Foley Catheter Research Articles

Effect of ionizing radiation on the physicochemical and functional properties of silicone rubber and silicone foley catheter

The utilization of ionizing radiation, such as gamma ray and electron beam, in medical product sterilization has seen significant growth in recent years, driven by concerns regarding the safety of ethylene oxide sterilization. This paper examines the effects of these radiation modalities on silicone rubber, and its applicability on a silicone rubber-containing medical device, specifically a silicone foley catheter, by assessing its functional properties before and after irradiation at varying absorbed doses.Analysis of the irradiated samples revealed the presence of carbonyl groups, indicating radiation-induced oxidation. Gamma irradiation did not exhibit fundamental changes in the polymer structure but showed degradation at higher temperatures due to oxidation mechanisms. Moreover, a significant decrease in elongation at break was observed indicating that the already highly crosslinked silicone rubber experienced additional crosslinking affecting its mechanical properties. In contrast, both irradiations led to degradation, as evidenced by a decrease in TG residue. However, the mechanical properties, including tensile strength and elongation at break, were less affected. This suggests limited crosslinking and fragmentation of the polymer backbone. At a lower dose, a decrease in both strength and elongation indicated the formation of branched structures, limiting mobility, introducing irregularities, and weakening the polymer's overall strength. Despite these effects, the functional properties of the silicone foley catheter were practically unaffected at low absorbed doses, except for the discoloration of the syringe ports. Overall, the study provides insights into the effects of ionizing radiation on silicone rubber, highlighting the complex interplay between crosslinking, chain scission, and oxidation mechanisms. The findings contribute to understanding the changes in the polymer's structure and properties under different radiation modalities and doses, facilitating the development of effective sterilization techniques for medical devices containing silicone rubber.

Urinary Retention a Rare Cause of Bowel Obstruction: A Case Report

A 60-year-old man presented to the emergency department with diffuse abdominal pain without passing stool or gas since 4 days. The diagnostic work-up included a plain abdominal radiograph and an abdominal computed tomography scan that revealed small-bowel obstruction with a rare cause. The obstruction was secondary to external compression by a distended bladder. The immediate management was insertion of an indwelling urinary catheter. We suggested re-evaluation, and after several hours the symptoms resolved. Although rare, pressure from the distended bladder due to urinary retention can cause complete bowel obstruction.

Characteristics and Mitigation Measures of Candidaauris Infection: Descriptive Analysis from a Quaternary Care Hospital in Saudi Arabia, 2021–2022

ObjectiveTo analyze the characteristics of C. auris cases, and to describe the interventions applied for improving the diagnosis and controlling the transmission.MethodMedical records of C. auris cases reported between January 2021 until June 2022 at King Saud Medical City (KSMC), Riyadh, Kingdom of Saudi Arabia have been reviewed. We analyzed the demographic and clinical characteristics of the cases to illustrate the possible contributing factors with C. auris infection. A multidisciplinary committee has been formulated to investigate the potential source of the outbreak among clusters of cases in the intensive care units (ICU). A bundle of mitigation measures has been applied which was successful to contain the outbreak.ResultsDuring the study period, a total of 129 cases of C. auris were identified, their mean age is 47 ± 22.3 SD, and 72.1% are males. 57% of cases were colonized, all of them were identified through active screening. A number of comorbidities were present including 27.9% were having hypertension, 27.1% with diabetes, 22.5% with COVID-19 and 20.2% with respiratory diseases. The average length of stay before reported positive was 36.23 days. 78.3% of those patients were in the critical care unit, 73.6% with vascular catheter, 88% with urinary catheters and 66.7% with mechanical ventilation. The vast majority of patients were using multiple antibiotics (86%). As per the univariate logistic model, risk factors significantly associated with mortality were (Age, Trauma RTA, ICU, Vascular Access, Foley Catheters, Mechanical Ventilation, Tracheostomy and Endotracheal Tubes) with p values (0.0038, 0.0159, 0.0108, 0.0122, 0.0071, <.0001, 0.0148 and 0.0107), respectively. Multivariate logistic regression showed that having a Foley Catheter was the only statistically significant factor associated with mortality.ConclusionThis retrospective analysis highlights the main characteristics associated with C. auris-infected patients. In addition, it highlights the effectiveness of the bundle of mitigation strategies applied to limit the spread of C. auris in healthcare facilities.

Urinary tract infections and intermittent catheterization among patients with spinal cord injury in Chinese community

We conducted a cross-sectional study using an online questionnaire to investigate the current status of urinary tract infections (UTIs) and the use of clean intermittent catheterization (CIC) in Chinese community-based SCI patients and to explore the risk factors for UTIs in patients using CIC. Our findings suggest that the prevalence of UTIS is higher in Chinese community-based SCI patients compared with patients in medically developed countries. In addition, we found that CIC had the lower incidence of UTIs than urinary indwelling catheter (UIC) and suprapubic catheter (SPC), and that SCI patients with CIC had low rates of use and poor compliance. Further analysis indicated that most of the risk factors for UTIs in CIC patients were associated with irregular use of CIC. Therefore, we call for not only the need to provide stronger caregiver support and financial assistance to improve CIC adherence in Chinese community SCI patients, but also the establishment of a database of Chinese SCI patients in order to enhance the management of bladder emptying methods and further standardize the CIC operation in such patients, thus reducing the risk of UTIs in Chinese community SCI patients.

Is concomitant use of misoprostol and extra amniotic saline infusion more effective or safer for cervical ripening: A RCT in a tertiary center

Various methods have been proposed for cervical ripening. Due to conflicting results and significant heterogenisity among previous studies, we designed a randomized clinical trial to find out wether concomitant use of Misorostol and extra-amnitic saline infusion (EASI) would lead to better outcomes or not. Ninety term pregnant women were randomly assigned to three different groups of ripening methods: vaginal misoprostol, EASI, and concomitant use of both. Time interval to reach a bishop score of five (primary outcome), time interval to amniotic membranes rupture and delivery rate, delivery route, need to oxytocin infusion, fetal distress associated cesarean delivery, meconium staining, and 1st and 5th minute Apgar scores were study outcomes.

FRI212 Adrenalitis Caused By Proteus Mirabilis In An Immunocompetent Patient

Abstract Disclosure: J.O. Abdelkarim: None. U. Tarabichi: None. M. Jakoby: None. Infectious adrenalitis with Mycobacterium tuberculosis remains the leading cause of primary adrenal insufficiency in developing countries, but the incidence of adrenalitis from infection with other bacterial species is quite low. We present a patient with radiographic evidence of adrenalitis during an infection with Proteus mirabilis that resolved after antimicrobial treatment.An 86-year-old male with an indwelling Foley catheter presented to the hospital for evaluation of abdominal pain and distension. The patient was afebrile and normotensive. Examination was notable for a distended bladder and obstructed urinary catheter. Computed tomography (CT) revealed a dense right lower lobe infiltrate and bilaterally enlarged, hypointense adrenal glands with irregular margins. Radiographic findings were new compared to a CT scan obtained approximately 10 weeks before admission to hospital. Turbid and malodorous urine was drained after replacement of the patient’s urinary catheter, and urine culture grew &amp;gt; 105 CFU/mL Proteus mirabilis. Antibiotics were dosed before blood cultures were drawn, and no organisms were grown from blood cultures. Since there was no clinical or biochemical evidence (e.g. hyponatremia or hyperkalemia) of primary adrenal insufficiency, an ACTH stimulation test was deferred. The patient responded well to replacement of his urinary catheter and antibiotics and was discharged to his extended care facility three days later. A CT scan obtained 10 days after treatment showed resolution of the changes to the patient’s adrenal glands observed on admission imaging.The radiographic changes are most plausibly due to P. mirabilis bacteremia and adrenalitis. The patient had urine culture confirmed infection with P. mirabilis and radiographic evidence of disseminated infection in the right lung and adrenal glands. Adrenal enlargement is well described in cases of acute M. tuberculosis adrenalitis, and radiographic changes of adrenalitis resolved after successful treatment of the patient’s infection. P. mirabilis has been documented as an etiology of Waterhouse-Friderichsen syndrome and cultured from an adrenal abscess. Blood cultures in this case were almost certainly negative due to timing relative to initial antibiotic doses. Injury to the adrenals in bacterial adrenalitis is thought to occur due to multiple mechanisms including direct infection of the glands, endotoxemia, vasculitis, and disseminated intravascular coagulation (DIC). Hemorrhage appears to occur in about 60% of cases. Elevated ACTH level is postulated as a factor predisposing to adrenal hemorrhage, and this prompted deferral of stimulation testing to evaluate adrenal function since there was no clinical evidence of primary adrenal insufficiency. Early management of the patient’s infection likely prevented the occurrence of adrenal insufficiency and deterioration of his clinical status. Presentation: Friday, June 16, 2023

Foley catheter for induction of labor after cesarean section

Induction of labor may be necessary in around twenty-five to thirty percent of a woman's subsequent pregnancies when she has already given birth through cesarean section. During our research, the objective had been to ascertain the rate of spontaneous vaginal birth, rate of cesarean section, and rate of complications that followed the induction of labor with transcervical foley catheter in females who had previously had 1 cesarean section. This retrospective cohort trial was performed in the largest city in Palestine at a tertiary teaching hospital. In subsequent pregnancy, pregnant cases with a history of a prior CS delivery (n = 306) underwent labor induction at term with a Foley catheter. Women who underwent labor induction with transcervical foley catheter at Al-Ahli Hospital in Hebron, Palestine. From April 2017 until March 2020. Our research revealed that 46.7 percent of women had spontaneous vaginal births, 14.4 percent had assisted vaginal births, and one woman experienced uterine rupture. The frequency of postpartum hemorrhage is 30 percent, the most prevalent complication. 10 percent and 5 percent of mothers experienced intrapartum and postpartum infections, correspondingly. 5% of newborns had a confirmed infection, and there was one perinatal fatality related to uterine rupture.

Hospital-related factors associated with incontinence following vesicovaginal fistula repair at Bwaila fistula care centre

Background/Aims Surgery remains the only reliable treatment option for vesicovaginal fistula; however, not all women who undergo surgical treatment regain continence. Information on predictors of vesicovaginal fistula closure outcomes is scarce and mostly limited to patient-related factors. This study examined hospital-related factors associated with incontinence in women following vesicovaginal fistula repair at the Bwaila fistula care centre in Malawi. Methods This quantitative retrospective cross-sectional study used simple random sampling to identify 174 case files of women who underwent vesicovaginal fistula repair. Data were analysed using binary and multivariable logistic regression to explore the effects of hospital-related variables on the likelihood of women remaining incontinent after obstetric fistula repair. Results The overall closure rate was 73.6%. Only number of days with a Foley catheter was found to predict incontinence after fistula repair at discharge from the hospital (P=0.013), in multivariate analysis. Conclusions Number of days with a catheter was the only significant predictor of incontinence after repair. Surgeons should consider reducing the number of days assigned with a catheter following surgery. Future studies should follow a prospective approach in settings where all variables can be effectively explored.

Trans-anal Foley catheter facilitates endoscopic submucosal dissection of a distal rectal tumor.

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Validating a Simple Urethra Surrogate Model to Facilitate Dosimetric Analysis to Predict Genitourinary Toxicity.

The urethra may be a critical structure in prostate radiotherapy planning as some studies have shown that higher urethral dose correlates with worse genitourinary (GU) toxicity. Identifying the urethra requires an MRI planning scan or foley catheter insertion at CT planning. Most surrogates have been developed and validated against the urethra identified by a foley catheter. However, the urethral position can shift with catheter placement. We, therefore, aim to validate a simple urethra surrogate model against MRI-defined urethra. The surrogate model can be used to correlate urethra dose-volume parameters (DVP) with late GU toxicity and to apply urethral constraints in those with a CT-only based workflow. Thirty-nine MRI-defined urethras from patients in the PACE-C trial were assessed to determine the average position of the urethra in the midline sagittal prostate plane along the ¼ gland, midgland, ¾ gland, apex and 3mm below apex. Using these average positions, a Python script was developed, which places a 10mm diameter circle in the 1/4 gland, midgland, ¾ gland, apex and 3mm below the apex. The observer manually contours a 10mm circle at the prostate base (prostate-bladder neck interface) to infer the urethra position and interpolates the contours. The urethra surrogate model was compared against 20 MRI-defined urethras (within the treatment PTV) in patients treated with 36.25Gy in 5 fractions as part of the PACE-B trial. To assess the surrogate's geometric performance, the Dice similarity coefficient (DSC), Hausdorff distance (HD), mean surface distance to agreement (MDTA) and the percentage of MRI-defined urethra outside the surrogate (UOS) were calculated. The surrogate model's dosimetric performance was assessed by comparing the mean D99, D98, average dose, D50, D2 and D1 using a paired t-test. The D(n) is the dose (Gy) to (n)% of the urethra. The median results were: DSC 0.36 (IQR 0.28-0.42), HD 0.88cm (IQR, 0.70-1.04), MDTA 0.24cm (IQR, 0.21-0.28), UOS 29% (IQR, 17-52%). When comparing DVP between the MRI-defined urethra and surrogate urethra, the mean D99, D98 and D95 as 38.8Gy vs 39.1Gy (p = 0.17), 39.3Gy vs 39.5Gy (p = 0.23), 40.1Gy vs 40.4Gy (p = 0.21), respectively. The mean D50, average dose, D2 and D1 was 41.8Gy vs 41.9Gy (p = 0.03), 41.7 vs 41.8Gy (p = 0.04), 42.9Gy vs 43.0Gy (p = 0.05) and 43.0Gy vs 43.1Gy (p = 0.03), respectively. While there were geometric differences between the surrogate urethra and MRI-defined urethra, there was no statistically significant difference between most urethral dose-volume parameters (D99, D98, D95, and D1). Similarly, the actual differences in urethra DVP were not clinically significant. This surrogate model could be validated in a larger cohort and then used to estimate the urethra position on CT planning scans for dosimetric analysis in those without an MRI planning scan or urinary catheter.

A Phase I/II Dose-Escalation Study Evaluating the Safety of 21 Gy, 23 Gy, and 25 Gy for High Dose Rate (HDR) Prostate Brachytherapy: An Interim Toxicity Report.

Single-fraction high dose rate (HDR) prostate brachytherapy has shown improved actuarial biochemical control rates from 66% to 82% with dose escalation from 19 to 20.5 Gy, respectively, but is still inferior to the reported low dose rate brachytherapy control rates of over 90%. We aimed to identify whether dose escalation to 21, 23, and 25 Gy can be safely accomplished. Patients with previously untreated, pathologically confirmed, low-risk (cT1-T2a, Gleason ≤6, PSA <10 ng/mL) or favorable intermediate risk (Gleason 3+4, percentage of positive biopsy cores <50%, ≤1 NCCN intermediate risk factor) prostate adenocarcinoma were enrolled from a single institution. PSA and toxicity assessment were performed at baseline and at routine 6-month follow-ups. From May 9, 2018 to May 12, 2022, 18 patients were enrolled. None had received prior androgen deprivation therapy, 44% had low risk disease, and 61% were ECOG 0 at baseline. Median age was 68 years (total range: 43-79), and 83% were Caucasian. Eight patients received 21 Gy, nine patients received 23 Gy, and one patient received 25 Gy, with the 25 Gy cohort still accruing. The mean prostate size and range, determined by pre-operative prostate volume study on trans-rectal ultrasound, were as follows: 21Gy cohort (mean: 41.2cc; range: 21.9-63.1cc), 23Gy Cohort (mean: 41.2cc, range 28.3-71.7cc), 25Gy cohort (65.3cc). A median of 17 catheters (range: 16-20) were implanted. At a median follow-up of 35.7 months (range: IQR 4.4 - 50.2), only one grade 3 toxicity was reported, which was an ulcerative colitis (UC) flare noted in a patient whose UC was poorly controlled, requiring multiple courses of prednisone in the 6 months prior to his brachytherapy. Regarding toxicities attributable to therapy, fourteen and four patients experienced a grade 1 and 2 genitourinary toxicity respectively; four and four patients experienced a grade 1 and 2 reproductive system toxicity respectively; one patient experienced a grade 1 GI toxicity. Two patients needed foley catheters upon discharge, with neither requiring the foley long term. There were two treatment failures in the 21Gy cohort at 1.39 and 1.67 years from date of HDR brachytherapy; date of failure was defined by the first PSA 2.0ng/mL over nadir. Of these patients, one underwent focal salvage HDR, whilst the other underwent radical prostatectomy with only 1% of the volume involved by prostate cancer. Of note, there was seminal vesicle involvement on restaging prostate biopsy for the patient that underwent radical prostatectomy, however, this was not appreciated on the final prostatectomy specimen. Both patients have no evidence of disease currently. HDR brachytherapy appears well tolerated in patients with low to favorable intermediate risk prostate cancer at 21 and 23 Gy, with more accrual needed at 25Gy. Long-term follow-up needed to assess efficacy.

Memory-efficient low-compute segmentation algorithms for bladder-monitoring smart ultrasound devices

Post-operative urinary retention is a medical condition where patients cannot urinate despite having a full bladder. Ultrasound imaging of the bladder is used to estimate urine volume for early diagnosis and management of urine retention. Moreover, the use of bladder ultrasound can reduce the need for an indwelling urinary catheter and the risk of catheter-associated urinary tract infection. Wearable ultrasound devices combined with machine-learning based bladder volume estimation algorithms reduce the burdens of nurses in hospital settings and improve outpatient care. However, existing algorithms are memory and computation intensive, thereby demanding the use of expensive GPUs. In this paper, we develop and validate a low-compute memory-efficient deep learning model for accurate bladder region segmentation and urine volume calculation. B-mode ultrasound bladder images of 360 patients were divided into training and validation sets; another 74 patients were used as the test dataset. Our 1-bit quantized models with 4-bits and 6-bits skip connections achieved an accuracy within 3.8% and 2.6%, respectively, of a full precision state-of-the-art neural network (NN) without any floating-point operations and with an 11.5times and 9.0times reduction in memory requirements to fit under 150 kB. The means and standard deviations of the volume estimation errors, relative to estimates from ground-truth clinician annotations, were 5.0pm 33 ml and 6.8pm 29 ml, respectively. This lightweight NN can be easily integrated on the wearable ultrasound device for automated and continuous monitoring of urine volume. Our approach can potentially be extended to other clinical applications, such as monitoring blood pressure and fetal heart rate.

Focal Boosted IMRT Treatment of Prostate Cancer to 84 Gy in 28 Fractions: Preliminary Clinical Outcomes and Dosimetry

The FLAME trial reported that focal boosting of prostate tumor to 95 Gy in 35 fractions improves biochemical control. However, this treatment is not commonly used in the United States. We investigated a focally boosted treatment of 84 Gy in 28 fractions (EQD2 108 Gy, BED 252 Gy). Between 2019-2022, men with unfavorable intermediate risk (uIR) and high risk (HR) prostate cancer were enrolled on a prospective registry and received a novel IMRT regimen. The dose levels were 84 Gy to the gross tumor volume (GTV) as defined on mpMRI (T2W and ADC) with no added margin, 70 Gy to the prostate and proximal seminal vesicles, and optional 50.4 Gy to elective pelvic lymph nodes (all 28 fractions). Patients received fiducial markers and hydrogel spacer. The treatment planning goal was to cover 95% of the GTV at 84 Gy, and also meet the target and normal tissue dosimetry criteria of the hypofractionated treatment arm of NRG-GU005. VMAT was used for treatment delivery. ADT was given at the discretion of the treating physician. A total of 20 men were included in the study, 2 (10%) uIR and 18 (90%) HR. 9 (45%) tumors were GS 7, 7 (35%) were GS 8, and 4 (20%) were GS 9. There were 13 (65%) stage cT1, 4 (20%) cT2 and 3 (15%) cT3. One (5%) patient received short term ADT, 18 (95%) long term ADT, and 1 (5%) refused ADT. 18 (90%) men received elective nodal radiation. The mean baseline PSA was 25.1 (range 4.2-73.4). The median baseline IPSS score was 11.1 (IQR 4.5-12), and 4 patients had severe baseline urinary symptoms (IPSS ≥20). The mean baseline prostate volume was 57.4 cc (range 26.8-198.3). The mean volume of the 84 Gy boost target was 7.1 cc (range 2.3-15.0) and the mean proportion of the prostate boosted was 14.8% (range 2% - 47%). There were 10 (50%) men with 1 boost target, 6 (30%) with two, 3 (15%) with three, and 1 (5%) had 4 boost targets. Targets were located in peripheral zone (85%), transition zone (30%), and central zone (5%). Patients met all per-protocol normal tissue criteria of NRG-GU005, except for bladder D0.03cc. The mean±SD (Gy) rectum D15%, D25%, and D30% were 51±5, 45±5, 42±4. The mean±SD (Gy) bladder D0.03cc, D30%, D50% were 79±4, 50±8, 38±10. At a median follow up time of 21.3 months (range 7.1-38.2), no patients have developed biochemical progression, local recurrence, distant progression, or death from prostate cancer. One patient died at 18 months from metastatic colorectal cancer, unrelated to prostate cancer treatment. Acute grade 1-2 GU toxicity occurred in 13 (65%) patients, and acute grade 1-2 GI toxicity occurred in 4 (20%) patients. No patients developed grade 3+ acute or late GU or GI toxicity. Two patients required temporary foley catheter for obstruction during RT, and both had IPSS >20 at baseline. The patient who refused ADT had a PSA bounce of magnitude 2.2 ng/mL at 14 months, PSA values declined without additional treatment. A novel 28-fraction focal boosted IMRT treatment is feasible and has an acceptable early toxicity profile. Oncologic results are promising but require longer follow up.

Long-Term Outcomes of Prospective Clinical Trial HDR-Brachytherapy Monotherapy in Single Day in Patients with Localized Prostate Cancer

This prospective clinical trial to evaluated long-term outcomes associated with 2 fractions in a single day, one implant, high-dose-rate (HDR) brachytherapy as monotherapy for patients with localized prostate cancer. We report Genitourinary (GU) and gastrointestinal (GI) toxicity and Disease control. Between November 2010 and Feb 2016 a total of 120 patients diagnosed with low/intermediate-risk localized prostate cancer were treated. The prescribed dose was 27 Gy in 2 fractions in a day using a single implant. 34 patients (28%) were intermediate-risk cancer. 38 patients (31,7%) received hormonal therapy. We measured the incidence of no biochemical evidence of disease (bNED) based on the Phoenix definition of failure (nadir prostate-specific antigen (PSA) + 2 ng/mL). GU and GI toxicity were evaluated by CTCAE v4.0 and sexual function were prospectively documented at each follow up visit. With a median follow-up was 123 months (range 9-148) the actuarial rates of Local Control were 96%, Biochemical Control 93.4%, Distant Failure 3.3%, Disease-Free Survival 92.3 %, Metastasis-free survival 96.67% and Overall Survival was 86.7%. The cumulative incidence of acute grade (G) 1-2 GU toxicity was 20.8%, mainly frequency/urgency (10%), dysuria (10%), dribbling/hesitancy (0.8%). 3 patients required a Foley catheter during 1 week. No acute GI toxicities were recorded. Chronic G1-2 GU toxicities were 29 %, mainly dysuria (12.6%), urinary frequency/urgency (5.8%) and urinary Incontinence G2 (1.6%). 1 patient had G2 rectal bleeding and 2 patients had G3 GU toxicity requiring transurethral resection of bladder (TURB). 23.7% of patients without Hormonal therapy reported G1-2 sexual impotence after 2 years therapy. With 10 years of follow-up, our prospective data are sufficiently mature to report on efficacy and toxicity outcomes, making a single implant, 2 fractions HDR-BT an attractive option for patients with localized low/intermediate-risk prostate cancer and be able to consider it a standard of care in this setting. To the best of our knowledge, this is the first report regarding single day HDR-BRT as monotherapy with a median follow-up of 10 years.

A case study on using an intrauterine foley catheter to reduce postpartum bleeding in a patient with hemophilia.

SynopsisCase of a pregnant patient suffering from severe hemophilia A who had effective uterine foley tamponade to treat postpartum hemorrhage.

Using a Multi-pronged Behavioral Intervention to Standardize Antibiotic Prophylaxis at the Time of Foley Catheter Removal After Radical Prostatectomy

To identify antibiotic prescribing patterns at the time of foley catheter removal after radical prostatectomy and implement a multi-pronged behavioral intervention to standardize antibiotic use. This was a single-institution study examining the prescribing of antibiotics at the time of foley catheter removal after radical prostatectomy. Pre-intervention data were collected retrospectively to establish baselines for antibiotic prescribing, patient characteristics, and urinary tract infection rates. A single dose of an oral antibiotic taken at the time of foley catheter removal was recommended as the standard antibiotic protocol. A multi-pronged behavioral intervention was used to encourage compliance with our protocol. Adherence to the protocol, quantity of antibiotics prescribed, and rate of urinary tract infection were recorded prospectively. Durability of the intervention was evaluated during a post-intervention phase. A total of 416 patients and 6 surgeons were included in the study. Accordance with the standardized antibiotic protocol was 59% in the pre-intervention phase and 91% in the intervention phase (P = .03). No patients in the intervention or post-intervention phase were prescribed more than one dose of an antibiotic. The rate of urinary tract infection did not differ across the study phases. Implementation of a multi-pronged behavioral intervention resulted in a high rate of surgeon compliance with a standardized antibiotic protocol. This led to a significant reduction in antibiotic use with no change in the rate of urinary tract infection after foley catheter removal after radical prostatectomy.

Knowledge, Implementation, and Perception of Enhanced Recovery After Surgery Amongst Surgeons in Pakistan: A Survey Analysis.

An increasing shift towards non-communicable diseases and an existing high surgical burden of disease in low-middle-income countries (LMICs), such as Pakistan, has driven the need for implementing Enhanced Recovery After Surgery (ERAS), a safe and cost-effective surgical service aimed at improving patient recovery and reducing post-operative complications. Despite countless benefits, there are few ERAS programs throughout Pakistan andsparse literature on healthcare professionals' views regarding ERAS. Without a deep understanding of healthcare professionals' perspectives on ERAS, underlying barriers and facilitators to a long-term ERAS implementation cannot be addressed and improved upon.Therefore, the purpose of this study is to better understand the knowledge, implementation, and perception of ERAS from the perspective of healthcare professionals across Pakistan. Upon receiving ethical approval from the McGill University Health Center (MUHC), a previously validated questionnaire was modified and a 29-question survey was developed and disseminated to healthcare professionals practising in Pakistan. Quantitative data was analyzed using descriptive statistics and potential correlations that exist between the implementation of ERAS and the participants' gender, employment setting, and surgical specialty were investigated using the chi-squared analysiswith a p-value of 0.05 as the cutoff. A total of 49 participants responded to this survey of whom 34 (69%) worked at a tertiary care teaching hospital whereas 15 (31%) worked at a private hospital. Surprisingly, 42 (85%) participants expressed being aware of the ERAS guidelines with only 30 (61%) either strongly agreeing or agreeing to successfully implementing ERAS into practice. The largest discrepancies in implementation were seen when discussing specific elements of the ERAS guidelines such as preoperative carbohydrate loading, practicing prolonged preoperative fasting, performing mechanical bowel preparation, performing active patient warming, and early postoperative removal of Foley's catheter. Surgeons employed at a private institution were more likely to discuss postoperative pain management and control, less likely to utilize prolonged fasting, more likely to perform regular body temperature monitoring, more likely to practice providing chewing gum to patients postoperatively, and more likely to perform early removal of the Foley's catheter. An understanding of ERAS, the implementation of various elements, and a positive attitude toward its benefits definitely seem to be prevalent among healthcare professionals in Pakistan. However, key barriers and enablers specific to the underlying healthcare environment seem to be hindering the long-term successful implementation of ERAS across Pakistan. It is crucial for future studies to explore these barriers in further detail and involve theperspective of these key stakeholders to help enhance long-term ERAS adoption.

Pelvic binder radiography detects occult instability in cadaveric simulated lateral compression type I (LC1) pelvic fractures

ObjectivesOccult instability in minimally displaced lateral compression (LC) pelvic ring injuries may have clinical relevance for treatment. We describe two novel LC pelvis fracture stress examinations – pelvic binder stress radiography (PBR) and pelvic binder stress bladder manometry (PBM) – which do not require sedation, anesthesia, patient transport, or radiation of personnel. MethodsA biomechanical study was performed with five fresh elderly cadavers. Sequential osteotomies of the pelvis simulated increasingly unstable LC pelvis fracture patterns (OTA/AO 61A2.2, 61B1.1a, 61B1.1b, 61B2.1). Compressive force was quantitatively applied using a pelvic binder and scale. Pelvis fracture displacement was measured on AP and inlet fluoroscopic views. Pelvic bladder pressure (PBM) was measured using a Foley catheter as a water column. ResultsFracture displacement strongly correlated with force applied (R2=0.600-0.963). PBR discriminated between simulated LC injuries. Mean displacement of 61B1.1b injuries >1cm was observed at 3.8kg on AP view and 5kg on inlet view. Mean displacement of 61B1.1a injuries >1cm was observed at 8.2kg on AP view and 9.3kg on inlet view. 61A2.2 injuries did not displace >1cm at forces up to 10kg. >95% of 61B1.1a and 61B1.1b injuries displaced >1cm at 10kg. PBM moderately correlated with force applied (R2=0.517-0.842) but did not discriminate between LC injuries. ConclusionsPBR is feasible, precisely quantified occult mechanical instability in simulated LC pelvis fractures in response to reproducible applied force, and discriminated between simulated LC pelvis fractures. PBM did not discriminate between simulated LC fractures. A clinical trial to validate the safety and efficacy of PBR for assessing occult instability in LC pelvis fracture is warranted.

Nurse's knowledge and practice towards prevention of catheter‐associated urinary tract infection: A systematic review

AbstractCatheter‐associated urinary tract infection (CAUTI) is a common complication associated with indwelling urinary catheters, frequently used in healthcare settings. Nurses play a critical role in preventing CAUTI, as they are often responsible for inserting, maintaining and removing urinary catheters. Therefore, it is important to comprehensively assess nurses' level of knowledge about CAUTIs and the variables that influence their application of best practices and recommendations for preventing these infections. The PRISMA principles were used to conduct a literature search for relevant research publications across several online databases (Web of Science, PubMed, MEDLINE and Scopus). The quality of these studies was evaluated using the Mixed Methods Appraisal Tool. There were 397 research articles, however only 21 articles were included after the screening. The majority of participants possessed diplomas ranging from 3% to 88.2%. In addition, the percentage of nurses with bachelor's degree's ranges from 11.80% to 100%. Moreover, 23.90% of registered nurses hold a master's degree. Most nurses had between 1 and 5 and more than 5 years of experience. Nurses held good/adequate and average knowledge and practices regarding prevention and control of CAUTIs. Furthermore, age, gender, work experience, professional experience, in‐service training, CAUTI prevention guidelines, time, equipment, personnel availability and work unit were all identified barriers. While continuing/in‐service education and self‐guided modules served as facilitators for the prevention of CAUTIs. Meanwhile, studies were found of good methodological quality. Improving nurses' knowledge and practice towards preventing CAUTI is crucial to reducing the prevalence of the infection and improving patient outcomes. Implementing evidence‐based interventions can help bridge the gap in knowledge and practice among nurses, ultimately leading to better patient care and outcomes.

Usefulness of 3D reconstruction of low dose pelvic CT as an innovative tool for surgical planning in definitive correction of cloacal malformations

PurposeTo describe the results of the use of a low dose pelvic CT protocol for preoperative imaging in cloacal anomalies at a referral center. MethodsWe reviewed 43 cases of cloacal anomalies treated at our institution from 2012 to 2022. The patients underwent a cystoscopy under general anesthesia, with measurement of the common channel and the urethra, and visualization of the Müllerian structures, and a Foley catheter was placed in the bladder. Then the patient was transferred to the CT suite for a low dose pelvic CT, filling the bladder, the vagina (by overflow) and the sigmoid/rectum (as in a distal colostogram) with diluted meglumine. Volume rendering was obtained at the CT station. Results43 girls with cloaca were treated our institution, 40 of them operated on for correction. The median effective radiation dose was of 2.19mSv (0.81 - 2.96 mSv). The measurement of the common channel had a Pearson coefficient of 0.96 when correlated with the actual measurement. The length was < 1 cm in 3, 1-3 cm in 18, 3-5 cm in 15, and >5 cm in 4. Total urogenital mobilization was possible in 28 patients. We found vaginal duplication in 16, and vaginal reconstruction was performed in 13 others. ConclusionThis technique provided the spatial anatomy of the urinary, vaginal, and colorectal components, with a higher fidelity than fluoroscopy. Since we do not have rotational fluoroscopy, we overcame that limitation with this modality, and found it to be an improvement for planning, allowing for better outcomes.