Foley Catheter Placement Research Articles

The Decision to Incision Curriculum

PURPOSE: To evaluate the effectiveness of a preoperative skills curriculum, and to assess competence in associated level 1 Milestones. BACKGROUND: With implementation of the Milestones, medical educators must ensure that incoming interns have met various level 1 Milestones, including those related to preoperative skills for which formal education is lacking. METHODS: Thirteen fourth-year medical students completed the Decision to Incision curriculum which taught preoperative consent, patient positioning, Foley catheter placement, surgical scrub, and preoperative time out. Knowledge, skills, and competency were assessed using checklists before and after the educational intervention. Performance was measured using a 5-point Likert scale, and competency was assessed as present or absent. Change in performance was analyzed using χ2 and t tests. RESULTS: Overall performance significantly improved for 3 of 5 skills with scores improving from 2.69 to 4.33 (P<.001) for consent, 2.08–4.3 (P<.001) for positioning, and 2.23–3.69 (P<.001) for time out. The percentage meeting Milestone competency significantly improved from 30.8% to 84.6% (P=.005) for consent, 0–100% (P<.001) for positioning, 69.2–100% (P=.03) for scrub, and 15.4–100% (P<.001) for time out. Overall, competence was achieved in 93.8% (61/65) of skills assessments. DISCUSSION: The Decision to Incision Curriculum significantly improves preoperative skills, particularly skills students are unlikely to perform during medical school but may perform on day 1 of residency. This curriculum also facilitates achievement and documentation of competence in multiple Milestones.

Peritonitis-induced septic shock: Atypical Foley catheter placement

Peritonitis-induced septic shock: Atypical Foley catheter placement

Incidentally Discovered Foley Catheter Placement Into a Transplanted Kidney

Although unusual, placement of a Foley catheter into the renal pelvis or ureter has been reported. Proposed predisposing factors for errant placement include pre-existing hydronephrosis or congenital ureteral orifice enlargement. We report a case where aberrant placement of a Foley catheter into the renal pelvis of a transplanted kidney was detected by ultrasound in a patient being evaluated for acute kidney injury. The Foley had been in place for 2 weeks. This is the only reported case we are aware of involving accidental catheterization of a transplant's renal pelvis.

The use of a nursing home in central bundle care reduces the effectiveness of urinary tract infection

Purpose: Urinary tract infection is one of long-term care residents infections occur most frequently, According to statistics, there are as many as 50% of the residents have a long-term indwelling catheter, and urinary tract infections and catheter placement has its relevance, indwelling catheter a few days more elderly, the likelihood of the occurrence of urinary tract infection is higher,Through the catheter placement checklist designed foley catheter placement and foley catheter placement care evaluation form to assess the care and use of the audit form of education and training and auditing foley catheter Bundle Care Strategies to reduce residents of indwelling foley catheter urinary tract infection, the ability to enhance the care of nurses and care attendants, enhance quality of care quality institutions that residents have access to safe and comfortable in life. Methods: Date: July4, 2014 to 30 September 30,2014; Tools: Designed for use nursing home checklist foley catheter placement, Foley catheter home care assessment form, foley catheter care assessment audit table set, and translate Vietnam text for nurses and Taiwan, according to foreign attendants use. Educational training: Classroom speech urinary tract infectionrelated knowledge, catheters Bundle Care Policy and related pretest and posttest questionnaire (in Vietnamese), indwelling catheter care reply teach the skills, training, seed care colleagues modular units internal improvement activities to promote long-term monitoring of audit, develop reward and punishment mechanism. Results: The urinary tract infection catheter placement April-June average 7.93&,July-September6.2 &, the improvement rate of 1.31 &; hospital handwashing compliance rate of 33.6% up to 53.5; urinary tract infectionrelated knowledge, before class The total average pretest score 63.6, nurses: 85.9 according to attendants: 53.2, after measuring the total average score of 88.5, paramedics: 95.6, care attendants: 86.3; modular care measures before class average pretest score: 60.3, nursing staff: 71.8, according to the attendants: 53.8, after measuring the total average score of 85.4, paramedics: 92.5 according to attendants: 85.9. Conclusion: Indwelling foley catheter Bundle Care implementation of successful elements, including the unit in charge of the support and promotion, regular education and training, standardization of monitoring and feedback, this measure is long-term and sustained, so there must be good planning.

Surgical management of traumatic penile amputation: a case report and review of the world literature.

IntroductionThere is paucity of case reports that describe the successful reimplantation of a penis after amputation. We sought to report on self-inflicted penile amputation and comment on its surgical management and review current literature.AimTo report on self-inflicted penile amputation and comment on its surgical management and review current literature.MethodsA 19-year-old male with no prior medical history presented to our university-affiliated trauma center following sustaining a self-inflicted amputation of shaft penis secondary to severe methamphetamine-induced psychosis. He immediately underwent extensive reconstructive reimplantation of the penis performed jointly by plastics and urology teams reattaching all visible neurovascular bundles, urethra, and corporal and fascial layers. The patient was discharged with a suprapubic tube in place and a Foley catheter in place with well-healing tissue.Main Outcome MeasuresTo review the current published literature and case reports on the management of penile amputation with particular emphasis its etiology, surgical repairs, potential complications and functional outcomes.ResultsWe report herein a case of a traumatic penile amputation and successful outcome of microscopic reimplantation and review of the published literature with particular comments on surgical managements.ConclusionWe review the literature and case reports on penile amputation and its etiology, surgical management, variables effecting outcomes, and its complications. Raheem OA, Mirheydar HS, Patel ND, Patel SH, Suliman A, and Buckley JC. Surgical management of traumatic penile amputation: A case report and review of the world literature. Sex Med 2015;3:49–53.

Simplified percutaneous large bore suprapubic cystostomy for acute urinary retention—A cost saving procedure

Introduction and objectivesCommercial cystostomy kits/trocars are not always readily available in regions with insufficient funding. Open suprapubic cystostomy procedures are yet prevalent. This paper presents a simplified percutaneous suprapubic cystostomy technique that utilizes specially selected surgical blades in the place of commercial trocars. Subjects and methodsEighty-nine male patients with acute urinary retention underwent puncturing of the visibly and palpably distended bladder with surgical blade size 20 (7mm diameter), 21 or 22 (9mm diameter) to allow resistance-free placement of Foley catheter size 18Fr (maximum diameter of 6mm) or size 20 (maximum diameter of 6.7mm) respectively under local anesthesia along the mid abdominal line in a sagittal direction – two finger breadths above the pubic symphysis. The main outcome measures were to determine the success rate and the encountered complications. ResultsSuccessful bladder puncture and insertion of the Foley catheter of choice was possible in all cases. There was no mortality and no adjacent visceral injury. There were two cases of catheter blockage with clots that were easily flushed out. ConclusionsEmergency cystostomy can be safely achieved through direct puncture of the visibly and palpably distended bladder with appropriately selected surgical blades that will subsequently allow resistance-free placement of sizable Foley catheters.

High-dose rate brachytherapy in localized penile cancer: short-term clinical outcome analysis

PurposeTo assess clinical outcomes of high-dose rate interstitial brachytherapy (HIB) in localized penile carcinoma.Material and methodsFrom 03/2006 to 08/2013, patients with biopsy-proven T1-T2 (<4 cm) non-metastatic localized penile squamous cell carcinoma underwent HIB. Under general anaesthesia, after Foley catheter placement, needles were placed in the target volume using a dedicated template. Planification was carried out with a post-implant CT-scan to deliver a total dose of 36 Gy in 9 fractions over 5 days (in adjuvant setting) or 39 Gy in 9 fractions over 5 days (as monotherapy). Dose-volume adaptation was manually achieved using graphical optimization. Dosimetric data and clinical outcomes were retrospectively analyzed. Toxicities were graded using the CTC v4.0.ResultsWith a median follow-up of 27 months [5.1-83], 12 patients including 8 T1a, 3 T1b and 1 T2 N0 underwent HIB (sole therapy: 11 pts; adjuvant: 1 pt). The actuarial 5-year relapse-free, cause-specific and overall survival rates were 83%, 100% and 78% respectively. Comparing pre and post treatment evaluation, no IPSS or IIEF-5 changes were reported. Dermatitis was reported systematically 1 month after HIB including 6 G1, 5 G2 and 1 G3. Only 1 experienced long-term G3 successfully treated with hyperbaric oxygen therapy. One urethral meatus stenosis G3 required meatotomy.ConclusionIn selected patients with T1-T2 localized penile cancer, HIB may be considered as an optional conservative therapy. Longer follow-up is needed to confirm these encouraging preliminary results.

Contemporary predictors of extended postoperative hospital length of stay after carotid endarterectomy

Hospital length of stay (LOS) contributes to costs. Carotid endarterectomy (CEA) is performed frequently by vascular surgeons, making contemporary CEA LOS rates and predictors vital knowledge for quality evaluation and cost containment initiatives. Using a prospective single-institution database, we retrospectively identified consecutive patients undergoing CEA from 2001 to 2011. Demographic and perioperative factors were prospectively collected. The primary end point was extended postoperative LOS (ELOS), defined as postoperative LOS ≥2 days. Factors associated with ELOS were analyzed in a multivariable logistic regression model. Rates of 1-year readmission and death were compared with the Kaplan-Meier method (log-rank test). Eight hundred forty patients underwent 897 CEAs with 39% of procedures among females and 35% for symptomatic disease. One hundred two (11.4%) patients were inpatients prior to the day of CEA ("preadmitted"); their preoperative days by definition are not included in ELOS. Median postoperative LOS was 1 day (interquartile range, 1-2). Four hundred fourteen patients (46.2%) had ELOS. Preadmission was associated with ELOS (72% vs 41%; P < .01) and ELOS patients were less likely to be discharged home (11.9% vs 1.5%; P < .01). There was no association between ELOS and unplanned 30-day postdischarge readmission (6.0% vs 7.0%; P = .59). On multivariable analysis, preoperative factors significantly associated with ELOS included preadmission (adjusted odds ratio [OR], 3.3; 95% confidence interval [CI], 1.9-5.7; P < .001), history of congestive heart failure (OR, 2.1; 95% CI, 1.1-4.2; P = .03), female gender (OR, 1.9; 95% CI, 1.4-2.6; P < .001), and history of chronic obstructive pulmonary disease (OR, 1.7; 95% CI, 1.0-2.9; P = .04). Operative factors included electroencephalography change (OR, 1.9; 95% CI, 1.2-3.2; P = .01), operating room start time after 12:00 pm (OR, 1.7; 95% CI, 1.2-2.4; P < .01), and total operating room time (OR, 1.5 per hour; 95% CI, 1.2-2.9; P < .01). Postoperative factors included transfer to intensive care unit (OR, 5.4; 95% CI, 3.1-9.4; P < .01), number of in-hospital postoperative complications (OR, 3.7; 95% CI, 2.2-6.5; P < .01), and Foley catheter placement (OR, 2.1; 95% CI, 1.3-3.4; P < .01). Over 1 year, ELOS was associated with increased hospital readmission (93.6% vs 84.7%; log-rank test, P < .01) and decreased survival (95.1% vs 98.3%; log-rank test, P < .01). Nearly half of CEA patients were discharged on or after postoperative day 2. Interventions on modifiable risk factors, such as early Foley catheter placement to prevent urinary retention and morning CEA scheduling, may decrease LOS. ELOS may identify a subset of patients at increased risk for long-term readmission and mortality.

Missed signs of autonomic dysreflexia in a tetraplegic patient after incorrect placement of urethral Foley catheter: a case report

BackgroundAutonomic dysreflexia is poorly recognised outside of spinal cord injury centres, and may result in adverse outcomes including mortality from delayed diagnosis and treatment. We present a spinal cord injury patient, who developed autonomic dysreflexia following incorrect placement of urethral Foley catheter. Health professionals failed to recognise signs and symptoms of autonomic dysreflexia as well as its significance in this tetraplegic patient.Case presentationA tetraplegic patient started sweating profusely following insertion of a Foley catheter per urethra. The catheter was draining urine; there was no bypassing, no bleeding per urethra, and no haematuria. Patient’s wife, who had been looking after her tetraplegic husband for more than forty years, told the health professionals that the catheter might have been placed incorrectly but her concerns were ignored. Ultrasound scan of urinary tract revealed no urinary calculi, no hydronephrosis. The balloon of Foley catheter was not seen in urinary bladder but this finding was not recognised by radiologist and spinal cord physician. Patient continued to sweat profusely; therefore, CT of pelvis was performed, but there was a delay of ten days. CT revealed the balloon of Foley catheter in the over-stretched prostate-membranous urethra; the tip of catheter was not located within the urinary bladder but was lying distal to bladder neck. Flexible cystoscopy was performed and Foley catheter was inserted into the bladder over a guide wire. The intensity of sweating decreased; noxious stimuli arising from traumatised urethra might take a long while to settle.ConclusionInserting a catheter in a tetraplegic patient should be carried out by a senior health professional, who is familiar with spasm of bladder neck which occurs frequently in tetraplegic patients. Facilities for urgent CT scan should be available to check the position of Foley catheter in spinal cord injury patients when a patient manifests signs and symptoms of autonomic dysreflexia following insertion of a urethral catheter. When an isolated symptom such as flushing or sweating is noticed in a tetraplegic patient, doctors should seek out other signs/symptoms of autonomic dysreflexia.

The Timing of Adverse Events with Foley Catheter Preinduction Cervical Ripening; Implications for Outpatient Use

We sought to determine the rate and timing of adverse events that occur during preinduction cervical ripening using the Foley catheter before extrusion of the balloon and institution of oxytocin. Using electronic medical records, we identified all women who presented for preinduction cervical ripening using a Foley catheter with a term (≥37 weeks) singleton vertex live fetus from January 1, 2006, to June 14, 2009. Women were excluded if they had had a previous cesarean delivery, gestational hypertension or preeclampsia, pregestational diabetes, rupture of membranes before induction, fetal anomaly, or antepartum stillbirth. Outcomes were cesarean delivery for nonreassuring fetal tracing, vaginal bleeding, placental abruption, or intrapartum stillbirth occurring between 2 hours after Foley catheter placement and 6 am. Among 2,514 women, 1,905 met the inclusion criteria. No adverse outcomes were noted among term, singleton uncomplicated pregnancies receiving a Foley catheter for preinduction cervical ripening who met inclusion criteria (relative risk, 0.0; 95% confidence interval, 0.0-0.002). In a low-risk population, the use of the Foley catheter for preinduction cervical ripening was associated with no adverse outcomes. It appears to be a safe mechanism for cervical ripening and has the potential for use in the outpatient setting in a selected subset of women.

Focal Stereotactic Body Radiation Therapy for Prostate Cancer: A Dosimetric Comparison Between Whole and Hemi-Gland Treatment

Focal Stereotactic Body Radiation Therapy for Prostate Cancer: A Dosimetric Comparison Between Whole and Hemi-Gland Treatment

A prática do (a) enfermeiro (a) na inserção do cateter de Folley em pacientes de unidade de terapia intensiva: limites e possibilidades

Backgound and Objectives: Nursing has an important role in urinary tract infection prevention and control. Urinary catheters insertion represents the local topography with the highest rate of hospital infection. Foley catheter placement is performed solely by the nurse and requires aseptic techniques during its performance, thus preventing risks to the patients. The study aimed to evaluate the training of nurses on Foley catheter insertion and point out limits and possibilities of this practice in patients at the Intensive Care Unit (ICU) of Hospital Geral do Interior da Bahia (HGIB). Methods: This was a qualitative, exploratory and descriptive study. Data collection was carried out through semi-structured interviews. After data analysis, two categories were evaluated, namely: the training of nurses on Foley catheter insertion in ICU patients and the limits and possibilities of Foley catheter insertion practice by nurses in ICU patients. Bardin analysis was used for data analysis. Results: The study shows that the nurse’s practice on Foley catheter insertion in ICU patients is based on the use of aseptic techniques for urinary tract infection prevention, theoretical and practical knowledge on Foley catheter insertion in ICU patients, knowledge on urinary tract infections and associations with catheter insertion, whereas the limits and possibilities of Foley catheter insertion practice by nurses are understood through measures to minimize the risk of hospital infection caused by long-term catheter use in the ICU. Nurses point out that the risks of hospital infection are inherent to long-term catheter use. This is an important fact, as the knowledge or its absence may constitute a limit or possibility for Foley catheter insertion practice by the nurse in ICU patients. Conclusion: Nurses must seek the systematization of knowledge, which warrants support for the team, as well as information, safety and prompt care, allowing the reduction of urinary tract infection rates and its complications in critically-ill patients. Training of the multidisciplinary team is necessary, as well as continuing education, interaction and communication with the medical team and the Hospital Infection Control Committee (CCIH) to prevent and fi ght against hospital infections. KEYWORDS: Nursing. Hospital Infection Control. Intensive Care Unit. Catheter Folley.

The impact of Foley catheter placement by medical students on rates of postoperative urinary tract infection

He, Jin MD, PhD; Kilic, Arman MD; Soares, Kevin MD; Lindeman, Brenessa MD; Wick, Elizabeth C. MD, FACS Author Information

On-Q® pain pump versus epidural for postoperative analgesia in children

The On-Q(®) pain pump provides a continuous infusion of local anesthesia for management of postoperative pain. The objective of this study was to assess the efficacy and outcomes of the On-Q(®) pump compared to continuous epidural in children postoperatively. We performed a retrospective review of patients in our hospital who received a postoperative epidural or On-Q(®) pump from 2005 to 2008. Patients were sub-categorized by incision type. Seventy patients received epidural and 66 On-Q(®). On-Q(®) therapy was longer by 1 day (p < 0.0001), but did not affect postoperative length of stay. Patients with On-Q(®) pumps had a decreased rate of Foley catheter placement (p = 0.002) and shorter duration of catheter use by more than a day (p < 0.001). Moderate to severe pain was similar in the two groups on postoperative days 0-5. Supplemental narcotic use was higher in the On-Q(®) group only on postoperative day 1 (p = 0.005) and in patients with midline and transverse abdominal incisions. No differences were seen in time to ambulation or recovery of postoperative ileus. The On-Q(®) pain pump is an effective method for postoperative pain control, without the inherent risks of epidural catheters.

Massive Transfusion Protocol: Saving Our Patients Lives

Poster Presentation Background Postpartum hemorrhage remains the single most significant cause of maternal death worldwide. It occurs in 2% to 6% of women who deliver vaginally. It can occur early ( 24 hours and 500 ml blood loss following vaginal delivery, >1,000 ml following cesarean, or a 10% decrease in hematocrit (HCT). Interventions for postpartum hemorrhage include treating the underlying cause and managing the symptoms with medications, surgical interventions, placement of uterine tamponade devices, and blood volume replacement. Improved outcomes are seen with coordinated team efforts and established hospital processes. Case A 45‐year‐old, G4P1 presented to labor and delivery in early labor at term. On admission her HCT was 39.9. Her labor was augmented, and she progressed quickly and delivered vaginally. Following delivery of her placenta, she began to hemorrhage. The patient was treated in the delivery room with fundal massage, Misoprostol, Hemabate, placement of Foley catheter, and Bakri balloon. Anesthesia and a second obstetrician were consulted and a disseminated intravascular coagulation (DIC) panel and two units of packed red blood cells were ordered. The patient became symptomatic and was transferred to the operating room (OR). A Code White was called and an interdisciplinary team of obstetricians, laboratory, intensive care unit (ICU), and spiritual care personnel responded. After intubation in the OR, the patient continued to hemorrhage. The decision was made to proceed with a hysterectomy. A massive transfusion protocol was initiated with the blood bank to facilitate preparation and thawing of blood products. During the surgical procedure, the patient developed ventricular tachycardia, and a Code Blue was activated. Additional interdisciplinary team members from the emergency department, pharmacy, and ICU responded. At this time, the patient's HCT dropped to 21.9, fibrinogen Conclusion To efficiently manage massive postpartum hemorrhage, early treatment must be initiated, interdisciplinary teams should be utilized, and in this case our massive transfusion protocol was activated. Coordination of care with the blood bank was critical to receive the necessary blood products in a timely manner.

Glidewire-assisted Foley catheter placement: a simple and safe technique for difficult male catheterization

Difficulty in Foley catheter placement is a frequently encountered problem. We describe a simple and safe technique for this condition. Rather than using force, which may lead to the formation of a false passage, one should place a glidewire into the bladder through the area of resistance, followed by the placement of a Foley catheter over the glidewire. This is a very easy procedure and can be taught to nurses and nurse practitioners to avoid an unnecessary call for a urologist in the emergency department.

Percutaneous Management of Postoperative Duodenal Stump Leakage with Foley Catheter

This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites.

Ureteral rupture from aberrant Foley catheter placement: A case report

We present the case of a 59 year old female with history of severe neurologic dysfunction from advanced multiple sclerosis who presented with lethargy and oliguria several hours after urethral Foley catheterization. A contrast-enhanced CT scan of the abdomen/pelvis showed an aberrantly placed Foley catheter with its balloon inflated in the proximal left ureter, a rare complication of Foley catheterization with only 5 other cases reported. Incomplete ureteral rupture was demonstrated and confirmed by a followup CT scan in the urographic phase. One of our institution's Interventional Radiologists then placed a nephroureteral stent across the injured ureter to facilitate healing. The patient expired 9 days after the procedure from unrelated sepsis from a chronic stage IV decubitus ulcer, so long term monitoring could not be performed. Following description of our case, we conduct a literature review of presentations, imaging characteristics, and treatment of ureteral Foley catheter placement.

Preventing inadvertent placement of foley catheter into prostatic urethra during suprapubic trocar cystostomy: A simple face-saver trick

During suprapubic cystostomy using standard technique, there always remains a chance of accidental migration of foley catheter through bladder neck into prostatic urethra. We herein present a point of technique in which by keeping the direction of cannula slot toward umbilicus and making it vertical or slightly tilting its tip toward umbilicus during foley placement, prevents the inadvertent migration of catheter into prostatic urethra and further complications.

BK Virus Disease Following Allogeneic Stem Cell Transplantation: A Cohort Analysis

Abstract 1927BK virus (BKV) reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) affects the genitourinary (GU) tract with manifestations ranging from asymptomatic viruria to severe hemorrhagic cystitis. Knowledge about epidemiology, morbidity and clinical spectrum of BKV disease is limited. We studied a recent HSCT cohort at our institution to assess and quantify the incidence and severity of BKV disease.Between January 1, 2010 and December 31, 2011, 491 patients underwent first HSCT. BKV disease was defined as detection of BKV by PCR testing in association with GU symptoms. BKV disease was considered severe when patients had at least 1 of the following: hematuria with clot formation, GU tract inflammation on imaging, need for invasive GU interventions, or hospitalization for BKV disease management. Medical records were reviewed for patient and HSCT characteristics. For patients with BKV disease, reason for testing, clinical presentation and course, imaging results, and treatments were captured. Time at risk was censored at time of death, second HSCT or on July 1, 2012. Fisher's exact or Wilcoxon test were used to compare variables. Cox modeling was used to analyze potential risk factors for BKV disease.168 (34.2%) patients were tested for BKV at our institution during the study period. Median time to testing was 61 days (range, 2–663; IQR 19.5 – 114). 88 patients (17.9%) were diagnosed with BKV disease with an incidence rate of 0.54/1000 patient-days (95% CI, 0.43 – 0.66). Most common symptoms at presentation and during a first BKV disease episode are shown in the Table.TableCommon symptoms of BKV disease (n=88).SymptomAt presentationDuring first episodeDysuria45 (51.1%)59 (67.0%)Hematuria31 (35.2%)42 (47.7%)Urinary frequency16 (18.2%)40 (45.5%)Urgency10 (11.4%)21 (23.9%)Bladder spasms3 (3.4%)15 (17.0%)Flank pain3 (3.4%)11 (12.5%)31 patients had severe BK disease (35.2%, 6.3% of the cohort): 17 patients (19.3%) had hematuria with clot formation; 16 patients (18.2%) demonstrated GU tract inflammation on imaging studies, including bladder wall (14, 15.9%) or ureteral (5, 5.7%) thickening. 4 patients were hospitalized for management of BKV associated symptoms. Invasive GU interventions were performed in 16 (18.2%) patients including Foley catheter placement in 12, bladder irrigation in 7, intravesicular cidofovir in 3, cystoscopy in 2, and alum instillation in 1. Additional prescribed treatments during BKV disease episodes included quinolones (39, 44.3%), antispasmodics (29, 33.0%), IVIG (20, 22.7%) and pain medications (18, 20.5%). Cidofovir was used in 7 (8.0%) patients and leflunomide in 8 (9.1%). 3 patients had concomitant bacterial GU infections; 1 patient had GU adenovirus disease. Patients (n=71) were symptomatic for a median of 31 days (range 2–385, IQR 9–67). Additional BKV disease episodes were seen in 26/88 patients (29.5%).Median initial urine BKV load was 3.4×108 copies/mL (range; 600, >1×1010). Median peak urine BKV load during first BKV disease episode was 1.5×109 c/mL (range; 600, >1×1010). Blood BKV loads were obtained in 35 patients, with median initial BKV load of 800 c/mL (range, 0, 1.52×106) and median peak BKV load of 2000 c/mL (range, 0, 1.52×106). Detection of BKV viremia was 74% sensitive and 38% specific for severe BKV disease.Cohort characteristics associated with increased BKV disease risk included myeloablative conditioning (p=0.01), cyclophosphamide conditioning (p=0.0008), cord blood HSCT (p=0.03), GVHD prophylaxis with mycophenolate (MMF, p=0.0006) and acute GVHD (aGVHD) grades II-IV (p< 0.0001). On multivariate Cox modeling, time-dependent aGVHD (adjusted HR [aHR] 3.65, 95%CI 2.23 – 5.97), MMF use (aHR 3.11, 95%CI 1.76 – 5.48), and cyclophosphamide use (aHR 1.95, 95%CI 1.25 – 3.04) remained significant. Time-dependent aGVHD (aHR 5.02, 95%CI 2.20 – 11.5), cord blood HSCT (aHR 4.60, 95%CI 1.67 – 12.7) and cyclophosphamide use (aHR 2.17, 95%CI 1.04 – 4.56) were independent risk factors for severe BKV disease.BKV disease is a common complication of HSCT, associated with significant and prolonged morbidity, especially in the setting of aGVHD, cyclophosphamide and MMF use, and after cord blood HSCT. Prospective studies are needed to better define the morbidity of BKV disease and to properly inform the impact of future prophylaxis and treatment trials. Disclosures:Off Label Use: ciprofloxacin, levofloxacin, moxifloxacin, cidofovir, leflunomide use for treatment of BK virus infection. Marty:Chimerix: Consultancy, Research Funding.