Indwelling Bladder Catheter Research Articles

Purple urine bag syndrome: a unique clinical case and management considerations

Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag.This was the first patient in this region to be reported with this manifestation.

Bladder catheterization improves bacterial interference with asymptomatic Escherichia coli 83972 in an experimental porcine model of urinary tract infection.

Urinary tract infection (UTI) is a common disease with a significant risk of relapse. Deliberate bladder colonization with asymptomatic Escherichia coli is being explored as a potential strategy to fend off invading uropathogens thereby mitigating the risk symptomatic UTI. Currently, one major obstacle is the low success rates for achieving persistent bladder colonization with asymptomatic bacteria and experimental challenge studies are lacking. Here, we assessed the influence of an indwelling bladder catheter on the ability of asymptomatic E. coli to colonize the bladder and to assess the protective efficacy of such colonization against experimental urinary tract infection with uropathogenic E. coli. Pigs with or without indwelling bladder catheters were experimentally inoculated with the asymptomatic E. coli strain 83972 and subsequently challenged by inoculation with the uropathogenic E. coli isolate, UTI89. The animals were monitored with regular urine and blood samples and bladders and kidneys were harvested at termination. All pigs with indwelling catheters were colonized by 83972 in response to inoculation, compared to pigs without catheters in which only one of eight animals were colonized. When removing the catheter, 83972 were spontaneously cleared. Colonization with 83972 prevented experimental infection in 50% of animals compared to controls that all became infected. The presence of indwelling bladder catheters strongly facilitates the colonization of 83972, indicating that individuals using catheters may be particularly suited for receiving this treatment. The research supports prophylactic colonization with 83972 as a potential strategy to reduce the risk of urinary tract infections.

Holmium laser enucleation of the prostate (HoLEP) in short-circuit outpatient care: Is prostatic volume a limiting factor?

Our goals were to study prostatic volume as a limiting factor after HoLEP surgery with short-circuit outpatient care (4 h) and to define other factors that affect the success of the proposed circuit. An observational analysis and review was performed using a prospective database. Preoperative, intraoperative, and postoperative variables were included for patients who were scheduled for short-circuit outpatient care (SCOC) and who underwent HoLEP between 2020 and 2023. We defined SCOC as a postoperative hospital stay of 4 h. Subjects who required more than 4 h in hospital were categorized as conventional hospital admission (CHA). A descriptive populational study was conducted, expressing the mean using a 95% confidence interval and percentages for the continuous variables. In order to analyze them, we used the Student's t-test for the continuous variables and the chi-squared test for the categorical variables. Sixty-eight patients were included, 54 of which completed SCOC, which represented a success ratio of 79.5%. The mean age and prostatic volume of the whole cohort were 68.9 (±6.8) years and 79.5 (±29.1) mL, respectively. We found no significant differences in age, prostatic volume, antiplatelet drug use, indwelling bladder catheter, or applied energy among the subjects who completed SCOC and those who required CHA. No patient was presented with a complication of Grade 3 (or higher) in the modified Clavien-Dindo classification. At the six-month follow-up, no differences were observed in the uroflowmetry or International Prostate Symptoms Score variables. Prostatic volume does not seem to be a limiting factor after undergoing HoLEP with short-circuit outpatient care.

Early Removal of Indwelling Catheter and Vaginal Pack After Vaginal Prolapse Surgery: A Retrospective Cohort Study.

After vaginal pelvic organ prolapse (POP) surgery a vaginal pack and indwelling bladder catheter are inserted to reduce blood loss and bladder overdistension. The ideal timing of removal remains unclear. In this study we compared removal of vaginal pack and indwelling catheter 3 h post-surgery with removal the next day. This retrospective cohort study performed in the Netherlands included patients undergoing POP surgery between 1 January 2019 and 31 December 2020. Patients in whom the vaginal pack and catheter were removed the day after surgery (group A) were compared with patients in which the vaginal pack and catheter were removed 3h post-surgery (group B). Both groups were compared regarding urinary retention and the need for re-intervention owing to active blood loss within 6weeks postoperatively. Baseline characteristics, such as age, type of operation and type of anaesthesia in group A (n = 280) and group B (n = 207) were comparable. No significant differences were found regarding complications such as urinary retention (17.2 versus 23.2%; p = 0.255). The rates of re-intervention because of active blood loss and occurrence of infection were also comparable. Removal of the indwelling catheter and vaginal pack 3h after vaginal POP surgery does not lead to more postoperative complications than removal the 1st day after surgery. Therefore, early removal is a feasible and safe alternative to the standard timing of removal the morning after surgery of women undergoing POP surgery. In the future this could help with introducing same-day discharge.

Economic Impact of Postoperative Urinary Retention in the US Hospital Setting.

Background: Postoperative urinary retention (POUR) is a common and distressing surgical complication that may be associated with the pharmacological reversal technique of neuromuscular blockade (NMB). Objective: This study aimed to investigate the impact that POUR has on medical charges. Methods: This was a retrospective observational study of adult patients undergoing select surgeries who were administered neuromuscular blockade agent (NMBA), which was pharmacologically reversed between February 2017 and November 2021 using data from the PINC-AI™ Healthcare Database. Patients were divided into 2 groups: those experiencing POUR (composite of retention of urine, insertion of temporary indwelling bladder catheter, insertion of non-indwelling bladder catheter) during index hospitalization following surgery and those without POUR. Surgeries in inpatient and outpatient settings were analyzed separately. A cross-sectional comparison was performed to report total hospital charges for the 2 groups. Furthermore, patients experiencing subsequent POUR events within three days after discharge from index hospitalization were studied. Results: A total of 330 838 inpatients and 437 063 outpatients were included. POUR developed in 13 020 inpatients and 2756 outpatients. Unadjusted results showed that POUR was associated with greater charges in both inpatient ( 78 556 without POUR, p < .001) and outpatient ( 35 433 without POUR, p < .001) settings. After adjusting for confounders, POUR was found to be associated with greater charges with an overall mean adjusted difference of 95 760- 13 160 (95% CI 14 571, p < .001) in outpatient settings. Charges associated with subsequent POUR events following discharge ranged from 1694 outpatient charges. Conclusions: Surgical patients who were pharmacologically reversed for NMB and developed a POUR event incurred greater charges than patients without POUR. These findings support the use of NMB reversal agents associated with a lower incidence of POUR.

Compliance, Agreement and Reliability of the Assistance Team to Preventive Bundle for Urinary Tract Infections Associated with the Indwelling Bladder Catheter Procedure

AbstractPreventive measures to avoid urinary tract infection associated with indwelling bladder catheter (UTI-IBC). Have been associated with significant impact on patient’s outcomes. The aim of this study was to verify UTI-IBC prevention bundle compliance, agreement and reliability of the CCU assistance team. Prospective, quantitative, observational research approved by the research ethics committee (number 2.991.245), performed in the adult CCU of a university hospital. Patients hospitalized in the CCU for more than 24 hours who used IBC were included. Data were collected for three months consisted of evaluating bundle care records obtained in two different ways: the registries of IBC care included on the medical records, and the daily bedside IBC bundle checklist. The sample consisted of 40, 77.5% were male and the mean age was 62.05(±15.6) years. The compliance of the CCU healthcare team to the prevention bundle was 100%. For the items "Need to use the catheter" and "Collector bag below ⅔” agreement was very high and reliability was strong. In the item "Catheter properly fixed", although the agreement was high, reliability was slight. The items "Collector bag below the bladder's level" and "Intimate hygiene" agreement were very high, but it was not possible to verify reliability due to the limitation of Kappa's test. The healthcare team adhered to the implementation of prevention bundles. The agreement among the items was high, but not all items presented strong reliability, showing the importance of the continuous formation of the healthcare team. Keywords: Urinary Tract Infections. Urinary Catheterization. Patient Care Bundles. Intensive Care Units. Patient Care Team. ResumoMedidas preventivas para evitar a infecção do trato urinário associada ao cateter urinário residente (UTI-IBC) têm sido associadas a um impacto significativo nos resultados dos pacientes. O objetivo deste estudo foi verificar a aderência, concordância e confiabilidade da equipe de assistência da UCC frente aos bundles de prevenção de ITU-CVD. Estudo prospectivo, quantitativo e observacional aprovado pelo comitê de ética (número 2.991.245), realizado na UCC adulto de um hospital universitário. Foram incluídos pacientes hospitalizados na UCC por mais de 24 horas que utilizavam o CVD. Os dados foram coletados por três meses e consistiram na avaliação dos registros obtidos de duas formas diferentes: prontuário eletrônico, e à beira do leito. A amostra foi composta por 40 pacientes, 77,5% eram do sexo masculino, com idade média de 62,05 (±15,6) anos. A adesão da equipe de saúde da UCC aos bundles de prevenção foi de 100%. Para os itens "Necessidade do uso de cateter" e "Bolsa coletora abaixo de ⅔", a concordância foi muito elevada e a confiabilidade foi forte. No item "Cateter devidamente fixado", embora a concordância elevada, a confiabilidade apresentou-se fraca. Os itens "Bolsa coletora abaixo do nível da bexiga" e "Higiene íntima" apresentaram concordância muito elevada, mas não foi possível verificar a confiabilidade devido à limitação do teste Kappa. A equipe de cuidados aderiu aos bundles de prevenção. A concordância entre os itens foi elevada, porém nem todos os itens apresentaram confiabilidade alta, sinalizando a importância da educação permanente da equipe. Palavras chave: Infecções Urinárias. Cateterismo Urinário. Pacotes de Assistência ao Paciente. Unidades de Terapia Intensiva. Equipe de Assistência ao Paciente.

Enhanced Recovery After Surgery (ERAS®) Society Guidelines for Gynecologic Oncology: Addressing Implementation Challenges - 2023 Update

ABSTRACT Implementation of the Enhanced Recovery after Surgery (ERAS) Society Guidelines in 2016 has resulted in an approximate decrease in hospital length of stay (LOS), reduction in complications and readmission, and cost saving. Recent publications however have demonstrated that barriers and gaps in understanding may result in many ERAS recommendations being poorly adhered to in gynecologic oncology patients. The aims of this second update to the ERAS Society Guidelines for gynecologic oncology is to summarize and update the evidence investigating specific implementation challenges to increase ERAS uptake and improve clinical outcomes for patients. A literature search was conducted for topics specified to 9 ERAS implementation challenges identified: perioperative oral intake safety, preoperative medication importance, penicillin allergies, intraoperative analgesia, how to manage urinary drainage, venous thromboembolism prophylaxis, postoperative opioid prescription practices, same-day discharge programs, and how can I overcome barriers to ERAS implementation. The quality of evidence and recommendations was evaluated, and recommendations graded as strong or weak based on quality, balance between desirable and undesirable effects on holistic clinical outcomes, and on values and preferences of practitioners. Regarding perioperative oral intake safety, patients should be encouraged to consume clear liquids in 2 hours before surgery and preoperative carbohydrate loading improves satisfaction and comfort. Optimal preoperative medications include nonsteroidal anti-inflammatory drugs, acetaminophen, and gabapentinoids. Patients with penicillin allergies should receive standard surgical antibiotic prophylaxis. For intraoperative analgesia, wound infiltration with local anesthetic and TAP block are preferred over thoracic epidural analgesia. Indwelling bladder catheters should be removed as early as possible in the postoperative period such as on the day of surgery for minimally invasive procedures and no later than postoperative day 1 for laparotomy. Patients at increased risk of venous thromboembolism should receive dual prophylaxis with compression and medications, and extended chemoprophylaxis should be prescribed to those with high-risk criteria or after laparotomy. Multimodal opioid-reduction is critical for all patients, and decreased postdischarge opioid proscribing is improved with a team approach and does not affect pain control or patient satisfaction. Patient controlled analgesia is a last resort for those requiring repeated treatment with intravenous opioids. Multidisciplinary same-day discharge programs should be considered in minimally invasive surgeries, and implementation requires a multidisciplinary team approach with patient education, case selection, and ERAS principles. Overcoming barriers to ERAS principles is more successful with changes at the management level and education. Communication of the economic benefits of ERAS to administrators may be a strong incentive to garner support. Although the evidence level varied between moderate and strong for each of these recommendations, the recommendation grade for each was strong. This updated ERAS guideline focuses on addressing implementation challenges and controversial aspects of ERAS defined by a stakeholder clinician group and offers suggestions based on objective data for overcoming these barriers.

Initial Experience of Robot-Assisted Simple Prostatectomy with Hugo Robot-Assisted Surgery System: Step-by-Step Description of Two Different Techniques.

Introduction: There are only a few clinical data on nononcologic procedures performed with the new Hugo™ robot-assisted surgery (RAS) system. Robot-assisted simple prostatectomy (RASP) is a minimally invasive treatment option for benign prostatic hyperplasia, and it demonstrated equal early functional and better perioperative outcomes as compared with open simple prostatectomy. In this article, we reported the first large series of RASP performed with Hugo RAS system. Methods: This Supplementary Video S1 is a step-by-step description of two different techniques for RASP. We analyzed the data of 20 consecutive patients who underwent RASP at OLV Hospital (Belgium) between February 2022 and March 2023. Patients baseline characteristics, perioperative and pathologic, and 1-month postoperative outcomes were reported, using the median (interquartile range [IQR]) and frequencies, as appropriate. Results: Median age (IQR) and preoperative prostate specific antigen (PSA) were 72 (67-76) years, and 7.7 (5.0-13.4) ng/mL, respectively. A total of 11 patients experienced an episode of preoperative acute urinary retention, and 8 men had an indwelling bladder catheter at the time of the surgery. No intraoperative complication occurred, and there was no need for conversion to open surgery. Median operative and console time were 165 (121-180) and 125 (101-148) minutes. On the first postoperative day the urethral catheter was removed in 80% of the patients. Median length of stay was 3 (3-4) days. Three patients had minor postoperative complications. On final pathology report, median prostate volume was 120 (101-154) g. On postoperative uroflowmetry, median Qmax and postvoid residual were 16 (13-26) mL/s and 15 (0-34) mL, respectively. Conclusions: This series represents the first report of surgical outcomes of RASP executed with Hugo RAS system. Awaiting study with longer follow-up, our study suggests that Hugo RAS has multiple applications, and it can ensure optimal outcomes in nononcologic procedures.

Comparative simulation of T‐Control® indwelling bladder catheter insertion versus open and closed Foley urinary catheter systems

Luque M. is co-founder and shareholder of Rethink Medical, a company that develops and owns the rights of T-Control®. Serrano M. is the Technical Director, Scientific Manager and Regulatory Officer of Rethink Medical, a company that develops and owns the rights of T-Control®. Molina-Mazón C. S. from Bellvitge University Hospital declares that he has no conflict of interest. Luque L. from Healthcare Living Lab Catalonia declares that she has no conflict of interest. Endrényi S. is co-founder and shareholder of Rethink Medical, a company that develops and owns the rights of T-Control®.

Incidence and risk factors of abdominal compartment syndrome in pediatric oncology patients: a prospective cohort study.

Abdominal compartment syndrome (ACS) has been the subject of increasing research over the past decade owing to its effects on morbidity and mortality in critically ill patients. This study aimed to determine the incidence and risk factors of ACS in patients in an onco-hematological pediatric intensive care unit in a middle-income country and to analyze patient outcomes. This prospective cohort study was conducted between May 2015 and October 2017. Altogether, 253 patients were admitted to the PICU, and 54 fulfilled the inclusion criteria for intra-abdominal pressure (IAP) measurements. IAP was measured using the intra-bladder indirect technique with a closed system (AbViser AutoValve®, Wolfle Tory Medical Inc., USA) in patients with clinical indications for indwelling bladder catheterization. Definitions from the World Society for ACS were used. The data were entered into a database and analyzed. The median age was 5.79years, and the median pediatric risk of mortality score was 7.1. The incidence of ACS was 27.7%. Fluid resuscitation was a significant risk factor for ACS in the univariate analysis. The mortality rates in the ACS and non-ACS groups were 46.6% and 17.9%, respectively (P < 0.05).This is the first study of ACS in critically ill children with cancer. Conclusion: The incidence and mortality rates were high, justifying IAP measurement in children with ACS risk factors.

Rate of Postoperative Urinary Retention after Anterior Compartment Prolapse Surgery: A Randomized Controlled Trial Comparing Early versus Conventional Transurethral Catheter Removal.

Pelvic organ prolapse is a common condition of pelvic floor dysfunction in women, especially in adult vaginally parous and elderly women. Because of its anatomy, the anterior compartment has a significant effect on urinary symptoms. Anterior colporrhaphy and colpocleisis are major anterior compartment prolapse-related surgeries. As we know, postoperative urinary retention (POUR) is one of the most common complications following pelvic floor surgery. To prevent this complication, indwelling bladder catheterization is routinely applied. In contrast, to minimize risk of infection and the patient's discomfort, the catheter should be removed as soon as possible. However, there is a lack of clarity regarding the optimal timing for catheter removal. Therefore, the aim of this trial is to compare the rate of POUR after anterior prolapse surgery between early transurethral catheter removal (24 h postoperatively) and our standard practice (on postoperative day 3). We conducted a randomized controlled trial among patients undergoing anterior compartment prolapse surgery between 2020 and 2021 at a university hospital. Women were randomized into two groups. After removal, if the second void residual urine volume exceeded 150 mL, POUR was diagnosed, and intermittent catheterization was performed. The primary outcome was the POUR rate. The secondary outcomes included urinary tract infection, asymptomatic bacteriuria, time to ambulation, time to spontaneous voiding, length of hospitalization, and patient satisfaction. Analysis was performed according to the intention to treat principle. The calculated sample size was 68 patients (34 patients in each group) for a 95% confidence interval, 80% power, 5% probability of type I error, and 10% data loss. This study demonstrated that early catheter removal was comparable in POUR rate to conventional treatment with shorter hospitalization among patients undergoing anterior compartment prolapse surgery. Additionally, we observed no re-hospitalization owing to POUR. Therefore, early transurethral catheter removal is preferable following anterior compartment prolapse-related surgery.

Indwelling catheter patient experiences and the potential usability and acceptance of the T‐Control® prototype urinary catheter

AbstractThe aim of this study was to analyse the experience of users of indwelling bladder catheters and evaluate the anticipated usability of a prototype of the T‐Control® urinary catheter (without being inserted) by patients who were able to compare the differences between the T‐Control® prototype and other urinary catheters and urinary catheter accessories. A qualitative study was conducted with people who had lived with an indwelling urinary catheter for at least 1 week. Two user‐centred design techniques were applied: patient experience trajectory map and Think Aloud, a method where the participants were able to express their previous experiences, expectations and preferences while manipulating the devices. The experiential trajectory was collected based on a semi‐structured following interviews. Participants were able to manipulate the new T‐Control® and, based on their previous experiences, compare the potential usability of T‐control® with Foley‐type catheter and its accessories All the participants stated that they had experienced negative emotions concerning bladder catheterisation during the trajectory of use, from the initial prescription and adaptation to the follow‐up, and the forced life changes that a permanent catheterisation implies. The most frequent emotions were rejection and sadness. The new T‐Control® device could potentially improve the patient experience, as all participants perceived advantages related to the closure system, ease of use, safety and discretion. Participants also noted its closure system as an advantage and highlighted its ease of use, although one‐handed operation required some learning. Catheters currently on the market are functional, but some patients do not always have a satisfactory experience. This might negatively affect their quality of life, so there is a wide market opportunity for new devices that improve clinical and psychological care. Based on patient evaluation, the new T‐Control® device with a built‐in valve could provide benefits for patients.

Maternal Sepsis in Italy: A Prospective, Population-Based Cohort and Nested Case-Control Study.

Maternal sepsis represents a leading cause of mortality and severe morbidity worldwide. In Italy, it is the second cause of direct maternal mortality. Delay in recognition and treatment initiation are the drivers of sepsis-associated adverse outcomes. Between November 2017 and October 2019, the Italian Obstetric Surveillance System coordinated a prospective population-based study on maternal sepsis occurring before or after childbirth from 22 weeks' gestation onward and up to 42 days following the end of pregnancy. A nested 1:2 matched case-control study on postpartum sepsis was also performed. Maternal sepsis was diagnosed for the presence of suspected or confirmed infection alongside signs or symptoms of organ failure. The aim of this study was to assess maternal sepsis incidence and its associated risk factors, management, and perinatal outcomes. Six Italian regions, covering 48.2% of the national births, participated in the project. We identified an incidence rate of 5.5 per 10,000 maternities (95% CI 4.80-6.28). Seventy percent of patients had a low education level and one third were foreigners with a language barrier. Genital, respiratory, and urinary tract infections were the predominant sources of infection; the majority of cases was caused by E. coli and polymicrobial infections. The presence of vascular and indwelling bladder catheters was associated with a nine-fold increased risk of postpartum sepsis. There were no maternal deaths, but one fourth of women experienced a serious adverse event and 28.3% required intensive care; 1.8% of newborns died. Targeted interventions to increase awareness of maternal sepsis and its risk factors and management should be promoted.

Fungal biocompounds as strategy to control infection associated with urinary catheter

Catheter-associated urinary tract infections continue to be of concern, given the growth of epidemiological data, costs, bacterial resistance, and complications and morbidity. Bioprospection of plants as a strategy to control pathogenic microorganisms has gained space in the literature, due to the wide diversity existing in the Brazilian flora, which allows the exploration of endophytic fungi and various compounds, to be used in planktonic cells or to inhibit the formation of biofilms. This review aims to address the formation of biofilm in bladder catheters and perspectives with endophytic fungi, secondary metabolites and bioactive compounds against pathogenic microorganisms. The present data demonstrate a favorable use of endophytic fungi in the control of gram-positive and gram-negative microorganisms. The metabolites extracted from endophytic fungi with antibacterial action can be categorized especially among the class of phenolic compounds. In addition, they can be used to control the formation of biofilms in medical devices, such as indwelling bladder catheters, which are very susceptible to microbial colonization, being responsible for severe and persistent infections.

Management for Ureteral Injury during Laparoscopic or Robotic Hysterectomy: Minimally Invasive Strategies

<h3>Study Objective</h3> To demonstrate minimally invasive techniques to repair ureteral injury or ureteral stenosis related to minimally invasive hysterectomy. <h3>Design</h3> Retrospective cohort study. <h3>Setting</h3> Gynecology and Obstetrics department of a general hospital. <h3>Patients or Participants</h3> 23 patients who suffered from ureteral injury during surgery or ureteral stenosis or ureterovaginal fistula after hysterectomy. <h3>Interventions</h3> Between January 2010 and December 2021, 7,154 patients underwent laparoscopic or robotic simple hysterectomy for benign pathology. 16 patients experienced intraoperative ureteral injury found during the procedure. (Group 1) All were repaired in the same operative session using laparoscopic or robotic ureteroneocystostomy using bladder mobilization. In cases with large defects, psoas hitch or boari flap are used to compensate. 7 patients had ureteral injuries undetected intraoperatively and discovered as stenosis or fistula 3 to 12 days postoperatively. (Group 2) All were repaired via laparoscopic or robotic ureteroneocystostomy with or without psoas hitch. <h3>Measurements and Main Results</h3> No patient required reoperation and no patient required laparotomy. Although Group 1 the patients required 3 days placement of an indwelling bladder catheter, the hospital stay of patients was the same as patients who did not experience injury. Operative duration for repair is difficult to evaluate as it is combined with the difficult hysterectomy procedure time. Estimations show intraoperative repair took 40-104 minutes. Group 2 patients required surgical duration ranging from 70- 120 minutes. Blood loss was minimal to 150mL. No patient suffered from stenosis of the anastomotic site. 7 patients suffered from mild vesicoureteral regurgitation which did not require surgical intervention. 7 patients suffered from pyelonephritis, but only one or two episodes. (Follow up period: 3 months to 10 years.) <h3>Conclusion</h3> Avoiding open surgery in cases where injury occurs is important for maintaining the minimally invasive goals of the original surgery. Even if technically demanding, knowledge of laparoscopic and robotic urinary tract reconstruction techniques makes it possible to avoid open surgery for repair.

SC154 - Efficacy of prostate artery embolization in patients with indwelling bladder catheter

SC154 - Efficacy of prostate artery embolization in patients with indwelling bladder catheter

Indwelling Bladder Catheter Using in Cesarean Section: Is It Really Necessary?

Aim: This study aimed to evaluate the safety of cesarean section (CS) without an indwelling bladder catheter. We also aimed to compare the differences of clinical and voiding characteristics in patients with or without the urinary catheter after CS.&#x0D; &#x0D; Materials and Methods: This case-control study was conducted retrospectively in Gazi University Faculty of Medicine Hospital between April and September 2021. A total of 40 patients having an elective CS were reviewed. Among these patients, two groups were analyzed according to urinary catheter use: Patients without the urinary catheter (Group 1 / Study) and patients with the urinary catheter (Group 2 / Control). Outcome measures were postoperative urination, postoperative mobilization, and the discharge time of the patients. &#x0D; &#x0D; Results: While cesarean duration was significantly longer in group 1, postoperative urination, postoperative mobilization, and the hospital discharge times were significantly longer in group 2 (p

Assessing the impact of spinal versus general anesthesia on postoperative urinary retention in elective spinal surgery patients

ObjectivePostoperative urinary retention (POUR) is a common and vexing complication in elective spine surgery. Efficacious prevention strategies are still lacking, and existing studies focus primarily on identifying risk factors. Spinal anesthesia has become an attractive alternative to general anesthesia in elective lumbar surgery, with the potential of having a differential impact on POUR. Methods422 spinal anesthesia procedures were prospectively collected between 2017 and 2021 and compared to 416 general anesthesia procedures retrospectively collected between 2014 and 2017, at a single academic center by the same senior neurosurgeon. The main outcome was POUR, defined as the need for straight bladder catheterization or indwelling bladder catheter placement after surgery due to failure to void. A power calculation was performed prior to data collection. ResultsThe general anesthesia group had a higher rate of POUR (9.1 %) compared with the spinal anesthesia group (4.3 %), p = 0.005. At baseline, the spinal anesthesia cohort had an older average age and fewer patients with a history of previous spine surgery. Other comorbid conditions were comparable between the groups. For perioperative characteristics, spinal anesthesia patients had higher ASA scores, shorter operative times, shorter lengths of hospital stay, less operative levels, and zero use of intraoperative bladder catheterization. Acute pain service consult was similar between the groups. A multivariable logistic regression revealed that spinal anesthesia was associated with a significantly lower rate of urinary retention in the spinal anesthesia group (p = 0.0130), after adjusting for potentially confounding factors. Other statistically significant risk factors for POUR included diabetes, (p = 0.003), BPH (p = 0.014), operative time (p = 4.94e-06), and ASA score (p = 0.005). ConclusionsWe collect and analyze one of the largest available cohorts of patients undergoing simple and complex surgeries under spinal and general anesthesia, finding that spinal anesthesia is independently associated with a lower incidence of POUR compared to general anesthesia, even when adjusted for potentially confounding risk factors. Further prospective trials are needed to explore this finding.

Pregnancy after sexuality preserving cystectomy with urinary diversion for bladder cancer: case report and review of the literature

BackgroundRadical cystectomy for bladder cancer represents a high demolitive surgical procedure with a significative impact on quality of life. Sexuality preserving techniques have been proposed in order to improve functional outcomes. Although sex-sparing techniques would provide women with the chance of having pregnancy, experience is still limited when malignant conditions are considered. We report the outcomes of pregnancy and delivery in a 43-year-old woman with a Padua ileal orthotopic neobladder after robot-assisted sexuality preserving cystectomy for muscle-invasive urothelial bladder cancer performed four years earlier, at age 39.Case presentationSince pregnancy was confirmed, the patient had been under close urological and gynecological observation. Hydronephrosis and voiding-relating complications were reported and treated by inserting a nephrostomy tubes and indwelling bladder catheter. At the time of delivery, elective caesarian section was performed without complications.ConclusionsSexuality preserving cystectomy could be an option in selected and highly motivated young patients with diagnosis of bladder cancer. A multidisciplinary team of experts included gynecologists, urologists, radiologists, anesthesiologists and neonatologists is required for the optimal management of pregnancy and peripartum care in women with urinary diversion.

Hospital practices and clinical outcomes associated with behavioral symptoms in persons with dementia.

Hospitalized persons living with dementia (PLWD) often experience behavioral symptoms that challenge medical care. This study aimed to identify clinical practices and outcomes associated with behavioral symptoms in hospitalized PLWD. A retrospective cross-sectional study. The study included PLWD (65+) admitted to one of severe health system hospitals in 2019. Behavioral symptoms were defined as the presence of (1) a psychoactive medication for behavioral symptoms; (2) an order for physical restraints or constant observation; and/or (3) physician documentation of delirium, encephalopathy, or behavioral symptoms. Associations between behavioral symptoms and patient characteristics and hospital practices (e.g., bladder catheter) were examined. Multivariable logistic/linear regression was used to evaluate the association between behavioral symptoms and clinical outcomes (e.g., mortality). Of hospitalized PLWD (N = 8637), the average age was 84.5 years (IQR = 79-90), 61.7% were female, 60.1% were white, and 9.4% (n = 833) were Hispanic. Behavioral symptoms were identified in 40.6% (N = 3606) of individuals. Behavioral symptoms were significantly associated with male gender (40.3% vs. 36.9%, p = .001), white race (62.7% vs. 58.3%, p < .001), and residence in a facility prior to admission (26.6% vs. 23.7%, p < .001). Regarding hospital practices, indwelling bladder catheters (11.2% vs. 6.0%, p < .001) and dietary restriction (41.9% vs. 33.8%, p < .001) were associated with behavioral symptoms. In multivariable models, behavioral symptoms were associated with increased hospital mortality (odds ratio [OR]: 1.90, CI95%: 1.57-2.29), length of stay (parameter estimate: 2.10, p < .001), 30-day readmissions (OR: 1.14, CI95%: 1.014-1.289), and decreased discharge home (OR: 0.59, CI95%: 0.53-0.65, p < .001). Given the association between behavioral symptoms and poor clinical outcomes, there is an urgent need to improve the provision of care for hospitalized PLWD.