Foley Catheter Research Articles

Bedside Extraction of a Rectal Foreign Body Using Hyperinflated Foley Catheter Traction: A Case Report

Bedside Extraction of a Rectal Foreign Body Using Hyperinflated Foley Catheter Traction: A Case Report

An overview of healthcare-associated Candida auris outbreaks in Ministry of Health hospitals–Saudi Arabia 2020–2022; Retrospective multicentric study

Background Candida auris (C. auris) is an emerging fungus pathogen associated with nosocomial infections that is seen as a serious global health issue. Aim To describe the epidemiology and features of hospital-acquired Candida auris outbreaks in the Ministry of Health hospitals (MOH). Methods A three-year (2020–2022) retrospective analysis of Candida auris outbreaks in the Saudi MOH hospitals. A total of 45 hospitals were involved, with 511 cases of Candida auris. The data collected from the General Directorate of Infection Prevention and Control (GDIPC) platform comprises all patients’ data for C. auris instances, whether infected or colonized. Results Out of the 511 Candida auris recruited cases, 291 (56.9%) were infected, whereas 220 (43.1%) were colonized. 32.9% of cases were above the age of 65, and 68.9% were male. The majority of cases were admitted in the ICU unit (95.5%). Approximately 18.8% of cases were diabetes, and 18.5% were hypertensive. Central lines were discovered in 37.7% of the cases. Approximately 85.9% of cases had Foley catheters, 68.5% were on ventilators, and 53.8% had a tracheostomy. The crude mortality rate was particularly high (41.5%) among the study cases. It was non-significantly higher among infected individuals (44.7%) than colonized patients (37.3%) at (p value = 0.093). The prevalence of hypertension (p = 0.001), DM (p = 0.003), and peripheral line insertion (p = 0.004) was significantly higher among colonized patients. While the presence of COVID-19 (p = 0.001), and central line insertion (p = 0.001) was significantly higher among infected patients. Conclusion C. auris is a new pathogen that causes hospital outbreaks. Strict adherence to infection prevention and control criteria established by the Centre for Disease Control (CDC) and GDPIC has significantly contained and reduced the spread of these outbreaks. One-month retrospective surveillance before diagnosing the index case and a prospective surveillance strategy for at least three months is highly recommended.

In Situ Aqueous Spice Extract-Based Antifungal Lock Strategy for Salvage of Foley’s Catheter Biofouled with Candida albicans Biofilm Gel

Candida forms a gel-like biofilm in the Foley’s catheter (FC) causing tenacious biofouling and severe urinary tract infections (UTIs). For the first time, a spice extract-based antifungal lock therapy (ALT) has been developed to inhibit the Candida albicans gel matrix in FC. Aqueous extracts of garlic, clove, and Indian gooseberry were used as ALT lock solutions and tested against biofilm-forming multidrug-resistant clinical isolates of C. albicans. Reduction in the gel matrices formation in the catheter was confirmed by Point inoculation, MTT assay, CFU, and SEM analysis at 12 and 24 h of incubation. Garlic was effective in controlling both C. albicans M207 and C. albicans S470; however, clove and gooseberry effectively controlled the latter. As evidenced by CFU assay, there were 82.85% and 96.81% reductions in the growth of C. albicans M207 and S470, respectively, at 24 h of incubation. SEM revealed a switch from the biofilm to the yeast mode and a drastic reduction in cell numbers, with mostly clumped or lysed cells. The study will provide an impetus to the development of novel spice extract-based ALT, reducing the selection pressure on the pathogen and lowering antimicrobial resistance. Further research in this area has the potential to leverage clinical applications.

PERINATAL ASPECTS OF DELIVERY OF WOMEN WITH OBESITY AND GESTATIONAL DIABETES

Obesity increases the likelihood of hypertension and pre-eclampsia and increases the risk of thrombosis in pregnant women, which can lead to thromboembolism and maternal and fetal death. Obesity most commonly increases the incidence of gestational diabetes mellitus (GDM) in pregnant women. GDM in the setting of obesity can complicate the process of childbirth, causing difficulties during delivery of the fetus (shoulder dystocia, birth trauma, fetal distress, etc.) and increase the rate of cesarean section (CS) delivery. The aim of the study was to determine the characteristics of the delivery of women with obesity and gestational diabetes mellitus and to optimize the provision of obstetric care to them in order to reduce perinatal complications. Materials and methods of the study. Examination, antepartum preparation and delivery of 136 pregnant women were performed, including 33 (24.3%) obese women (group 1), 35 (25.7%) obese women and GDM (group 2), 38 (27.9%) with GDM (group 3) and 30 (22.1%) women with physiological pregnancy formed the 4th (control) group. The traditional method (PG E2 - dinoprostone intravaginally) followed by induction and the complex method (insertion of a Foley catheter into the cervical canal followed by oral administration of prostaglandin E1 (PG E1) were used to prepare for childbirth. The study was conducted in accordance with the principles of good clinical practice (GCP, 1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Medical Research with Human Subjects (1964-2008), and the Order of the Ministry of Health of Ukraine from 23.09.2009 № 690 (amended by the Order of the Ministry of Health of Ukraine from 12.07.2012 № 523). The draft of the study was discussed and approved at the meeting of the Medical Ethics Committee of KhNMU (Protocol ¹ 23 of November 13, 2024). Statistics. Statistical processing was performed using the MS Excel software package. The Mann-Whitney U test, mean and standard deviation (M±m), and standard error (p) were used to compare quantitative data. At the level of probability of error (p<0.05), the results of comparisons were considered reliable. The work was carried out within the framework of the research plan of the Department of Obstetrics and Gynecology No.2 of KhNMU: "Improvement of diagnostic and therapeutic measures and prevention of pregnancy complications and gynecological diseases in women with extragenital pathology (state registration number 0124U002218). Results. Doppler examination of the hemodynamics of the fetoplacental complex in pregnant women revealed signs of uteroplacental and fetoplacental circulation disorders in 5 (15.5%) obese pregnant women, in 8 (22.9%) women with combined pathology (GDM in the setting of obesity), in 4 (10.5%) women with GDM, which was considered as placental dysfunction. Fetal anomalies according to CTG with STV (short-term variation) were observed in 6 (18.2%) obese pregnant women, 5 (15.2%) women with obesity, and 4 (10.5%) women with GDM. According to the results of ultrasound cervicometry in pregnant women in the control group, the average length of the cervix was 18.7±2.3 mm, which is considered promising for spontaneous delivery. The size of the cervical canal in pregnant women with GDM and obesity was 30.1±2.7 mm, in pregnant women with GDM - 27.3±2.6 mm, in obese women - 25.2±2.9 mm, significantly different from the control group (p<0.05). Conclusions. Childbirth in women with obesity and GDM is associated with several obstetric complications, in particular premature rupture of membranes, weakness of labor, fetal distress, clinically narrow pelvis, ineffective induction of labor leading to a high percentage of cesarean sections, and perinatal morbidity (neonatal asphyxia, diabetic fetopathy, hypoglycemia, CNS disorders). Effective completion of pregnancy and delivery without maternal and neonatal complications in women with GDM and obesity depends mainly on the state of the cervix before delivery, which is assessed by various methods (Bishop's scale, cervicometry, optimally using elastography). The best way to prepare for childbirth is a comprehensive process with a Foley catheter and PGE1, and induction with a half dose of oxytocin combined with epidural anesthesia, which reduces the rate of cesarean section and perinatal complications for both mother and fetus.

Safety and efficacy of low-powered holmium laser enucleation of the prostate in comparison with plasma kinetic resection of prostate.

To compare the efficacy and safety of low-power holmium laser enucleation of the prostate (LP-HoLEP) with plasma kinetic resection of prostate (PKRP). Sixty-three patients treated with transurethral LP-HoLEP (observation group) and 68 patients treated with transurethral PKRP (control group) at Beijing Hospital of Traditional Chinese Medicine from November 2019 to November 2022 were retrospectively compared with regard to operation duration, intra-operative blood loss, prostate resection ratio, postoperative bladder irrigation time, postoperative indwelling urinary catheter time, postoperative urinary incontinence incidence, International Prostate Symptom Scale (IPSS), maximum urine flow rate (Qmax), and residual urine volume (RUV). In both groups, postoperative IPSS, Qmax, and RUV were significantly improved compared to preoperative values (P < 0.05). Comparing the observation group to the control group, the intra-operative blood loss were (59.6 ± 18.1) and (173.1 ± 85.3) ml, respectively (t = -10.350, P < 0.01); the prostate resection ratios were (81.2 ± 4.6) % and (56.7 ± 9.7)%, respectively (t = 18.230, P < 0.01); the postoperative bladder irrigation time was (39.1 ± 9.6) h and (49.7 ± 6.0) h, respectively (t = -7.623, P < 0.01); and the postoperative indwelling urinary catheter time was (111.5 ± 19.4) h and (120.4 ± 12.8) h, respectively (t = -3.125, P < 0.01). Comparing the observation group to the control group, the operation duration was (76.2 ± 18.6) and (83.0 ± 32.4) min, respectively, with no statistical difference (t = -1.226, P = 0.208); the postoperative urinary incontinence incidence was 12.7% and 8.8%, respectively and there was no statistical difference (χ² = 0.514, P = 0.473). LP-HoLEP offers excellent surgical efficacy and safety. LP-HoLEP is superior to PKRP in intra-operative blood loss, postoperative bladder irrigation time, and postoperative indwelling urinary catheter time, and can enucleate more hyperplastic glands.

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes.

Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

Aldehyde free - Bovine Pericardium - A New Option of Graft in Urethral Stricture Treatment.

The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, bladder mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material) (1, 2). In the present video, we present a case where we used a new option of graft to treat urethral strictures: the L-Hydro® tissue treatment technology 100% aldehyde free, VIVENDI graft. The present study was approved according to the ethical standards of the hospital's institutional committee on experimentation with human beings. A 57 year-old male patient developed a urethral stricture due to prolonged use of a urinary catheter during a previous hospitalization. A cystourethrogram was performed, which revealed a stenosis of the penile urethra measuring 2.5 cm in length. Urethroplasty was proposed for the surgical treatment in this case. We used a longitudinal penile incision with a ventral sagittal urethrotomy in the penile stricture. A free VIVENDI graft was placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. The patient will receive post-operative follow-up for 3 months for clinical assessment through symptoms, uroflowmetry, urethroscopy and residual urine volume after urination. No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the three-month follow-up. Four weeks after surgery, he underwent urethroscopy, which revealed a good appearance of the urethra, with no stenosis or signs of infection. In the present case the use of bovine pericardium graft for the treatment of penile urethral stricture had a good result and can be an option to repair complex urethral strictures. However, the results presented require a larger population group in addition to multicenter studies with longer follow-up time to ensure the findings obtained. Available at: http://www.intbrazjurol.com.br/video-section/20249928_Vieiralves_et_al.

Safety and Clinical Efficacy of Prostatic Artery Embolization in Patients with Indwelling Urinary Catheter for Benign Hyperplasia-A Multicenter Study.

Background/Objectives: This multicentric study aimed to evaluate the efficacy and safety of prostatic artery embolization (PAE) to remove indwelling urinary catheter (IUC) in patients with symptomatic benign prostatic hyperplasia (BPH). Secondary objectives were to identify features associated with post-PAE catheter-free survival (PCFS). Methods: All consecutive patients who underwent PAE for IUC related to BPH with a follow-up of at least 2 years (except for early death) in 6 French University Hospitals were retrospectively included. Clinical efficacy was defined as the removal of the IUC after PAE (through a trial without catheter [TWOC]) and evaluated at regular intervals. Chi-square tests, Wilcoxon tests and multivariable binary logistic regressions were utilized to investigate predictors of TWOC success. Univariable and multivariable Cox regressions were utilized to investigate predictors of PCFS in patients with TWOC success. Results: 140 men with IUC (median age: 82.5 years, interquartile range [IQR] = 73-88.2 years, range: 46-100) who underwent PAE between January 2017 and March 2021 were included. Initial successful catheter removal (TWOC success) following PAE occurred in 113/140 (80.7%) patients, and 3/140 (2.1%) patients encountered major complications. In patients with TWOC success, PCFS at 6 months, 1 year and 2 years were 87.5% (95%CI: 81.4-94.1), 84.4% (95%CI: 77.7-91.7) and 79% (71.3-87.4), respectively. No independent predictive factors for TWOC success and PCFS were identified. Conclusions: PAE should be considered as a safe option with good clinical efficacy in the short and long term for elderly and inoperable patients with IUC due to symptomatic BPH.

Primary central nervous system lymphoma of the spinal cord: A LOC network cohort study.

Primary central nervous system lymphoma (PCNSL) mainly affects the brain (>90% cases); there are very little data pertaining to PCNSL involving the spinal cord. We retrospectively selected from the French LOC network database adult immunocompetent patients diagnosed with PCNSL involving the spinal cord between 2011 and 2022. Of the 2043 patients records retrieved from the database, 16 patients (median age: 62.5 years, median Karnofsky performance status: 40) satisfied our study's selection criteria. The median diagnostic delay was 97 days. Upon diagnosis, 10 patients could not walk, and seven had an indwelling urinary catheter. All of the patients had undergone MRI that revealed expansive lesion(s) with homogeneous contrast enhancement. Brain lesions were found in nine patients and CSF IL-10 was increased in 9 of 10 patients. The diagnosis of PCNSL was made based on brain biopsy (n=6), spinal cord biopsy or surgery (n=6) or cytologic analysis of CSF (n=4). All the patients were treated with high-dose methotrexate-based chemotherapy, followed by spinal cord irradiation (n=1) or autograft (n=4). The median PFS and OS were 29 and 51 months, respectively. Among the responders, 33% remained in a wheelchair, and only 25% regained the ability to walk without assistance. Considering the high risks associated with a spinal cord biopsy, the rarity of the disease and the lack of specificity of its clinicoradiological presentation, the diagnosis of spinal cord lymphoma is often delayed. Searching for other lymphomatous locations or assaying CSF IL-10 may be helpful in this disease, which can cause irreversible handicap.

Tugging the Foley Catheter Balloon Every Three Hours in Induction of Labor After One Previous Cesarean: A Randomized Controlled Trial.

Induction of labor after one previous cesarean (IOLAC) with unripe cervixes is at especially high risk for unplanned cesarean birth and uterine rupture. Balloon mechanical ripening is often preferred over prostaglandin during IOLAC, as uterine rupture is associated with prostaglandin use. The transcervical Foley balloon can dislodged past the ripened cervix and be comfortably retained in the vagina during passive placement. Tugging of the Foley catheter can be a non-invasive and tolerated method for timelier retrieval of the retained balloon; expediting discovery of a ripened cervix, permitting follow-on amniotomy and oxytocin infusion, thus hastening birth. To evaluate tugging the Foley balloon for 30 seconds every three hours compared to standard care (no tugging) during the 12 hours of scheduled placement on the induction to birth interval and patient satisfaction. A randomized controlled trial in a university hospital in Malaysia recruited participants from April 2023 to March 2024. Eligible participants admitted for Foley balloon induction of labor who had one previous cesarean were recruited. After balloon insertion, participants were randomized to tugging or standard care. Following balloon displacement, a vaginal examination was performed to check the cervix. The examination findings then dictated follow-on IOLAC management according to usual practice. The primary outcomes were the induction (Foley insertion) to delivery interval and participants' satisfaction with the birth process. Secondary outcomes were largely derived from the core outcome set for trials (CROWN) on IOL. A sample size of 126 was calculated to cover for a 4 hours reduction in the induction to delivery interval and a 1.5 point increase in satisfaction score based on 0-10 numerical rating scale predicated on a superiority hypothesis with the level of significance set at 0.05, power at 80% and a 10% drop out rate. Analysis was by t-test, Mann-Whitney U test, Chi square test and Fisher exact test as appropriate to the data on an intention-to-treat basis. 126 participants were randomized; 63 to each trial arm. The induction to birth interval was (mean±standard deviation) 29.7±9.6 hours vs. 29.8±9.1 hours p=0.950 and maternal satisfaction with the IOLAC birth process assessed by 0-10 numerical rating scale was median [interquartile range] 8[7-9] vs. 8[7-9] p=0.936 for 3-hourly tugging and standard care respectively. Caesarean delivery rate was 37/63 (59%) vs. 41/63 (65%) p=0.238 and the main indication for unplanned caesarean was failure to progress was 24/37 (65%) vs. 24/41 (59%) p=0.914 in tugging vs. standard care arms respectively. Three-hourly tugging also did not shorten the intervals from induction to balloon displacement, amniotomy, start of oxytocin infusion or the second stage. At Foley balloon IOLAC with a scheduled 12 hour balloon placement, tugging the catheter every three hours compared to standard care did not hasten birth or improve patient satisfaction.

Effectiveness of Nurse‐Led‐Intervention on Quality‐of‐Life Among Patients With Long‐Term Indwelling Urinary Catheter

ABSTRACTLong‐term indwelling urinary catheters can lead to various health problems among patients resulting in impaired quality of life. Nurses are vital in providing access to resources, education, and support services, such as catheter care training, family support groups, and psychological counselling. They can empower patients with long‐term indwelling urinary catheters to manage their condition effectively and enhance their quality of life. The objective of the study was to develop and implement booklet‐based nurse‐led intervention on patients with long‐term indwelling urinary catheters and to assess the effectiveness of the urinary catheter care package (UCCP) on catheter care practices among caregivers and quality of life among patients. A randomised controlled trial was conducted at a tertiary care centre in Northern India. After obtaining informed consent from each participant, a total enumeration sampling technique was used for sampling ensuring the inclusion of all eligible participants followed by computer‐generated day‐wise randomization. Fifty participants (patient and caregiver dyad) in each group were selected. Participants in the intervention group were given booklet‐based nurse‐led intervention while standard care was given to participants in the control group. Data were collected using a validated semi‐structured interview schedule consisting of (a) a socio‐demographic profile of patients and their caregivers, (b) a clinical profile of patients, (c) an ICIQ‐LTCQOL (Quality of life questionnaire) to assess the quality of life among patients, and (d) observation checklist to assess catheter care practices among caregivers. Statistical analysis was done using SPSS version 22.0 employing descriptive and inferential methods. The mean age of patients was 54.88 ± 20.14 years and 53.56 ± 18.93 years in the control and intervention group, respectively. Majority of patients were male, with 86.0% in the control group vs. 80.0% in the intervention group (p = 0.424). Majority of patients had urine retention as a chief complaint for long‐term placement of indwelling urinary catheter in both the control group and intervention group, that is, 76.0% and 60.0%, respectively (p = 0.086). At follow up, the mean catheter function and concern score was 19.44 ± 3.45 in the control group vs. 10.17 ± 2.08 in the intervention group (p &lt; 0.001). At follow up, the mean lifestyle impact score was 11.19 ± 2.36 in the control group vs. 8.30 ± 3.79 in the intervention group (p = &lt; 0.001). Mean pain, discomfort and soreness score was 1.47 ± 0.65 in the control and 0.67 ± 0.59 in the intervention group at follow‐up (p = 0.001). There was significant decrement in the mean catheter function and concern score, mean lifestyle impact score, and mean pain, discomfort and soreness score among the intervention group as compared to the control group at follow up (p = &lt; 0.001). At follow up, the mean overall QoL score was 33.53 ± 5.04 in control and 19.73 ± 3.98 in the intervention group. There was significant improvement in overall QoL among the intervention group as compared to the control group at follow‐up (p = &lt; 0.001). At follow‐up, the mean urinary catheter care practices score among caregivers was 5.06 ± 3.02 in control and 14.28 ± 1.09 in the intervention group. There was a significant improvement in the mean practice score among the intervention group as compared to the control group at follow up (p &lt; 0.001). The study has shown that Booklet‐based Nurse‐led intervention significantly improved catheter care practices among caregivers and quality of life among patients with long‐term indwelling urinary catheters.

Emergency Department Healthcare Providers’ Knowledge and Attitudes regarding Appropriate Indications for Indwelling Urinary Catheter Use

Abstract Introduction: Indwelling urinary catheters (IUCs) are frequently used in emergency departments (EDs), but many insertions lack clear indications, leading to potential overuse. This overuse contributes to catheter-associated urinary tract infections (CAUTIs), costing billions in preventable healthcare expenses. Campaigns such as Choosing Wisely and Centers for Disease Control and Prevention guidelines aim to reduce unnecessary IUC use, improve patient outcomes and prevent CAUTIs. Materials and Methods: A cross-sectional survey and retrospective chart review were conducted at an academic tertiary care centre. The survey targeted ED providers, including physicians and nurses, while the chart review encompassed all adult ED patients in 2022. The survey covered demographic information, self-reported understanding and attitudes towards urinary catheters, including clinical scenarios, to evaluate the knowledge of appropriate indications for IUC insertion. The data analysis was performed using NCSS software and involved t-tests or one-way analysis of variance to explore associations between sample characteristics and knowledge scores. The significance level for all analyses was set at P &lt; 0.05. Results: A total of 96 of the 198 ED staff members participated in the survey. The confidence rate for knowledge of appropriate indications for IUC insertion was 100% among physicians and 97.8% among nurses. However, the results from the clinical scenarios in the survey showed that participants incorrectly answered in a range of 8%–75%. The mean scores of correct answers among consultants, residents and nurses were 65%, 67% and 66%, respectively. Conclusion: There is a considerable gap between ED healthcare providers’ subjective knowledge and attitudes and objective knowledge of appropriate IUC placement, which serves as a basis for an intervention to reduce the potential for inappropriate IUC insertion.

Outcomes following intradetrusor onabotulinumtoxinA in a national cohort of nursing home residents

AbstractObjectivesTo determine predictors of treatment success and complications following intradetrusor onabotulinumtoxinA injections among a large cohort of nursing home (NH) residents, representing one of the most frail and vulnerable populations in the United States.Materials and methodsThis is a retrospective cohort study of long‐stay NH residents who underwent onabotulinumtoxinA injections between 2014 and 2016. Residents were identified using the Minimum Data Set (MDS) linked to Medicare claims. Frailty was measured using the Claims‐based Frailty Index and socioeconomic status using the Area Deprivation Index (ADI; higher ADI = increasing social deprivation). The primary outcome was treatment success, defined as repeat onabotulinumtoxinA injection within 1 year of index injection. Secondary outcomes included 30‐day complications and urinary retention, defined as new indwelling urinary catheters identified on the MDS at 3 months.ResultsOnabotulinumtoxinA injections were performed in 1683 NH residents. Mean age was 78.2 years, 74% were female and 22.8% had an indwelling urinary catheter at baseline. A total of 38.4% of residents had ≥1 30‐day complication and 14.6% had a new catheter at 3 months. Repeat injections were performed in 34.3% of residents within 1 year. Repeat injections were more likely among residents who were female [adjusted relative risk (aRR) 1.29; 95% CI 1.08–1.54] and who had a baseline catheter (aRR 1.30; 95% CI 1.11–1.52). Residents who were ≥85 years (aRR 0.78; 95% CI 0.64–0.96) and those in the lowest quartile ADI (aRR 0.75; 95% CI 0.61–0.93) were less likely to undergo repeat injections.ConclusionAmong this population of NH residents, who are by definition frail and comorbid, rates of repeat onabotulinumtoxinA injections are comparable to retrospective analyses of younger adults and independent of frailty and comorbidity. Based on these findings, surgeons should consider the entire clinical picture when evaluating patients for onabotulinumtoxinA injections and should not necessarily exclude those who are frail or comorbid from this potentially quality‐of‐life‐improving therapy.

La réinstillation distale du chyme des stomies : une technique efficace pour gérer le débit stomial postopératoire

Background: High output enterostomy leads to malnutrition and fluid/electrolyte loss which may be challenging to manage despite dietary modification, anti-motility, anti-secretory drugs, and parenteral nutrition. Distal infusion stomal enteroclysis (DISE) is an alternative to restore nutritional deficit and replace parenteral nutrition in resource-limited settings where treatment cost and availability of trained nurses are limiting factors.Objective: To assess the effectiveness and feasibility of DISE in managing postoperative enterostomal output.Methods: Consecutive patients who met the inclusion criteria and underwent enterostomy in one year were included. Postoperatively, DISE was started after the return of bowel movement. Stomal effluent was collected, filtered, and reinfused through the distal limb using a Foley catheter. The patients and caregivers were trained to perform under supervision. At discharge, they were encouraged to maintain regular contact and advised to report back when necessary.Results: Twenty-five patients received DISE, of which 22 were discharged and successfully continued to manage at home, while 3 expired. The median age was 36 years, the median BMI at admission and discharge was 18.99 kg/m2 and 17.76 kg/m2 respectively (the difference was statistically significant), and the male: female ratio was 2.5: 1. Thirty-day readmission was done for 2 patients to manage minor complications. The average stomal output was 820.20 ml/day initially and 477.55 ml/day at discharge. The median duration of DISE was 12 days. Thirteen patients (52%) needed parenteral nutritional support due to inadequate oral intake.Conclusion: DISE is a feasible and effective technique for managing high output enterostomies. It can be easily taught and performed with minimal resources at home.

Hysteroscopic treatment of complete uterine septum, double cervix and longitudinal vaginal septum (U2bC2V1): the use of a Foley catheter balloon

This is the case of a 30-year-old nulliparous patient with a complete uterine septum, double cervix and non- obstructive longitudinal vaginal septum (Class U2bC2V1 according to the ESHRE/ESGE classification). The patient presented with severe dyspareunia and dysmenorrhea. Imaging revealed a complex Müllerian anomaly and hysteroscopic treatment was agreed. We present an approach of hysteroscopic metroplasty after insertion of a Foley catheter balloon in one uterine hemi-cavity, which serves as a guide for septum resection using a resectoscope in the contralateral hemi-cavity. No complications were encountered. The patient was discharged after a short period of observation. A post-operative evaluation revealed complete resection of the vaginal septum and the formation of a single, normal uterine cavity.

Early Experience of the Single-Port Robotic Transvesical Radical Prostatectomy: Case Series

Purpose: This study evaluated the feasibility and safety of single-port transvesical robotic radical prostatectomy.Materials and Methods: Four patients underwent a transvesical robotic radical prostatectomy using a singleport robotic system. The procedure involved a 2.5-cm suprapubic incision to access the anterior bladder wall, which was incised by approximately 2 cm. Utilizing a floating-docking technique.Results: All surgeries were successfully completed without the need for additional ports or open conversion. Intraoperative complications were not observed. The median (interquartile range, IQR) console time was 159 (96–198) minutes. The median (IQR) estimated blood loss was 350 (300–700) mL. The median (IQR) duration for Foley catheter removal and patient discharge postsurgery was 7.5 (6–10) days. None of the patients experienced total incontinence after Foley catheter removal, and at 1-month postsurgery, all patients used only a safety pad. Pathology revealed positive surgical margins in 2 patients (both with pT3a and pT3b), with one of these patients having a persistent prostate-specific antigen level of 0.48 ng/mL at 1-month postsurgery. Additionally, 2 patients experienced gross hematuria within 2-week postdischarge.Conclusion: This series demonstrates that single-port robotic transvesical radical prostatectomy is a feasible procedure with favorable perioperative functional outcomes. This offers the advantage of rapid continence recovery without oncological disadvantages.

A New Method And An Algorithm For Non-Deflating Foley Catheter Balloons

Background: In rare cases, the catheter balloon cannot be deflated during catheter removal or repla-cement. In this study, we aimed to create a treatment algorithm for patients whose catheter balloon could not be deflated and to evaluate the effectiveness of a newly applied method. Materials and Methods: 55 male patients who applied to our clinic between January 2020 and July 2023 because the foley catheter could not be removed were evaluated. The methods applied in line with the algorithm we applied in our clinic were evaluated in terms of complications. However, a new met-hod that has not been described before in the literature was evaluated in terms of complications and effectiveness Results: A total of 55 patients were included in the study. The average age of the patients was 73.8 years. The average foley catheter stay was 14.9±8 days. When we examine the reasons for patients' catheterization; A catheter was placed in 5 patients, due to neurogenic bladder, 30 patients due to immobility, and 10 patients due to inability to urinate due to bladder outlet obstruction. All patients were successfully treated with the algorithm we applied. Conclusions: In rare cases, failure to deflate the foley catheter balloon is a very disturbing situation for patients. However, complications, mostly minor, may occur during treatment. We think that this met-hod and algorithm we have described is a method that can be used safely like other methods.

Development of a Clinically Relevant Preclinical Animal Model to Mimic Suburethral Implantation of Support Materials for Stress Urinary Incontinence.

Following the severe complications widely reported in some women following polypropylene suburethral mesh implantation for the treatment of stress urinary incontinence, it has become clear that careful preclinical study in an appropriate animal model is essential. The preclinical model described here allows the postoperative clinical and histochemical assessment of material implanted in the sheep vagina and represents a model that allows prediction of the potential vaginal tissue responses to suburethral mesh implantation before implantation into humans. To develop and evaluate a relevant preclinical animal model to mimic suburethral implantation of support materials for stress urinary incontinence. Fourteen parous ewes of 30-40 kg were used. Under general anesthetic, animals were placed in the lithotomy position. A 12-French Foley catheter was inserted. The ventral vaginal wall was longitudinally incised. The space between the vaginal wall and the urethra was developed, with lateral retropubic dissection. Either a standard transvaginal polypropylene tape (seven animals) or a fascia mimetic microfibre spun polyurethane tape (seven animals) were inserted using an introducer either via a suprapubic (seven animals) or a transvaginal approach (seven animals) into the suburethral and retropubic space. The incisions were closed, and the catheter was removed. A betadine vaginal pack was placed and removed after 24 h. Postoperatively, the animals were observed carefully for pain and complications and allowed access to water and food under continuous veterinary supervision adhering to USA-approved protocols. On the second postoperative day, all the animals passed urine freely and had regular bowel motions. No procedure related complications were observed. This is the first large animal model which has been designed for suburethral implantation. and which can be effectively used for the preoperative evaluation of novel materials designed for suburethral implantation. We believe that this technique in this large animal model accurately reproduces the surgical technique used to treat stress urinary incontinence in women. It provides a new and effective in vivo model for the objective evaluation of new materials to treat female stress incontinence.

Complications of Induction of Labour with Foley's Catheter in Patients with a Previous Cesarean Section

Background: Management of IUFD has immense significance in today’s obstetric practice. To summarize, dinoprostone gel, misoprostol and intra cervical catheter can be used for induction of labour in second and third trimester IUFD. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Objective: To observed the complications of induction of labor with Foley's catheter in patients with a previous cesarean section. Materials and Methods: The observational study was carried out in the Department of Obstetrics &amp; Gynecology, Dhaka Medical College Hospital. Dhaka, Bangladesh. Total 52 patients with singleton pregnancy with IUFD, at ≥28 weeks of gestation was attending in the Department of Obstetrics &amp; Gynae were included in this study. Details of history, general physical and systemic examination, ultrasonography, basic laboratory investigations like haemoglobin level, and DIC profile were recorded. Results: Forty three (82.7%) received augmentation with oxytocin, 3(5.8%) developed scar tenderness and 8(15.4%) had failed induction. Failed ICC was found 8 cases, among them 5(62.5%) had dinoprostone gel used followed by vaginal birth, 2(25.0%) had LUCS and 1(12.5%) had laparotomy. Induction delivery interval was found 16.3±5.5 hours. Regarding maternal outcome 49(94.2%) patients had normal vaginal delivery, 4(7.7%) had PPH, 3(5.8%) had fever, 2(3.8%) were ICU admission, 1(1.9%) had laparotomy and 1(1.9%) had rupture uterus. Conclusion: Common maternal complications were PPH, fever, ICU admission, laparotomy and rupture uterus. Induction can be done safely in carefully selected cases of previous LSCS with Foley’s Balloon.

The Characterisation of Carbapenem-Resistant Acinetobacter baumannii and Klebsiella pneumoniae in a Teaching Hospital in Malaysia.

Background/Objectives: The emergence and dissemination of carbapenem-resistant organisms, particularly Acinetobacter baumannii and Klebsiella pneumoniae, pose a significant threat to healthcare systems worldwide. This retrospective study aims to characterise carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Klebsiella pneumoniae (CRKP) strains in a teaching hospital and to determine the risk factors associated with patients' in-hospital mortality. Methods: A total of 90 CRAB and 63 CRKP were included in this study. Carbapenemase genes and MLST types of CRAB and CRKP were determined using specific primers. Risk factors associated with in-hospital mortality were analysed with collected data. Results: All the CRAB strains consisted of OXA carbapenemase genes, with 98% of the strains co-harbouring blaOXA-23-like and blaOXA-51-like carbapenemase genes. Conversely, blaNDM is the predominant carbapenemase gene in CRKP, followed by blaOXA-48-like carbapenemase genes. ST2 and ST20 are the dominant MLST types in CRAB and CRKP, respectively. In CRAB, multivariate analysis identified age, ethnicity, the presence of a mechanical ventilator, and patients who experienced previous exposure to clindamycin in the last 90 days as associated with an increased risk of in-hospital mortality. In contrast, older age, male, ICU admission, and the presence of an indwelling urinary catheter were significantly associated with an increased risk of mortality for patients with CRKP. Conclusions: Both CRAB and CRKP lead to high rates of mortality. The MLST profile showed that the genomic patterns of CRKP were highly diverse, whereas CRAB strains had low genetic diversity. To tackle these challenging pathogens, robust surveillance and an in-depth understanding of molecular epidemiology and genomics studies are needed to tailor infection control strategies and individualise treatment approaches.