Pericatheter Leakage Research Articles

Efficacy and Safety of Urethral Catheter with Continuous Infusion of Ropivacaine after Urologic Surgery: A Pilot Prospective Randomized Controlled Trial.

Catheter-related bladder discomfort (CRBD) has been found in many patients with urologic surgery. The authors investigated the effect of analgesic-eluting urethral catheters on postoperative CRBD. 60 subjects scheduled for urologic surgery requiring urethral catheterization were randomized prospectively to one of three groups (control arm, 0.5% ropivacaine 1 mL/h arm [Study 1 arm] and 0.5% ropivacaine 2 mL/h arm [Study 2 arm]; n = 20 each). The incidence and severity of CRBD were evaluated postoperatively at 24 h as primary outcomes. The incidence of adverse events regarding urethral catheter utilization was assessed as a secondary outcome. The CRBD incidence at 24 h postoperatively in the control, study 1 and study 2 arms was 50.0%, 10.0%, and 15.0%, respectively (p = 0.002). The CRBD severity at 24 h postoperatively showed that patients in the study 1 and study 2 arms had significantly less postoperative CRBD than those in the control arm (visual analog score [VAS]; the mean VAS of the control, study 1, and study 2 arms: 2.1 vs. 1.6 vs. 0.9, p = 0.045). Urethral pain regarding catheter was significantly less severe in the study arms than in the control (VAS score: 6.2 vs. 1.5 vs. 1.4, p < 0.001). The severity and incidence of adverse events did not differ significantly among groups (p = 0.287). Peri-catheter leakage was more frequent in the study 2 arm (p = 0.057). The proper usage of a ropivacaine-eluting catheter can not only alleviate CRBD but reduce catheter-related urethral pain in patients with urologic surgery followed by catheterization, without major adverse events.

Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes

Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy. This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value< 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis. A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P= 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes. ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile.

#1125 CAPD in ESRD and CLD patients with refractory ascites: a 12-month follow-up study

Abstract Background and Aims Refractory ascites secondary to chronic liver disease among ESRD patients are a major source of morbidity and mortality. Hemodialysis is frequently interrupted due to intradialytic hypotension and other complications which make ultrafiltration removal among CLD patients, a big challenge. This results in sub-optimal clearance which translates into poor quality of life along with recurrent admissions. CAPD in these patients is effective in providing a good clearance as well as removal of ascites with adequate ultrafiltration removal. There is a lack of data regarding the feasibility, safety, and clinical outcomes of CAPD among CLD patients with ascites. We conducted a study with objectives to evaluate serum albumin levels at baseline and 12 months, and to determine peritonitis rates and dialysis modality suitability in CLD patients. Method Study Design A retrospective cohort study. Study Population All hemodialysis patients with refractory ascites due to CLD. Refractory ascites was defined as the need for &amp;gt;5 therapeutic paracentesis in the last 3 months after optimal clinical, dietary and fluid management. All CLD patients were extensively counselled regarding high protein intake. Each patient visited either the Nephrologist or PD Nurse, renal dietician at least once in 4-6 weeks. Results Over a period of five years, 34 patients were included in the analysis to assess the efficacy of Continuous Ambulatory Peritoneal Dialysis (CAPD) for ascites management in chronic liver disease. Baseline characteristics are presented in Table 1. The frequency of ascites drainage prior to CAPD was every 3.4 weeks. Open catheter insertion was performed in 31 out of 34 patients. Serum albumin levels increased from 2.98 ± 0.4 g/dL at baseline to 3.1 ± 0.28 g/dL at 12 months (p = 0.21) (Fig. 1). Child-Pugh Score and MELD score remained stable. Bacterial peritonitis episodes were higher at 12 months (3 vs 9; p = 0.04). PD-related complications at one year included one omental wrap, three pericatheter leaks, and one umbilical hernia. At the 12-month follow-up, 32 patients survived. One patient died from myocardial infarction, and another experienced severe hepatic encephalopathy and aspiration pneumonia. Conclusion PD was well tolerated in patients with refractory ascites, presenting no additional hypoalbuminemia risk. Continuous multidisciplinary monitoring for malnutrition remains critical. Peritonitis risk was elevated relative to SBP in HD patients yet was on par with typical PD rates, without an increase in hospital admissions.

Nursing management of catheter-related non-infectious complications of PD: Your questions answered.

A review from the last seven years (August 2016-July 2023) of questions posted to the International Society for Peritoneal Dialysis (ISPD) website "Questions about PD" by nurses and physicians from around the world revealed that 19 of the questions were associated with optimal approaches for preventing, assessing, and managing issues related to PD catheter non-infectious complications. Our review focused on responses to these questions whereby existing best practice recommendations were considered, if available, relevant literature was cited and differences in international practices discussed. We combined similar questions, revised both the original questions and responses for clarity, as well as updated the references to these questions. PD catheter non-infectious complications can often be prevented or, with early detection, the potential severity of the complication can be minimized. We suggest that the PD nurse is key to educating the patient on PD about PD catheter non-infectious complications, promptly recognize a specific complication and bring that complication to the attention of the Home Dialysis Team. The questions posted to the ISPD website highlight the need for more education and resources for PD nurses worldwide on the important topic of non-infectious complications related to PD catheters, thereby enabling us to prevent such complications as PD catheter malfunction, peri-catheter leakage and infusion or drain pain, as well as recognize and resolve these issues promptly when they do arise, thus allowing patients to extend their time on PD therapy and enhance their quality of life whilst on PD.

Incidence and Determinants of Catheter-Related Bladder Spasms Following Transurethral Resection of the Prostate; A Prospective Review of 80 Cases.

Bladder spasms due to involuntary contraction of the bladder occur frequently following Transurethral resection of the prostate (TURP). They may be aggravated by the presence of a catheter, blood clots, preoperative overactive bladder, or preoperative ingestion of bladder stimulants like caffeine. These bladder spams are painful, associated with peri-catheter leakage of urine, increased post-operative bleeding, and often refractory to postoperative analgesia. The incidence and risk factors for the occurrence of bladder spasms following TURP need to be reviewed and validated to ensure adequate patient counseling and possible lifestyle modification before surgery. We conducted a prospective review of the determinants of bladder spasms in our patients following TURP. The study population was patients with benign prostatic obstruction scheduled for TURP between March 2022 and April 2023. Monopolar transurethral resection of the prostate was done using a continuous flow resectoscope. The primary endpoint of the study was occurrences of bladder spasms postoperatively before the trial without a catheter. Pain perception during the spasms was assessed using a visual analog scale. Clinical data were collected and analyzed to determine their association with the occurrence of bladder spasms postoperatively using regression analysis. Sub-group analysis was also done to correlate significant variables with the severity of pain in patients with spasms. The mean age of the 80 patients reviewed was 66.9 ±8 years. Bladder spasms were seen in 41(51.2%) of the patients. The presence of overactive bladder (OAB) symptoms and the use of bladder stimulants were statistically significant determinants with a p-value of 0.003 and 0.026 respectively. The age of the patient, preoperative indwelling catheter, prostate volume, and resection time were not statistically determinant variables in the occurrence of bladder spasms post-operatively. 61% had severe pains and 39% had mild pains. There was no significant correlation between the presence of OAB or the use of bladder stimulants with the severity of pains in patients with bladder spasms after TURP. Half of the patients are likely to have bladder spasms after TURP. The risk of having these spasms is higher in patients with preoperative OAB or patients who are exposed to bladder stimulants. The severity of spasms is however independent of these risk factors.

Perioperative Analgesic Modality and Effectiveness in Paediatric Patients Who Have Undergone Common Major Urology Surgery - A Two-Year Retrospective Study

Perioperative paediatric major urology surgery pain management remains challenging. These surgeries require general anaesthesia (GA) combined with either regional analgesia technique or systemic morphine infusion for optimal pain relief. We aimed to compare and evaluate the effectiveness of both analgesic techniques. This single centre retrospective descriptive study involved 88 patients, aged 3 months to 12 years old with American Society of Anaesthesiologists (ASA) I or II status, who underwent major urology surgery under GA. Group A patients received perioperative systemic morphine while Group B received regional anaesthesia blocks (continuous caudal epidural infusion, single-shot caudal blocks or single-shot erector spinae blocks). We measured requirements of perioperative rescue intravenous (IV) fentanyl, pain scores using Face, Leg, Activity, Cry, Consolability (FLACC) scale, perioperative non-opioid IV analgesia usage and associated complications. Intraoperative rescue fentanyl in both groups was comparable. Intraoperative non-opioid analgesia and postoperative rescue fentanyl requirement were significantly higher in Group A compared to Group B (p&lt;0.001). Median FLACC scores in Group A were higher than Group B (p&lt;0.001) for first 12 hours post-surgery. Commonest complications in Group A was vomiting (38.6%) and peri-catheter leak in Group B (6.81%). Regional anaesthesia technique is superior to systemic morphine in providing analgesia in the first 12 hours post paediatric major urology surgery and is devoid of opioid side effects.

#5623 PERITONEAL DIALYSIS AND POSTOPERATIVE OUTCOMES IN CHILDREN AFTER CARDIAC SURGERY: A SINGLE-CENTER COHORT STUDY

Abstract Background and Aims Acute kidney injury (AKI) is a frequent complication in neonates and infants after congenital heart disease surgery, with great impact on morbidity and mortality. Peritoneal dialysis (PD) is the renal replacement therapy of choice, as it allows continuous gentle ultrafiltration with minimal impact on hemodynamic status. However, there is no standardized prescription. The present study aimed to describe our experience of using PD in the management of AKI after cardiac surgery in pediatric patients and the postoperative outcomes. Method Single-center cross-sectional study including 21 children undergoing cardiac surgery between 2017 and 2022, in a congenital heart disease reference center. Demographic and clinical data were collected from the electronic records. Results Of the 21 patients treated with PD, 11 were female. Mean age was 32 ± 45 days and median weight was 3.4 kg (IQR 0.5). All pregnancies had been full-term with a mean birth weight of 3.2 ± 0.3 kg. No congenital urinary tract anomalies had been previously documented. Previous history of AKI was present in 2 patients. Transposition of the great arteries was the most common surgical indication (52%). RACHS-1 score was ≥4 in 12 patients and median PRISM-IV score was 6.5% (IQR 6). Cardiopulmonary bypass was performed in 19 patients with a mean time of 181 ± 72 minutes and a mean aortic clamping time of 94 ± 29 minutes. All patients required inotropic support after cardiac surgery with ≥2 drugs, for 197 ± 136 hours. Median time with mechanical ventilation support was 126 hours (IQR 288) and median length of stay at the intensive care unit (ICU) was 9 days (IQR 15.3).The indications for PD initiation were anuria (66.7%), oliguria (23.8%) and fluid overload (9.5%). Median time between cardiac surgery and AKI diagnosis was 2.5 hours (IQR 8.8) and between AKI diagnosis and PD initiation was 1.8 hours (IQR 4.3). Median duration under dialysis was 2 days (IQR 3.5). Exchange volume of dialysate varied between 6 and 15 mL/kg at the beginning of PD. In 11 patients, this volume was progressively increased to a maximum of 60 mL/kg (minimum: 30 mL; maximum: 120 mL). Continuous veno-venous hemodiafiltration was required in 3 patients, mainly due to mechanical catheter dysfunction. Complications related to PD occurred in 5 patients: 1 patient developed peritonitis, 1 patient had mechanical catheter dysfunction and 3 patients had peri-catheter leak. Complete recovery of renal function was achieved in 14 patients. Longer time on PD was associated with lower weight before surgery (p = 0.04), longer time on mechanical ventilation and inotropic support (p &amp;lt; 0.001), and longer stay at the ICU (p &amp;lt; 0.001). Time on inotropic support could predict time on PD using a multiple regression model (adjusted R2 = 59%, p = 0.003), adjusted to cardiopulmonary bypass time, time on mechanical ventilation support and weight before surgery (adjusted ß = 0.7, p = 0.005). Eight patients died during hospitalization, due to multiorgan failure (38%), cardiogenic shock (38%), disseminated intravascular coagulation (13%) and septic shock (13%). Longer cardiopulmonary bypass time was associated with in-hospital mortality (149 ± 53 vs 235 ± 46, p = 0.004). Both the time between AKI diagnosis and PD initiation and the time on PD were not associated with in-hospital mortality. Conclusion Our study suggests that PD is a safe and effective dialysis modality in the management of post-cardiac surgery AKI in pediatric population. Early identification of high-risk infants is important to implement preventive measures.

Minimally Invasive Peritoneal Dialysis Catheter Insertion with Intraoperative Ultrasound-Doppler Measurement of Rectus Muscle Width and Inferior Epigastric Artery Localization

Laparoscopic peritoneal dialysis catheter insertion is an established method for peritoneal dialysis catheter placement. One critical aspect of this procedure is rectus sheath tunneling. Proper peritoneal dialysis catheter incorporation within the abdominal wall is important for reducing pericatheter leaks and for proper peritoneal dialysis functioning. Particularly, accurate positioning of the internal cuff within the rectus muscle sheath is crucial to prevent potential dialysate fluid leakage. In the present report, we describe the utilization of intraoperative ultrasound as a valuable tool for determining the ideal location of the internal cuff and assessing the course of the inferior epigastric artery during rectus sheath tunneling. This technique aims to optimize the position of the internal cuff and minimize complications such as vessel injury and pericatheter leaks. Furthermore, we demonstrate that post-catheter insertion, ultrasound imaging offers valuable insights into evaluating the appropriate placement of the internal cuff, external subcutaneous cuff, and potential bleeding within the abdominal wall.

Primary placement of low-profile or ‘button’ versus traditional balloon-retention radiologically inserted gastrostomy catheters in adults: a retrospective review

ObjectiveDe novo percutaneous placement of radiologically inserted low-profile or ‘button-type’ gastrostomy catheters (LPG) is infrequently reported in adults. This study compares the safety and clinical outcomes of primary percutaneous placement...

Abstract No. 56 Comparing Outcomes of Percutaneous Biliary Drainage Catheters in Right versus Left Hepatic Approaches

Determine if there is a difference in complications associated with right or left hepatic percutaneous biliary drain placement in patients with benign or malignant biliary etiology. This retrospective study included patients with benign or malignant biliary stricture and treated with percutaneous biliary drainage at a single institution from 7/28/2004 to 3/30/2021. Three hundred fifty-seven patients met inclusion criteria, seventy-seven on the left and two hundred and eighty on the right, with a mean age of 65.1 years. Complications associated with the initial drain placement or during subsequent intervention were collected and categorized. Perioperative complications included surgery, infection, hemorrhage, and drain failure. Complications during treatment with a percutaneous biliary drain included death, chills, catheter displacement, cholangitis, biliary stones, drain malfunction, fever resolving without treatment, and pericatheter leakage. Complications were also grouped as major or minor. Statistical analyses were performed using logistic regression analysis and P values less than 0.05 were considered significant. Major interventional and treatment complication rates showed no statistical significance between left and right drains. The rate of minor interventional and treatment complications also showed no statistical significance between right and left drains. However, when cholangitis was analyzed individually, right sided hepatobiliary drains demonstrated a statistically significant increase in complication rates. Current literature describes safety of right biliary drain placement when compared with left, despite current equivocal study analyses. This large group analysis describes no statistically significant difference in complications between right and left hepatobiliary drains aside from slightly higher incidence of cholangitis for right sided drains.

Technical Considerations and Complication of Percutaneous Transhepatic Biliary Drainage: A Single Center Retrospective Study

Introduction: With comparable outcomes, percutaneous transhepatic biliary drainage (PTBD) is the preferred method for relieving biliary obstruction when the gold standard endoscopic retrograde cholangiopancreaticography (ERCP) fails or is not practicable.&#x0D; Aims &amp; Objectives: To evaluate the technical success rate, clinical success rate, and complications of PTBD.&#x0D; Place and duration of study: This study was carried out in Radiology Department of Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan from 29th February 2020 to 1st November 2021.&#x0D; Material &amp; Methods: In this study, consecutive PTBD procedures performed from 29th February 2020 to 1st November 2021 were retrospectively reviewed. We collected data including patients' age, gender, diagnosis, indications, prior ERCP performance, preoperative and post operative bilirubin, and complications. Technical success, clinical success, and complications were documented. SPSS Version 26 was used for data entry and analysis, P-value&lt;0.05 was taken as significant.&#x0D; Results: A total of 96 procedures were performed in 64 patients with the mean age of 52 years (range: 20 - 91 years). Out of 96, 66 (68.8%) procedures were performed in malignant obstruction with most common cause being cholangiocarcinoma (24%). Technical success was achieved in100% of the cases while clinical success rate was 90.6%. In total 96 procedures, 7 complications were reported. Major complication rate was 5.2%. These included 2 cases of post-procedure cholangitis (2.1%), 2 cases of acute pancreatitis (2.1%), and a case of bilio-venous fistula (1%). Minor complication rate (including 2 cases of pericatheter leakage) was 2.1%.&#x0D; Conclusion: PTBD is a reliable and effective procedure. In general, complication rate after PTBD is not high, and the patients having malignant disease were more prone to the complications.

Arterioportal fistula with hepatic artery pseudoaneurysm: A rare complication of percutaneous transhepatic biliary drainage

We describe a rare complication of percutaneous transhepatic biliary drainage in a 51-year-old female with recurrent hilar cholangiocarcinoma. The patient presented with blood-mixed pericatheter leak of bile, 1 month after placement of a 10F ring biliary internal-external drainage catheter through the left-sided biliary radical. Color Doppler and triphasic computed tomography angiography revealed a pseudoaneurysm arising from segment 3 branch of the left hepatic artery and an arterioportal fistula immediately distal to the pseudoaneurysm. Endovascular coil embolization of the hepatic artery proximal to the pseudoaneurysm was done which resulted in occlusion of the pseudoaneurysm and fistula as well as clinical improvement in the symptoms.

The Influence of Peritoneal Dialysis Catheter Tip Design on Technique Survival: A Retrospective Observational Study.

The clinical practice guidelines for peritoneal access state that no particular peritoneal dialysis catheter (PDC) type has been proven superior to another. We present our experience with the use of different PDC tip designs. The study is a retrospective, real-world, observational, outcome analysis correlating the PDC tip design (straight vs. coiled-tip) and technique survival. The primary outcome was technique survival, and the secondary outcome included catheter migration and infectious complications. A total of 50 PDC (28 coiled-tip and 22 straight-tip) were implanted between March 2017 and April 2019 by using a guided percutaneous approach. The 1-month and 1-year technique survival in the coiled-tip PDC was 96.4% and 92.8%, respectively. Of the two coiled-tip catheters lost, one was a consequence of the patient having undergone live related kidney transplantation. The corresponding 1-month and 1-year technique survival with straight-tip PDC was 86.4% and 77.3%, respectively. When compared to straight-tip PDC, the use of coiled-tip PDC was associated with fewer early migration (3.6% vs. 31.8%; odds ratio (OR): 12.6; 95% confidence interval (CI): 1.41-112.39; P = 0.02) and a trend toward favorable 1-year technique survival (P = 0.07; numbers needed to treat = 11). Therapy-related complications noted in the study included peri-catheter leak and PD peritonitis. The PD peritonitis rate in the coiled-tip and straight-tip group was 0.14 and 0.11 events per patient year, respectively. The use of coiled-tip PDC, when placed using a guided percutaneous approach, reduces early catheter migration and shows a trend toward favorable long-term technique survival.

Radiological versus laparoscopic insertion of peritoneal dialysis catheter: a study comparing outcomes at a single centre.

Although peritoneal dialysis (PD) is a well-established and effective form of renal replacement therapy in end-stage renal failure (ESRF) patients, there is no consensus as to the optimal insertion technique. This study compares the outcomes of PD catheters inserted radiologically versus laparoscopically at a single centre. Patients who underwent either radiological PD catheter insertion (RC) or laparoscopic insertion (LC) between 2013 and 2019 were retrospectively reviewed. Primary outcome was catheter patency at 12 months. Secondary outcomes included exit-site infections, peritonitis, and pericatheter leaks within 30 days of insertion, any complications associated with insertion, overall catheter survival, and inpatient length of stay (LoS). There were 81 patients included in this study, with a total of 100 procedures performed (RC=48, LC=52). There were significantly fewer overall complications in the LC group compared to the RC group (P< 0.001). However, when individual complications were considered, this significant difference was only seen in the rate of malpositioned catheters (10.4% versus 0%, P= 0.023). Hospital LoS was longer in the LC group compared to the RC group (3 versus 2 days, P= 0.004), but this was outweighed by the fact that there were more laparoscopically inserted PD catheters still functioning and patent at 12 months compared to those inserted radiologically. This study has demonstrated that our laparoscopic PD catheter insertion technique of securing the catheter tip low in the pelvis is safe and effective, providing a lower complication rate and longer-term viability when compared to the radiological percutaneous approach.

SP6.1.1 The Safety of Laparoscopic Feeding Jejunostomy Insertion in Patients with Oesophago-gastric Pathology

Abstract Aims Feeding jejunostomy (FJ) to support enteral nutrition has traditionally been placed using an open approach (OA). As minimally invasive surgery (MIS) for oesophageal and gastric surgery gains popularity, it is imperative to develop a standardised technique and examine its safety. We describe our MIS approach to FJ insertion and compare outcomes to OA. Methods This was a retrospective analysis of patients undergoing FJ insertion via MIS and OA in a high volume tertiary oesophago-gastric centre, from 2018 to 2020. Identifying and placing FJ in first jejunal loop at low pneumoperitoneum pressure, constructing Witzel tunnel and placing antitorque sutures are our institution's standardised steps. Outcomes assessed included catheter-related adverse events. Results Of 226 patients, 130 (57.5%) had MIS, while 96 (42.5%) had OA. Median age (63.0 vs. 66.0 years, p=0.04), BMI (26.1 vs. 26.2 kg/m2, p=0.30), Charleston comorbidity index (4.0 vs. 4.0, p=0.73) and gender (75.4% vs. 76.0% males, p=1.00) were comparable. Median days FJ remained in situ was 162, 85.0% were placed in patients undergoing cancer resection, while MIC tube was used in 80.5%. A higher peri-catheter infection was seen with MIS (p=0.01); however, no differences (p≥0.42) were observed between MIS vs. OA, in tube dislodgement (9.0vs.6.0), fracture (2.0vs.2.0), blockage (2.0vs.0.0), peri-catheter leakage (6.0vs4.0), bowel obstruction (5.0vs.2.0) and perforation (0.0vs1.0). No feed inspissation or enterocolitis was observed. Misplacing FJ beyond first jejunal loop caused volvulus, necessitating reintervention. Conclusion FJ insertion via MIS is safe, provided standardised steps are followed meticulously. Evaluating confounding factors for better understanding of MIS-associated peri-catheter infection is recommended.

Vesical Calculus Around Neglected Foley’s Catheter: Case Report

Background: Long term bladder catheterization is complicated by bacteriuria, encrustation by mineral salts, stone formation etc. In the presence of an indwelling catheter, the development of bacteriuria is inevitable and the colonization of the catheter withurease producing organisms alkalinizes the urine, promoting the precipitation of calcium phosphate salts and a biofilm of bacteria on the surface of the catheter. Aseptic techniques at catheter insertion and prompt treatment of urinary tract infections will thereforeminimize the occurrence of intravesical calculi formation. A review of literature suggests that the longest reported case of retained bladder catheter with intravesical calculus formation is two years. We report two cases of long term indwelling catheter, five yearsand two years respectively, with intravesical calculus formation around the catheter.Case Report: Case 1. A 44 year old man with urethral strictures retained a latex suprapubic Foley’s catheter for five years and reported with pericatheter leakage of urine A stone found to have formed around the catheter was removed at open suprapubic cystolithotomy. Case 2. A 61year old man retained his urethral cathetern assed for urine retention for two years. He presented in acute retention and a vesical calculus found to be around the catheter was removed at suprapubic cystolithothomy.Conclusion: Long term indwelling catheter usually gets complicated by urethral encrustation and stone formation. Aseptic techniques at urethral catheterization and proper patient education on regular catheter change are required to minimize stone formation around urethral catheter.

Feasibility and Safety of Laparoscopic Placement of Peritoneal Dialysis Catheter Using Percutaneous Endoscopic Gastrostomy Device.

We developed a novel technique of peritoneal dialysis (PD) catheter placement using an existing device originally utilized to insert a percutaneous endoscopic gastrostomy tube. We investigated the feasibility and safety of the procedure. This study included 21 consecutive patients who underwent laparoscopic placement of PD catheter between August 2021 and December 2021. We retrospectively investigated the clinical variables and perioperative results. The laparoscopic procedure was successfully performed in all patients. The duration of surgery was 21 (18-37) minutes. All patients could start PD within the seventh postoperative day. However, 1 patient had peri-catheter leakage due to exit-site infection. There were no patients with catheter migration, catheter obstruction, peritonitis, procedure-related death, and withdrawal of PD. The laparoscopic placement PD catheter using percutaneous endoscopic gastrostomy device was feasible and safe. (128 words).

POS-671 PATIENTS WITH POLYCYSTIC KIDNEY DISEASE ON PERITONEAL DIALYSIS: A SINGLE CENTRE TERTIARY CARE RENAL UNIT EXPERIENCE FROM UNITED KINGDOM

Autosomal dominant polycystic kidney disease is the commonest hereditary cause of chronic kidney disease. The reduction of intra-abdominal volume for peritoneal dialysis (PD) due to the enlarging polycystic kidneys and other cystic organs, and the higher risk of complications such as abdominal and inguinal hernias, pericatheter leaks, intestinal perforations, hydrothorax due to pleuro-peritoneal communication, diverticular disease and gastrointestinal reflux raise the concerns about PD catheter insertions, survival, and outcome.

Neglected Retained Suprapubic Catheter with Varied Management Options: A Case Series

Supra-pubic catheterization of bladder is used as a short or long term alternative to per-urethtral catheterization. Some catheter materials are more resistant to encrustation than others. If kept indwelling for longer duration, sooner or later all catheters cause complications like urinary tract infection (UTI), trauma, peri-catheter leakage, non-deflation of balloon, encrustations and stone formations resulting into retained catheter. Stone formation over neglected indwelling catheter is not an unusual clinical scenario and its management depends on etiology of catheter retention and complication. This article discusses etiopathogenesis, clinical presentations, diagnosis and varied management options used for the neglected retained supra-pubic catheter in three cases

Minimally invasive peritoneal dialysis catheter insertions with concomitant cholecystectomy or hernioplasty: Surgical technique and our experiences.

Peritoneal dialysis is a well-accepted replacement therapy in patients with end-stage renal disease. There are many different options adopted on how to insert a peritoneal dialysis catheter. In our institution, a laparoscopic insertion has become the method of choice for providing peritoneal dialysis access in adult patients. The aim of this study was to analyze surgical outcomes of patients after laparoscopically assisted placement of a PD catheter some of them after concomitant cholecystectomy or hernioplasty. We have evaluated 70 consecutive patients from 1st of October 2015 to 30th of April 2020 who underwent laparoscopic insertion of a peritoneal dialysis catheter. Demographic data, details about surgery and about peri- and postoperative complications were gathered. Out of 70 enrolled patients, 15 had gallstones (21%) and underwent concomitant laparoscopic cholecystectomy. Three patients (4%) had abdominal wall hernia and underwent concomitant hernioplasty. We observed no perioperative complications connected with any of the performed procedures. There was one early postoperative complication: an early leak of dialysate fluid. Late complications were observed in nine patients (13%): mechanical catheter problems (two patients), peritonitis (three patients), skin exit-site infections (two patients), peri-catheter leak (one patient), and port-site hernia (one patient). For all patients with concomitant gallbladder disease or abdominal wall hernias we suggest to perform synchronous surgeries, due to finding no more complications after concomitant procedures in comparison to patients in whom only a PD catheter was inserted. Concomitant procedures are done to spare patients two separate procedures and to avoid possible complications. We also suggest using the cholecystectomy first, PD catheter insertion second approach for having excellent peri- and postoperative results.