Foley Catheter Balloon Research Articles

YOUR GUESS IS AS GOOD AS MINE; DEALING WITH RECURRENT SECONDARY POST-PARTUM HAEMORRHAGE CAUSED BY UTERINE ARTERY PSEUDOANEURYSM

Uterine artery pseudoaneurysm (UAP) is a rare cause of secondary postpartum haemorrhage (PPH). Ultrasound may suggest this condition and pelvic arteriography is done to confirm the diagnosis and to institute treatment via uterine artery embolization. Herein, we describe a case who experienced recurrent episodes of secondary PPH with inconclusive findings on ultrasound and pelvic arteriography. Foley catheter balloon was used several times to arrest acute bleeding episodes. Exploratory laparotomy revealed pseudoaneurysm of the branch of right uterine artery. Transection and ligation of the involved artery followed by ligation of bilateral internal iliac arteries were performed. Post operation, patient made a full recovery. This case highlights uterine artery pseudoaneurysm as a rare but important cause for secondary PPH. We recommend a simple measure to provide intrauterine tamponade by using Foley catheter balloon. Diagnosis of UAP may not be straightforward and this condition may only be discovered during surgery.

Intravaginal misoprostol versus Foley catheter balloon for induction of labor: A systematic literature review, meta-analysis, meta-regression, and trial sequential analysis

Induction of labor is a common procedure in obstetrics. Numerous methods (both mechanical and pharmacological) are used for induction, however, there is lack of consensus for a safe effective means. Objective: The aim of this review was to compare intravaginal Misoprostol to Foley catheter balloon for induction of labor and cervical ripening in uncomplicated pregnancy, with regards to safety and effectiveness. Method: We systematically searched MEDLINE and EMBASE for randomized controlled trials comparing both means. Included studies were assessed for risk of bias and certainty of evidence using GRADE methodology. Results were presented as forest plots of odds ratio or mean difference. Predefined subgroup analyses and meta regression were conducted to account for heterogeneity, and the conclusiveness of results was evaluated in a trial sequential analysis (TSA).Results: 19 studies were identified, the primary outcome of caesarean section showed a 20% reduction in odd of CS with Misoprostol [OR = 0.8 (95% CI: 0.67 – 0.96; p = 0.02), secondary outcomes of NICU admission and APGAR score < 7 at 5 minutes were not different between both groups, while Misoprostol induced group had a lower intervention to delivery interval and a higher incidence of maternal tachysystole. Quality of evidence was downgraded low to Very low for the different outcomes, and results were deemed inconclusive by TSA.Conclusion: Low quality inconclusive evidence suggest decreased likelihood of CS with intravaginal Misoprostol induction compared to Foley catheter balloon.

Management of Life-Threatening Hemorrhage from Maxillofacial Firearm Injuries Using Foley Catheter Balloon Tamponade.

The aim of this study is to evaluate the efficacy of Foley catheter in the management of hemorrhage from penetrating maxillofacial injuries in austere environment. This retrospective cohort study evaluated all penetrating head and neck trauma caused by firearm injuries reported to a military hospital at a forward aid location during 2015-2017. Foley catheter was used in the emergency management of bleeding in 11 cases. The effectiveness of this technique in controlling hemorrhage, its indication, contraindications, and complications has been explained. Out of 26 penetrating injuries received during the time period, 11 patients underwent Foley catheter balloon tamponade for the control of hemorrhage. Ten out of 11 patients responded adequately to balloon tamponade. One patient with a bullet lodged inside the neck underwent immediate surgical exploration for its removal and repair of internal jugular vein. No neurological deficits or complications were noted in any of the patients. Foley catheter balloon tamponade is very effective in managing hemorrhage from head and neck penetrating injuries. It significantly reduces the mortality by controlling bleeding from the major vessels especially in a combat environment.

Foley catheter balloon tamponade as a method of controlling iatrogenic pulmonary artery bleeding in redo thoracic surgery

Foley catheter balloon tamponade as a method of controlling iatrogenic pulmonary artery bleeding in redo thoracic surgery

MEchanical DIlatation of the Cervix­­ in a Scarred uterus (MEDICS): the study protocol of a randomised controlled trial comparing a single cervical catheter balloon and prostaglandin PGE2 for cervical ripening and labour induction following caesarean delivery

IntroductionLabour induction in women with a previous caesarean delivery currently uses vaginal prostaglandin E2 (PGE2), which carries the risks of uterine hyperstimulation and scar rupture. We aim to compare the...

A modified guidewire technique for deflating a non-deflating Foley catheter in the emergency department

Stuck catheter due to a non-deflating balloon is one of the complications of urinary catheters and these patients usually seek visits in the emergency department. The guidewire technique for deflating the balloon of a stuck Foley catheter is easy and non-invasive. But due to the characteristics of the guidewire in some instances, it could not be passed through the tight and narrow inflation port of the Foley catheter and the procedure would be frustrating for the physician and the patient. We made a modification that was successful in a case series of 8 male patients and made further invasive steps (rupture of the balloon by suprapubic or transrectal puncture) unnecessary.

Mechanical Properties of the Every Second Matters for Mothers-Uterine Balloon Tamponade (ESM-UBT) Device: In Vitro Tests.

Objective Postpartum hemorrhage (PPH) is the most common cause of maternal mortality and morbidity worldwide, most of which occurs in resource-poor settings. Placement of a uterine balloon may be life-saving in uncontrolled PPH. The Every Second Matters for Mothers-Uterine Balloon Tamponade (ESM-UBT) device is an ultra-low-cost uterine balloon designed for global access. The purpose of this study was to evaluate the mechanical properties of the ESM-UBT device. Study design Intraluminal pressures, diameters, and burst volumes of condom uterine balloons and Foley catheter balloons of ESM-UBT devices were measured in open air and inside uterus models. Condom uterine balloons were tested with uterus model sizes of 100, 250, and 500mL. The condom-catheter O-ring attachment tensile strength was also evaluated. Results All 28 samples of ESM-UBT condom uterine balloons maintained their integrity for at least 3 hours when subjected to pressures of 200 mm Hg or greater across each of the tested uterine volumes. No Foley catheter balloons burst after instillation of 30mL, O-rings withstood forces of 15.4 ± 2.1 N, and condom uterine balloons stretched to 35.8 ± 2.1 cm without loss of integrity. Conclusion The mechanical properties of the ESM-UBT device make it attractive for scale across resource-poor settings.

Increased Intracranial Pressure Damages Optic Nerve Structural Support.

Optic nerve sheath diameter (ONSD) is used clinically as a noninvasive measure for elevated intracranial pressure (ICP). This study had two purposes: to investigate the immediate effects optic nerve sheath (ONS) dilation post-ICP increase on trabecular fibers connecting the optic nerve to the ONS and to document any changes in these fibers 30 days post-increased ICP. In a swine model, ICP was increased by inflating a Foley catheter balloon in the epidural space. Three control pigs received the catheter insertion without inflation (no increase in ICP) and four experimental pigs received the catheter with inflation (increased ICP). The control and two randomly selected pigs with increased ICP were euthanized immediately after the procedure. The two other pigs were euthanized 30 days post-catheter inflation. For all pigs, the ONS was removed and imaged using a scanning electron microscope, calculating percent porosity values. Porosity values for the experimental groups (Immediately measured [IM] μ = 0.5749; Delayed measured [DM] μ = 0.5714) were larger than the control group (μ = 0.4336) and statistically significant (IM vs. Control, p = 0.0018; DM vs. Control, p = 0.0092). There was no significant difference (p = 0.9485) in porosity of the DM group when compared with the IM group. This study demonstrated that the trabecular fibers immediately post-increased ICP (ONS dilation) were more porous than the control and remained statistically different (more porous) after 30 days. These results suggest a structural change that occurs in the ONS with elevations in ICP.

The Effect of Intracranial Migration of Foley Balloon Catheter after Tumor Resection

The incidence of intracranial tumor is 5% of that of systemic tumor. Some of them are presented as large ones because of slow growth. The higher complications are challenging due to their potential behaviors after resection such as large residual cavity, cortex collapse and bridging vein rupture.

Blown out of proportion? Induction Foley balloon ruptures associated with overinflation

Larger volume Foley catheters are occasionally used for labor induction. In some instances the balloon is overinflated to obtain this volume. Neither the risk or rate of rupture are known for this practice. The purpose of this study was to evaluate the use of overinflated Foley catheter balloons and the rate of rupture in prospective trials and to describe rupture events in our institutions. Clinical trials and prospective cohorts were identified through a search of MEDLINE from 2000 through May 1, 2017; prospective studies were examined for the use of overinflated Foley catheters. Reports of overinflated balloons were then reviewed in detail to determine if rupture occurred and to record any reported maternal, neonatal, or gynecologic outcomes. Internal reports to the Obstetric Safety Report System were used to describe the local cases at our institutions. We reviewed 296 abstracts. Seventeen prospective cohorts or randomized trials used larger balloon volumes (≥50 mL), of which 12 abstracts confirmed routine overinflation of the balloon. Within these studies, 19 patients who underwent cervical ripening with overinflated Foley catheters experienced balloon rupture during use. The incidence of rupture in these studies was 0.9%. No adverse maternal or fetal effects were noted. Internal safety reporting yielded an additional case. One gynecologic case was identified internally. The patient had an overinflated Foley catheter balloon used to tamponade excessive uterine bleeding after uterine evacuation. Balloon rupture was noted, and hysteroscopy was needed to remove fragments of the balloon. Overinflation of Foley catheter balloons in obstetric and gynecologic applications may cause rupture. Because of possible underreporting, the extent of complications that may result from balloon rupture is unknown.

Indwelling Intrauterine Foley Balloon Catheter for Intraoperative and Postoperative Bleeding in Cesarean Scar Pregnancy

Study ObjectiveCesarean scar pregnancy (CSP) is a rare type of ectopic pregnancy, and a significant concern in the management of this condition is the control and prevention of bleeding. We aimed to determine the efficacy and value of an indwelling, intrauterine Foley balloon catheter in controlling and preventing intraoperative and postoperative bleeding in patients with CSP. DesignRetrospective case series. SettingUniversity-affiliated hospital. PatientsBetween January 1, 2015 and May 31, 2017, 70 patients presented with CSP. InterventionsAll patients underwent uterine curettage under hysteroscopic guidance and ultrasound monitoring. Patients were then assigned to 2 groups: the study group, with an indwelling Foley balloon catheter placed in the uterine cavity during surgery and retained for 24 to 48 hours, and the control group, without catheter placement. Data were collected to compare the 2 groups in terms of intraoperative and postoperative complications, surgical time, and status of menstruation resumption. Measurements and Main ResultsThe average daily volume of postoperative blood loss during the first 3 postoperative days in the study group was 23.1 mL compared with 31.5 mL observed in the control group (p = .041). Moreover, the study group had significantly shorter average duration of bleeding (p = .027) and fewer menstruation abnormalities than the control group. Uterine ultrasonography performed after resumption of menstruation showed that none of the enrolled patients had any intrauterine abnormalities. ConclusionsThe use of an indwelling, intrauterine Foley balloon catheter has positive results in the management of CSP.

Foley catheter versus cervical double balloon for labor induction: a prospective randomized study

Objective Cervical ripening by mechanical methods enhances labor induction success. We compared Cervical Ripening Double Balloon catheter (CRDB) to Foley catheter. Study design This prospective blind study randomized 85 nulliparas and 95 multiparas to labor induction by either Foley catheter or CRDB. Primary outcomes were Bishop score increment, time from catheter withdrawal to delivery, and cesarean section rate. Results In multiparas, mean Bishop score increment between pre- and post-catheter was significantly higher in the CRDB catheter than in the Foley group (4.4 ± 1.9 and 3.4 ± 2.0, respectively, p = .02). Mean interval from catheter withdrawal to delivery was shorter in the CRDB catheter (14.6 ± 12.3 and 8.6 ± 5.4) than in the Foley catheter group (22.6 ± 27.2 and 13.9 ± 17.7), in both nulliparas and multiparas (p = .05 and p = .03, respectively). In nulliparas, no statistically significant differences were found in mean Bishop score increment between the two catheters, but cesarean section rate was higher in the Foley group than the CRDB group (46.5% and 20%, respectively, p = .02). Conclusion Bishop score increment by CRDB catheter is more effective than induction by Foley catheter in multiparas. CRDB catheter is associated with decreased time to delivery in both nulliparas and multiparas and a lower cesarean section rate in nulliparas. ClinicalTrials.gov Identifier: NCT00501033

Analysis of risk factors and prognosis for intrauterine adhesion after hysteroscopic submucosal myoma

Objective To explore the risk factors of intrauterine adhesions after abortion and the effect of hysteroscopic surgery. Methods Through retrospective analysis method, from January 2014 to October 2016, 80 artificial abortion patients with intrauterine adhesions were collected as adhesion group.During the same period, 80 patients without adhesion after artificial abortion were selected as non-adhesion group.The general data of the two groups were compared.By logistic multivariate analysis, the influencing factors of intrauterine adhesions were analyzed.And the effect of surgical treatment of hysteroscopic adhesion was analyzed. Results The adhesion group and the non-adhesion group had statistically significant differences in the times of pregnancy(t=6.848, P<0.001), missed abortion(t=12.004, P<0.001), painless curettage times(t=7.24, P<0.001), painless abortion history(χ2=5.079, P=0.024). Multivariate logistic regression analysis indicated that number of missed abortion(OR: 7.083, 95% CI: 2.406-17.392; P=0.002), curettage times(OR: 9.147, 95% CI: 2.875-32.068; P=0.014), painless abortion of history(OR: 5.276, 95% CI: 1.973-13.492; P=0.029) were the independent risk factors for uterine cavity adhesions (P<0.05). The total effective rate of the mild-to-moderate uterine cavity adhesions was significantly higher than that of the severe uterine cavity adhesions (χ2=16.449, P<0.001). Conclusion The number of missed abortion, curettage, painless history are independent risk factors for intrauterine adhesion, the effect of treatment is related to the degree of adhesion, hysteroscopic intrauterine adhesions after treated with the combination therapy of estrogen and Foley balloon catheter, IUD and absorbable membrane can help reduce the risk of readhesion, it is worthy of clinical attention. Key words: Abortion, induced; Postoperative complications; Risk factors; Prognosis

021 The Role of Office-Based Somatic and Autonomic Neuro-Genital Testing of Persistent Genitourinary Numbness in Women

In women with sexual dysfunction, a bothersome/distressing symptom is persistent numbness in the genitourinary region, the clitoris, vagina and urethra. Women with persistent numbness often find it difficult to feel their clitoris when touched, or feel objects placed within their vagina, or feel urine flowing in their urethra. This symptom often leads to orgasmic dysfunction and limited sexual pleasure. Using office-based neuro-genital testing, we examined the integrity of the somatic and autonomic neurologic pathways of genitourinary sensation to better understand the etiology of female genitourinary sensory impairment. Office-based neuro-genital testing includes quantitative sensory testing, sacral and foot dermatome testing, bulbocavernosus reflex latency testing, vaginal pelvic afferent nerve testing and urethral pelvic afferent nerve testing. Quantitative sensory testing measures somatic vibration, cold, and heat perception threshold values in the glans clitoris, right and left inner surface of labia minora, and uses the right pulp index finger threshold values as the control. Sacral and foot dermatome testing measures somatic vibration perception in the right and left gluteal, thigh, calf, heel, arch, medial and lateral aspects of the foot, using the right pulp index finger threshold values as the control. Bulbocavernosus reflex latency testing with electromyographic monitoring of the external anal sphincter muscle contraction measures the integrity of the somatic sensory and motor neural pathways in response to mechanical stimulations of the glans clitoris. The vaginal pelvic afferent neural pathway test measure visceral awareness of distension of an anorectal (up to 60 ml) balloon within the vagina. The urethral pelvic afferent neural pathway test measure visceral awareness of distension of a Foley catheter (up to 0.4 ml) balloon within the urethra.

Foley catheter balloon tamponade for penetrating neck injury management in military medicine: a case report

Background&#x0D; The use of Foley catheter balloon tamponade (FCBT) to address bleeding in the neck and maxillofacial area associated with penetrating trauma is widely accepted in South African Emergency Departments. Its efficacy has been documented in combat settings in the Iraqi area of operations, with significant improvement of patients survival rate. Despite such evidence, Special Operations Forces (SOF) medics training in these techniques is limited.&#x0D; Case&#x0D; We present the case of a partner forces (PF) soldier that received shrapnel injuries during combat operations, resulting in life-threatening haemorrhage from the neck.&#x0D; Conclusion&#x0D; The Special Operations Forces medics who treated this patient decided to apply FCBT to prevent re-bleeding during an unsupervised ground vehicle movement to the host nation (HN) definitive care. None of the SOF medics involved had received formal training in the technique prior to the case. Their only knowledge was based on anecdotal evidence and self-study of the literature. Due to the lack of accountability by admitting a patient into the HN chain of care, there is no information on the outcome other than the patient survived. FCBT was performed after the wound was packed ineffectively with hemostatic gauze resulting in an unstable clot that failed with patient movement resulting in a probable carotid artery Zone I I neck bleed. FCBT has the potential to be a quick and effective adjunct to control bleeding in the complicated narrow track wound patterns in the neck and maxillofacial area that are not amenable to manual pressure or hemostatic agents in combat trauma medicine.&#x0D; Keywords&#x0D; Foley; Foley catheter balloon tamponade; Special Operations forces Medics; Bleeding.&#x0D;

From “Disappointing” to “Fantastic”: Patient Experiences With Labor Induction [02OP

INTRODUCTION: While over 20% of deliveries in the U.S. involve labor induction, there is a dearth of evidence regarding patient perceptions of their experiences and preferences about the process of care. We conducted postpartum qualitative interviews to elucidate women's expectations and experiences of the labor induction process. METHODS: We recruited women who underwent labor induction during their most recent delivery from our hospital's postpartum ward, aiming to enroll equal numbers with vaginal and cesarean deliveries. We conducted semi-structured qualitative interviews within two months of delivery. Research questions included expectations and lived experiences of the labor induction process, side effects and health outcomes of concern, reflections on personal tolerance of different interventions, and thoughts about an ideal process. RESULTS: From April-September 2018, we interviewed 36 women; 18 with a vaginal delivery and 18 with a cesarean delivery. The labor induction process involved a wide range of experiences, from unexpected, exhausting, stressful, overwhelming, and frustrating, to fast, smooth, and simple. Preliminary data show that women often perceived their induction to be longer than they expected. The medical intervention with the most adverse opinions was the Foley balloon catheter. Women's concerns regarding side effects and the need for intrapartum cesarean delivery largely centered on the health of their baby. CONCLUSION: Women's experiences with the overall process of labor induction, as well as specific medical interventions, influence their perceptions of quality of care during labor and delivery. Patient education, management of expectations, and shared decision-making throughout the process may improve patient experience and satisfaction.

Stereotactic Body Radiation Therapy Boost for Intermediate-Risk Prostate Cancer: A Phase 1 Dose-Escalation Study

High-dose-rate brachytherapy boost plus external beam radiation therapy is an established option for intermediate-risk prostate cancer (PCa). Stereotactic body radiation therapy (SBRT) boost can potentially mimic high-dose-rate boost and could be a viable alternative. Here we report the long-term outcomes of a phase 1 dose-escalation trial of single-fraction SBRT boost. Patients had intermediate-risk PCa and were accrued to 3 different SBRT single-fraction dose-level cohorts (10Gy, 12.5Gy, and 15Gy). All received supplemental radiation therapy afterwards (37.5Gy in 15 fractions). Three gold fiducials were implanted for image guidance. Patients were simulated and treated with a foley catheter and intrarectal balloon. A T2 magnetic resonance imaging scan was used for contouring, and a cine magnetic resonance imaging scan was used tocalculate patient-specific internal target volume margins. Toxicity and quality-of-life data were collected using Common Terminology Criteria for Adverse Events v3.0 and the Expanded Prostate Cancer Index Composite. 30 patients were accrued, 10 in each cohort. Median follow-up was 72months. 60% had unfavorable intermediate-risk PCa. Two patients in the 15Gy cohort developed late grade ≥3 gastrointestinal and genitourinary toxicity, with 1 patient suffering from a grade-4 rectal fistula after a rectal ulcer was biopsied repeatedly. Two patients had biochemical failure. Median PSA nadir was 0.4ng/mL with 10Gy, 0.09ng/mL with 12.5Gy and 0.07ng/mL with 15Gy. Median PSA at 4years as well as proportion achieving a nadir <0.2ng/mL improved significantly with higher doses. There was no significant change in quality of life from baseline in any of the domains, and the minimal clinically important change was not statistically different between the 3 cohorts. Other than a grade 4 toxicity, which may in part be due to repeated biopsies of a rectal ulcer, single-fraction SBRT boost was feasible and well tolerated. Larger studies are warranted to better document the outcomes of such an approach.

A Randomized Controlled Trial using iTClamp, Direct Pressure, and Balloon Catheter Tamponade to Control Neck Hemorrhage inaPerfused Human Cadaver Model.

Penetrating neck wounds are common in the civilian and military realms. Whether high or low velocity, they carry a substantial morbidity and mortality rate. We endeavored to ascertain whether the iTClamp is equivalent to direct manual pressure (DMP) and Foley catheter balloon tamponade (BCT). Using a perfused cadaver, a 4.5-cm wound was made in Zone 2 of the neck with a 1-cm carotid arteriotomy. Each of the hemorrhage control modalities was randomized and then applied to the wound separately. Time to apply the device and fluid loss with and without neck motion was recorded. There was no significant difference between the fluid loss/no movement (p>0.450) and fluid loss/movement (p>0.215) between BCT and iTClamp. There was significantly more fluid lost with DMP than iTClamp with no movement (p>0.000) and movement (p>0.000). The iTClamp was also significantly faster to apply than the Foley (p>0.000). The iTClamp and BCT were associated with significantly less fluid loss than DMP in a perfused cadaver model. The iTClamp required significantly less time to apply than the BCT. Both the iTClamp and the BCT were more effective than simple DMP. The iTClamp offers an additional option for managing hard-to-control bleeding in the neck.

Management of Cesarean Scar Pregnancy among Vietnamese Women.

Objective:To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks’ gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital.Subjects and Methods:A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (β-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar.Results:A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%–93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age <6 weeks (odds ratio [OR] 3.1, 95% CI: 1.03%–8.76%), β-hCG level <11,000 mUI/mL before discharge from the hospital (OR 6.5, 95% CI: 1.42%–30.6%), gestational sac volume 2 weeks after treatment measuring <5 cm3 (OR 9.1, 95% CI: 1.96%–50.1%).Conclusions:This is an easily applicable method with a short follow-up period and reduction in treatment costs compared to standard treatment with methotrexate injection.

Reduction and Fixation of Orbital Floor Fracture Using Trans-Antral Balloon Technique: A Case Report

Orbital floor fracture is considered as a major function and aesthetic challenge for maxillofacial surgeons. The emergence of endoscopic controlled techniques in reducing this type of fractures has gained popularity in the last few years. Here we present a case of orbital floor fracture, accompanied with zygomatico-maxillary complex (ZMC) fracture that was treated through intraoral incision using trans-antral balloon. The fractured orbital floor was accessed and reduced through the underneath antrum under endoscopic control and was temporarily supported using Foley catheter balloon. This technique seems safe easy and feasible technique for reducing orbital floor fracture.