Foley Catheter Placement Research Articles

Complete Posterior Urethral Disruption Accompanied by Complex Pelvic Fractures: Clinical Outcomes of Fluoroscopic Primary Posterior Urethral Realignment

PurposeTo evaluate the clinical outcomes of fluoroscopic primary posterior urethral realignment (PPUR) for complete posterior urethral disruption (PUD) accompanied by complex pelvic fractures. Materials and MethodsData from 15 male patients (median age, 58 years; range, 32–76 years) with traumatic PUD treated with fluoroscopic PPUR between 2016 and 2019 at a regional trauma center were retrospectively analyzed. The technical success (continuity of the ruptured urethra in PUD by Foley catheter placement) rate of fluoroscopic PPUR, trauma mechanism, concurrent embolization for pelvic arterial hemorrhage, time from the hospital visit to the start of the procedure, procedure time, Foley catheterization duration, and delayed complications were investigated. ResultsFluoroscopic PPUR was technically successful for 13 of 15 (87%) patients. Concurrent embolization for pelvic arterial hemorrhage was performed in 11 of 15 (73%) patients. The mean time between the hospital visit and procedure initiation was 181.6 minutes ± 83.2. The mean procedure time was 66.3 minutes ± 26.6. The mean Foley catheterization duration for 13 patients (technical success group) was 52.3 days ± 39.8 (median, 40 days; range, 21–177 days). Symptomatic urethral stricture developed in 9 of 13 (69.2%) patients after the procedure; 7 underwent visual internal urethrotomy, 4 required regular urethral dilatation, and 2 needed urethral stent insertion. Three of 13 (23%) patients did not have delayed complications during the 1-year follow-up. ConclusionsPPUR with fluoroscopic guidance appears safe and effective for achieving the continuity of the ruptured urethra in PUD. It enables PPUR without general anesthesia and the lithotomy position in patients with complex pelvic fractures.

Pull the Foley: Improved Quality for Middle-Aged and Geriatric Trauma Patients Without Indwelling Catheters.

Urinary tract infection (UTI) complications are often attributed to the inappropriate use of urinary catheters. We sought to examine the effectiveness of a hospital-wide policy aimed at reducing the use of indwelling Foley catheters. We completed a retrospective review of prospectively collected data on 577 hip and femur fracture patients aged 55 years and older who were operatively treated at a Level 1 trauma center between October 2014 and March 2019. New standard-of-care guidelines restricting the use of indwelling Foley catheters were implemented starting January 2018, and we compared perioperative outcomes between cohorts. Over a 50% absolute reduction in indwelling Foley catheter use and a near 30% relative reduction in hospital-acquired UTI were achieved. Postpolicy cohort patients without indwelling Foley catheters experienced lower odds of hospital-acquired UTI, higher odds of home discharge, as well as decreased time to surgery, shorter length of stay, and lower total inpatient cost compared with those with indwelling Foley catheters. The policy of restricting indwelling Foley catheter placement was safe and effective. A decrease in indwelling Foley catheter use led to a decrease in the rate of hospital-acquired UTI and positively affected other perioperative outcomes.

The Role of Foley Catheter in the Treatment of Low Grades Vesico-Ureteric Reflux (VUR)

Vesicoureteral reflux can be defined as a congenital anomalies of the lower urinary tract characterize by adefect in the vesico-ureteric valve (which is a functional valve result from the oblique intramural passage ofthe lower 2.5 cm. of the ureters in wall of the bladder) resulting in retrograde passage of urine into one orboth ureters up to the kidneys during voiding. From March 2014 to June 2016, 60 (38 males and 22 females)children with low-grade primary VUR (10 with G1, 16 had G2 and 34 had G3) who are seeking medicaladvice in the urological department of Alhilla teaching and Alsadiq teaching hospitals and private clinics wereincluded in this study. All patients evaluated by thorough medical history, complete physical examination,send for urinalysis, PCV, and ultrasonography, and confirm the diagnosis by voiding cystography. No Foleycatheter put for patients with G1 VUR, while Foley catheter put for eight patients with G2 VUR (50%) andfor 20 patients with G3 reflux (58.8%). Patients are fallowed for at least 1 year for any breakthrough upperor lower urinary tract infection and for the grade of reflux by frequent urinalysis and ultrasonography forany new renal scaring while voiding cystography repeat every 6 months. Conservative treatment is the firstoption in the treatment of low grade VUR. The use of indwelling Foley catheter in the treatment of low gradeVUR remain controversy regarding its role in decreasing the back pressure on the renal parenchyma and itsincreasing rate of UTI .however this study reveal that the incidence of UTI occur in 6.25% of cases treatedwith continuous prophylactic antibiotic (CPA) alone and occur in 25% of cases treated with CPA with Foleycatheter placement.

S3374 Overflow Diarrhea and AKI as a Presentation of Fecal Impaction That Led to Obstructive Uropathy

INTRODUCTION: Fecal impaction is a known complication of chronic constipation and is particularly bothersome in the elderly. Common complications of fecal impaction include hemorrhoids, megacolon, overflow diarrhea and obstructive uropathy among others. Overflow diarrhea is often misdiagnosed and treated with antidiarrheal medications leading to further worsening of impaction. Obstructive uropathy is a well-established complication of fecal impaction with obstruction occurring at any level of the urinary tract. Children and young adults are at high risk as are the elderly due to multiple risk factors including but not limited to diabetes mellitus, dementia, opioid use and depression. Many case reports have been published with fecal impaction and obstructive uropathy though none have reported overflow diarrhea as a presentation. CASE DESCRIPTION/METHODS: An 82-year-old male patient presented with diarrhea and acute kidney injury that was caused by fecal impaction that led to obstructive uropathy. He had a 4-week history of non-bloody watery diarrhea with associated fecal incontinence and generalized abdominal pain. He reported a long-standing history of constipation prior to this. Generalized abdominal tenderness with mild diffuse distention and a distended urinary bladder were noted on exam, along with normal rectal tone with loose brown stool in absence of hemorrhoids or prostate enlargement. Lab work showed elevated creatinine and hypokalemia. Upon IV fluid resuscitation and foley catheter placement, CT abdomen was done which showed bilateral hydronephrosis. Stool studies showed no evidence of infection. He was managed with laxatives and had significant improvement in kidney function as well as significantly reduced stool burden. DISCUSSION: Our patient had multiple risk factors for impaction including age, immobility, diabetes, and medications including azacitidine. Chronic constipation in our patient led to fecal impaction which eventually led to overflow diarrhea and obstructive uropathy. It is important to consider impaction as a cause of fecal incontinence and diarrhea in the elderly as it can lead to high morbidity and mortality. The treatment of this diarrhea is counter-intuitive since the impaction benefits from catharsis not antidiarrheals. Diet counseling, biofeedback, and rarely surgical intervention can be used in refractory cases.Figure 1.: Computed Tomography imaging showing bilateral hydronephrosis (A) and dilation of rectum (B).Figure 2.: Computed Tomography imaging showing improvement in hydronephrosis and stool burden post catharsis.

O-56 Primary Repair for Distal Uretral Perforation During Implantation of Penile Prosthesis

The distal urethral perforation (DUP) during implantation of penile prosthesis (IPP) has been conservatively treated with the placement of urethrovesical Foley catheter and with a new IPP attempt posteriorly. This study describes the primary repair for the DUP during malleable IPP in two patients.

Pseudocyst of Pancreas Transplant Allograft: A Case Report

BackgroundPancreatic pseudocysts are rarely reported complications of pancreas transplant. CaseWe present a case of a patient with simultaneous pancreas and kidney transplant with bladder exocrine drainage who developed reflux pancreatitis and symptomatic pancreatic pseudocyst as a result of neuropathic bladder, 15 years after the original transplant. He was initially managed with percutaneous aspiration and drainage along with Foley catheter placement to help with bladder emptying. But the pseudocyst recurred after drains and Foley were removed. Eventually, he underwent an enteric conversion of the pancreas allograft with resolution of his symptoms and the pseudocyst. ConclusionsEnteric conversion should be considered in cases of bladder-drained pancreas transplants with recurrent reflux pancreatitis and/or pseudocyst formation.

Labor and Delivery Outcomes with the Sequential Use of Misoprostol Followed by Cervical Foley Catheter.

Studies demonstrate shorter time to delivery with concurrent use of misoprostol and cervical Foley catheter. However, concurrent placement may not be feasible. If misoprostol is used to start an induction, little is known regarding the benefit of sequentially using Foley catheter. We examine obstetrical outcomes in women with Foley catheter placed after misoprostol compared with those only requiring misoprostol. Retrospective cohort study of singleton pregnancies, intact membranes, and an unfavorable cervix (Bishop score of ≤6 and dilation ≤2 cm) undergoing term induction May 2013 to June 2015. We compared obstetrical outcomes between women receiving misoprostol alone versus those that had a Foley catheter placed after misoprostol. Outcomes are mode of delivery, time to delivery, chorioamnionitis, admission to neonatal intensive care unit, and maternal morbidity. Chi-square and Fisher's exact tests were used for categorical variables, Mann-Whitney U-tests compared continuous variables. Among 364 women, 281 began induction with misoprostol alone. A total of 135 (48%) subsequently had a Foley catheter placed. Characteristics were similar between the groups, although nulliparity and cervical dilation <1 cm at start of induction were more likely to have subsequent Foley catheter. Women with Foley catheter placement after misoprostol had a longer median time to delivery (15 vs. 11 hours, p < 0.001), twofold higher rate of cesarean (42 vs. 26%, odds ratio: 2.1, 95% confidence interval: 1.26-3.44, p = 0.004), and increased risk of neonatal intensive care unit (NICU) admission (21 vs. 11%, p = 0.024). There was a nonsignificant increased risk of chorioamnionitis (12 vs. 7%, p = 0.1) and maternal morbidity (15 vs. 8%, p = 0.08) in the misoprostol followed by Foley catheter group. In women receiving misoprostol for induction, nulliparas and those with dilation <1 cm are more likely to have subsequent Foley catheter placement. Sequential use of cervical Foley catheter after misoprostol is associated with longer labor, higher cesarean rate, and increased NICU admission. Requirement of Foley catheter after misoprostol confers higher risk and may guide counseling. · Little is known regarding efficacy of misoprostol followed by cervical Foley catheter.. · Nulliparas and dilation <1 cm increases need for Foley after misoprostol.. · Complications were more common in women requiring Foley after misoprostol..

Clinical Predictors for Abnormal Renal Bladder Ultrasound in Hospitalized Young Children With a First Febrile Urinary Tract Infection.

Physicians often obtain a routine renal bladder ultrasound (RBUS) for young children with a first febrile urinary tract infection (UTI). However, few children are diagnosed with serious anatomic anomalies, and opportunity may exist to take a focused approach to ultrasonography. We aimed to identify characteristics of the child, prenatal ultrasound (PNUS), and illness that could be used to predict an abnormal RBUS and measure the impact of RBUS on management. We conducted a single-center prospective cohort study of hospitalized children 0 to 24 months of age with a first febrile UTI from October 1, 2016, to December 23, 2018. Independent variables included characteristics of the child, PNUS, and illness. The primary outcome, abnormal RBUS, was defined through consensus of a multidisciplinary team on the severity of ultrasound findings important to identify during a first UTI. A total of 211 children were included; the median age was 1.0 month (interquartile range 0-2), and 55% were uncircumcised boys. All mothers had a PNUS with 10% being abnormal. Escherichia coli was the pathogen in 85% of UTIs, 20% (n = 39 of 197) had bacteremia, and 7% required intensive care. Abnormal RBUS was found in 36% (n = 76 of 211) of children; of these, 47% (n = 36 of 76) had moderately severe findings and 53% (n = 40 of 76) had severe findings. No significant difference in clinical characteristics was seen among children with and without an abnormal RBUS. One child had Foley catheter placement, and 33% received voiding cystourethrograms, 15% antibiotic prophylaxis, and 16% subspecialty referrals. No clinical predictors were identified to support a focused approach to RBUS examinations. Future studies should investigate the optimal timing for RBUS.

Cateterismo ureteral iatrogeno: a propósito de dos casos y revisión de la literatura

Background: Bladder catheterization is one of the most frequent procedures in Urology, but it is not exempt from complications.&#x0D; Relevance: Unintentional Foley catheter placement in the ureter is a rare occurrence that can produce serious complications. Few cases are described in the literature.&#x0D; Case report: We present herein two cases of inadvertent Foley catheter balloon inflation in the ureter. Case 1: an 85-year-old-patient with an indwelling Foley catheter was admitted to our emergency department due to abdominal pain in the hypogastrium, dysuria, and diagnosis of septic shock from extended-spectrum beta-lactamase-producing Escherichia coli. Case 2: a 75-year-old patient underwent transurethral resection of the bladder and presented with persistent hematuria and abdominal pain in the postoperative period.&#x0D; Conclusion: Unintentional urinary catheter placement in the ureter is an unusual complication and a diagnostic challenge that should be suspected in the presence of abdominal pain after bladder catheterization.

Inadvertent urinary catheter placement in the ureter: A report on two cases and a literature review

Background: Bladder catheterization is one of the most frequent procedures in Urology, but it is not exempt from complications.&#x0D; Relevance: Unintentional Foley catheter placement in the ureter is a rare occurrence that can produce serious complications. Few cases are described in the literature.&#x0D; Case report: We present herein two cases of inadvertent Foley catheter balloon inflation in the ureter. Case 1: an 85-year-old-patient with an indwelling Foley catheter was admitted to our emergency department due to abdominal pain in the hypogastrium, dysuria, and diagnosis of septic shock from extended-spectrum beta-lactamase-producing Escherichia coli. Case 2: a 75-year-old patient underwent transurethral resection of the bladder and presented with persistent hematuria and abdominal pain in the postoperative period.&#x0D; Conclusion: Unintentional urinary catheter placement in the ureter is an unusual complication and a diagnostic challenge that should be suspected in the presence of abdominal pain after bladder catheterization.

Characteristics, Burden, and Necessity of Inpatient Consults for Academic and Private Practice Urologists

ObjectiveTo compare differences in the characteristics and outcomes of inpatient consults between academic and private practice urologists. Materials and MethodsWe performed a retrospective review of urology consults at a large tertiary-care hospital from June 1st, 2017 to June 30th, 2018. Patient demographics, timing of consult, location of consult, reasons for consult, requesting physicians, and procedures performed were analyzed and compared. ResultsA total of 613 consults were identified. The most common consults were for a Foley catheter/suprapubic tube (16%), urinary retention (15%), kidney/bladder stones (11%), and hematuria (11%). Seventy-seven percent of the consults were seen in the day time and 79% were seen on the weekdays. One hundred and ten (18%) consults resulted in an operative intervention during the same admission. The others required a Foley catheter placement or suprapubic exchange (17%), bedside procedure (9%), or interventional radiology procedure (4%). The remaining 319 consults (52%) required no intervention and were considered potentially unnecessary. There were no differences in the timing of the consults and the need for intervention between academic and private practice urologists (P = .20). Only 37% of patients followed up as an outpatient. These potentially unnecessary consults resulted an annual loss of 265.8 hours for the urologists and $44,376.09 in excess health care costs. ConclusionOver half of inpatient urologic consultations required no urologic intervention and therefore represented potential overuse of urgent inpatient specialty care. This may contribute towards the growing epidemic of burnout in urology. Further work needs to be done to educate other hospital services and nurses to minimize these unnecessary consults.

Postoperative Urinary Retention in Patients Undergoing Lung Resection: Incidence and Risk Factors

The purpose of this study was to (1) determine the incidence of postoperative urinary retention (POUR) in patients undergoing lung resection at our institution, (2) identify differences in potential risk factors between patients with and without POUR, and (3) describe patient outcomes across POUR status. The medical records of 225 patients between 2016 and 2017 were reviewed, and 191 met criteria for inclusion. The institution's catheterization removal protocol was followed in all patients. Recatheterization was defined as requiring in-and-out catheterization or Foley catheter placement. Fisher exact and Wilcoxon tests were used for analysis. POUR developed in 35 patients (18%). Patients with POUR were older (P= .01), had increased baseline creatinine (P= .04), and a higher prevalence of benign prostatic hyperplasia (P= .007). POUR patients were also less likely to get a Foley catheter intraoperatively (P= .0002). Other intraoperative factors, such as surgical approach and extent of resection, were not significantly different between patients with and without POUR. Postoperative factors (epidural use or days with chest tube) were similar. Although patients with POUR were more likely to be discharged with a Foley catheter (13% vs 0%, P= .002), no difference in length of stay, incidences of urinary tract infections, or 30-day readmission were observed. POUR develops in approximately 1 in 5 patients undergoing lung resection. Patients with POUR were more likely to not have a Foley catheter placed intraoperatively. However, patients who had POUR did not have worsened patient outcomes (urinary tract infections, length of stay, or 30-day readmission).

Incidence of and risk factors for postoperative urinary retention in men after carotid endarterectomy

ObjectiveThe goal of this study was to determine the incidence of postoperative urinary retention (POUR) in men after carotid endarterectomy (CEA) and to identify preventable risk factors for the development of this complication. MethodsAll male patients who underwent CEA from 2014 to June 2018 were identified. Exclusions included CEA with concomitant cardiac surgery, baseline dialysis, and indwelling or straight catheterization. POUR was the primary end point, defined as inability to void requiring catheterization within 24 hours postoperatively or after removal of a preoperatively placed Foley catheter. POUR was further classified as mild (single catheterization), moderate (multiple catheterizations), or severe (catheterization prolonging discharge or discharge with catheter). Logistic regression assessed for POUR risk factors. ResultsThere were 294 male patients who underwent CEA during the study period; 82 (28.2%) developed POUR. Of these, 48 (57.8%) were mild, 15 (18.1%) were moderate, and 20 (24.1%) were severe. At baseline, POUR was associated with older age, peripheral artery disease (PAD), chronic kidney disease, diabetes, ambulation deficit, prior urinary retention, and statin and chronic tamsulosin use. Overall, 31.6% (93) of the cohort had a Foley catheter placed before the procedure, and this was protective against POUR (no Foley vs Foley, 31.8% vs 20.4%; P = .043). Independent risk factors for POUR included prior urinary retention (odds ratio [OR], 3.4 [1.6-7.3]; P = .002), diabetes (OR, 2.1 [1.1-3.7]; P = .016), PAD (OR, 2.3 [1.1-5.2]; P = .036), and age (per year: OR, 1.1 [1.02-1.10]; P < .001). Preoperative Foley catheter placement remained protective (OR, 0.4 [0.2-0.7]; P = .003). Preoperative Foley catheter placement was not associated with urinary tract infection (preoperative Foley catheter: 0% vs 1%; P = .54). However, POUR was associated with an increased risk for urinary tract infections (10% vs 1%; P = .001), which was highest in severe POUR (20% vs 1%; P = .001). POUR was also associated with a discharge to rehabilitation (16% vs 4%; P = .002), with highest rates in the moderate and severe POUR cohorts (20% each). ConclusionsPOUR is common in men undergoing CEA, and almost a quarter of those with POUR have a discharge delay or are discharged with a Foley catheter. Preoperative Foley catheterization is protective against POUR and should be considered in older patients, diabetics, patients with PAD, and those with a history of urinary retention.

Technical and Clinical Considerations for Successful Management of Postoperative Bowel Perforation by Percutaneous Foley Catheter Placement.

PurposeThe aim of this study was to analyze several technical and clinical factors associated with the successful management of postoperative leakage by percutaneous Foley catheter placement.Materials and MethodsThirty-two patients were included in this retrospective study. Postoperative gastrointestinal leakage was diagnosed by computed tomography (CT) and the patients underwent percutaneous Foley catheter placement into the leakage site through Jackson-Pratt tubes or imaging-guided methods. Clinical success was defined as successful Foley catheter removal without symptom recurrence within 1 week and the risk factors for clinical failure were analyzed.ResultsIn all patients, percutaneous Foley catheter placement was successfully achieved without complications. Foley catheter was placed at a median of 10 days (range, 1–68) after the confirmation of leakage on CT. Clinical success was achieved in 26 of the 32 patients (81%). Systemic comorbidity (p < 0.001) and failed oral intake (p = 0.015) were the statistically significant risk factors for clinical failure.ConclusionPercutaneous Foley catheter placement can be considered an effective approach for the management of postoperative bowel leakage. The presence of systemic comorbidity and successful oral diet after Foley catheter placement are significant factors for successful clinical recovery.

297: High-dose misoprostol with subsequent foley versus low-dose misoprostol with concurrent foley for cervical ripening

A prominent trial showed low-dose misoprostol with concurrent Foley for cervical ripening increased the likelihood of vaginal delivery and shortened the median time to delivery when compared to either method alone, prompting many institutions to adopt this protocol. Our study aimed to address differences in labor outcomes with low-dose misoprostol and concurrent Foley versus high-dose misoprostol and subsequent Foley. This was a retrospective before-and-after study of nulliparous women with non-anomalous, term, singletons delivered at the University of California San Francisco (UCSF) in two separate two-year periods before and after changes in UCSF’s IOL protocol. In May 2017, the term IOL protocol changed from 50-100 mcg PO every 4 hours with subsequent Foley to 25 mcg PO every 2 hours with concurrent Foley. The primary outcome was time from first misoprostol dose to delivery. The Kruskal-Wallis test was used to compare median values, and chi-squared tests were used to compare proportions. 1,496 women met the inclusion criteria. Comparing the high-dose group (n = 698) to the low-dose group (n = 798), we found no statistically significant differences in time to delivery (29.1 vs 29.9 hr, P = 0.689), rate of cesarean delivery (30% vs 26%, P = 0.086), or cesarean delivery for fetal indications (11% vs 8%, P = 0.145). Among vaginal delivers, there was similarly no difference in time to delivery (26.9 vs 27.0 hr, P = 0.893). Although the low-dose cohort had a lower cumulative misoprostol dose (100 mcg vs 150 mcg, P < 0.001), this group had a higher number of misoprostol administrations (4 vs 2, P < 0.001). Protocols using high-dose misoprostol with subsequent Foley and low-dose misoprostol with concurrent Foley did not differ in time to delivery, time to vaginal delivery, or likelihood of vaginal delivery. In the absence of a superior clinical method for cervical ripening a shared-decision making model, incorporating patient preference, may be applied regarding timing of Foley catheter placement and dosing of misoprostol.

1474. Epidemiology and Outcomes of Hospitalized Patients with Urinary Tract Infections (UTI) Due to Multidrug-Resistant Organisms (MDRO)

BackgroundMDROs are a threat to public health, and UTIs are the most common type of MDRO infection. The objective of this study was to describe risk factors and outcomes associated with MDRO UTIs.MethodsA retrospective cohort study with IRB approval from Barnes-Jewish Hospital, January 1, 2006–November 8, 2017. Demographics, comorbidities, procedures, outcomes, and culture data were collected from the BJC Healthcare Informatics database for hospitalized patients with MDRO UTIs. MDROs were defined according to European and US CDC standards.ResultsA total of 7,945 hospitalized patients with MDRO UTI were identified. Demographics and comorbidities are described in Table 1. Notably, 69% of patients were female, 23% had underlying urinary system disease, and at least 20% had a foley catheter in place. Of these patients, 18% required an intensive care unit (ICU) stay within 48 hours before/after the positive urine culture, and 7% died during their hospitalization (Table 2). The most frequent cause of UTIs was MDR Enterobacteriaceae (Table 3).ConclusionPatients who are hospitalized with MDRO UTIs frequently have underlying urinary system disease and/or foley catheter. MDRO UTIs are a significant cause of morbidity and mortality in hospitalized patients, with 18% requiring an ICU stay, and death in 7% during the hospitalization. Further research is needed regarding risk factors and interventions to prevent, detect, and treat MDRO UTIs. Disclosures All authors: No reported disclosures.

1329 Surgical Management of Longitudinal Vaginal Septum and Complete Uterine Septum

Video Objective To illustrate the steps for surgical correction of a longitudinal vaginal septum and complete uterine septum using narrative video footage. Setting A longitudinal vaginal septum and complete uterine septum are anomalies of Mullerian duct development that occur during embryological development. The exact incidence of Mullerian anomalies is difficult to determine, since women with them are often not diagnosed if asymptomatic, but is approximately 2-3%. In women who present with infertility, the incidence of uterine anomalies is often higher, approximately 5-10%. Although some women with vaginal anomalies are asymptomatic, some may note difficulty inserting tampons or dyspareunia. Reproductive outcomes in women with a complete uterine septum include possible decreased chance of implantation, and increased risk of spontaneous abortion and preterm labor/delivery. Benefits of surgical correction of a uterine septum include possible improved reproductive success and decreased poor obstetric outcomes. Interventions In this video, we illustrate the key surgical steps of excision of a longitudinal vaginal septum and hysteroscopic metroplasty for a complete uterine septum resection. Key surgical steps include: 1. Exam under anesthesia Lidocaine with epinephrine injection into vaginal septum. 2. Excision of septum with mayo scissors and re-approximation of vaginal mucosal edges. 3. Dilation of one side of cervical canal and placement of pediatric foley catheter to instill methylene blue-dyed fluid. 4. Hysteroscopic incision of septum using bipolar resectoscope until blue dye is visualized. 5. Complete incision of uterine septum. 6. Placement of uterine balloon for endometrial healing. 7. Vaginal packing placed to promote vaginal healing. Conclusion Surgical management of a longitudinal vaginal septum and complete uterine septum is a minimally invasive procedure to correct these Mullerian anomalies that could impact a woman's quality of life and possible reproductive success in the future.

Urology in Undergraduate Medical Education.

Urology is an essential topic in undergraduate medical education (UME). The objective of this article is to review the current state of exposure to urology in medical school, to discuss why it is critical to maintain a urology curriculum, and to review methods in establishing an effective curriculum for all students with limited resources. UME curriculum in urology should be geared toward the widest group of students, namely those entering primary care or internal medicine, where patients with urologic complaints are most likely to first present. Hands-on teaching should focus on skills such as the genitourinary exam and Foley catheter placement, while ancillary modules should be utilized for complex concepts. Medical schools do not sufficiently incorporate didactics in urology as part of their core curriculum. As such, educators in urology must develop curricula that provide fundamental knowledge to all students, especially those pursuing non-urologic specialties who will undoubtedly treat patients with urologic complaints.

Symptomatic vulvar mucinous cyst: A case report and review of the literature

BackgroundVulvar mucinous cysts are rare, benign, noninvasive masses. They can be mistaken for cysts of Bartholin gland, Skene gland, vestibular, or canal of Nuck. Generally, they may be left untreated, but observed. However, if symptomatic, they may require surgical removal.CaseWe report a large vulvar mucinous cyst in a 29-year-old woman with no contributory medical history. Excision of the mass was performed because its size had begun to cause symptoms. The diagnosis of a mucinous cyst was based on radiological and clinicopathologic features. The patient developed a post-operative vulvar hematoma and was discharged 2 days after the surgery with a Foley catheter in place. Continued follow-up was maintained for the hematoma, which drained spontaneously and resolved without incident. There has been no recurrence of the cyst after completion of short-term surgical follow-up.ConclusionVulvar mucinous cysts are rare masses. We present the diagnosis and treatment of a large vulvar mucinous cyst. The cyst was completely removed during surgery, but long-term surveillance for recurrence is currently being conducted.

Re: Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection.

Re: Impact of Foley Catheter Placement by Medical Students on Rates of Postoperative Urinary Tract Infection.