Inflation Of Balloon Catheter Research Articles

Number of attempts and interventions to obtain a valid pulmonary artery wedge pressure.

A valid pulmonary artery wedge pressure (PAWP) is essential for the hemodynamic characterization of pulmonary hypertension (PH). We prospectively investigated the methodology for obtaining a valid PAWP measurement, while assessing the impact of prespecified factors on its determination. In this prospective observational cohort study, we included consecutive patients who underwent right heart catheterization (RHC) using fluoroscopy at the Pulmonary Vascular Disease program at Cleveland Clinic, between February and May 2023. Once a valid PAWP was obtained, we recorded the number of attempts, reason for repeating the determination, pulmonary artery location, depth of the pulmonary artery catheter (PAC) from the introducer hub, and inflation volume of the PAC balloon. We included 195 patients, age: 57.5±15.7 years, 111 (57%) women, 156 (80%) with PH. The PAWP was 16.4±5.9 mmHg, requiring 1, 2 and ≥3 attempts for a valid measurement in 139 (71%), 39 (20%) and 17 (9%) patients, respectively. PAWP was repeated due to abnormal waveform, incomplete wedge and over wedge. A valid PAWP was obtained in the right pulmonary circulation in 168 (86%) patients, and in the lower third in 134 (69%), middle third in 58 (30%), and upper third of the lung in 3 (2%) patients. The pulmonary artery catheter balloon inflation at valid PAWP was 1.0±0.3 mL, at a distance from the introducer hub of 52.6±5.2 cm. Aspiration of blood in PAW position was obtained in 141 (72%) patients with an arterial oxygenation of 97% (95-99%). The number of measurements for a valid PAWP was directly associated with mean pulmonary artery pressure (mPAP) (r=0.18, P=0.01), PAWP (r=0.22, P=0.002), and pulmonary artery diameter on computed tomography (r=0.16, P=0.04). A valid PAWP was obtained during the first or second attempt in about 90% of patients that undergo RHC. Advanced interventions such as relocating the PAC to a different place of the same lung or contralateral pulmonary circulation are needed in about 10% of patients.

COMPARING THE EFFICACY OF 30 ML AND 60 ML FOLEY'S CATHETER BALLOON INFLATION FOR INDUCTION OF LABOR IN TERM SINGLETON MULTIGRAVIDA PATIENTS: A RANDOMIZED TRIAL

Labour induction is a common obstetric technique, especially for term singleton multigravida patients. The Foley's catheter balloon inflation method is widely used, and the efficacy of this technique may be affected by differences in balloon capacity. Thus, this study aimed to compare the effectiveness of two balloon inflation volumes, 30 mL and 60 mL, for inducing labour in term singleton multigravida patients. This study was a prospective, randomized, parallel-group design conducted at Gajju Khan Medical College, Swabi, between September 2022 and September 2023 The study included 112-term singleton multigravida with a gestational age of 37 weeks or more, a single-fetus pregnancy, and prior pregnancies. Using computer-generated random numbers, participants were randomly assigned to Group A (30 mL) or Group B (60 mL). The results of the study showed that both groups had similar baseline characteristics. Group A had an average age of 28.5 years, while Group B had an average age of 29.2 years. Group A's mean gestational age was 39.1 weeks, while Group B's was 38.9 weeks. Patients in both groups were multiparous. The mean induction-to-delivery delay was 10.2 days for Group A and 12.8 days for Group B, with a statistically significant difference (p=0.034). After balloon inflation, Group A bishop scores improved from 4.2 to 7.8, and Group B bishop scores improved from 4.1 to 7.6 (p=0.498). The research shows that 60 mL of folleys catheter balloon inflation for cervical ripening in labour induction may shorten the induction-to-delivery period without compromising newborn outcomes.

Successful conversion of transpapillary bile duct drainage to endoscopic ultrasound-guided choledochoduodenostomy using an inflated balloon catheter.

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Evaluation of Optimal Esophageal Catheter Balloon Inflation Volume in Mechanically Ventilated Children.

Accuracy of esophageal pressure measured by an air-filled esophageal balloon catheter is dependent on balloon filling volume. However, this has been understudied in mechanically ventilated children. We sought to study the optimal filling volume in children receiving ventilation by using previously reported calibration methods. Secondary objectives included to examine the difference in pressure measurements at individualized optimal filling volume versus a standardized inflation volume and to study if a static hold during calibration is required to identify the optimal filling volume. An incremental inflation calibration procedure was performed in children receiving ventilation, <18 y, instrumented with commercially available catheters (6 or 8 French) who were not breathing spontaneously. The balloon was manually inflated by 0.2 to 1.6 mL (6 French) or 2.6 mL (8 French). Esophageal pressure (Pes) and airway pressure tracings were recorded during the procedure. Data were analyzed offline by using 2 methods: visual determination of filling range with the calculation of the highest difference between expiratory and inspiratory Pes and determination of a correctly filled balloon by calculating the esophageal elastance. We enrolled 40 subjects with median (interquartile range [IQR]) age 6.8 (2-25) months. The optimal filling volume ranged from 0.2 to 1.2 mL (median [IQR] 0.6 [0.2-1.0] mL) in the subjects with a 6 French catheter and 0.2-2.0 mL (median [IQR] 0.7 [0.5-1.2] mL) for 8 French catheters. Inflating the balloon with 0.6 mL (median computed from the whole cohort) gave an absolute difference in transpulmonary pressure that ranged from -4 to 7 cm H2O compared with the personalized volume. Pes calculated over 5 consecutives breaths differed with a maximum of 1 cm H2O compared to Pes calculated during a single inspiratory hold. The esophageal elastance was correlated with weight, age, and sex. The optimal balloon inflation volume was highly variable, which indicated the need for an individual calibration procedure. Pes was not overestimated when an inspiratory hold was not applied.

Cost-effectiveness of a novel urethral catheter safety device in preventing catheterization injuries in the UK

Aims Intraurethral catheter balloon inflation is a substantial contributor to significant catheter-related urethral injury. A novel safety valve has been designed to prevent these balloon-inflation injuries. The purpose of this evaluation was to assess the cost-effectiveness of urethral catheterisation with the safety valve added to a Foley catheter versus the current standard of care (Foley catheter alone). Materials and methods The analysis was conducted from the UK public payer perspective on a hypothetical cohort of adults requiring transurethral catheterization. A decision tree was used to capture outcomes in the first 30 days following transurethral catheterization, followed by a Markov model to estimate outcomes over a person’s remaining lifetime. Clinical outcomes included catheter balloon injuries [CBIs], associated short-term complications, urethral stricture disease, life years and QALYs. Health-economic outcomes included total costs, incremental cost-effectiveness ratio, net monetary benefit (NMB) and net health benefit. Results Over a person’s lifetime, the safety valve was predicted to reduce CBIs by 0.04 per person and CBI-related short-term complications by 0.03 per person, and nearly halve total costs. The safety valve was dominant, resulting in 0.02 QALYs gained and relative cost savings of £93.19 per person. Probabilistic sensitivity analysis indicated that the safety valve would be cost-saving in 97% of simulations run versus standard of care. Conclusions The addition of a novel safety valve aiming to prevent CBIs during transurethral catheterization to current standard of care was estimated to bring both clinical benefits and cost savings.

Safety and efficacy of a novel calcified plaque modification technique - Shockwave Intravascular Lithotripsy - in patients with coronary artery disease: Mid-term outcomes.

Coronary interventions in calcified lesions are associated with a higher rate of adverse clinical events. Initial aggressive plaque modification along with post-implantation optimization is pivotal for achieving a favorable outcome of percutaneous coronary intervention (PCI). Recently, the Shockwave C2 Intravascular Lithotripsy (S-IVL) System, a novel acoustic wave-based device designed to modify calcified plaque, has been introduced into clinical practice. We evaluated the mid-term safety and efficiency of S-IVL in a cohort of 131 consecutive patients with severely calcified coronary lesions. We retrospectively analyzed a total of 131 consecutive S-IVL PCI procedures. The study had two main inclusion criteria - the presence of a calcified resistant lesion (defined by inadequate non-compliant balloon catheter inflation) or a significantly underexpanded stent (more than 20% of reference diameter). The study had two primary endpoints - successful clinical outcome and safety concerns. Clinical success was defined as effective stent deployment or optimization of a previously underexpanded stent (with less than <20% in-stent residual stenosis). Safety outcomes were defined as periprocedural complications, such as device failure and major adverse cardiac and cerebrovascular events (MACCE). Clinical follow-up was performed at the end of hospitalization and 6 months after the index procedure. In-hospital MACCE was 4.6% with 1.5% target lesion revascularization (TLR) and one case of subacute fatal stent thrombosis. At 6-month follow-up, the MACCE rate was 7.9% with a concomitant TLR rate of 3.8%. Our mid-term data confirm acceptable safety and efficacy of intravascular lithotripsy as a valuable strategy for lesion preparation and stent optimization in a cohort of 131 consecutive patients with severely calcified coronary lesions.

Patient Pain and Satisfaction With 10, 30, and 70 mL Transcervical Foley Balloons for Cervical Ripening During Induction of Labor.

Objective To assess patient pain and satisfaction and time to delivery following transcervical Foley catheter balloon inflation to 10, 30, or 70 mL with simultaneous administration of oxytocin. Methods We performed a randomized prospective study with 30 or 70 mL transcervical Foley balloon catheters in combination with oxytocin during labor induction at term. A 10 mL group was included as a sham control group. Time to delivery was measured, and a patient questionnaire was administered at the time the catheter was expelled to determine patient pain and satisfaction. Results In 120 enrolled patients, there was a non-significant trend towardreduced time to delivery in the large Foley balloon group (10 mL: 30:45 ± 38:53, 30 mL: 26:41 ± 20:53, and 70 mL 22:40 ± 15:35, hh:mm, P = 0.412). The pain score at the time the balloon was expelled was significantly higher in the 70 ml group compared to the 10 ml and 30 ml groups (P = 0.004 and P = 0.034, respectively). We found no other differences in patient satisfaction or pain scores at the time of placement of the Foley catheter for the three groups. Conclusion Small gains in time to delivery should be balanced against patient experiences, and expectations of pain during the ripening process should be addressed at the time of Foley insertion.

Editorial Comment

No AccessJournal of UrologyNew Technology and Techniques1 Jul 2023Editorial CommentThis article comments on the following:A Prospective Multi-institutional Study Using a Novel Safety Valve for the Prevention of Catheter Balloon Inflation Injury of the Urethrais a letter which has replyReply by Authors Nathan Lawrentschuk Nathan LawrentschukNathan Lawrentschuk EJ Whitten Prostate Cancer Centre, Epworth Healthcare, University of Melbourne, Melbourne, Australia Department of Surgery, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003449.01AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Comment." The Journal of Urology, 210(1), p. 185 REFERENCES 1. A prospective multi-institutional study using a novel safety valve for the prevention of catheter balloon inflation injury of the urethra. J Urol. 2023; 210(1):179-185. Link, Google Scholar 2. Sensible government decisions on funding for imaging can change practice and deliver better care for men with prostate cancer. BJU Int. 2022; 130(Suppl 1):4. Google Scholar 3. There is a need for a universal language in the reporting and grading of complication and intervention events to ensure comparability and improvement of surgical care. Eur Urol. 2022; 81(5):440-445. Crossref, Medline, Google Scholar 4. Evolution and implications of the novel CAMUS reporting and classification system: from rationale to end product. Eur Urol Open Sci. 2023; 50:123-126. Crossref, Medline, Google Scholar © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsRelated articlesJournal of Urology31 Mar 2023A Prospective Multi-institutional Study Using a Novel Safety Valve for the Prevention of Catheter Balloon Inflation Injury of the UrethraJournal of Urology9 Jun 2023Reply by Authors Volume 210Issue 1July 2023Page: 185-185 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nathan Lawrentschuk EJ Whitten Prostate Cancer Centre, Epworth Healthcare, University of Melbourne, Melbourne, Australia Department of Surgery, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, Melbourne, Australia More articles by this author Expand All Advertisement PDF downloadLoading ...

A prospective study in nurse‐led clinics and community nursing using the transurethral catheterisation safety valve for the prevention of catheter balloon inflation injury of the urethra

A prospective study in nurse‐led clinics and community nursing using the transurethral catheterisation safety valve for the prevention of catheter balloon inflation injury of the urethra

Mechanical and morphological characterisation of porcine urethras for the assessment of paediatric urinary catheter safety

Paediatric urinary catheters are often necessary in critical care settings or to address congenital anomalies affecting the urogenital system. Iatrogenic injuries can occur during the placement of such catheters, highlighting the need for a safety device that can function in paediatric settings. Despite successful efforts to develop devices that improve the safety of adult urinary catheters, no such devices are available for use with paediatric catheters. This study investigates the potential for utilising a pressure-controlled safety mechanism to limit the trauma experienced by paediatric patients during inadvertent inflation of a urinary catheter anchoring balloon in the urethra. Firstly, we establish a paediatric model of the human urethra using porcine tissue by characterising the mechanical and morphological properties of porcine tissue at increasing postnatal timepoints (8, 12, 16 and 30 weeks). We identified that porcine urethras harvested from pigs at postnatal week 8 and 12 exhibit morphological properties (diameter and thickness) that are statistically distinct from adult porcine urethras (postnatal week 30). We therefore utilise urethra tissue from postnatal week 8 and 12 pigs as a model to evaluate a pressure-controlled approach to paediatric urinary catheter balloon inflation intended to limit tissue trauma during inadvertent inflation in the urethra. Our results show that limiting catheter system pressure to 150 kPa avoided trauma in all tissue samples. Conversely, all of the tissue samples that underwent traditional uncontrolled urinary catheter inflation experienced complete rupture. The findings of this study pave the way for the development of a safety device for use with paediatric catheters, thereby alleviating the burden of catastrophic trauma and life changing injuries in children due to a preventable iatrogenic urogenital event.

Simultaneous biventricular pressure-volume analysis in rats.

The pressure-volume (PV) analysis is used for an accurate assessment of load-independent cardiac function and is important for the study of cardiovascular diseases and various therapeutic modalities. PV analysis is often performed on one of the ventricles, or on both ventricles but sequentially. Since both ventricles interact with each other and their functions are mutually interdependent, especially in various disease conditions such as pulmonary hypertension or heart failure, it is important to quantify the function of both ventricles at the same time. Therefore, our aim was to describe a standardized protocol for simultaneous right (RV) and left (LV) ventricle of PV analysis, including an especially controllable preload reduction manoeuver. Our second aim was to test whether simultaneous catheterization of both LV and RV is necessary for the determination of biventricular PV relationship compared to sequential measurement of both ventricles separately. In this article, we showed the feasibility and the value of simultaneous biventricular PV analysis in the measurement of contractility parameters (end-systolic pressure-volume relationship (ESPVR), ventricular pressure over time (dP/dt)max, divided by end-diastolic volume (dP/dt max-EDV)) with a comparison to the sequential measurement of the RV and LV ventricles separately. We described in detail the protocol for simultaneous biventricular PV analysis in rats using a pair of conductance-micromanometer catheters with a preload-reducing manoeuver using balloon catheter inflation in the inferior vena cava. We also described technical tips and show examples of PV loop data obtained in normotensive and hypertensive rats, with and without heart failure due to volume overload. This protocol could be useful for scientists studying hemodynamics and cardiac contractility in various models of cardiovascular diseases with a focus on biventricular differences and ventricular interdependence.

Integration of multiple prognostic predictors in a porcine spinal cord injury model: A further step closer to reality.

Spinal cord injury (SCI) is a devastating neurological disorder with an enormous impact on individual's life and society. A reliable and reproducible animal model of SCI is crucial to have a deeper understanding of SCI. We have developed a large-animal model of spinal cord compression injury (SCI) with integration of multiple prognostic factors that would have applications in humans. Fourteen human-like sized pigs underwent compression at T8 by implantation of an inflatable balloon catheter. In addition to basic neurophysiological recording of somatosensory and motor evoked potentials, we introduced spine-to-spine evoked spinal cord potentials (SP-EPs) by direct stimulation and measured them just above and below the affected segment. A novel intraspinal pressure monitoring technique was utilized to measure the actual pressure on the cord. The gait and spinal MRI findings were assessed in each animal postoperatively to quantify the severity of injury. We found a strong negative correlation between the intensity of pressure applied to the spinal cord and the functional outcome (P < 0.0001). SP-EPs showed high sensitivity for real time monitoring of intraoperative cord damage. On MRI, the ratio of the high-intensity area to the cross-sectional of the cord was a good predictor of recovery (P < 0.0001). Our balloon compression SCI model is reliable, predictable, and easy to implement. By integrating SP-EPs, cord pressure, and findings on MRI, we can build a real-time warning and prediction system for early detection of impending or iatrogenic SCI and improve outcomes.

Regional Differences in Intestinal Contractile Responses to Radial Stretch in the Human Lower Gastrointestinal Tract.

Radial stretch evokes an increase or decrease in contractions in the lower gastrointestinal tract via mechanosensory enteric neurons that project into the muscle layers. We aim to elucidate the differences in stretch reflexes according to their location in the human colon. We used healthy intestinal smooth muscle tissue excised during elective colon cancer surgery. Conventional intracellular recordings from colonic muscle cells and tension recordings of colonic segments were performed. Radial stretch was evoked through balloon catheter inflation. Changes in the membrane potential and frequency, amplitude, and area under the curve of muscle contractions were recorded before and after the radial stretch at proximal and distal segment sites. In intracellular circular muscle recordings, hyperpolarization was noted at the distal site of sigmoid colonic segments after radial stretch, in contrast to depolarization at all other sites. In tension recordings at proximal ascending or sigmoid colonic segment sites, contractile activation was observed with statistically significant increases in the frequency, amplitude, and area under the curve after radial stretch. Distal sites of ascending and sigmoid colonic segments showed increase and decrease in contraction, respectively. Radial stretch in the human colon (in vitro) evokes excitatory activity at both proximal and distal sites of the ascending colon and at the proximal site of the sigmoid colon, whereas it elicits inhibitory activity at the distal site of the sigmoid colon.

Regional Differences in Intestinal Contractile Responses to Radial Stretch in the Human Lower Gastrointestinal Tract.

Radial stretch evokes an increase or decrease in contractions in the lower gastrointestinal tract via mechanosensory enteric neurons that project into the muscle layers. We aim to elucidate the differences in stretch reflexes according to their location in the human colon. We used healthy intestinal smooth muscle tissue excised during elective colon cancer surgery. Conventional intracellular recordings from colonic muscle cells and tension recordings of colonic segments were performed. Radial stretch was evoked through balloon catheter inflation. Changes in the membrane potential and frequency, amplitude, and area under the curve of muscle contractions were recorded before and after the radial stretch at proximal and distal segment sites. In intracellular circular muscle recordings, hyperpolarization was noted at the distal site of sigmoid colonic segments after radial stretch, in contrast to depolarization at all other sites. In tension recordings at proximal ascending or sigmoid colonic segment sites, contractile activation was observed with statistically significant increases in the frequency, amplitude, and area under the curve after radial stretch. Distal sites of ascending and sigmoid colonic segments showed increase and decrease in contraction, respectively. Radial stretch in the human colon (in vitro) evokes excitatory activity at both proximal and distal sites of the ascending colon and at the proximal site of the sigmoid colon, whereas it elicits inhibitory activity at the distal site of the sigmoid colon.

Use of Irrigation Device for Duct Dilatation during Sialendoscopy

Continuous irrigation of the duct with isotonic saline is one of the fundamental stages of a successful sialendoscopic procedure. It allows for an adequate luminal distension for the removal of debris and mucous plugs and for the conservative treatment of strictures. This procedure, which commonly involves the use of a medical syringe, can be laborious, and it is often necessary to interrupt irrigation during surgery due to the high resistance to saline. Academic university hospital. We propose the use of an irrigation device which consists of a high-pressure syringe barrel, an ergonomic piston handle, and a gauge used to monitor the inflation and deflation of balloon catheters. The system allows for a simple and safe dilation, ensuring good visualization of the salivary duct lumen during sialendoscopy. The irrigation system described can be widely used to perform a diagnostic or interventional sialendoscopy more effectively than with a typical manual irrigation procedure.

Abstract 13151: Left Ventricular Hypovolemia Secondary to in Utero Mitral Valve Inflow Obstruction in a Late-Gestation Fetal Lamb Model

Introduction: Hypoplastic left heart syndrome (HLHS) is a congenital heart defect of an underdeveloped left ventricle (LV), necessitating palliative interventions after birth to survive. HLHS often occurs alongside mitral or aortic valve stenosis, lending to the hypothesis that reduced blood flow into and out of the LV in utero could retard LV growth. We have developed a late-gestation fetal lamb model to investigate if in utero mitral inflow obstruction could cause LV hypovolemia. Methods: Twelve pregnant ewes with twin fetuses at 82% gestation were used. In the experimental fetuses (EXPT), mitral inflow obstruction was achieved with an inflatable balloon catheter implanted into the left atrium (LA) in a beating heart. Other implants included a flow probe on the ascending aorta to measure cardiac output, and carotid artery and jugular vein catheters to monitor fetal health. After recovery from surgery, progressive LA balloon inflation began at ~86% gestation, and was left inflated for 8 days (92% gestation). Transesophageal fetal ultrasound was performed at baseline and at termination to measure cardiac chamber volumes and function. Hearts were explanted, weighed and prepared for histology. Results: Fetal body weights were similar (EXPT: 4.6±0.9kg vs CTRL: 4.5±0.6kg, p=0.8597). Total heart weight was higher in EXPT (31.4±5.6g) than CTRL (26.4±2.4g, p=0.0471), but LV weight was similar (EXPT: 7.4± 1.8g vs. CTRL: 7.9± 1.1g, p=0.5652). LV end-diastolic volume was 2.3± 0.7ml in EXPT vs. 7.1± 0.8ml in CTRL (p&lt;0.0001), and end-systolic volume was 1.01ml (0.95 to 1.95ml) in EXPT vs. 3.38ml (3.28 to 3.57ml) in CTRL (p=0.0025). LV/RV weight ratio was 0.83±0.17 in EXPT and 1.08±0.19 in CTRL (p=0.0209), whereas LV/RV chamber area ratio was 0.21±0.06 in EXPT and 0.56±0.05 in CTRL (p=0.0005). Conclusions: In this fetal sheep model, obstructing mitral inflow retarded LV growth, demonstrating a potential mechanistic link between blood inflow and in utero LV volumetric growth.

Oral 17 - Use of the Transurethral Catheterisation Safety Valve (TUCSV) for the Prevention of Catheter Balloon Inflation Injury of the Urethra: A Prospective Multi-Institutional Study

Oral 17 - Use of the Transurethral Catheterisation Safety Valve (TUCSV) for the Prevention of Catheter Balloon Inflation Injury of the Urethra: A Prospective Multi-Institutional Study

Comparison of two volumes for extra-amniotic Foley catheter balloon inflation at preinduction of labor cervical ripening in nulliparae

Background: The success of induction of labor is dependent on how favorable the cervix is and the unripe cervix thus remains a well-recognized impediment to the successful induction of labor. Objective: The objective is to compare the efficacy of 50 ml versus 30 ml fluid inflation of Foley catheter balloon for cervical ripening in postdate nulliparous women billed for induction of labor. Materials and Methods: A comparative analytical study with randomization involving 88 nulliparous women with postdated pregnancy requiring cervical ripening prior to induction of labor was carried out from January 1, 2018, to August 31, 2018. They were randomized into Group A consisting of women who had 50 ml (study) and B who received 30 ml (control). Bishop score was assessed 12 h later. Data were entered into a pro forma and analyzed using the IBM Statistical Package 20. Results: A total of 88 patients participated in the study. A statistically significant higher mean change in Bishop score was observed in the study group when compared to the control group (5.6 ± 2.5 vs. 3.1 ± 1.6,P= 0.0001), and the difference was statistically significant. Similarly, 41 (93.2%) patients in the study group had a favorable cervix post-ripening, while in the control group, 30 (68.2%) patients had a favorable cervix (P = 0.003). More of the control group had repeat Foley catheter insertion compared to the study group (31.8% vs. 6.8%,P= 0.008). Conclusion: The use of 50 ml of fluid to inflate Foley catheter balloon for cervical ripening improves Bishop score better than the smaller volume of 30 ml.

AB061. SOH22ABS028. A prospective multi-institutional study using the transurethral catheterisation safety valve (TUCSV©) for the prevention of catheter balloon inflation injury of the urethra

Background: Catheter balloon injuries (CBI) of the urethra are avoidable iatrogenic injuries which occur in just over 1% of hospitalised male inpatients. The transurethral catheterisation safety valve (TUCSV©) is a novel safety device designed to prevent CBIs. The aim of this multi-institutional clinical study was to prospectively assess the TUCSV’s ability to prevent urethral CBI over a 3-month study period.

Differential effects on urethral function, epithelial morphology, and molecular profile in two different rat models of stress urinary incontinence by simulated birth trauma or estrogen deficiency

ABSTRACT Introduction Stress urinary incontinence (SUI) is the common type of urinary incontinence with a significantly negative impact on quality of life, including sexual dysfunction, in women. Although the etiology of SUI in women seems to be multifactorial, multiple vaginal parities and estrogen deficiency (ED) are considered to be major risk factors of SUI in elderly women. Thus, animal models of simulated birth trauma induced by multiple vaginal distention (VD) and ED induced by bilateral ovariectomy (OVX) have been used to study the SUI pathophysiology in rats. In previous studies, bilateral ovariectomy (OVX) reportedly induces the morphological changes in the rat urethral epithelium. It has also been reported that serotonergic (5HT+) paraneurons uniquely located in the urethra modulate urethral sensory function and that their numbers decrease in aged or diabetes rats. However, the difference of changes in the urethra such as those in epithelial morphology and expression of 5HT+ paraneurons in the urethra, in these two models has not been well characterized. Objective We therefore evaluated the histological changes of the urethral epithelium and 5HT+ cell expression, and urethral continence function in rats with OVX-induced ED or VD-induced simulated birth trauma. Methods Nulliparous SD rats were divided into: (1) sham group; (2) OVX 3-weeks group; (3) OVX 6-weeks group; (4) VD-1 group (1 time VD 2 weeks before assays); (5) VD-3 group (3 times VDs every 2 weeks). VD was induced by balloon catheter inflation for 4 hours in the vagina under isoflurane anesthesia. Urethral function was evaluated by the amplitude of urethral pressure responses during sneezing (A-URS) and urethral baseline pressure (UBP), which was measured by a microtransducer-tipped catheter inserted into the mid-urethra (n=6, each group). Following the urethral function analysis, the mid urethra was harvested, and the tissue sections (10 μm) were stained with Hematoxylin-eosin (H&amp;E) and anti-5HT antibodies for immunofluorescent detection of 5HT+ paraneurons. In addition, in separate groups of rats, changes in urethral mRNA levels of tryptophan hydroxylase-1 (TPH1), a key enzyme of 5HT synthesis, were quantified by RT-PCR (n=6, each group). All data are represented as means ± SE. P &amp;lt; 0.05 was considered significant. Results OVX 6-weeks and VD-3 rats exhibited significant decreases in UBP and A-URS vs. sham (Fig. 1A). The mean epithelial thickness was significantly decreased in OVX 3, 6-weeks, VD-1 and 3 rats (Fig 1B,C) vs. sham. The number of urethral 5HT+ paraneurons was significantly decreased in OVX 3, 6 weeks, VD-1 and 3 rats (Fig. 2A,B) vs. sham. TPH-1 mRNA levels were significantly decreased in OVX 3, 6-weeks and VD-3 rats (Fig. 2C) vs. sham. Conclusions These results indicate that urethral epithelial atrophy and loss of 5HT+ paraneurons occur prior to SUI- inducing urethral dysfunction in both models, with the changes being rapid and greater in OVX compared to VD. These histological changes in the urethra may contribute to the establishment of SUI in ED and multiple birth trauma. Disclosure Work supported by industry: no.