Early Catheter Research Articles

Immediate versus early (24-hours) urinary catheter removal after elective minimally invasive colonic resection: study protocol for a randomized, multicenter, non-inferiority trial

BackgroundEnhanced Recovery After Surgery (ERAS) represents the standard of care in colorectal surgery. Among ERAS items, early removal of urinary catheter (UC) is considered a key issue, though adherence to this specific item still varies among centers. UC placement allows for monitoring of post-operative urinary output but relates to an increased risk of urinary tract infection (UTI), reduced mobility, and patient’s discomfort. Several studies investigated the role of early UC removal specifically looking at the rate of acute urinary retention (AUR) but most of them were retrospective, single-center, underpowered, cohort studies. The main purpose of this study is to compare the rate of AUR after immediate (at the end of the surgery) versus early (within 24 h from the completion of surgery) removal of UC in patients undergoing minimally invasive colonic resection (MICR). The secondary outcomes focus on goals that could be positively impacted by the immediate removal of the UC at the end of the surgery. In particular, the rate of UTIs, perception of pain, time-to-return of bowel and physical functions, postoperative complications, and length of hospital stay will be measured.MethodsThis is a prospective, randomized, controlled, two-arm, multi-center, study comparing the rate of AUR after immediate versus early removal of UC in patients undergoing MICR. The investigators hypothesize that immediate UC removal is non-inferior to 24-h UC removal in terms of AUR rate. Randomization is at the patient level and participants are randomized 1:1 to remove their UC either immediately or within 24 h from the completion of surgery. Those eligible for inclusion were patients undergoing any MICR with an anastomosis above the peritoneal reflection. Those patients who need to continue urinary output monitoring after the surgery will be excluded. The number of patients calculated to be enrolled in each group is 108 based on an expected AUR rate of 3% for the 24-h UC removal group and considering acceptable an AUR of 9% for the immediate UC removal group.DiscussionThe demonstration of a non-inferiority of immediate versus 24-h removal of UC would call into question the usefulness of urinary drainage in the setting of MICR.Trial registrationClinicalTrials.gov NCT05249192. Prospectively registered on February 21, 2022.

Abstract 9981: Comparison of 30-day Readmission and Healthcare Costs Between Early and Late Catheter Directed Thrombolysis for Acute Pulmonary Embolism in the United States

Introduction: Pulmonary embolism (PE) is a major cause of morbidity and mortality accounting for 100,000 deaths per year in the United States and 5-10% of in-hospital deaths. There is sparse comparative data on readmission patterns and healthcare costs in patients who undergo early versus late catheter directed thrombolysis (CDT) for acute PE. Hypothesis: Procedure Day for acute PE may be associated with difference in 30-day readmission rates and healthcare costs. Methods: This study was performed by using National readmission database between January 2016 and November 2019. Patients with acute PE who underwent CDT were identified using the International Classification of Diseases, Tenth Edition (ICD 10) codes. Patients who were <18 years old and patients who underwent thrombolysis for STEMI and Ischemic stroke were excluded. Results: Among a total of 23,564 patients who underwent CDT for acute pulmonary embolism, 12,528 (53.2%) were male and 11034 (46.8%) were female (P=0.014). The mean age of the patients was 60.3 years. The median length of hospital stay was 4 days. Thirty-day readmission rates were higher for patients who underwent CDT on Day 2 or afterwards compared to Day 1 and Day 0 (7.1% vs 5.7% vs 5.2%, for day 2, day 1 and day 0 respectively; p=0.016). Patients who had CDT on Day 2 or more had a higher rate of 30-day readmission mortality compared to those who had CDT on Day 1 or 0 (0.6% vs 0.3% vs 0.2%, for day 2, day 1 and day 0 respectively; Adjusted OR 2.96, 95% CI 1.18 to 7.47 (Ref: day 0), p = 0.021). Thirty-day readmission for heart failure was higher among patients who had CDT on Day 2 vs those who had CDT on Day 0 of admission (2% vs 1.0% vs 0.9%, for day 2, day 1 and day 0 respectively; Adjusted OR 1.97, 95% CI 1.24 to 3.13 (Ref: day 0), p=0.004). Total 30-day costs for patients who underwent CDT on day 2 or more was higher in patients with CDT on day 2 ($55,087; IQR $41,361-$74,092) compared to those with CDT on Day 1 ($45,942; IQR $36,016-$61,211) or Day 0 ($44,814; IQR $34,264-$60,072) (P <0.001). Conclusions: Delayed CDT for acute PE was associated with increased rates of 30-day readmission, readmission mortality, readmission for heart failure and increased healthcare costs. These findings emphasize the need for earlier CDT for the treatment of acute PE.

The efficacy and safety of an improved percutaneous peritoneal dialysis catheter placement technique in urgent-start peritoneal dialysis patients: a retrospective cohort study.

Urgent-start peritoneal dialysis has high catheterization skill requirements and that early complications. The optimal catheter placement method remains debatable in urgent-start peritoneal dialysis patients. Safe and effective peritoneal dialysis catheterization is needed in clinical work. We retrospectively analyzed the data of 34 patients diagnosed with end-stage renal disease who opt for peritoneal dialysis, 19 males and 15 females, with an average age of 62.3±14.7 years, peritoneal dialysis catheter implantation was completed by the improved percutaneous catheterization technique. They were followed for 6 months, early and late complications were observed and the survival rate of the catheter technique was calculated. All 34 patients diagnosed with end-stage renal disease successfully underwent catheter placement using the improved percutaneous technique; the catheterization success rate was 100%. No severe organ injuries, such as intestinal perforation and bladder perforation, occurred intraoperatively. Peritoneal dialysis was started immediately after surgery. The early complications included one case of leakage, one case of omental wrapping, and six cases of rectus abdominis hemorrhage. The late complications included one case of pleuro-abdominal fistula and two cases of peritonitis. The 6-month technical survival rate for the catheter was 94.1% (32/34). Compared to previously reported studies, this technique may reduce leakage and early catheter dysfunction, and improve the technical survival of catheters. The improved percutaneous peritoneal dialysis catheter placement technique might be an effective and safe method for urgent‑start peritoneal dialysis patients.

Omitting routine cystography after RARP: Analysis of complications and readmission rates in suprapubic and transurethral drained patients.

Robot-assisted radical prostatectomy (RARP) has become the therapy of choice for local treatment of prostate cancer. Postoperatively, urologists perform cystography before removing urinary catheters due to concerns about the integrity of the vesicourethral anastomosis. This study aims to evaluate the safety of waiving cystography before early catheter removal after RARP. A total of 514 patients from two tertiary referral centers who underwent RARP were retrospectively included. Patients received postoperative urinary drainage by transurethral (TUC) or suprapubic catheter (SPC). During the first year, both centers performed routine cystography before removing TUC or SPC on postoperative day 5. In the following year, management changed and catheters were removed without cystography unless indicated by the surgeon. Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard cystography (StCG), no cystography (NCG), and selective cystography (SCG). Groups were comparable regarding demographic and oncological parameters. Analysis showed no significant difference regarding major complications and readmission rates between standard and no cystography (p= 0.155 and 0.998 respectively). Omitting routine cystography did not lead to inferior postoperative courses regardless of both urinary drainage used and tumor stage. Subgroup analysis showed an increase of major complications in SCG patients when compared with NCG (p= 0.003) while readmissions remained comparable (p= 0.554). Waiving routine cystography before early catheter removal after RARP appears to be safe and feasible regardless of urinary drainage. However, the selective cystogram at the surgeon's request still plays a role in monitoring patients with an elevated risk profile.

The Fast Track Surgery in Perioperative Nursing of HoLEP Operation

Objective: The Fast-track surgery for transurethral holmium laser prostatectomy a perioperative nursing research study.
 Methods: We performed a retrospective analysis of transurethral holmium laser enucleation of the prostate in 89 patients with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH) who were admitted to and treated at our hospital between 2018 and 2019. Measures such as early postoperative feeding and early catheter removal, adequate preoperative preparation, psychological counseling, intraoperative warming, unobstructed lavage, ensuring postoperative sleep, indwelling analgesic pump, and prevention and treatment of postoperative complications, as well as a successful job in postoperative health guidance and discharge guidance, were all implemented, and the extubation was performed, during the perioperative period in which advanced fast track surgery was used.
 Results: All 89 patients who underwent holmium laser enucleation of the prostate made a full recovery, with only one experiencing post-operative recurrent hyphema, five experiencing post-operative urinary tract infection, and ten experiencing transient and urge urinary incontinence; all were discharged after conservative treatment.
 Conclusion: Using fast track surgery as a guide for perioperative care of HoLEP surgeries might lessen the number of issues that arise after surgery and help patients get back to normal quicker.

Prevalence of modifiable risk factors and related poor cardiovascular outcomes following atrial fibrillation ablation

Abstract Background Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit. Purpose This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice. Methods This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI >5% prior to ablation, mean systolic/diastolic blood pressure >125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) >6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed. Results The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI >5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c >6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1. Conclusion Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c >6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center

The impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy: a retrospective analysis of consecutive 432 cases from a single institution.

After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder (OAB) symptoms after robot-assisted radical prostatectomy (RARP). Four hundred and thirty-two consecutive patients underwent RARP by a single surgeon between Nov 2020 and Oct 2021. Time to catheter removal was categorized into 7, 10, and ≥14 days. Continence was defined as no more than 1 pad used or no more than 20 g of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4, 12, and 24 weeks after catheter removal. Overall, continence rates were 37.3% 48 hours after catheter removal, 54.4% 1 week, 77.5% 4 weeks, 92.1% 12 weeks, and 97.9% 24 weeks after catheter removal. The median time to regain continence was 1 week. At 4 weeks after catheter removal, the continence rate in the ≥14 days group (70.5%) was significantly lower than the 7 days group (86.3%) and 10 days group (83.0%) (P=0.001). In a univariate Cox regression analysis, the presence of diabetes, higher pre-operative OABSS, and a catheterization time of 10 days were associated with worse continence recovery. The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 4, 12 and 24 weeks after catheter removal. At 24 weeks after catheter removal, the mean OABSS in the 7 days group was significantly lower than in other groups. Early catheter removal (7 days) was associated with better continence results and lower OABSS at 4 and 24 weeks after catheter removal respectively.

Раннее удаление уретрального катетера после робот-ассистированной радикальной простатэктомии

Robot-assisted radical prostatectomy (RARP) is a widely used treatment method for patients with clinically localized prostate cancer. Posterior reconstruction of urethrovesical anastomosis (UVA) is one of the techniques that provides early recovery of urinary continence after surgery. Changes in the technique of performing posterior reconstruction of UVA may contribute to further improvement of functional results.To evaluate the functional results of early removal of the urethral catheter (after 3 days) after RARP using a modified surgical technique of performing posterior reconstruction of UVA compared with the standard catheterization time (7 days after surgery).Patients who underwent RARP were randomly assigned to early catheter removal (3 days after surgery, main group, n=15) and standard catheterization time (7 days after surgery, control group, n=15). RARP was performed using the Da Vinci Si system. The primary end point was the rate of spontaneous voiding after catheter removal. Secondary endpoints were the incidence of urine leakage into the paravesical tissue during retrograde cystography, as well as complications according to the Clavien-Dindo system. The frequency and severity of stress urinary incontinence after catheter removal was assessed using the International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form (ICIQ-UI SF).There were no significant differences between groups in terms of baseline and perioperative parameters. After removal of the catheter, no acute urinary retention was observed in both groups. Also, there were no cases of urine leakage into the paravesical tissue during retrograde cystography. The ICIQ-UI SF questionnaire showed no significant differences between the groups at 1, 3, 6, and 12 months after surgery.The method of modified posterior reconstruction allows to remove the urethral catheter 3 days after RARP. Early removal of the urethral catheter did not adversely affect the early recovery of urinary continence, the quality of UVA, and did not increase the incidence of acute urinary retention. Further studies with longer follow-up periods are needed.

Early Versus Late Catheter Ablation of Atrial Fibrillation and Risk of Permanent Pacemaker Implantation in Patients With Underlying Sinus Node Dysfunction.

BackgroundAtrial fibrillation (AF) is associated with anatomical and electrical remodeling. Some patients with AF have concomitant sick sinus syndrome and may need permanent pacemaker (PPM) implantation. Association between catheter ablation of AF timing and need for PPM in sick sinus syndrome has not been assessed.Methods and ResultsWe used pooled electronic health data to perform retrospective cross‐sectional analysis of 66, 595 patients with AF and sick sinus syndrome to assess the need of PPM implantation temporally, with AF performed divided into earlier within 5 years (group 1), 5 to 10 years (group 2), or beyond 10 years (group 3) of diagnosis. PPM implantation was lowest among those who had catheter ablation within 5 years of sick sinus syndrome diagnosis: group 1 versus group 2 (18.15% versus 27.21%) and group 1 versus group 3 (18.15% versus 27.22%). Interestingly, there was no difference in risk of PPM between group 2 and group 3 (27.21% versus 27.22%; odds ratio [OR], 1.00 [95% CI, 0.85–1.20]).ConclusionsEven after controlling known risk factors that increase the need for pacemaker implantation, timing of AF ablation was the strongest predictor for need for PPM. Patients adjusted OR of PPM was lower if patients had catheter ablation within 5 years of diagnosis compared with later than 5 years (adjusted OR, 0.64 [95% CI, 0.59–0.70]).

Early percutaneous catheter drainage in protecting against prolonged fever among patients with pyogenic liver abscess: a retrospective cohort study

Background Percutaneous catheter drainage (PCD) has been viewed as first-line treatment for pyogenic liver abscess (PLA), yet detailed guidance is lacking for best practice of PCD. This study investigated characteristics of patients with PLA who had received PCD, identified factors associated with prolonged fever, and aimed to evaluate the relationship between timing of PCD and clinical improvement. Methods This was a retrospective study of patients with PLA who had undergone PCD over a 7-year period. PCD performed when the liquefaction degree of abscesses was less than 30% and/or within 1 week after fever onset was defined as early PCD. Patients were grouped and analysed based on the timing of PCD (early vs. delayed). Factors associated with prolonged fever were also analysed using univariate and multivariate logistic regression. Results Among 231 patients with PLA, 81 treated with PCD were included in the study after exclusion. The size of abscesses ranged from 3.4 to 16 cm in diameter. Interestingly, the abscesses were predominantly multiloculated in this cohort (82.7%). The most common pathogen isolated from pus was Klebsiella pneumoniae (60.5%), followed by Escherichia coli (8.6%). The duration of fever was significantly shortened with early PCD as compared to delayed PCD intervention (p = .042). No statistical differences were found between the two groups with regard to catheter adjustment and salvage drainage. Maximum body temperature and diameter of abscess > 7.5 cm were found to be associated with prolonged fever while early PCD was inversely related to prolonged fever. Multivariate analysis suggested that early PCD treatment was an independent protective factor of prolonged fever (p = .030). Conclusions Large abscesses with loculation could be successfully treated with PCD, and early PCD protected patients with PLA from prolonged fever. Our findings suggest that early intervention should be provided if PCD is indicated in clinical practice. KEY MESSAGES Large abscesses and multiloculated abscesses can be treated with percutaneous catheter drainage. Early percutaneous catheter drainage is identified as a protective factor of prolonged fever among patients with pyogenic liver abscesses. Early intervention should be provided if percutaneous catheter drainage is indicated for pyogenic liver abscesses.

Early pulmonary artery catheterization is not associated with survival benefits in critically ill patients with cardiac disease: An analysis of the MIMIC-IV database

BackgroundMany studies demonstrated no improved survival in patients with pulmonary artery catheter placement. However, no consistent conclusions have been drawn regarding the impact of pulmonary artery catheter in critically ill patients with heart disease. This study aimed to investigate the association of early pulmonary artery catheter use with 28-day mortality in that population. MethodsThe Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database, a single-center critical care database, was employed to investigate this issue. This study enrolled a total of 11,887 critically ill patients with cardiac disease with or without pulmonary artery catheter insertion. The primary outcome was 28-day mortality. The multivariate regression was modeled to examine the association between pulmonary artery catheter and outcomes. Additionally, we examined the effect modification by cardiac surgeries. Propensity score matching was conducted to validate our findings. ResultsNo improvement in 28-day mortality was observed among the pulmonary artery catheter group compared to the non–pulmonary artery catheter group (odds ratio 95% confidence interval: 1.18 [1.00–1.38], P = .049). When stratified by cardiac surgeries, the results were consistent. The patients in the pulmonary artery catheter group had fewer ventilation-free days and vasopressor-free days than those in the nonpulmonary artery catheter group after surgery stratification. In the surgical patients, pulmonary artery catheter insertion was not associated with the occurrence of acute kidney injury, and it was associated with a higher daily fluid input (mean difference 95% confidence interval: 0.13 [0.05–0.20], P = .001). In nonsurgical patients, the pulmonary artery catheter group had a higher risk of acute kidney injury occurrence (odds ratio 95% confidence interval: 1.94 [1.32–2.84], P = .001). ConclusionEarly pulmonary artery catheter placement is not associated with survival benefits in critically ill patients with cardiac diseases, either in surgical or nonsurgical patients.

EP News: Allied Professionals

In this multcenter, international, randomized controlled trial, Tung et al (Circulation May 4, 2022; doi:10.1161/CIRCULATIONAHA.122.060039, PMID 35507499) sought to assess the efficacy of early catheter ablation of ventricular tachycardia (VT) at the time of implantable cardioverter-defibrillator (ICD) implantation as compared with conventional therapy. The Pan-Asia United States Prevention of Sudden Cardiac Death trial enrolled patients from centers in China, Japan, South Korea, and Taiwan who had structural heart disease (SHD) and an indication for secondary prevention ICD or who had VT inducible at the time of electrophysiology study (EPS) and met criteria for primary prevention ICD.

Short- and long-term outcomes of early initiation of peritoneal dialysis following catheter insertion.

Early-start peritoneal dialysis (PD) (use of PD catheter within 48 hours of insertion) is an innovative approach for prompt initiation of PD. This study was conducted to analyze the outcomes of early-start PD. A total of 100 patients on PD were retrospectively analyzed. Patients were grouped according to the "break-in period": < 48 hours (PD1) and ≥ 14 days (PD2). PD was initiated with low dwell volumes (500 mL) in a recumbent position within 48 hours of surgery. PD prescription was gradually incremented over 10 days to minimize any complications. In our study, there were 48 patients in the PD1 group and 52 in the PD2 group. The most common cause of end-stage kidney disease (ESKD) was diabetes mellitus in both groups. Incidence of early mechanical complications (within 30 days of catheter insertion), such as catheter obstruction, early catheter leakage, catheter malposition, tip migration, and infectious complications, were not found to be higher in the PD1 group. 1- and 4-year catheter patency rates were 97.0% and 96.2% in the PD1 group, respectively. These rates were comparable with those in the PD2 group. Early-start PD was not associated with an increased incidence of catheter failure (HR = 1.0, 95% CI 0.28 - 3.47). An early break-in period of < 48 hours is a feasible option for ESKD patients without any significantly increased risk of mechanical or infectious complications. It offers a safe and efficacious option for renal replacement therapy.

Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial.

Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.

Impact of early ventricular tachycardia ablation in patients with an implantable cardioverter-defibrillator: An updated systematic review and meta-analysis of randomized controlled trials

There is limited information on whether early catheter ablation (CA) for ventricular tachycardia (VT) is associated with better outcomes compared with alternative strategies in patients with implantable cardioverter-defibrillator (ICD). The purpose of this article was to assess the efficacy of early VT CA in patients with ICD. EMBASE, PubMed, and Cochrane were searched from inception to April 2022. Randomized controlled trials comparing the efficacy of early VT CA with control groups, both in patients with ICD, were included in the analysis. Data on effect estimates in individual studies were extracted and combined via random effects meta-analysis using the DerSimonian and Laird method, a generic inverse variance strategy. Nine randomized controlled trials with 1106 patients (n = 1018, 92.1% with ischemic cardiomyopathy and n = 88, 7.9% with nonischemic cardiomyopathy) were evaluated. VT CA was associated with reduced VT recurrences (odds ratio [OR] 0.64; P = .007), appropriate ICD shocks (OR 0.53; P = .002), ICD therapies (OR 0.54; P=.002), and cardiovascular hospitalization (OR 0.67; P=.004). However, no significant differences were observed in terms of mortality rate, heart failure hospitalization, and quality of life between the early VT CA and control groups. Early CA was beneficial in reducing VT burden and ICD therapies. However, it did not affect mortality rate and quality of life. Since most patients in the included studies presented with ischemic cardiomyopathy, further studies on nonischemic cardiomyopathy should be conducted to validate if early CA has similar outcomes.

Impact of timing of urinary catheter removal on voiding dysfunction after radical hysterectomy for early cervical cancer

ObjectivesTo evaluate whether the timing of postoperative urinary catheter removal is associated with voiding dysfunction after radical hysterectomy for early cervical cancer within contemporary surgical practice.MethodsWe performed an institutional retrospective...

Catheter ablation for atrial fibrillation - standard of care and future perspectives

Atrial fibrillation is the most frequent cardiac arrhythmia in adults. For symptomatic atrial fibrillation, catheter ablation has proven to be an effective and safe treatment that is superior to antiarrhythmic drug treatment regarding quality of life and maintenance of normal sinus rhythm. Moreover, there is increasing evidence that early rhythm control and catheter ablation can be of prognostic benefit. Especially heart failure patients with impaired left ventricular systolic function seem to benefit from rhythm control therapy by catheter ablation. Furthermore, technological innovations such as novel single-shot devices, contact force mapping, the concept of high-power-short-duration (HPSD) ablation and implementation of electroporation (pulsed field ablation) offer the prospect of further improving ablation efficiency and safety. This review provides an overview of current standards of care as well as future trends in atrial fibrillation catheter ablation techniques.

Urgent catheter ablation for treatment refractory symptomatic atrial fibrillation: Health care utilization and outcomes.

Early catheter ablation for paroxysmal atrial fibrillation (AF) has been found to be more effective than medical therapy for maintenance of sinus rhythm.1,2 Typically, an AF ablation procedure is scheduled electively after medical optimization; however, there are a subset of previously uncharacterized patients who undergo “urgent” AF ablation during AF-related hospitalization. These patients’ AF episodes are unable to be managed effectively in the outpatient setting, resulting in repeated emergency department visits and an increased rate of health care utilization.

A Comparative Study on the Outcomes of Hypospadias Surgery Following Early Versus Late Bladder Catheter Removal.

BackgroundHypospadias is the most common penile malformation affecting up to one in 300 live male births. In general, a urinary diversion (urethral stent or bladder catheter) is maintained in situ for two to seven days or more after hypospadias repair. Because of the low level of evidence, the latest guidelines of the European Association of Urology and the European Society of Paediatric Urology provide no recommendations concerning the timing of catheter removal after hypospadias surgery. In this study, we aimed to compare the outcomes of hypospadias surgery (tubularized incised plate urethroplasty, TIPU) following early versus late bladder catheter removal.MethodologyIn total, 62 patients were included in this study. All patients underwent TIPU by the same team of surgeons. All patients were divided into the following two groups: group A (32 patients) had their catheter removed on or before the fifth postoperative day, and group B (30 patients) had their catheter removed after the fifth postoperative day. All patients were scheduled for an outpatient assessment after two weeks, at one month, after three months, and at six months if necessary.ResultsThe mean age of patients in group A was five years (three to seven years) and in group B was five years (four to 7.25 years) with a p-value of 0.378. Among the early complications of the surgery, the occurrence of wound infections, urinary tract infections, and urinary retention was comparable among the two groups. The rate of bladder spasms (0% versus 13.3%, p = 0.033) was significantly higher in group B than in group A. The rate of urinary retention (12.5% versus 0%, p = 0.045) was significantly higher in group A than in group B. Superficial wound infection occurred in two out of 32 patients in group A (6.3%) and two out of 30 patients in group B (6.7%) (p = 0.94). Both groups had similar incidences of wound complications. Urinary tract infections also had a similar incidence in both early and late catheter removal groups, i.e., one out of 32 patients in group A (3.1%) and three out of 30 patients (10%) in group B (p = 0.271). Urinary extravasation following hypospadias repair occurred in two out of 32 patients (6.3%). No extravasation was noted in the late catheter removal group. However, the difference was not clinically significant (p = 0.164). Two patients in both groups developed urethrocutaneous fistula (6.3% in group A versus 6.7% in group B). However, the difference was not clinically significant. Meatal stenosis developed in three out of 32 patients in group A and two out of 30 patients in group B (9.4% versus 6.7%; p = 0.696). One patient in the early catheter removal group developed urethral stricture as a late complication. None of the patients in the late catheter removal group developed this complication.ConclusionsThe occurrence of long-term complications of TIP hypospadias repair was not affected by the early removal of the bladder catheter. The shortcomings of our study were its descriptive nature and the small sample size. Further prospective randomized controlled trials are needed to ascertain the safety of early catheter removal and improvement in quality of life in the immediate postoperative period.

First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent With Defibrillator Implantation: The PAUSE-SCD Randomized Trial.

Catheter ablation as first-line therapy for ventricular tachycardia (VT) at the time of implantable cardioverter defibrillator (ICD) implantation has not been adopted into clinical guidelines. Also, there is an unmet clinical need to prospectively examine the role of VT ablation in patients with nonischemic cardiomyopathy, an increasingly prevalent population that is referred for advanced therapies globally. We conducted an international, multicenter, randomized controlled trial enrolling 180 patients with cardiomyopathy and monomorphic VT with an indication for ICD implantation to assess the role of early, first-line ablation therapy. A total of 121 patients were randomly assigned (1:1) to ablation plus an ICD versus conventional medical therapy plus an ICD. Patients who refused ICD (n=47) were followed in a prospective registry after stand-alone ablation treatment. The primary outcome was a composite end point of VT recurrence, cardiovascular hospitalization, or death. Randomly assigned patients had a mean age of 55 years (interquartile range, 46-64) and left ventricular ejection fraction of 40% (interquartile range, 30%-49%); 81% were male. The underlying heart disease was ischemic cardiomyopathy in 35%, nonischemic cardiomyopathy in 30%, and arrhythmogenic cardiomyopathy in 35%. Ablation was performed a median of 2 days before ICD implantation (interquartile range, 5 days before to 14 days after). At 31 months, the primary outcome occurred in 49.3% of the ablation group and 65.5% in the control group (hazard ratio, 0.58 [95% CI, 0.35-0.96]; P=0.04). The observed difference was driven by a reduction in VT recurrence in the ablation arm (hazard ratio, 0.51 [95%CI, 0.29-0.90]; P=0.02). A statistically significant reduction in both ICD shocks (10.0% versus 24.6%; P=0.03) and antitachycardia pacing (16.2% versus 32.8%; P=0.04) was observed in patients who underwent ablation compared with control. No differences in cardiovascular hospitalization (32.0% versus. 33.7%; hazard ratio, 0.82 [95% CI, 0.43-1.56]; P=0.55) or mortality (8.9% versus 8.8%; hazard ratio, 1.40 [95% CI, 0.38-5.22]; P=0.62]) were observed. Ablation-related complications occurred in 8.3% of patients. Among patients with cardiomyopathy of varied causes, early catheter ablation performed at the time of ICD implantation significantly reduced the composite primary outcome of VT recurrence, cardiovascular hospitalization, or death. These findings were driven by a reduction in ICD therapies. URL: https://www. gov; Unique identifier: NCT02848781.