using the Birth Satisfaction Scale (BSS-30) questionnaire. Following randomization, 73 individuals were allocated to the IC group and 74 to the CC group. Mean time to PUR resolution was significantly shorter in the IC compared with the CC group (10.2±11.8 h vs. 26.5±9.0 h, p<0.001), with 75% and 93% resolution rates after one and two catheterizations, respectively. The number of individuals who achieved resolution at 24 h was 72 (99%) and 67 (91%) in the IC and CC groups, respectively (p=0.043). The satisfaction rate was higher in all categories in the IC compared with the CC group (p<0.001). No intercohort differences were found in the urinary tract infection rates (p=0.89) or hospital stay length (p=0.58). Intermittent catheterization for urinary retention following delivery is associated with quicker PUR resolution and a higher satisfaction rate, compared with indwelling catheterization, without increasing complication rates.

Study of Prevalence, Microbiologic Agents, and Bladder Management Methods of Urinary Tract Infections among Spinal Cord Injury Patients

Background and Aim: Spinal cord injury (SCI) patients have an increased risk of developing urinary tract infections. The method of bladder drainage influences the risk of urinary tract infection (UTI), and most persons with SCI on per urethral continuous catheterization (CC) or clean intermittent catheterization (CIC) develop urinary tract infection. Identification and treatment of severe UTI with appropriate antibiotics as early as possible is associated with better outcomes in SCI patients. The aim of this study was to determine the prevalence and causative organisms of symptomatic urinary tract infection in spinal cord injury patients with different bladder management methods. Materials and Methods: A total of 50 patients with SCI were followed up at a rehabilitation centre from Jan 2020 to Dec 2021 in a prospective descriptive study. The demographic status, clinical and laboratory findings of the patients with SCI were studied and the prevalence and causative organisms of symptomatic UTI in these patients with different bladder management methods were analysed. Results: The commonest organisms isolated were E. coli (31%), Pseudomonas (29%) and Klebsiella (21%). The organisms isolated in the UTI were most sensitive to colistin (82%), followed by 59% being sensitive to both imipenem and tigecycline. Least sensitivity was seen to Piperacillin, Ceftriaxone and Levofloxacin. Maximum UTI episodes were seen in cases with CC followed by CIC. Least UTI episodes were seen in cases where supra-pubic cystostomy was done followed by patients who were self-urinating. Conclusion: Symptomatic UTI in SCI patients is more prevalent in patients with CC and CIC. Such patients should be started as early as possible on antibiotics depending on the antibiotic sensitivity pattern of the organisms isolated.

Management of postpartum urinary retention: a multi-center randomized controlled trial

To assess the most effective catheterization strategy to resolve overt postpartum urinary retention (PUR). A prospective randomized controlled trial was conducted at 4 university-affiliated medical centers. Women with PUR (bladder volume >150 mL) up to 6 hours following vaginal or cesarean delivery were randomly allocated to one of two protocols: intermittent catheterization every 6 hours (up to 4 times) or an indwelling urinary catheter for 24 hours (continuous catheterization), until full resolution (defined as post-void residual volume < 150 mL, estimated by either catheter or transabdominal ultrasound). If PUR was not resolved after 24 hours an indwelling catheter was inserted for additional 24 hours in both groups. The primary outcome was mean time to PUR resolution. Secondary outcomes included post-catheter urinary tract infection (UTI) rate and the length of hospital stay. We estimated that 73 women/group would have to be included to have 90% power to detect a 13 hours difference in the primary outcome (from 3024 to 1724 hours). From 1/2020 to 6/2022, 182 women were eligible for enrollment, while 147 women were eventually randomized: 73 in the intermittent group and 74 women in the continuous catheterization group. As shown in table 1, baseline and delivery characteristics were not different between the groups, including mode of delivery. Mean post-void residual bladder volume preceding catheterization was similar between the groups (813410 mL vs. 924448 mL, p=0.12) (Table 2(. Mean time to PUR resolution was significantly shorter in the intermittent catheterization group (10.211.8 vs. 26.59.0 hours, p< 0.001), with 75% and 93% resolution rates after one and two catheterizations, respectively. Satisfaction rate was higher in all categories among intermittent catheterization group. No difference was found in UTI rate or hospital stay. An intermittent catheterization for PUR following delivery, compared to an indwelling catheter for 24-hours, is associated with a quicker PUR resolution, and a higher satisfaction rate, without increasing complications rate.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Retracted: Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement.

[This retracts the article DOI: 10.1155/2021/9299001.].

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ОСТРОГО ПОВРЕЖДЕНИЯ ПОЧЕК ПОСЛЕ ПЕРЕНЕСЕННОЙ ИНФЕКЦИИ COVID-19 У ПАЦИЕНТА СО СПИНАЛЬНЫМ НЕЙРОГЕННЫМ МОЧЕВЫМ ПУЗЫРЕМ

Complications after COVID-19, even in mild and moderate form, can be detected in children. Patients with chronic diseases are the most susceptible to the development of complications. The impact of COVID-19 on exacerbation of pyelonephritis and acute kidney injury (AKI) in children is not studied enough as yet. The authors present a clinical case observation of a COVID-19 complication in a 6 years old male patient with spinal neurogenic lower urinary tract dysfunction in a form of areflex maladaptive bladder. Two weeks after the coronavirus infection the patient developed an exacerbation of chronic pyelonephritis and AKI with an increase in creatinine, urea, and microalbuminuria levels. Continuous catheterization of the bladder, crystalloid infusions and antibiotic therapy coupled with Dipyridamole made it possible to stop the AKI manifestations within 10 days.

Clinical Efficacy of CT-Guided Continuous Catheterization Drainage for Spinal Tuberculosis with Large Abscesses.

Objective This study aimed to determine the efficacy of computed tomography (CT)-guided local catheterization for the treatment of spinal tuberculosis (TB) with abscess. Methods Clinical data from 22 cases of lumbar TB with abscess receiving treatments from July 2015 to January 2021 were analyzed. Some patients (n = 11) underwent pure surgery (control group) and the others (n = 11) received CT-guided catheterization drainage. The operation and hospitalization time, erythrocyte sedimentation rate (ESR), visual analog scale (VAS), ASIA damage grade, and C-reactive protein (CRP) levels of both groups were compared. Results The operation time, intraoperative blood loss, and hospital stay of the observation group were significantly less than those of the control group (P < 0.05). As the differences in preoperative ESR, CRP, and VAS scores between both groups did not reach significance (P > 0.05), after treatments, the observation group had a lower level of ESR and CRP (P < 0.05); the postoperative VAS scores of the two groups decreased (P > 0.05). Before treatment, the control group comprised 2 cases of ASIA grade A, 1 case of B, 6 cases of C, and 2 cases of D with 3 patients having dyskinesia. After surgery, the motor function of the patients was improved, and there were 3 cases of ASIA D and 8 cases of E. Meanwhile, the preoperative observation group consisted of 9 cases of ASIA D and 2 cases of E. Due to CT-guided catheterization, all patients achieved clinical healing (ASIA E) when the lesions were significantly alleviated, and symptoms such as low back pain and lower extremity pain disappeared. Conclusion CT-guided percutaneous catheter drainage for continuous administration of drugs is effective treatment for spinal TB with abscess, when shortening the operation and hospitalization time and reducing intraoperative blood loss and erythrocyte sedimentation rate. It is worthy of popularization and application.

Intermittent versus Continuous Catheterization and Differences in the Evolution of Labor: Systematic Review and Meta-analysis.

To evaluate the differences between bladder emptying options (permanent catheterization and intermittent bladder emptying/spontaneous urination) regarding the effects on labor length, need of operative vaginal deliveries, and cesarean section rate. The search was conducted in MEDLINE, Scopus, Web of Science, and The Cochrane Central Register of Controlled Trials databases. The survey returned 964 studies. A total of 719 studies were evaluated by title and abstract, of which 4 were selected for inclusion. All references were inserted in the Rayyan QCRI tool (Rayyan Systems Inc., Cambridge, MA, USA). The full text of the selected articles was obtained so we could later decide whether or not to include them in this systematic review. No differences were found in the number of instrumented deliveries or in cesarean section rate between groups. After evaluating the studies performed on the topic, we concluded that there is no clear advantage to either method, although continuous catheterization was associated with a greater occurrence of eutocic births. In the remaining outcomes, there were no differences between catheterization types.

Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement.

This study aims at exploring the effect of continuous catheterization on reducing postoperative urinary tract infection in cervical cancer patients with double J tube placement. To be specific, a retrospective analysis was performed on 120 cases of cervical cancer patients who underwent laparoscopic or open radical hysterectomy in Shengjing Hospital of China Medical University from January to December 2019. They were divided into a persistent group (n = 70) and a short-term group (n = 50) according to indwelling catheter time. The incidence of postoperative complications and the positive rate of bacterial culture in bladder urine and double J tube bacterial culture were compared between the two groups. As a result, it was found that the incidence of postoperative fever and urinary tract infection in the short-term group was significantly higher than that in the persistent group (P < 0.05). There was no significant difference in the incidence of postoperative hematuria, bladder stimulation, and urinary system injury between the two groups. The positive rate of double J tube bacterial culture in both groups was also proved to be higher than that in bladder culture, and the difference was statistically significant (P < 0.05). And in the short-term group (P < 0.05), the difference in the positive rate of bladder culture between the two groups was not statistically significant. To conclude, we found that continuous catheterization can reduce the incidence of postoperative urinary tract infection in cervical cancer patients with double J tube placement, which might be helpful for the treatment of cervical cancer.

Comparison of Intermittent Catheterization to Continuous Catheterization During Labor

Comparison of Intermittent Catheterization to Continuous Catheterization During Labor

Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer

Purpose Locally advanced prostate cancer can cause bladder outlet obstruction, gross hematuria and frequent hospitalization. While these complications are commonly treated by palliative transurethral resection of the prostate, the improvement is often insufficient. The purpose of this study was to evaluate the safety and feasibility of MRI-guided transurethral ultrasound ablation as an alternative palliative treatment option (pTULSA) for men suffering from symptomatic locally advanced prostate cancer. Methods This prospective, phase one study included 10 men in need of palliative surgical intervention due to urinary retention and gross hematuria caused by locally advanced prostate cancer. Patients were followed for 1 year at 3-month intervals. Time without catheter, time without hematuria, reduction in hospitalization time, and adverse events were measured. Results Ten patients with locally advanced prostate cancer were enrolled, all having continuous catheterization due to urinary retention and nine had gross hematuria before treatment. At 1 week post-pTULSA five patients were catheter-free. At last follow-up catheter-free and gross hematuria-free rates were 70% and 100%, respectively. Average hospitalization time from local complications reduced from 7.3 to 1.4 days in the 6 months before and after pTULSA. No > Grade 2 treatment related adverse events were reported, with all five being urinary tract infections. Conclusions pTULSA appears safe and feasible for palliative ablation of locally advanced prostate cancer. The therapy seems to accomplish long-term hematuria control, can relieve bladder outlet obstruction in selected patients, and seems to reduce the burden of hospitalization due to local complications. Trial Registration Number: NCT03350529

URINARY TRACT INFECTIONS IN POST OPERATIVE PATIENTS: PREVALENCE RATE, BACTERIAL PROFILE, ANTIBIOTIC SENSITIVITY AND SPECIFIC RISK FACTORS

Background and objective: Urinary tract infections (UTIs) are the most common minor complication after operations, mostly due to bladder catheterization that used routinely during operations. This investigation seeks to determine prevalence rate, bacterial features, antibiotic sensitivity and risk factors for urinary tract infection in postoperative patients in tertiary hospitals in Sana’a, Yemen.&#x0D; Methods: This prospective analysis included 390 patients undergoing surgery between 2017 and 2018 at Al-Thawra Hospital. The study includes 258 male and 132 female between the ages 5 to 80 years. Clinical and demographic data and factors affecting UTIs were collected in the standard questionnaire, and the sample was obtained after catheter removal; or, in patients with a clinical indication of continuous catheterization, a sample was obtained after the replacement of a new catheter. The samples were cultured, examined for significant possible bacterial pathogens, isolated and identified by standard laboratory techniques, and microbial sensitivity testing was carried out by disc diffusion method. The operative characteristics associated with postoperative UTI were also analysis.&#x0D; Results: Postoperative UTI (POUTI) occurred in 144/390 (37%), and the predominant post-operative uropathogen was Escherichia coli (34%), followed by Pseudomonas aeruginosa 1(27%) and Staphylococcus coagulase negative (16.7%). In Gram-negative bacteria, high resistance to ampicillin (95%), nalidixic acid (63%), ceftriaxone (68%) and cotrimoxazole (55%) was recorded, while high sensitivity to amikacin (98%) and ciprofloxacin. (84%), cefotaxime (87%), gentamicin (87%) and imipenem (98%). In Gram-positive bacteria, high resistance to penicillin (90%), erythromycin (85%), and amoxicillin (78%) was recorded, while high sensitivity to aztreonam (94%), augmentin (83%), ciprofloxacin (93%), cefotaxime (86%), gentamicin (85%), Rifampicin (100%) and vancomycin (97%). The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.3–3.2), Rubber PTFE catheter (OR 4.7, 95% CI 1.99–11.4), longer duration of catheterization &gt;10 days (OR 4.4, 95% CI 2.3–8.3), overweight (OR 1.7, 95% CI 1.1–2.9), and emergency surgery (OR 1.9, 95% CI 1.2–3.0).&#x0D; Conclusions: POUTI remains an important problem in our hospitals and what complicates the situation is that all the causative microorganisms are MDR with few treatment options; and several risk factors were independently associated with POUTI.&#x0D; Peer Review History: &#x0D; Received 14 May 2020; Revised 15 June; Accepted 1 July, Available online 15 July 2020&#x0D; UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency.&#x0D; Received file &#x0D; &#x0D; Average Peer review marks at initial stage: 6.0/10&#x0D; Average Peer review marks at publication stage: 8.0/10&#x0D; Reviewer(s) detail:&#x0D; Name: Dr. Amany Mohamed Alboghdadly&#x0D; Affiliation: Princess Nourah bint abdulrahman university, Riyadh&#x0D; E-mail: amalbgadley@pnu.edu.sa&#x0D; &#x0D; Name: Dr. A.A. Mgbahurike&#x0D; Affiliation: University of Port Harcourt, Nigeria&#x0D; E-mail: amaka_mgbahurike@yahoo.com&#x0D; &#x0D; Comments of reviewer(s): &#x0D; &#x0D; Similar Articles:&#x0D; A SHORT REVIEW OF URINARY SYMPTOMATOLOGY- GRECO ARAB MEDICINE&#x0D; BIOFILM FORMATION AND ANTIBIOTIC SUSCEPTIBILITY OF UROPATHOGENS IN PATIENTS WITH CATHETER ASSOCIATED URINARY TRACT INFECTIONS IN IBB CITY -YEMEN

Práticas baseadas em evidências: cateterismo vesical contínuo na prática clínica

Objetivo: analisar aspectos da técnica de inserção do cateter vesical contínuo em unidades de internação clínica de um hospital. Método: trata-se de um estudo qualitativo, descritivo, exploratório. Procedeu-se à coleta de dados mediante entrevista semiestruturada, gravadas, transcritas e submetidas à técnica de Análise de Conteúdo na modalidade Análise Categorial. Resultados: elencaram-se as categorias: &lt;&lt; Prática profissional frente ao cateterismo vesical contínuo &gt;&gt;; &lt;&lt; Domínio e busca de conhecimento técnico-científico &gt;&gt; e &lt;&lt; Sugestões para melhoria do cuidado ao paciente em uso de cateterismo vesical contínuo &gt;&gt;. Conclusão: conclui-se que o procedimento tem sido realizado de forma distinta e não uniforme, sendo relevantes a sua padronização e a necessidade premente de mais evidências e estudos sobre o tema. Observa-se que o procedimento de cateterismo vesical contínuo, assim como outros, enfrenta uma dicotomia entre a prática, o ensino e as evidências científicas sobre o assunto. Descritores: Cateterismo Urinário; Segurança do Paciente; Assistência ao Paciente; Cuidados de Enfermagem; Enfermagem Baseada em Evidências; Protocolos.AbstractObjective: to analyze aspects of the continuous bladder catheter insertion technique in clinical inpatient units of a hospital. Method: this is a qualitative, descriptive, exploratory study. Data were collected through semi-structured interviews, recorded, transcribed and submitted to the Content Analysis technique in the Categorical Analysis modality. Results: the categories were listed: &lt;&lt; Professional practice in the face of continuous bladder catheterization &gt;&gt;; &lt;&lt; Domain and search for technical and scientific knowledge &gt;&gt; and &lt;&lt; Suggestions for improving patient care using continuous bladder catheterization &gt;&gt;. Conclusion: it is concluded that the procedure has been performed in a different and non-uniform way, with its standardization and the pressing need for more evidence and studies on the subject being relevant. It is observed that the continuous bladder catheterization procedure, like others, faces a dichotomy between practice, teaching and scientific evidence on the subject. Descriptors: Urinary Catheterization; Patient Safety; Patient Assistance; Nursing Care; Evidence Based Nursing; Protocols. ResumenObjetivo: analizar aspectos de la técnica de inserción continua de catéter vesical en unidades de internación clínica de un hospital. Método: este es un estudio cualitativo, descriptivo, exploratorio. Los datos fueron recolectados a través de entrevistas semiestructuradas, registradas, transcritas y enviadas a la técnica de Análisis de Contenido en la modalidad de Análisis Categorial. Resultados: se enumeraron las categorías: &lt;&lt; Práctica profesional frente a la cateterización vesical continua &gt;&gt;; &lt;&lt; Dominio y búsqueda de conocimientos técnicos y científicos &gt;&gt; y &lt;&lt; Sugerencias para mejorar la atención al paciente mediante cateterismo vesical continuo &gt;&gt;. Conclusión: se concluye que el procedimiento se realizó de manera distinta y no uniforme, con su estandarización y la urgente necesidad de más evidencia y estudios sobre el tema que sean relevantes. Se observa que el procedimiento de cateterización vesical continua, como otros, enfrenta una dicotomía entre la práctica, la enseñanza y la evidencia científica sobre el tema. Descriptores: Cateterismo Urinario; Seguridad del Paciente; Asistencia al Paciente; Cuidados de Enfermería; Enfermería Basada en la Evidencia; Protocolos.

Acute urinary retention in pediatric patients: one-single center experience

Acute urinary retention (AUR) in pediatrics is a rare disease with various causes. In this study, we were aimed to review and analyze cases of pediatric patients with AUR at Nanjing Children’s Hospital Affiliated to Nanjing Medical University. AUR was defined as the inability to void and associated bladder region pain and agitation that lasts more than 12 hours; or distended palpable bladder associated with pain. All children with AUR were alleviated with urethral catheterization or vesicopuncture. The past and current history, physical examination, laboratory tests and imaging modalities were reviewed and extracted by two independent authors. Finally, the basic characteristics, the causes of AUR and risking factors were analyzed. A total of 97 pediatric patients were included in our study. Lower urinary tract stones, neurological disorders and trauma were identified as the most common causes of the AUR in pediatrics in our center. For the boys, lower urinary tract stone was identified as the primary cause of AUR, whereas the prolapse of urethra was observed to be the first leading cause of AUR in girls. Ten patients underwent surgery, and five patients required continuous catheterization during follow-up. AUR in pediatrics was characterized by a variable etiology. Lower urinary tract stones, neurological disorders and trauma were identified as the most common causes of the AUR in pediatrics.

The effect of bladder catheterization on the incidence of urinary tract infection in laboring women with epidural analgesia: a meta-analysis of randomized controlled trials.

There is conflicting evidence on whether intermittent catheterization (IC) is less associated with urinary tract infection (UTI) and more likely to prevent urinary retention than continuous catheterization (CC). We aimed to compare the effect of IC with that of CC on the incidence of postpartum UTI, urinary retention and hemorrhage in laboring women with epidural analgesia. Electronic searches were performed in PubMed, EMBASE and Cochrane Library from their inception to October 2018. We selected RCTs comparing IC with CC in laboring women with epidural analgesia. A meta-analysis was performed using the RevMan software, and a random-effects model was used to pool the effect size. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to rate the quality of evidence. Six RCTs (N = 850) were included in this review. The meta-analyses indicated that there was no significant difference between the IC and CC group in the incidence of postpartum UTI (RR = 1.25, 95% CI: 0.91 to 1.71, P = 0.16), postpartum urinary retention (RR = 0.76, 95% CI: 0.21 to 2.77, P = 0.68) and postpartum hemorrhage (RR = 1.72, 95% CI: 0.60 to 4.95, P = 0.31). GRADE assessment results showed that the quality of evidence was low. Based on the available evidence, there is no measurable difference in rates of UTI between CC and IC, not that neither stragety decreases UTI, since the included trials do not address this.

Evaluation of the super-selective prostate artery embolization combined with TURP for patients with large volume (>80 ml) benign prostatic hyperplasia

Objective To explore the safety and efficacy of super-selective prostate artery embolization (PAE) combined with TURP (transurethral resection of prostate) as an alternative method for patients with severe large BPH (>80 ml). Methods From March 2015 to June 2017, a total of 40 patients with large benign prostatic hyperplasia who failed in medical treatment were selected for PAE combined with TURP (18 cases)and TURP (22 cases). In the PAE combined with TURP group, the mean age was (75.0±8.7) years (ranging 60-88 years) and the mean prostatic volume was (111.0±23.3) ml, ranged from 83 to 145 ml). The international prostate symptom score (IPSS), quality of life (QOL), maximal urine flow rate (Qmax)and postvoid residual urine(PVR) were(25.2±3.6), (5.1±1.0), (6.4±2.3)ml/s and (107.7±32.6)ml, respectively. In the TURP group, the mean age was (76.0±6.9) years (ranging 62-85 years) and the mean prostatic volume was (107.5±27.4) ml, ranged from 80 to 150 ml). The IPSS, QOL, Qmax and PVR were(24.3±4.2), (4.9±0.9), (6.7±2.2)ml/s and (106.6±32.2)ml, respectively. Clinical data of all of patients were analyzed retrospectively, including operative time, estimate blood loss, weight and efficacy of resected tissue, time of continuous bladder irrigation and catheterization, IPSS, QOL, PVR, Qmax and postoperative complications. Results There were significant differences in the operative time [(75.8±25.1)min vs.(103.2±27.7) min], estimate blood loss [(122.8±33.9)ml vs.(447.6±36.0)ml], weight of resected tissue [(99.9±24.2)g vs.(82.9±15.5)g], efficacy of resected tissue [(76.9±20.7)g/h vs.(41.7±14.2)g/h], continuous bladder irrigation time [(1.4±0.5) d vs.(2.4±0.8) d] and catheterization time [(2.2±0.4)d vs.(3.4±0.6)d] between PAE combined TURP group and TURP group(P 0.05). Conclusions PAE combined TURP could be used a safe and effective therapy for treating patients with LUTS due to large volume (>80 ml) BPH. It has been a priority in less blood, more efficient of resected tissue and less postoperative complications. Key words: Benign prostatic hyperplasia; Prostatic artery embolization; Low urinary tract symptoms

Diastolic velocity half time is associated with aortic coarctation gradient at catheterization independent of echocardiographic and clinical blood pressure gradients.

The most accurate noninvasive parameter to predict whether a patient with aortic coarctation will meet interventional criteria at catheterization remains elusive. We aim to determine the best independent echocardiographic predictors of a coarctation peak-to-peak pressure gradient≥20mm Hg at catheterization, the accepted threshold for intervention. Retrospective query of our catheterization database from 1/2007 to 7/2016 for the diagnostic code of aortic coarctation was performed. Multiple echocardiographic measurements and blood pressure gradients prior to cardiac catheterization were collected. Univariate correlation of variables with the continuous catheterization peak were calculated using Spearman's rho. Univariate association with peak-to-peak gradient at catheterization≥20mm Hg was tested using Mann-Whitney U test and the Pearson chi-square test or Fisher's exact test. Multivariable logistic regression assessed the independent association of the clinically relevant metrics with gradient at catheterization≥20mm Hg. Sixty-eight patients met study criteria (median age 9.25years), of whom 84% underwent intervention at catheterization. Echocardiographic peak and mean coarctation velocity, indexed systolic and diastolic velocity half times (SVHTi, DVHTi), and blood pressure gradient all had moderate correlation (Spearman's rho=0.529-0.617, P<.001) with the continuous catheterization gradient and were significantly associated with the binary outcome of catheterization peak≥20mm Hg (P<.001). Logistic regression found echocardiographic mean systolic gradient (OR 1.213 [95% CI 1.041-1.414]) and DVHTi (OR 1.039 [95% CI 1.004-1.074]) independently associate with catheterization peak≥20mm Hg after controlling for blood pressure gradient (OR 1.066 [0.987-1.150]). Most echocardiographic estimates show moderate correlation with arch gradient at catheterization. Noninvasive four extremity blood pressure gradient is significantly associated with peak-to-peak gradient≥20mm Hg. DVHTi may provide a unique independently associated echocardiographic estimate of coarctation severity. Further study of these variables with larger cohorts may allow for development of predictive models to direct catheterization.

Effect of intermittent versus continuous bladder catheterization on duration of the second stage of labor among nulliparous women with an epidural: a randomized controlled trial.

Catheterization type among women laboring with epidural analgesia who develop bladder retention has been reported to affect labor duration and mode of delivery. We aimed to compare the effect of continuous bladder catheterization (CC) with that of intermittent bladder catheterization (IC) on the duration of the second stage of labor. In a randomized trial, term nulliparous women with singleton gestation who requested epidural analgesia and were unable to void spontaneously were eligible and randomized to either CC or IC. Epidural analgesia was maintained with patient control until delivery. The primary outcome was duration of the second stage of labor. Secondary outcomes were mode of delivery, and incidences of postpartum hemorrhage, bladder retention, and infection. It was assumed that, compared with IC, CC might better prevent bladder distention, which is thought to delay fetal descent. A sample size of 90 women in each group was calculated to be adequate to detect a reduction of 30min in the duration of the second stage of labor among the CC group. Between July 2014 and May 2015, a total of 184 women were randomized and included in the analysis; 90 and 94 women in the CC and IC groups respectively. Demographic and obstetric characteristics were similar. Duration of the second stage was 121.0±89.4 and 131.9±87.5min in the CC and IC groups respectively (p=0.29). The two groups did not differ significantly with regard to delivery mode, third-stage duration, and incidences of postpartum hemorrhage, bladder retention, and urinary tract infection. Duration of the second stage of labor is not influenced by bladder catheterization type in nulliparous women receiving an epidural.