Indwelling Urethral Catheter Research Articles

Multidisciplinary Development and Implementation of a Trial of Void Algorithm to Standardize and Reduce Indwelling Urethral Catheter Use.

Prolonged indwelling catheter use is a known risk factor for catheter-associated UTIs (CAUTIs). We sought to reduce catheter use by creating and implementing a trial of void (TOV) algorithm to standardize indwelling Foley catheter removal in surgical patients. We partnered with the Departments of General Surgery and Nursing to develop an evidence-based TOV algorithm for a step-down unit at a large urban teaching hospital. Our cohort included patients treated with intra-abdominal, thoracic, vascular, urologic, and gynecologic surgeries. The primary outcome was mean cumulative indwelling urethral catheter patient-days. For example, if 2 patients had catheters for 3 and 7 days, respectively, then cumulative catheter days would be 10. We analyzed changes in catheter use 90 days before and after algorithm implementation. The mean number of hospitalized patient-days before and after algorithm introduction did not differ (32.2 vs 32.0, P = .60). After implementation, mean cumulative catheter patient-days decreased (14.8 vs 9.9, P < .01), as did mean daily number of patients with catheters on the unit (3.7 vs 3.1, P = .02). There was 1 CAUTI before and after algorithm implementation, the latter deemed associated with algorithm nonadherence. Catheter use in a surgical floor control group where the algorithm was not implemented did not differ for any outcome over the same time period (P > .05). A multidisciplinary approach to standardize catheter care with a TOV algorithm is feasible and effective in reducing catheter use. Further research is needed to determine its impact on CAUTI rate.

A randomized clinical trial: timing of indwelling urethral catheter removal following transurethral resection of prostate.

Aim: We aimed to evaluate early versus delayed removal of the indwelling urethral catheter (IUC) following transurethral resection of prostate (TURP). Methods: In this clinical trial conducted between July2016and June 2020, 90 patients underwent TURP were randomized equally into: group A, early IUC removal (24h), and group B, delayed IUC removal (72h). Results: The mean length of hospital stay was longer among the patients in group B. There were no significant differences in recatheterization, secondary bleeding, or UTI between groups A and B. The mean VAS score and CRBD were higher in group B. Conclusion: Early IUC removal following TURP is safe approach with favorable clinical outcomes. Clinical Trial Registration: NCT04363970 (clinicaltrials.gov).

Transurethral Resection of Necrotic Tissue in the Bladder Caused by Emphysematous Cystitis

Emphysematous cystitis is a relatively rare form of urinary tract infection. A 72-year-old man with diabetes mellitus and long-term indwelling urethral catheterization was diagnosed with emphysematous cystitis. The clinical findings were resolved by conservatively managing the patient with antibiotics. However, cystoscopy subsequently revealed a yellowish-white soft tissue mass in the bladder, which was unlikely to be a bladder tumor. The mass could not be removed easily and frequently caused urinary catheter obstruction. We successfully removed this mass by performing transurethral resection twice. Through histopathological examination, the mass was identified as necrotic tissue comprising bacteria, fibrin, and suspected bladder mucosa.

(165) Shaeer's Cavernotome: Core Your Way Through Corporal Fibrosis

Abstract Introduction Penile prosthesis implantation in scarred corporal bodies is one of the most challenging urologic procedures, with high risks of perforation and/or failure. Objective We present Shaeer’s Cavernotome (patent application number PCT/EG2021/050003). This is the forward-cutting cavernotome that relies on the principle of controlled coring rather than forward stabbing, with fibrous tissue accommodated into the hollow core, thereby high efficacy and low risk of perforation. Methods This is a prospective study involving 18 patients with severe corporal scarring. Surgery is performed through a peno-scrotal incision with an indwelling urethral catheter. Corporotomies are incised and a 2cm long core of fibrous tissue is excised with scalpel. Shaeer’s Cavernotome (ShC) is introduced and is lodged against the fibrous tissue. Coring proceeds with the stretched corpus or crus held between the thumb and index fingers of the non-dominant hand as a guide, ahead of the tip. ShC doubles as a sizer. Following coring, penile prosthesis implantation proceeds. Results Dilation of the corpora cavernosa was successful in 17 out of 18 patients. Average coring time was 8 minutes 3.2. Dilation was up to girth 13 Hegar in 12 patients, and 11 in 5. No perforations or infections were encountered Conclusions Shaeer’s Cavernotome is an instrument that facilitates penile prosthesis implantation in scarred corporal bodies. Full excavation of both corpora cavernosa is achievable in under 10 minutes, with low risk for perforation. Disclosure No.

Systemic sarcoidosis presenting as a rare combination of interstitial nephritis with necrotizing vasculitis and urinary retention due to prostate involvement: a case report

BackgroundSarcoidosis affects multiple organs and exhibits diverse clinical manifestations. Although tubulointerstitial nephritis is a known feature of renal involvement, necrotizing vasculitis is rare. Furthermore, prostate involvement with urinary retention is unusual in patients with sarcoidosis. Here, we report a case of systemic sarcoidosis with a rare combination of manifestations and different acute kidney injuries.Case presentationA 66-year-old man developed sudden urinary retention and fever. He was diagnosed with prostatitis and admitted to our hospital. An indwelling urethral catheter was inserted, and antimicrobial therapy was initiated; however, the prostatitis was refractory. Computed tomography revealed enlarged mediastinal lymph nodes. Analysis of transbronchoscopic lymph node and prostate biopsies showed epithelioid cell granulomas, suggesting systemic sarcoidosis. During the clinical course, the serum creatinine level rapidly increased to 2.36 mg/dL without oliguria. A kidney biopsy revealed tubulointerstitial injury with moderate lymphohistiocytic infiltration and small-vessel vasculitis in the interstitium. Following oral administration of 60 mg/day prednisolone, the patient’s renal function immediately improved, and urinary retention did not recur.ConclusionsTo the best of our knowledge, this is the first reported case of sarcoidosis with two unusual complications. Given its clinical course and pathology, this case is clinically valuable.

Shaeer's Cavernotome for Penile Prosthesis Implantation in Scarred Corpora Cavernosa.

Penile prosthesis implantation in scarred corporal bodies is one of the most challenging urologic procedures, with high risks of perforation and/or failure. We present Shaeer's Cavernotome (patent application number PCT/EG2021/050003). This is the forward-cutting cavernotome that relies on the principle of controlled coring and grinding rather than forward stabbing, with fibrous tissue accommodated into the hollow core, thereby ensuring high efficacy and low risk of perforation. This is a prospective study involving 18 patients with severe corporal scarring. Surgery is performed through a peno-scrotal incision with an indwelling urethral catheter. Corporotomies are incised and a 2-cm-long core of fibrous tissue is excised with a scalpel. Shaeer's Cavernotome is introduced and lodged against the fibrous tissue. Coring proceeds with the stretched corpus or crus held between the thumb and index fingers of the non-dominant hand as a guide, ahead of the tip. Shaeer's cavernotome doubles as a sizer. Following coring, penile prosthesis implantation proceeds. Dilation of the corpora cavernosa was successful in 17 out of 18 patients. Average coring time was 8 ± 3.2 minutes. Dilation was up to girth 13 Hegar in 12 patients, and 11 in 5. No perforations or infections were encountered. Shaeer's cavernotome facilitates penile prosthesis implantation in scarred corporal bodies. Full excavation of both corpora cavernosa is achievable in less than 10 minutes, with a low risk for perforation.

Holmium Laser Enucleation of the Prostate Is Associated with Complications and Sequelae Even in the Hands of an Experienced Surgeon Following Completion of the Learning Curve

BackgroundHolmium laser enucleation of the prostate (HoLEP) is considered a challenging procedure even for surgeons who have completed the learning curve. ObjectivesTo assess outcomes and complications following HoLEP performed by a highly experienced surgeon. Design, setting, and participantsThis was a single-institution prospective study (NCT03583034) performed at a tertiary referral centre that included 243 consecutive patients with lower urinary tract symptoms (LUTS) due to benign prostatic enlargement (BPE) treated with HoLEP by a single experienced surgeon (>1600 cases). Outcome measurements and statistical analysisPatients were assessed using validated questionnaires and uroflowmetry at baseline and several follow-up dates. Intraoperative and postoperative complications were recorded. Kaplan-Meier analysis was used to estimate recovery rates for urinary continence and erectile function. Logistic regression models were constructed to assess predictors of postoperative complications. Results and limitationsOf the 243 patients, 78 (32.1%) had an indwelling urethral catheter. The median prostate volume (PV) was 87 cm3 (interquartile range 60–115) and 146 patients (59.8%) had PV >80 cm3. At 3-mo follow-up, 219 patients (90.1%) had a peak flow rate >20 ml/s and 182 (74.9%) had no postvoid residual urine. The improvement in subjective symptoms was significant at 1-mo follow-up and was maintained until 12 mo after surgery. Urinary continence recovery was slow, with an estimated rate of 68% (95% confidence interval [CI] 62–74%) at 1 mo and 94% (95% CI 91–97%) at 12 mo after HoLEP. The recovery rate for erectile function was 53% (95% CI 46–61%) at 1 mo and 85% (95% CI 77–90%) at 12 mo. Postoperative complications occurred in 36 patients (14.8%) during their hospital stay, in 34 (14%) within 1 mo following discharge from hospital, and in ten (4.1%) at later follow-up dates. Clinically significant complications (Clavien-Dindo ≥2) were observed in 44 cases (18%) and were more common for patients with an indwelling catheter at baseline (odds ratio 5.05; p = 0.006). ConclusionsHoLEP is an effective procedure for treating LUTS due to BPE, although it is not devoid of complications and sequelae, even in the hands of a highly experienced surgeon. Patient summaryHolmium laser treatment of the prostate to reduce its size has positive results for urinary function when performed by an experienced surgeon, even in complex cases, although there can be complications.

456 Urinary catheterisation in the nursing home setting: challenges and opportunities in catheter use and design: a questionnaire study

Abstract Introduction Urinary catheter use is associated with a range of complications including infection, encrustation, blockage, leakage, pain and discomfort (1). There is a limited evidence-base regarding prevalence of catheterisation, and issues experienced in using urinary catheters in the nursing home (NH) population. Aim To explore the prevalence of urinary catheterisation and the types of catheters used by NH residents in a region of the United Kingdom (UK), to investigate the most common issues associated with catheter use, and to explore urinary catheter services in NHs. Methods Three different versions of a questionnaire for self-completion were designed (for NH managers, nurses and non-registered healthcare assistants), piloted and distributed to NH staff in a region of the UK, via post or online. NH managers were recruited through postal distribution to all registered NHs in the region (n=243) and via email distribution facilitated by a non-profit membership organisation representing health and social care providers. Nurses and healthcare assistants in 83 nursing homes across the region were recruited through a gatekeeper (GM: an academic care home nurse specialist and link-link lecturer from the School of Nursing and Midwifery, QUB. Questionnaires contained 47 items (managers), 48 (nurses), and 18 items (healthcare assistants), with a mixture of Likert scale questions, yes/no questions and a small number of open questions. Data were anonymised and entered into SPSS (V27) for statistical analysis. Descriptive analysis was conducted for closed-ended questions, and thematic analysis was used for open-ended questions. Results Questionnaires were completed between March and June 2022 by 162 participants. Eighty-eight responses were received from NH managers (response rate = 36.2%; 88/243). Seventy-four responses were received from nurses and healthcare assistants (31 and 43, respectively). Prevalence of catheterisation among NH residents was 6.4% (206/3226) and numbers of catheter users ranged between zero and eight per NH. Most residents (78.6%; 162/206) used indwelling urethral catheters. Almost one third of NH managers (29.5%; 26/88) and nurses (32.3%; 10/31) reported that catheters cause UTIs often and almost one in ten (8.0%; 7/88 and 9.7%; 3/33, respectively) reported a UTI occurring every time a catheter is used. Two-thirds (67.0%; 59/88) of NH managers and 58.1% (18/31) of nurses reported that catheter care training is not mandatory for all staff. Most managers and nurses agreed or strongly agreed that they had adequate catheter training in the past (80.7%; 71/88 and 74.2% 23/31, respectively), but less than half of managers and nurses reported good availability of catheter care retraining (45.5%; 40/88 and 48.4%; 15/31, respectively). Around 64.8% (57/88) of managers and 71.0% (22/31) of nurses wanted catheters to be reviewed more often than they currently are. NH managers and nurses reported difficulty in contacting specialists regarding catheter-associated problems in complex cases; only one third of managers and nurses indicated this was easy or very easy (34.1%; 30/88 and 38.7%; 12/31, respectively). Improvements to catheter design were not considered feasible by many respondents; approximately one third of managers, nurses and healthcare assistants thought improvements could be made (35.2%; 31/88, 32.3%; 10/31 and 30.2%; 13/43, respectively). Conclusion These findings highlight issues in catheter care training and management of catheter-related complications in the NH setting. Providing all NH staff, including healthcare assistants, with adequate urinary catheter training in managing catheter-associated complications has the potential to improve patient quality of life and reduce unplanned hospital visits and represents a priority for research and clinical practice. This study is the first to examine catheter prevalence and issues with use in NHs in this region of the UK. However, findings may not be generalisable to other parts of the UK or internationally.

Purple urine bag syndrome: An unusual presentation of urinary tract infection

Introduction: Purple urine bag syndrome is a rare clinical entity characterized by purple discoloration of the urinary catheter and urinary drainage bag in chronically catheterized patients. Though it can be alarming to patients and clinicians, it is considered benign but can indicate an underlying urinary tract infection. Case Series: The first case was a 68-year-old woman with multiple comorbidities who was admitted to the orthopedic ward with a close fracture of the neck of the right femur. She was bedridden and had an indwelling urethral catheter. Her urine bag was noticed to stain purplish 22 days after bladder catheterization. Urine culture showed a heavy mixed growth. A change of urinary catheter and drainage bag led to a resolution of the condition. The second case was a 58-year-old male who was admitted on account of decompensated liver cirrhosis from chronic hepatitis C virus infection. He also had quadriparesis due to a traumatic cervical spine injury, urine retention, and constipation. On day 24 of his admission, his urine bag was stained with a purplish hue. A urine culture grew Klebsiella oxytoca. The urine bag remained clear and contained amber-colored urine after catheter changes and antibiotic treatment for cystitis. Conclusion: Purple urine bag syndrome can be alarming to the patient and caregiver who need to be reassured of its benign nature. Urine culture would identify any associated infection. Good catheter care, control of risk factors including constipation and antibiotic treatment for symptomatic urinary tract infection leads to the resolution of the discoloration.

MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS

You have accessJournal of UrologyCME1 Apr 2023MP02-08 CATHETER ASSOCIATED MUCOSAL PRESSURE INJURIES (CAMPI): A NOVEL STUDY DEFINING THE IMPACT OF LONG TERM URETHRAL CATHETERS Kandice Keogh, Devang Desai, and Hannah Flynn Kandice KeoghKandice Keogh More articles by this author , Devang DesaiDevang Desai More articles by this author , and Hannah FlynnHannah Flynn More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003213.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Indwelling urethral catheters (IDC) are common in surgical practice. Given their widespread use, it is tempting to dismiss IDCs as benign drainage tubes. However, a significant complication is erosion of the urethra and surrounding soft tissues resulting in a pressure injury. We coined the term Catheter-Associated Mucosal Pressure Injury (CAMPI) for this form of iatrogenic hypospadias. Active treatment for CAMPI can be invasive with significant side effect profiles, emphasizing the importance of prevention in these patients. To date, there has been little research into CAMPI. Existing publications are either isolated case reportsor small case series. This study explored the prevalence and risk factors of CAMPI in adults with long-term IDCs in regional Australia. METHODS: A multi-centre cross-sectional study was undertaken at two large regional hospitals. The cohort was comprised of 200 adults with an IDC in-situ for >4 weeks between January 2019 to June 2021. Data was collected via a voluntary questionnaire and review of medical records. A novel grading system based on existing hypospadias classification was developed (Image 1). RESULTS: Overall prevalence of CAMPI was 9% (17/200). The mean IDC duration in patients with CAMPI was 39 weeks (9.7 months). The shortest time between IDC insertion and CAMPI detection was only 2 weeks. Prevalence was higher in males (16/169, 10%) compared to females (1/31, 3%). In males, the grades of CAMPI were meatal (7/17, 41%), glanular (3/17, 18%), coronal (4/17, 23%), subcoronal (1/17, 6%), distal penile shaft (1/17, 6%) and mid-penile shaft (1/17, 6%). The female case involved erosion of the urethral orifice during a long hospital admission. Over two-thirds of adults with a CAMPI had an IDC >16Fr (13/18, 72%). Latex IDCs were more common than silicone IDCs in both groups (78% non-CAMPI vs 67% CAMPI, p=0.49). Poor mobility (36% non-CAMPI vs 72% CAMPI, p=0.01), community managed IDCs (26% non-CAMPI vs 50% CAMPI, p=0.03), and congestive cardiac failure (9% non-CAMPI vs 28% CAMPI, p=0.02) were associated with CAMPI formation. CONCLUSIONS: CAMPI is a prevalent complication of long-term IDCs and prevention is key. Catheter securement, hygiene and care must be prioritised by all clinicians who insert, manage and change IDCs. Source of Funding: Nil Funding © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e13 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kandice Keogh More articles by this author Devang Desai More articles by this author Hannah Flynn More articles by this author Expand All Advertisement PDF downloadLoading ...

LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE

You have accessJournal of UrologyCME1 Apr 2023LBA01-07 MULTI-DISCIPLINARY DEVELOPMENT AND IMPLEMENTATION OF A TRIAL OF VOID ALGORITHM TO REDUCE INDWELLING URETHRAL CATHETER USE David Han, Lovie Amolo, Hersy Contreras, Maureen Lowers Roach, Bridgette Bennett, Maria Sofia Luga, Shelly-Anne Layne, Coraima Rihan Veliz, Subhash Krishnamoorthy, David Weiner, Christopher Anderson, and Gina Badalato David HanDavid Han More articles by this author , Lovie AmoloLovie Amolo More articles by this author , Hersy ContrerasHersy Contreras More articles by this author , Maureen Lowers RoachMaureen Lowers Roach More articles by this author , Bridgette BennettBridgette Bennett More articles by this author , Maria Sofia LugaMaria Sofia Luga More articles by this author , Shelly-Anne LayneShelly-Anne Layne More articles by this author , Coraima Rihan VelizCoraima Rihan Veliz More articles by this author , Subhash KrishnamoorthySubhash Krishnamoorthy More articles by this author , David WeinerDavid Weiner More articles by this author , Christopher AndersonChristopher Anderson More articles by this author , and Gina BadalatoGina Badalato More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003360.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prolonged indwelling catheter use is a risk factor for catheter-associated urinary tract infections (CAUTIs). To reduce catheter use among post-operative patients, we sought to create and implement a novel algorithm to standardize the removal of indwelling Foley catheters. METHODS: We partnered with nursing leadership and the General Surgery Department to develop an evidence-based trial of void algorithm for a surgical Step-Down Unit at an urban teaching hospital [Figure 1A]. Our cohort included post-operative patients treated with intraabdominal, thoracic, vascular, and gynecologic surgeries; patients having urologic surgeries with an imperative indication for a long-term indwelling urethral catheter were excluded from the algorithm but included in analysis. The primary outcome was mean cumulative indwelling urethral catheter days (ex. if 2 patients had catheters for 3 and 7 days, then cumulative catheter days would be 10). We also measured mean total patient days (as a surrogate for patient volume), mean daily number of patients with catheters, and the number of CAUTIs, which are all nationally reported outcomes from the Centers for Disease Control and Prevention. Another surgical unit where the algorithm was not implemented was used as a natural control. We analyzed changes in relevant outcomes 90 days before and after algorithm implementation. RESULTS: The mean number of hospitalized patient days before and after algorithm introduction did not differ on the Step-Down Unit (32.2 vs. 32.0, p=0.60). After implementation, mean cumulative catheter days decreased (14.8 vs. 9.9, p<0.01), as did mean daily number of patients with catheters (3.7 vs. 3.1, p=0.02). Measures of catheter use variation also decreased [Figure 1B]. There was one CAUTI before and after algorithm implementation, the latter deemed potentially associated with algorithm non-adherence on root cause analysis. Measures of catheter use in the surgical floor control group did not differ for any outcome (p>0.05) over the same time-period. CONCLUSIONS: A multi-disciplinary approach to standardize catheter care with an evidence-based trial of void algorithm is feasible and effective in reducing catheter use. Further expansion of this pilot is needed to establish an impact on the associated rate of CAUTI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1178 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information David Han More articles by this author Lovie Amolo More articles by this author Hersy Contreras More articles by this author Maureen Lowers Roach More articles by this author Bridgette Bennett More articles by this author Maria Sofia Luga More articles by this author Shelly-Anne Layne More articles by this author Coraima Rihan Veliz More articles by this author Subhash Krishnamoorthy More articles by this author David Weiner More articles by this author Christopher Anderson More articles by this author Gina Badalato More articles by this author Expand All Advertisement PDF downloadLoading ...

MP74-14 SUPRAPUBIC CATHETER DRAINAGE FOR THE LONG-TERM MANAGEMENT OF LOWER URINARY TRACT DYSFUNCTION: LONGITUDINAL OUTCOMES AND UTILIZATION PATTERNS FROM A TERTIARY CARE PRACTICE

You have accessJournal of UrologyCME1 Apr 2023MP74-14 SUPRAPUBIC CATHETER DRAINAGE FOR THE LONG-TERM MANAGEMENT OF LOWER URINARY TRACT DYSFUNCTION: LONGITUDINAL OUTCOMES AND UTILIZATION PATTERNS FROM A TERTIARY CARE PRACTICE Faizan Khawaja, Kevin Flynn, Mei Tuong, Charles Schlaepfer, Andrew Metzger, and Bradley Erickson Faizan KhawajaFaizan Khawaja More articles by this author , Kevin FlynnKevin Flynn More articles by this author , Mei TuongMei Tuong More articles by this author , Charles SchlaepferCharles Schlaepfer More articles by this author , Andrew MetzgerAndrew Metzger More articles by this author , and Bradley EricksonBradley Erickson More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Suprapubic catheters (SPC) are considered to be a temporary, and often emergent, means to drain urine from the bladder. However, many individuals are managed with SPCs for longer periods of time, often because of patient choice. Our objective is to describe this population and report on the long-term outcomes of chronic SPC use for lower urinary tract dysfunction (LUTD). METHODS: An institutional review of CPT and ICD-9/10CM codes was conducted to identify a cohort of patients in which an SPC was placed at our institution over an 8-year period. Patients were then excluded if the SPC was placed emergently for lower urinary tract trauma (e.g. pelvic fracture) or for a pre-determined time-period. The final cohort was then analyzed for peri-operative and long-term complications, and for SPC survivability. RESULTS: Of 370 SPC placed from 2014-21, 190 met inclusion criteria (131 Male; 59 Female). Indications for SPC were most commonly Acquired Neurogenic Bladder (40%), Urinary Retention/Atonic Bladder (27%), Urinary Incontinence (11%) and Congenital Neurogenic Bladder (8%). Bladder management prior to SPC was indwelling urethral catheter (53%), intermittent catheterization (32%) and none (15%). There were no Clavian Grade III/IV complications with placement. Initial clinic SPC exchange was successful in 98% (4 required repeat tract dilation). Subsequent exchanges occurred in urology clinics (54%), care facilities (23%), interventional radiology (12%) and at home by patient (11%) at a median interval of 3.5 weeks. >30 day complications were common (51%), but all Clavian Grade I/II (UTI 27%, bladder spasms 13%). At median follow-up of 431 days, 74% continued to use their SPC (Figure 1), of which 53 (38%) perform daily irrigation. CONCLUSIONS: SPC is a commonly used, well-tolerated, poorly studied means of chronic bladder drainage for a wide-variety of LUTD in patients not suitable or willing to undergo surgical reconstruction. Considered to be a management method of last resort, its popularity amongst patients nonetheless suggests its use should be studied in further detail. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1075 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Faizan Khawaja More articles by this author Kevin Flynn More articles by this author Mei Tuong More articles by this author Charles Schlaepfer More articles by this author Andrew Metzger More articles by this author Bradley Erickson More articles by this author Expand All Advertisement PDF downloadLoading ...

Complications of different methods of urological management in people with neurogenic bladder secondary to spinal cord injury

Objective To investigate the association between multiple types of urological management and urological complications in patients with spinal cord injury (SCI). Design A retrospective cohort study. Setting Single medical center. Methods Medical records of SCI patients with regular follow-up of more than two years were reviewed. Urological management was classified into five groups: indwelling urethral catheter (IUC), clean intermittent catheterization (CIC), reflex voiding, suprapubic catheter (SPC), and self-voiding. We analyzed the incidence of urinary tract infection (UTI), epididymitis, hydronephrosis, and renal stone across the different urological-management groups. Results Of 207 individuals with SCI, the most common management type was self-voiding (n = 65, 31%) followed by CIC (n = 47, 23%). The IUC and SPC groups included more people with complete SCI than the other management groups. Compared with the IUC group, the SPC and self-voiding groups had lower risks of developing UTI (relative risk [RR] = 0.76, 95% CI, 0.59-0.97 and RR = 0.39, 95% CI, 0.28-0.55, respectively). The SPC group tended to have a lower risk of epididymitis than the IUC group (RR = 0.55, 95% CI, 0.18-1.63). Conclusion Long-term IUC use was associated with a higher incidence of UTI in people with SCI. As compared to those with IUC, a lower risk of UTI was found in persons with SPC. These findings may have implications for shared clinical decision-making.

Successful management of pelvic urethral strictures with balloon dilation in 3 cats.

To describe the successful management of pelvic urethral strictures in 3 young cats (1 after perineal urethrostomy, 1 after a third-time urethral obstruction, and 1 with prolonged lower urinary tract signs post-urethral obstruction) using balloon dilation and a short-term, indwelling urethral catheter. A 9-month-old neutered male domestic longhair cat with a urethral obstruction and a suspected congenitally narrowed urethra was treated via perineal urethrostomy. The cat later developed acute kidney injury, multidrug-resistant urinary tract infections, and a pelvic urethral stricture. A second case, a 2.3-year-old neutered male domestic shorthair cat, developed a stricture of the pelvic urethra after multiple obstructions and catheterizations. A third case, a 1.2-year-old neutered male domestic shorthair cat, had persistent and prolonged lower urinary tract signs after treatment for a urinary obstruction. The cat also had an abnormally small urethral opening and was ultimately found to have a proximal urethral stricture. The strictures in all 3 cases were successfully treated with a combination of fluoroscopic-guided balloon dilation and short-term indwelling urethral catheterization while managing any present infection. To the authors' knowledge, this is the first published case series of successful balloon dilations paired with the use of a short-term indwelling urethral catheter in cats that developed urethral strictures after catheterization due to urinary obstructions. This procedure appears safe and well tolerated and appears to offer a long-term, cost-effective solution to urethral strictures at the level of the pelvis.

To Compare Short-term Surgical Outcome among Patients given Continuous Postoperative Antibiotic Prophylaxis and those given no Postoperative Antibiotics after Urethroplasty for Hypospadias: A Pilot Study.

There is no well-accepted guideline or uniform practice for the usage of prophylactic antibiotics along with urethroplasty for hypospadias. As antibiotic resistance is growing, it is imperative to rationalize the usage of antibiotics when a patient is operated for hypospadias. The study is aimed at finding if there is any difference in outcome if prophylactic antibiotics are given after urethroplasty for hypospadias. Prospective randomized controlled study. Forty patients between 6 months and 12 years of age were included in the pilot study. All patients received a single preoperative antibiotic and surgery as per the discretion of the operating surgeon. The participants were randomly assigned to Group A or B, Group A not receiving any prophylactic antibiotic after surgery, and Group B receiving prophylactic antibiotics till indwelling urethral catheter was in situ as per the present antibiotic policy of the institute. The patients were followed up clinically at catheter removal, 1 week after surgery and 1 month after surgery. Urine was analyzed at the start of surgery and after catheter removal. Data were tabulated and analyzed using nonparametric Fischer's exact test with help of Epi Info™ v5.5.8. Twenty-four patients were included in Group A and 16 in Group B. The clinical profile is presented in the detailed manuscript. Although pus cells could be demonstrated on urine examination in 82.5% of the study participants, only 10% grew organisms on culture media. No difference could be demonstrated among the two groups statistically. On following up with the patients for 1 month, the groups were comparable with respect to surgical site infections, and surgical complications such as urethrocutaneous fistula/dehiscence and thin stream. [Table: see text]. There was a wide variability among practicing pediatric urologists in prescribing antibiotic prophylaxis for patients undergoing urethroplasty for hypospadias. In the Urologic Surgery Antimicrobial Prophylaxis Policy by the American Urology Association, no recommendation has been made with respect to urethroplasty. Our results are in concurrence with the available English literature which has not shown any benefit of prophylactic antibiotics after hypospadias repair. Antibiotics may not have a definite role in the prevention of surgical complications and it may be imperative to avoid unnecessary antibiotics to reduce antibiotic resistance.

Effect of external urinary collection device implementation on female surgical patients.

The Centers for Disease Control and Prevention reports that catheter-associated urinary tract infections (CAUTIs) are the most common hospital-acquired infection. Female external urinary collection devices (EUCDs) may be an alternative to indwelling urethral catheters (IUCs), thereby decreasing CAUTIs. However, no study has demonstrated that EUCDs can help reduce CAUTIs in female surgical patients. We sought to compare CAUTI rate and the median number of days an IUC was used before and after availability of this female EUCD for surgical patients. A retrospective analysis of adult female surgical patients admitted to a single academic institution who received an IUC and/or EUCD was performed. Patients who received an IUC three months before (PRE) EUCD availability (08/2017-10/2017) were compared to patients receiving an IUC and/or EUCD 12 months after (POST) (11/2017-11/2018). From 906 surgical patients receiving an IUC/EUCD, 127 received an EUCD in the POST cohort. Compared to the PRE, the POST had a higher rate of CAUTIs (infections per 1000 catheter days, 11.2 vs. 4.6, p=0.017) and overall UTI rate (infections per 1000 catheter days, 5.4 vs. 4.8, p=0.036), whereas IUC days were similar between cohorts (median, two vs. two days, p=0.18). The POST cohort rate of EUCD UTI was 4.6 infections per 1000 device days. While EUCDs appear to be a promising alternative to IUCs for female surgical patients, this study found increased CAUTIs after introduction of an EUCD. Further research is needed to clarify if female EUCDs are effective in decreasing CAUTI prior to widespread adoption.

Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury.

Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.

PD48-07 PEDIATRIC PYELOPLASTY AND PERIOPERATIVE URETHRAL CATHETER : WHAT ARE THE BENEFITS?

You have accessJournal of UrologyCME1 May 2022PD48-07 PEDIATRIC PYELOPLASTY AND PERIOPERATIVE URETHRAL CATHETER : WHAT ARE THE BENEFITS? Maria Camila Suarez, Sirpi Nackeeran, Daniel E. Nassau, Alireza Alam, Rafael Gosalbez, and Miguel Castellan Maria Camila SuarezMaria Camila Suarez More articles by this author , Sirpi NackeeranSirpi Nackeeran More articles by this author , Daniel E. NassauDaniel E. Nassau More articles by this author , Alireza AlamAlireza Alam More articles by this author , Rafael GosalbezRafael Gosalbez More articles by this author , and Miguel CastellanMiguel Castellan More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002616.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is a common practice to place an indwelling ureteral stent and urethral catheter after pediatric pyeloplasty. The foley is routinely removed on post-operative day (POD) 1; however, even with a limited indwelling time, it can increase the risk of urinary tract infection (UTI). Despite the short duration use of urethral catheters, it is unknown if they can be safely omitted during pyeloplasty. We recently discontinued perioperative foley use during pyeloplasty and aimed to compare the safety profile and outcomes of our early experience to a cohort of patients who had foley placement during pyeloplasty. METHODS: Our prospectively maintained database of patients who underwent pyeloplasty without use of a foley catheter from 2019-2021 was queried. Retrospective chart review was done from 2012-2020 of patients who underwent pyeloplasty with foley placement. Patients were excluded if they were >21 years of age. Indwelling ureteral stents with or without a string were placed in all patients either retrograde via cystoscopy immediately prior to the procedure or antegrade during the ureteropelvic junction reconstruction. Statistically significant differences between patients with and without foley were assessed using chi-squared tests, t-tests, Fischer’s exact and Wilcoxon Rank-Sum; where alpha=0.05. RESULTS: A total of 149 patients with (group A) and 51 patients without (group B) foley placement were included in the study. Comparison of clinical variables among groups is shown in Table 1. The mean operative time, POD of hospital discharge, and time of stent indwelling were statistically significant higher in group A than group B. Stent was removed in the office in 4% of group A and 43% of group B, in all other cases it was removed in the operating room cystoscopically and under general anesthesia. The incidence of UTI during the first 30 POD was higher in group A than group B (4.6% vs 2%), however it was not statistically significant (p=.25). Lower urinary symptoms in the first 30 POD also presented more frequently in group A (6%) than group B (0%) with p=0.08. Only 4% of group A required a redo-procedure; till the date none of the patients of group B had required a redo-pyeloplasty. CONCLUSIONS: Pediatric pyeloplasty without foley placement showed a favorable safety profile with durable post-operative outcomes across a wide range of clinical variables. “Foley-less” pyeloplasty had benefits beyond a low incidence of UTIs, including shorter operative time and days from discharge, and increasing the frequency of ureteral stents left on a string, negating the need for cystoscopic stent removal under general anesthesia. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e801 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Maria Camila Suarez More articles by this author Sirpi Nackeeran More articles by this author Daniel E. Nassau More articles by this author Alireza Alam More articles by this author Rafael Gosalbez More articles by this author Miguel Castellan More articles by this author Expand All Advertisement PDF DownloadLoading ...

The safety cutoff storage pressure for preventing upper urinary tract damage in neurogenic bladder from spinal cord pathology and risk factor analysis.

Low-compliance bladder or high bladder pressure undoubtedly leads to hydronephrosis and renal impairment. As four decades have elapsed since a previous study found a detrusor leak-point pressure (DLPP) >40 cm H2 O to result in hydronephrosis, we suspected the possibility of hydronephrosis or vesicoureteral reflux occurring at any point below the 40 cm H2 O DLPP reference. Therefore, this study aimed to determine the storage detrusor pressure value and risk factors related to upper urinary tract damage (UUTD). This study retrospectively reviewed the hospital records of 110 patients who visited the Neurogenic Bladder TU Service of Excellence Unit, Thammasat University Hospital, Pathum Thani, Thailand, and were diagnosed with neurogenic bladder between 2016 and 2020. The inclusion criteria were as follows: patients who were diagnosed with neurogenic bladder from spinal cord problems (spinal dysraphism, spinal cord disease [tumor, degenerative, arteriovenous malformation, etc.], or traumatic spinal cord injury) and underwent a complete examination, including urodynamic study and renal ultrasound. The exclusion criteria were as follows: patients who had previous pelvic irradiation, other concomitant neurological disease (stroke, Parkinson's disease, etc.), or other urological diseases (stone, tumor, etc.), and those who had an indwelling suprapubic or urethral catheter. We identified the cutoff point for storage pressure related to UUTD using receiver operating characteristic (ROC) curve analysis to identify the value that produced maximum sensitivity and specificity. To identify risk factors for developing UUTD, we included seven risk factors: intravesical pressure, poor compliance, detrusor overactivity (DO), detrusor sphincter dyssynergia (DSD), level of the spinal cord pathology, male sex, and spontaneous voiding in univariable and multivariable regression analyses. Of the 110 patients who met the inclusion criteria, 22 were excluded from the study. Fifty-nine patients had a normal upper urinary tract, and 29 had UUTD. The mean age, sex, voiding pattern, type of spinal cord pathology, and level of spinal cord lesions were not different between the two groups. After performing ROC curve analysis, a cutoff value for daily storage pressure≥15 cm H2 O provided 79.31% sensitivity and 67.80% specificity (area under the ROC curve: 0.73) for UUTD development. From univariable analysis, low compliance (cutoff values at <12.5and <20 ml/cm H2 O) and a storage pressure≥15 cm H2 O was related to UUTD with statistical significance (risk ratio [RR]: 3.16, 2.3, and 3.6, respectively[p < 0.05]). After performing multivariable analysis, a storage pressure≥15 cm H2 O and both cutoff values for low compliance were related to UUTD with statistical significance (RR: 3.9, 2.4, and 3.2, respectively[p < 0.05]). However, other factors, including male sex, spontaneous voiding, suprasacral lesion, DSD, and DO, were not related to UUTD. Our results demonstrated that low compliance and a storage pressure ≥15 cm H2 O were significantly associated with UUTD. Various bladder-management strategies have been developed to prevent UUTDs. However, the main concept continues to be the maintenance of a low storage pressure.

Postoperative Urinary Retention in Modern Rapid Recovery Total Joint Arthroplasty.

Postoperative urinary retention (POUR) is a disruptive complication after modern rapid recovery total joint arthroplasty. This review aims to synthesize the recent literature on POUR in the setting of total joint arthroplasty. The incidence of POUR ranges from 5.5% to 46.3%. The lack of a standardized definition of POUR accounts for some of this variability. Risk factors previously associated with the development of POUR include increasing age, male sex, benign prostatic hyperplasia, use of bupivacaine and intrathecal morphine in spinal anesthesia, glycopyrrolate, and volume of intraoperative intravenous fluid administered. Predictive scoring assessments, such as the International Prostate Symptom Score and a newer predictive nomogram, have not been adequately validated by high-quality studies. The treatment of POUR comprises either intermittent or indwelling urethral catheterization. Higher quality prospective studies are needed to allow for the standardization of all aspects of POUR from its diagnostic criteria to its treatment.