Emergency Treatment Of Patients Research Articles

The Correlation between Response Time and The Code Blue Success Levels

Cardiac arrest refers to the seized blood flow due to sudden dysfunction of the heart indicated by losing consciousness, cardiac respiration, and impalpable pulse on the large artery. The effort to prevent mortality from cardiac arrest requires some management, such as the activation of a code blue emergency system. The code blue team must work immediately to manage cardiac arrest. Immediate action for this patient could influence the success of the management. This research determined the correlation between the time response and the code blue team's success to manage the cardiac arrest case. This quantitative research applied correlation design with a cross-sectional study. The researchers took the respondents with accidental sampling. The results were 20 nurses of a code blue. The statistic test applied Chi-square and obtained a p-value of 9.615 with p value 0.008, (α < 0, 05). The value indicated a significant correlation between the time response and the code blue team success level of cardiac arrest at the hospital. The result showed that the nurses of the code blue team should improve their skills and knowledge by joining seminars and trainings about emergencies. In Conclusion there was a significant relationship between response time and the Code Blue Team success rate in the case of cardiac arrest. Recommendations in this research for nursing students is expected to always update their skills by attending seminars and training to add and update their knowledge in the treatment of emergency patients.

EFFICACY, SAFETY, AND PATIENT OUTCOMES OF EMERGENCY TREATMENT WITH IV INSULIN-DEXTROSE IN PATIENTS WITH HYPERKALEMIA

Hyperkalemia is a potentially life-threatening condition often encountered in emergency settings. Insulin-dextrose infusion is a common treatment to rapidly lower serum potassium levels, but this approach carries risks, particularly related to glucose imbalances. Objective: To evaluate the efficacy, safety, and clinical outcomes of insulin-dextrose infusion in the emergency treatment of patients with hyperkalemia. Methods: This retrospective study was conducted in the Emergency Department of Shifa International Hospital Islamabad from June 2023 to June 2024. The study included 400 patients with recorded potassium levels. Patients were categorized into non-hyperkalemic (K+ <5.5 mmol/L) and hyperkalemic (K+ ≥ 5.5 mmol/L) groups. Hyperkalemic patients received an insulin-dextrose infusion consisting of an average of 10 units of Actrapid insulin and 50 milliliters of 50% dextrose. Clinical outcomes, including efficacy and safety, were compared between treated hyperkalemic patients and those with moderate-severe hyperkalemia who did not receive the treatment. Statistical analysis was performed using odds ratios (OR) and 95% confidence intervals (CI) to assess the association between treatment variables and outcomes. Results: Glucose imbalances were observed in 60% of patients treated with insulin, with 50% developing hyperglycemia and 20% experiencing hypoglycemia, including 5% with severe hypoglycemia six hours post-treatment. Factors significantly associated with hypoglycemia included multiple insulin doses (OR: 2.9, 95% CI: 2.0-3.9), chronic kidney disease (CKD) (OR: 1.3, 95% CI: 1.0-2.1), and baseline glucose levels below seven mmol/L (OR: 3.0, 95% CI: 2.2-4.2). Hypoglycemic patients had a higher risk of mortality (OR: 1.49, 95% CI: 1.11-2.11). ICU admission occurred in three patients treated with insulin, with a higher risk associated with multiple doses (OR: 1.8, 95% CI: 1.4-2.9) and insulin doses greater than ten units (OR: 5.3, 95% CI: 2.9-10). Conclusion: The use of insulin-dextrose infusion in the emergency management of hyperkalemia is associated with a significant risk of hypoglycemia, ICU admission, and prolonged hospital stay. These findings suggest the need for improved treatment protocols to enhance patient safety in emergency settings.

Predictability of the emergency department triage system during the COVID-19 pandemic.

Emergency department (ED) triage systems are used to classify the severity and urgency of emergency patients, and Korean medical institutions use the Korean Triage and Acuity Scale (KTAS). During the COVID-19 pandemic, appropriate treatment for emergency patients was delayed due to various circumstances, such as overcrowding of EDs, lack of medical workforce resources, and increased workload on medical staff. The purpose of this study was to evaluate the accuracy of the KTAS in predicting the urgency of emergency patients during the COVID-19 pandemic. This study retrospectively reviewed patients who were treated in the ED during the pandemic period from January 2020 to June 2021. Patients were divided into COVID-19-screening negative (SN) and COVID-19-screening positive (SP) groups. We compared the predictability of the KTAS for urgent patients between the two groups. From a total of 107,480 patients, 62,776 patients (58.4%) were included in the SN group and 44,704 (41.6%) were included in the SP group. The odds ratios for severity variables at each KTAS level revealed a more evident discriminatory power of the KTAS for severity variables in the SN group (P<0.001). The predictability of the KTAS for severity variables was higher in the SN group than in the SP group (area under the curve, P<0.001). During the pandemic, the KTAS had low accuracy in predicting patients in critical condition in the ED. Therefore, in future pandemic periods, supplementation of the current ED triage system should be considered in order to accurately classify the severity of patients.

A Rare Case of Triple Negative Essential Thrombocythemia Presenting with Splenic Infarction: A Diagnostic Conundrum

Introduction Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by significant thrombocytosis with high propensity for thrombosis formation as well as other vascular complications. Most myeloproliferative neoplasms including ET are associated with Janus kinase ( JAK2) mutation. Other commonly associated mutations include Calreticulin ( CALR) and Myeloproliferative leukemia virus oncogene ( MPL) mutations. About 17% of cases of ET lack mutations in these driver genes. This presents a clinical conundrum for clinicians on initiation of appropriate treatment for these patients. We report a rare presentation of triple-negative ET with splenic infarction. Case Summary A 66-year-old Hispanic female who presented with left sided abdominal pain that gradually worsened over the course of 1 week; she believed it was stomach cramps. Laboratory evaluations were pertinent for platelet counts of 2000 x 10 9/L, hemoglobin level was 10.9 g/dl, and leukocytosis (white blood cell count 13.2k/uL) without left shift. Further work-up with iron studies was unremarkable and molecular studies were negative for BCR-ABL 1, PDGFR alpha/beta, FGFR 1, JAK2 V617F (including exons 12-13), CALR and MPL. A bone marrow biopsy showed an increase in megakaryocytes with some atypical forms with “enlarged size and nuclear hyper lobulation, and mild patchy reticulin fibrosis” suggestive of myeloproliferative neoplasm. Computed Tomography of the abdomen and pelvis with contrast showed evidence of splenic infarct. The patient was started on oral aspirin 81mg and oral hydroxyurea 2000 mg daily. Due to poor response to hydroxyurea and aspirin, she eventually had two cycles of platelet apheresis, and her platelet count improved to 1000 x 10 9/L. A repeat bone marrow biopsy was subsequently done to confirm essential thrombocythemia. At the time of discharge, the patient was asymptomatic and platelet count had decreased to 892 × 10 9/L. Discussion Essential thrombocythemia (ET) is a rare but recognized cause of vascular complications including arterial and venous thrombosis. Triple negative ET is quite uncommon and can pose a great deal of diagnostic challenge which can impact timing of initiation of appropriate therapy. This clinical vignette exemplified the conundrum encountered in making a diagnosis of triple negative ET. Following the World Health Organization (WHO) 2016 criteria for diagnosis of ET, patient has to have all 4 of: sustained platelet counts &amp;gt;450 x 10 9/L, bone marrow biopsy showing increased number of enlarged and mature megakaryocytes with no significant increase or left shift of granulopoiesis or erythropoiesis, presence of driver mutations/clonal markers (including JAK2, CALR and MPL mutations) or absent of evidence of iron deficiency or cause for reactive thrombocytosis and not meeting WHO criteria for Polycythemia vera or other myeloid neoplasms. Our patient met criteria for ET with no driver mutation detected, hence triple negative ET. She was also classified as high-risk ET using the revised International Prognostic Score for Essential Thrombocytopenia (IPSET). Initial work up of this patient was not confirmatory of the essential thrombocythemia due to the bone marrow biopsy not clearly defining features as per WHO stipulations, thus, a more aggressive therapy was not pursued. This can pose a great deal of diagnostic challenge which can impact timing of initiation of appropriate therapy. This is not uncommon especially considering sampling challenge. Studies has shown that early initiation of cytoreductive therapy prophylactically in a high-risk patients can avert vascular complications of ET (including splenic infarction). The index patient responded slowly to platelet apheresis which can be an effective treatment in acute thrombotic complication of ET. Conclusion The diagnosis of triple negative essential thrombocythemia can pose a clinical challenge which impacts effective management of this myeloproliferative neoplasm. There is a dire need for further discussion on this conundrum to provide more applicable recommendations to avert the rare but fatal complications of ET. Platelet apheresis can be an option for emergency treatment in patients presenting with a major vascular complication like splenic infarction.

Decision-Making Based on Predictive Process Monitoring of Patient Treatment Processes: A Case Study of Emergency Patients

This paper investigates predictive process monitoring problems in emergency treatment by combining the fields of process management and artificial intelligence. The objective is to predict the next activity and its timestamp in the treatment of emergency patients who have undergone surgery at the gastroenterology or urology surgery units in a hospital in Norway. To achieve this goal, three models were developed using different algorithms, and the best performing model was identified using various performance metrics. The results demonstrate the potential of predictive process monitoring to accurately forecast the outcome of patient treatments. By leveraging the insights gained from predictive process monitoring, hospitals can make more informed decisions. The findings of this study suggest that predictive process monitoring holds significant promise as a tool for improving the efficiency and effectiveness of emergency patient treatment processes. This research has significant implications for the field of decision sciences, particularly regarding resource allocation, reducing waiting times, and improving patient outcomes. The ability to predict the outcomes of patient treatment processes has important implications for hospitals, allowing the streamlining and acceleration of the treatment process. Overall, this study provides a promising framework for predicting patient treatment processes by using the predictive process monitoring method. This could be expanded upon in future research, ultimately leading to improved patient outcomes and better decision-making in healthcare.

Addressing problem of nocturnal dental pain and emergency treatment for patients

Addressing problem of nocturnal dental pain and emergency treatment for patients

The Consequences of the COVID-19 Pandemic on Emergency Surgery for Colorectal Cancer.

The aim of this study is to analyze the impact of the COVID-19 pandemic on the emergency treatment of patients with colorectal cancer in a university surgery clinic. Data from patients undergoing emergency surgery during the pandemic period (2020-2021) was taken into consideration and the results were analyzed and compared with the periods 2016-2017 and 2018-2019. A significant decrease in the number of patients undergoing emergency surgery was reported (p = 0.028). The proportion of patients who presented more severe symptoms at the hospital was significantly higher (p = 0.007). There was an increase in the average duration of surgical interventions compared to pre-pandemic periods (p = 0.021). An increase in the percentage of stomas performed during the pandemic was reported. The average duration of postoperative hospitalization was shorter during the pandemic. A postoperative mortality of 25.7% was highlighted. Conclusions: The pandemic generated by COVID-19 had significant consequences on the emergency treatment of patients with colon cancer. A smaller number of patients showed up at the hospital, and with more severe symptoms. In order to reduce the risk of infection with SARS-CoV-2 virus, the postoperative hospitalization period was shortened and a higher number of protective stomas were performed.

Priorities and overarching goals in the diagnosis and emergency treatment of patients with suspected ectopic pregnancy – retrospective study

Aim: Analysis of priorities in the emergency treatment of patients with ectopic pregnancy who are in a life-threatening condition. Observation of differences in the course of treatment depending on belonging to the age group. Material and methods: The study included 68 patients of the Gynaecological and Obstetric Specialist Hospital. E. Szczeklik in Tarnów, Małopolskie Voivode¬ship, who were diagnosed with ectopic pregnancy. The patients were divided into two groups according to age, counting 34 people in both cases.The study was retrospective and concerned patients hospitalized in the period 27.01.2016–01.08.2022. Results: The length of hospital stay due to ectopic pregnancy is not significantly longer in patients under 30 years of age compared to patients over 30 years of age. No significant relationship was observed between the patient’s age and the stage of pregnancy in which health collapse occurs and the need for medical intervention in connection with ectopic pregnancy occurs. Ectopic pregnancies are most often localized in the right fallopian tube. No significant differences between age groups were shown in laboratory tests of hCG, WBC, RGB, HGB, HCT, PLT levels. The most common treatment in both groups was surgical resection of the ruptured fallopian tube. No statistically significant differences were found between age groups and treatment. Conclusions: Ectopic pregnancy is a dangerous clinical situation for pregnant women regardless of their age. The intensity of haemorrhage as a result of rupture at the site of implantation of the embryo, assessed on the basis of laboratory tests, is comparable in both patients before and after 30 years of age.

Impact of an Emergency Department Isolation Policy for Patients With Suspected COVID-19 on Door-to-Electrocardiography Time and Clinical Outcomes in Patients With Acute Myocardial Infarction.

Rapid electrocardiography diagnosis within 10 minutes of presentation is critical for acute myocardial infarction (AMI) patients in the emergency department (ED). However, the coronavirus disease 2019 (COVID-19) pandemic has significantly impacted the emergency care system. Screening for COVID-19 symptoms and implementing isolation policies in EDs may delay the door-to-electrocardiography (DTE) time. We conducted a cross-sectional study of 1,458 AMI patients who presented to a single ED in South Korea from January 2019 to December 2021. We used multivariate logistic regression analysis to assess the impact of COVID-19 pandemic and ED isolation policies on DTE time and clinical outcomes. We found that the mean DTE time increased significantly from 5.5 to 11.9 minutes (P < 0.01) in ST segment elevation myocardial infarction (STEMI) patients and 22.3 to 26.7 minutes (P < 0.01) in non-ST segment elevation myocardial infarction (NSTEMI) patients. Isolated patients had a longer mean DTE time compared to non-isolated patients in both STEMI (9.2 vs. 24.4 minutes) and NSTEMI (22.4 vs. 61.7 minutes) groups (P < 0.01). The adjusted odds ratio (aOR) for the effect of COVID-19 duration on DTE ≥ 10 minutes was 1.93 (95% confidence interval [CI], 1.51-2.47), and the aOR for isolation status was 5.62 (95% CI, 3.54-8.93) in all patients. We did not find a significant association between in-hospital mortality and the duration of COVID-19 (aOR, 0.9; 95% CI, 0.52-1.56) or isolation status (aOR, 1.62; 95% CI, 0.71-3.68). Our study showed that ED screening or isolation policies in response to the COVID-19 pandemic could lead to delays in DTE time. Timely evaluation and treatment of emergency patients during pandemics are essential to prevent potential delays that may impact their clinical outcomes.

Analysis of Palliative Care Utilization and Medical Expenses among Patients with Chronic Diseases in Taiwan: A Population-Based Cohort Study.

Palliative care (PC) is an important alternative treatment for patients with chronic diseases, particularly for those in the later stages of disease progression. This is because these diseases are often irreversible, with progressive worsening of symptoms. By encouraging the use of tranquility resources for good death and spiritual relief, PC can reduce the physical and psychological burden on patients at the end of their lives. Currently, most discussions on PC have focused on patients with cancers, and few have further discussed the differences in medical expenses between PC and emergency treatment in patients with chronic diseases at the end of their lives. This study analyzed the top three chronic diseases in patients who used PC resources in the past decade and identified the impact of emergency treatment on mean survival time and medical expenses based on the medical records from the National Health Insurance Research Database. In total, 4061 patients with chronic diseases who were admitted to hospice wards were included in this study; of them, 85 patients still received emergency treatment, including urinary catheterization, nasogastric intubation, and respirator use, at the end of their lives. The mean survival time of patients aged 50–64 years who received emergency treatment was longer than that of the same age group who did not receive emergency treatment. Different comparisons of the mean survival time and medical expenses using real-world data provides important insights regarding PC management that may assist in establishing health policies in the future.

Quality of acute asthma care: an audit of clinical practice in a Victorian health service.

Gaps in the treatment of patients with acute asthma have been repeatedly described in Australia. We conducted a retrospective audit of acute asthma care at a Victorian tertiary institution. To describe acute asthma care at a large health network in metropolitan Melbourne, and evaluate the extent to which Emergency Department (ED) care was consistent with National Asthma Council guidelines. A retrospective audit was performed of medical records between July 2017 and June 2019. We included adult patients admitted to campuses within the Western Health network in Melbourne, Victoria, where the length of stay was at least 12 h, and the primary discharge diagnosis was asthma. Four hundred and ninety-three admissions were included in the analysis, representing 392 individual patients. Seventy-one percent of patients were female and 27% were current smokers. Ninety-six percent of patients had a prior asthma diagnosis, 63% had a previous hospital presentation and 75% were prescribed an inhaled preventer. In the ED, systemic corticosteroids and inhaled salbutamol were prescribed in 65% and 82% admissions respectively; adjunctive treatments included ipratropium (67% of admissions), magnesium sulfate (30%), adrenaline (11%) and non-invasive ventilation (9%). Overall, ED care was guideline concordant in 59% of admissions. On the wards, treatments prescribed within 24 h of admission included corticosteroids (90% of admissions), salbutamol (84%), ipratropium (64%) and inhaled preventers (63%). The proportion of patients prescribed these treatments, as well as documented follow up (e.g. asthma action plans), varied significantly depending on the treating specialty. The emergency treatment of patients with acute asthma frequently deviated from guidelines and there was significant variation in inpatient treatment. Quality improvement initiatives that incorporate structural changes are required to improve asthma care.

A multidisciplinary approach for the emergency care of patients with left ventricular assist devices: A practical guide

The use of a left ventricular assist device (LVAD) as a bridge-to-transplantation or destination therapy to support cardiac function in patients with end-stage heart failure (HF) is increasing in all developed countries. However, the expertise needed to implant and manage patients referred for LVAD treatment is limited to a few reference centers, which are often located far from the patient's home. Although patients undergoing LVAD implantation should be permanently referred to the LVAD center for the management and follow-up of the device also after implantation, they would refer to the local healthcare service for routine assistance and urgent health issues related to the device or generic devices. Therefore, every clinician, from a bigger to a smaller center, should be prepared to manage LVAD carriers and the possible risks associated with LVAD management. Particularly, emergency treatment of patients with LVAD differs slightly from conventional emergency protocols and requires specific knowledge and a multidisciplinary approach to avoid ineffective treatment or dangerous consequences. This review aims to provide a standard protocol for managing emergency and urgency in patients with LVAD, elucidating the role of each healthcare professional and emphasizing the importance of collaboration between the emergency department, in-hospital ward, and LVAD reference center, as well as algorithms designed to ensure timely, adequate, and effective treatment to patients with LVAD.

An Integrative Comparative Study Between Digoxin and Amiodarone as an Emergency Treatment for Patients With Atrial Fibrillation With Evidence of Heart Failure: A Systematic Review and Meta-Analysis.

The emergency treatment of atrial fibrillation (AF) involves utilizing two strategies. The first strategy normally involves permitting the atrial fibrillation to persevere as the ventricular rate is controlled. The other method involves utilizing anti-arrhythmic drugs in cardioversion and attempting to maintain sinus rhythm. Different pharmacological treatments, including digoxin and amiodarone, have been used to manage AF. A literature review on amiodarone and digoxin in the treatment of AF among patients with heart failure (HF) has shown that both drugs have potential risks. Therefore, we are conducting this systematic review and meta-analysis to compare the effectiveness of amiodarone and digoxin in the treatment of AF among patients with evidence of HF.A literature search of relevant articles was conducted on six electronic databases (PubMed, Web of Science, Medline, ScienceDirect, Cochrane Library, and Google Scholar) from 2000 to 2022. The search yielded seven studies that had met the inclusion criteria. Our meta-analysis of four studies showed that there was no significant difference in the reduction of heart rate after treatment with either amiodarone or digoxin (mean difference (MD): -5.44; 95% confidence interval (CI): -9.53 to -1.34; I2 = 25%; p = 0.26). On the other hand, the statistical analysis showed that amiodarone had a better effect on the conversion to sinus rhythm than digoxin (63% versus 35%, respectively).Based on evidence from our meta-analysis, the clinical effect of amiodarone and digoxin in the emergency treatment of AF on heart rate control was unclear. However, amiodarone has a significant impact on the restoration of sinus rhythm compared with digoxin and can be considered the first-line drug regimen in conversion to sinus rhythm for AF patients with evidence of heart failure. However, the use of amiodarone and digoxin is complicated by adverse events and all-cause mortality.

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Study on the Effectiveness and Complication Rate of Hemoperfusion and Hemodialysis in the Treatment of Emergency Patients with Severe Organophosphorus Pesticide Poisoning

Improving emergency treatment for patients with acute stroke: the PEARS research programme, including the PASTA cluster RCT

Improving emergency treatment for patients with acute stroke: the PEARS research programme, including the PASTA cluster RCT

Optimizing the Prehospital-Hospital Emergency Care Path Application Value in Emergency Treatment of Patients with Cerebral Hemorrhage.

Objective To explore the effect of optimizing the prehospital-hospital emergency nursing path on the rescue speed, rescue effect, and patient prognosis of patients with cerebral hemorrhage. Methods A retrospective study was performed to select 227 patients with acute cerebral hemorrhage who visited our hospital from August 2018 to October 2019, and we compared the optimization of the prehospital-hospital emergency nursing pathway (research group) with traditional prehospital time spent in the rescue and the prognosis of patients in the emergency care pathway (control group) in the hospital. The GOS score, FMA score, and Barthel index were used to compare the prognosis of the two groups of patients. Results The prehospital-hospital emergency nursing route was optimized compared with the traditional nursing route. The rescue time of patients in each link was shorter (P < 0.05), and the incidence of complications was low (P < 0.05). The scales and scores all suggested that patients had a better prognosis (P < 0.05). Conclusion Optimizing the prehospital-hospital emergency nursing path can significantly shorten the rescue time, improve the rescue effect, and improve the prognosis of patients.

Discussion on the Effect of Pre-examination and Triage Nursing Procedure in Emergency Treatment for Patients with Acute Abdomen

Discussion on the Effect of Pre-examination and Triage Nursing Procedure in Emergency Treatment for Patients with Acute Abdomen

The effect of nursing management in different levels and areas in emergency treatment of patients with acute ST segment elevation myocardial infarction

Objective: Study on the effect of nursing management in different levels and areas in emergency treatment of patients with acute ST segment elevation myocardial infarction. Methods: 200 patients with acute ST segment elevation myocardial infarction admitted by our hospital from January 2018 to October 2019 were divided into observation group and control group according to the nursing mode of patients, with 100 cases in each group. The patients in the control group were given routine emergency care, and the patients in the observation group were given graded and partitioned nursing management. Result: The time of emergency treatment, coronary angiography and stent placement were compared between the two groups. The results showed that the time of observation group was significantly shorter than that of control group (P &lt; 0.05). The results showed that the time of the observation group was significantly shorter than that of the control group (P &lt; 0.05). The incidence of complications was 11.00% in the control group and 1.00% in the observation group. There was statistical significance between the two groups (P &lt; 0.05). The nursing satisfaction of the control group was 80.00%, and that of the observation group was 96.00%. There was statistical significance between the two groups (P &lt; 0.05). Conclusion: The application effect of grading and zoning nursing management in the first aid of patients with acute ST segment elevation myocardial infarction is better. It can effectively shorten the waiting time of patients, reduce nursing complications, improve nursing satisfaction, and effectively improve the effect of first aid, which is worth popularizing.

Manikins versus simulated patients in emergency medicine training: a comparative analysis

PurposeEvery physician must be able to sufficiently master medical emergencies, especially in medical areas where emergencies occur frequently such as in the emergency room or emergency surgery. This contrasts with the observation that medical students and young residents often feel insufficiently prepared to handle medical emergencies. It is therefore necessary to train them in the treatment of emergency patients. The aim of this study is to analyze the influence of the assignment of manikin versus simulated patients during a training for undergraduate medical students on learning outcomes and the perceived realism.MethodsThe study had a prospective cross-over design and took place in a 3-day emergency medicine training for undergraduate medical students. Students completed three teaching units (‘chest pain’, ‘impaired consciousness’, ‘dyspnea’), either with manikin or simulated patient. Using a questionnaire after each unit, overall impression, didactics, content, the quality of practical exercises, and the learning success were evaluated. The gained competences were measured in a 6-station objective structured clinical examination (OSCE) at the end of training.Results126 students participated. Students rated simulated patients as significantly more realistic than manikins regarding the possibility to carry out examination techniques and taking medical history. 54.92% of the students would prefer to train with simulated patients in the future. Regarding the gained competences for ‘chest pain’ and ‘impaired consciousness’, students who trained with a manikin scored less in the OSCE station than the simulated patients-group.ConclusionSimulated patients are rated more realistic than manikins and seem to be superior to manikins regarding gained competence.

Prostatic artery embolization treatment for patients with benign prostatic hyperplasia who are permanent urinary catheter users ineligible for de-obstructive surgery

IntroductionBenign prostatic hyperplasia is considered the most frequent cause of lower urinary tract symptoms. Urinary catheterization is the emergency treatment for patients with urinary retention and surgery is indicated in patients refractory to medical treatment. There is a group of people with important comorbidities that make them ineligible for surgery. Prostatic arterial embolization (PAE) could be presented as a safe and effective alternative to achieve bladder emptying and spontaneous urination, thus avoiding permanent urinary catheterization in patients with significant comorbidities that represent a contraindication for surgery. In this retrospective study, we evaluated the efficacy of PAE in patients with permanent urinary catheterization who are ineligible for surgical treatment. Material and methodsRetrospective study of 26 patients with permanent urinary catheter who underwent prostatic embolization. Demographic and clinical data (age, use of anticoagulation, prostate volume, length of hospital stay, unilateral or bilateral embolization), Charlson comorbidity index evaluation and Clavien-Dindo classification for procedural complications were reviewed. Successful removal of permanent urinary catheter was analyzed at one month after the procedure. ResultsA total of 26 patients were included in the review. The median age was 85 years with a median prostate volume of 90 mL. A Charlson comorbidity score above 7 was obtained in 88.5% of the subjects. Only one patient had one Clavien-Dindo III complication. Of the 26 subjects, 17 (65.4%) had spontaneous micturition and a postvoid residual lower than 100 mL at one month post procedure. Overall, catheter removal was achieved in 19 out of 26 subjects (73.1%). ConclusionPAE is a safe and effective treatment for patients with permanent urinary catheterization who are ineligible for surgical treatment.