Urethral Catheter Placement Research Articles

Optimised Protocol for Managing Failed Catheterisation: Leveraging Bedside Retrograde Urethrography and Cystourethroscopy.

Introduction Urethral catheterization is a routine procedure often required for many hospitalized patients. Various conditions, such as meatal stenosis, stricture urethra, false passage, benign prostatic hyperplasia, bladder neck contractures, and impacted urethral stones, can contribute to difficulty in catheterisation. In the setting of failed attempts at per urethral catheter placement, the subsequent intervention is suprapubic catheter (SPC) insertion. SPC placement has its associated complications and causes inconvenience to the patients. We framed an algorithm to minimise the need for SPC insertion in cases of difficult per urethral catheterisation in a non-trauma setting. This study aimed to evaluate the common causes of difficult per urethral catheterisation and establish the efficacy of our algorithm in managing difficult catheterisation with bedside retrograde urethrography (RGU) and cystoscopy while avoiding SPC placement. Materials and methods This prospective observational study was conducted from September 2022 to June 2024. Patients admitted with urinary retention or requiring routine catheterisation, with one failed attempt at catheterisation, were included in the study. Our algorithm for the management of difficult catheterisation in a non-trauma setting, to avoid SPC, integrates a bedside RGUand retrograde urethroscopy using either a 15.5 Fr cystoscope sheath or a 6 Fr ureteroscope to identify the urethral pathology, followed by dilatation and per urethral catheterisation. Results Among 55 patients (aged 34-82 years), 48 (87.27%) were male and seven (12.73%) were female. The most common indication for catheterisation was routine catheterisation for output monitoring (n = 30; 54.54%), followed by acute retention (n = 25; 45.45%). Bulbar urethral stricture (n = 28; 50.9%) was the most common cause of difficult catheterisation, followed by meatal/sub-meatal narrowing (n = 13; 23.63%), enlarged prostate or high bladder neck (n = 4; 7.27%), and impacted stones (n = 3; 5.45%). Successful catheterisation was achieved in 48 male patients following urethroscopy with a 6 Fr ureteroscope or 15.5 Fr cystoscope. In females, reducing the pelvic organ prolapse enabled catheterisation in two cases, while five required serial dilatation and catheterisation. Successful per-urethral catheterisation was achieved in all 55 (100%) patients, thus avoiding SPC. Conclusions Conventional blind catheterisation techniques have limited success in the setting of failed initial catheterisation. This approach, which employs bedside fluoroscopy and direct visualisation of the urethra using a cystoscope or ureteroscope, helped achieve higher success rates (n = 55; 100%) for difficult per-urethral catheterisation and avoided the need for SPC. Proper implementation of this protocol for dealing with difficult per-urethral catheterisation will reduce the unnecessary burden on the healthcare system by minimising the potential iatrogenic urethral injuries and reducing the need for SPC.

Factors affecting Urethral Catheter Placement Following Flexible Ureterorenoscopy: RIRSearch Study Group

Background/Purpose: To investigate the factors affecting UC placement following flexible ureterorenoscopy (fURS) and the effect of urethral catheter (UC) placement on patient quality of life. Methods: The present study was performed in prospective manner from 1st January 2015 to 30th December 2023, and patients with renal stones smaller than two centimeters who underwent fURS were analyzed for study inclusion. Patients’ demographic characteristics, operative parameters, success of procedure, complications, and VAS score were recorded. Patients were categorized into two groups according to UC placement or not. These groups were compared according to preoperative parameters, intraoperative data, complications, success and VAS at postoperative 6th hour. Results: In total, 324 patients were enrolled into the study. UC was inserted in 170 patients following fURS and was not inserted to 154 patients. In the patient group with UC placement, ratio of male patients (p= 0.002), ratio of anticoagulant use (p= 0.002), preoperative creatinine level (p=0.001), stone size (p= 0.001), stone burden (p= 0.001), and ratio of multiple stones (p= 0.001) were significantly higher. Operation time was significantly longer (p= 0.003) and intraoperative complications (p= 0.045) were significantly higher in patients with UC insertion. Need for additional analgesia and VAS score was significantly lower in patients without UC placement (p= 0.004 vs. p= 0.001). Multivariate analysis revealed that male gender, higher preoperative creatinine level, higher stone size and stone burden, and longer operation time were predictive factors for UC placement following fURS (p= 0.008, p= 0.001, p= 0.001, p= 0.010, and p= 0.001, respectively). Conclusion: The present study demonstrated that UC placement following fURS was associated with increased analgesia requirements and more pain. Moreover, our study demonstrated that male gender, higher preoperative creatinine level, higher stone size and stone volume, and longer operation time resulted in UC insertion after fURS.

Long-term Results of Optical Laser Urethrotomy for Post-traumatic Stricture of the Membranous Urethra

Urethral stricture is a common condition characterized by the narrowing of the urethra, leading to difficulty in urination. This article presents a case report of a 47-yearold male with urethral stricture following a pelvic fracture. The patient presented with urinary retention and a history of traumatic injury. Diagnostic imaging revealed a 2.0-2.2 cm stricture in the membranous urethra. Surgical intervention, including optical laser urethrotomy and silicone urethral catheter placement, was performed successfully. Postoperative management included antibacterial and anti-inflammatory therapy, leading to the restoration of independent urination. Urodynamic examination confirmed the successful outcome of the surgery. This case demonstrates that endoscopic surgery for urethral strictures can have a favorable prognosis. However, due to the potential for recurrence, ongoing outpatient care and monitoring by a urologist are essential for these patients.

Outcomes and Safety of Suprapubic vs Urethral Catheterization Following Pelvic Fascia‒Sparing Robotic Prostatectomy.

Urethral catheter (UC) discomfort remains a burden following robotic-assisted radical prostatectomy (RARP). Suprapubic catheters (SPCs) may reduce patient discomfort and increase satisfaction. Pelvic fascia‒sparing (PFS) RARP reduces the technical challenges of intraoperative SPC placement. We examined postoperative outcomes of SPC vs UC placement following PFS-RARP. We conducted a retrospective review of a prospective institutional review board‒approved database of PFS-RARP patients from June 2020 to December 2022 receiving SPC (n = 108) or UC (n = 104) postoperatively. Demographics and clinical and perioperative outcomes were captured. Postoperative patient-reported quality of life was measured using EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice). Patients with intraoperative complications or intraoperative leaks or undergoing salvage prostatectomy were excluded. Univariate and multivariate regression analyses were performed to compare outcomes. No significant differences in demographics or oncologic outcomes existed. There were no differences in complications, including urethral stricture or anastomotic leak. Men receiving SPC vs UC had earlier return to continence (7 vs 16 days, P < .001) and higher continence rates at catheter removal (67.6% vs 43.3%, P = .0003). On adjusted analyses, SPC was an independent predictor of continence at catheter removal (OR 2.21, P = .023). There were no differences between groups in preoperative or postoperative EPIC-CP scores, including no differences in postoperative quality of life (P = .46). SPC after PFS-RARP is a safe and feasible alternative to UC. SPC is associated with an earlier return to continence and higher continence rates at catheter removal. Use of SPC may increase overall patient satisfaction following PFS-RARP.

Urologic Consultations for Urethral Catheter Placement: A Cost Analysis

To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P=.05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs.

Is Urethral Catheterization Necessary in Retzius-sparing Robot-assisted Radical Prostatectomy?

To analyze whether urethral catheter (UC)-free anastomosis during Retzius-sparing radical prostatectomy (RP) results in worsening immediate perioperative and postoperative complications. We retrospectively reviewed records of patients undergoing robotic-assisted RP with or without indwelling UC placement by a single surgeon between January 2020 and March 2022. Clinical and pathological characteristics were evaluated. An independent t-test was used to compare continuous variables, and Pearson's chi-square test or Fisher exact test was used to compare categorical variables. One hundred fifteen patients underwent robotic prostatectomy from January 2020 to June 2022. Sixty-two patients had both a UC for 12hours postoperatively and a suprapubic catheter for 6days, while in 53 patients a UC was omitted. There was no significant difference noted between the groups regarding age, body mass index, American Society of Anesthesiology score, prostate-specific antigen, stage, node status, or positive margins. There were no significant differences in the rates of anastomotic leak, ileus, or urethral stricture. Patients had a significantly higher pad-free rate in the suprapubic catheter-only group (P=.04) at 3months. There was no difference in average number of pads used or the number using more than 1 pad/day. Omission of urethral catheterization during Retzius-sparing RP is safe and doesn't result in an increased risk in perioperative or postoperative complications, but rather appears to be associated with a significantly improved 3-month pad-free rate.

Robotic assisted transvesical excision of recurrent bladder leiomyoma with intraoperative ultrasound guidance

Leiomyoma of the urinary bladder is uncommon benign tumor with a wide range of clinical presentations. Surgical excision remains the definitive treatment of leiomyoma with excellent outcomes. Seldom literatures reported the use of robotic-assisted surgical techniques for its excision. A 51-year-old woman presented with frequent episodes of visible hematuria in consistence with lower urinary tract symptoms. The initial diagnosis was a urinary tract infection. However, symptoms did not resolve even with the proper antibiotics. After further investigations a soft tissue density mass measuring 20 × 23 × 20 mm within the left posterior wall of the urinary bladder extending towards the bladder neck was found. The histological finding of the transurethral resected biopsy of the mass revealed a benign submucosal leiomyoma of the bladder with no evidence of any malignancy. Using the Intuitive Da Vinci X system the tumor was excised using the ultrasound guidance to define the tumour margins, sparing the left ureteric orifice and ureter. The patient was discharged home on the day of surgery, with a urethral catheter in place. The catheter was successfully removed after 10 days, with cystogram prior confirming no leakage. The ureteric stent was removed by flexible cystoscopy two weeks later. The final histology was reported as a bladder leiomyoma with no evidence of malignant features and negative circumferential resection margins. Herein, in the current case we present a safe and effective technique for the excision of recurrent bladder leiomyoma using the robotic-assisted transvesical approach with intraoperative ultrasound guidance.

Role of pelvic drain and timing of urethral catheter removal following RARP: a systematic review and meta-analysis.

To assess the clinical value of routine pelvic drain (PD) placement and early removal of urethral catheter (UC) in patients undergoing robot-assisted radical prostatectomy (RARP), as perioperative management such as the necessity of PD or optimal timing for UC removal remains highly variable. Multiple databases were searched for articles published before March 2022 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. Studies were deemed eligible if they investigated the differential rate of postoperative complications between patients with/without routine PD placement and with/without early UC removal, defined as UC removal at 2-4 days after RARP. Overall, eight studies comprising 5112 patients were eligible for the analysis of PD placement, and six studies comprising 2598 patients were eligible for the analysis of UC removal. There were no differences in the rate of any complications (pooled odds ratio [OR] 0.89, 95% confidence interval [CI] 0.78-1.00), severe complications (Clavien-Dindo Grade ≥III; pooled OR 0.95, 95% CI 0.54-1.69), all and/or symptomatic lymphocele (pooled OR 0.82, 95% CI 0.50-1.33; and pooled OR 0.58, 95% CI 0.26-1.29, respectively) between patients with or without routine PD placement. Furthermore, avoiding PD placement decreased the rate of postoperative ileus (pooled OR 0.70, 95% CI 0.51-0.91). Early removal of UC resulted in an increased likelihood of urinary retention (OR 6.21, 95% CI 3.54-10.9) in retrospective, but not in prospective studies. There were no differences in anastomosis leakage and early continence rates between patients with or those without early removal of UC. There is no benefit for routine PD placement after standard RARP in the published articles. Early removal of UC seems possible with the caveat of the increased risk of urinary retention, while the effect on medium-term continence is still unclear. These data may help guide the standardisation of postoperative procedures by avoiding unnecessary interventions, thereby reducing potential complications and associated costs.

PD14-11 PERCUTANEOUS URETHRAL SPHINCTER STIMULATION: SWINE MODEL FOR FEASIBILITY OF USE IN STRESS URINARY INCONTINENCE

You have accessJournal of UrologyCME1 Apr 2023PD14-11 PERCUTANEOUS URETHRAL SPHINCTER STIMULATION: SWINE MODEL FOR FEASIBILITY OF USE IN STRESS URINARY INCONTINENCE Kyle Waisanen, Tyler Maiers, Peter Natalzia, and Teresa Danforth Kyle WaisanenKyle Waisanen More articles by this author , Tyler MaiersTyler Maiers More articles by this author , Peter NatalziaPeter Natalzia More articles by this author , and Teresa DanforthTeresa Danforth More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003261.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Current treatment modalities for stress urinary incontinence (SUI) include pelvic floor physical therapy, urethral bulking agents, and urethral sling support. We aim to assess direct electrical external urethral sphincter stimulation as a means for treating SUI patients with intrinsic sphincter deficiency. The objective of this study was to assess the feasibility of percutaneous external urethral sphincter access and urethral pressure profiles associated with direct electric sphincteric stimulation. METHODS: An IACUC-approved swine model study was performed under general anesthesia. The urinary bladder was accessed by open cystotomy for placement of antegrade 7F urethral pressure catheter. Stimulation leads were deployed into the external urethral sphincter under transvaginal ultrasound guidance and antegrade urethroscopy was performed to confirm urethral integrity. Leads were then stimulated with serial increases in amplitude from an external pulse generator from 0.1 mA to 3.6 mA with pressure monitoring of the external urethral sphincter. RESULTS: Three swine subjects were utilized in the study. All subjects underwent successful percutaneous insertion of stimulation leads into the EUS without urethral violation. External urethral sphincter pressures recorded with electric stimulation amplitudes of 0 mA, 1.8 mA, and 3.6 mA were found to exhibit increased urethral pressures of 6-10 cm H2O, 16-20 cm H2O, and 31-36 cm H2O, respectfully. EMG capture was achieved in each subject with a corresponding increase in EMG activity with pulse generator amplitude increase represented in the urodynamic strip from subject #2 (Figure 1). CONCLUSIONS: Direct external urethral sphincter stimulation with increased urethral closure pressures is achievable by an ultrasound-guided percutaneous approach. Further studies are required to assess long-term effects and success of the stimulation in SUI modeled subjects with promising results seen in this preliminary proof-of-concept study. Source of Funding: Lent Foundation, University at Buffalo © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e416 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Waisanen More articles by this author Tyler Maiers More articles by this author Peter Natalzia More articles by this author Teresa Danforth More articles by this author Expand All Advertisement PDF downloadLoading ...

1094: UTILITY OF RENAL ULTRASOUND IN GUIDING MANAGEMENT OF ACUTE KIDNEY INJURY

Introduction: Although guidelines recommend renal ultrasound in patients with acute kidney injury (AKI) to assess for obstructive etiologies, several studies have suggested that the clinical utility of renal ultrasound for all patients with AKI is undetermined and should be reserved for patients with risk factors for urinary tract obstruction. We looked into the characteristics of patients with a radiology-performed renal ultrasound (radiology US) for AKI to evaluate the frequency of unnecessary exams. Methods: We conducted a retrospective chart review from 6/1/2021 to 6/1/2022 at a single urban teaching hospital of patients admitted to medicine, intensive care unit or cardiac care unit with a rardiology US performed for AKI. We collected baseline demographic data, ultrasound findings, interventions including urethral catheter placement, urologic procedures or hemodialysis (HD), and time from ultrasound order to result. Results: 108 patients were included in this study. The average age was 70.2+- 14.52 and 37% were women. Patients were of diverse race/ethnicity: 22% White, 24% Black, 20% Hispanic and 12% Asian. Nephrology was consulted in 67.6%. KDIGO criteria was met in 80.6%; others had unknown baseline creatinine or had chronic kidney disease. 14 patients (n=14/108, 12%) had a final diagnosis of obstructive AKI. Of these patients, hydronephrosis was initially diagnosed on CT for 4 cases (n=4/35, 11%) and POCUS for 3 patients (n=3/8, 0.375%), and radiology US for 7 patients. Of the 11 patients who had hydronephrosis in radiology US, 4 patients had a foley placed prior to ultrasound. Only 3 out of the 11 patients required urological intervention and 1 started HD. Time from AKI detection to ordering radiology US was median 1 day [IQR 1,3] and time from radiology US order to final report was 16.97 hours [IQR 4.89, 27.39]. Conclusions: Out of 108 patients who had a radiology US for AKI, only 8 patients resulted in a change in management, specifically placement of a foley. In addition, 7 patients had hydronephrosis diagnosed on an alternate imaging study. Our study showed that it takes approximately 2 days for radiology US to result. Prevalence of hydronephrosis was low and few had change in management. Moreover, our study suggests that alternative imaging for AKI may result earlier than radiology renal US.

Technical Note: A procedure to place urinary catheters in 1- and 6-week-old preweaned Holstein heifer calves for the in vivo evaluation of intestinal permeability.

Oral administration of indigestible markers and subsequent urine collection is a useful method to determine in vivo gastrointestinal tract (GIT) permeability in cattle for research purposes. However, urine sampling techniques often rely on total waste collection, which reduces the ability to perform more frequent sampling and obtain accurate volumes and sterile samples. An alternative is urethral catheterization, though the feasibility of this technique has not been thoroughly tested in preweaned Holstein heifer calves. The study objective was to develop a urethral catheter placement procedure in preweaned Holstein heifer calves for continuous and accurate urine collection to evaluate GIT permeability using an indigestible marker. Fifteen Holstein heifer calves had catheters placed at approximately 1 wk (8.0 ± 1.5 d) and 6 wk (40.0 ± 1.5 d) of age. During the procedure, calves were individually housed and restrained. The vulva was sterilized and then a sterile, lubricated speculum was inserted into the vagina. A sterile 0.09 cm diameter guidewire was guided into a lubricated, sterile 10 French Foley catheter. The catheter was inserted at approximately 5 through 7 cm into the urethral opening, guided into the bladder, and the catheter balloon was filled with 10 mL of water. The guidewire was removed, and urine flow confirmed correct placement before a 4-L urinary drainage bag was attached to the catheter. After catheterization (24 h), 1 L of chromium (Cr)-ethylenediaminetetraacetic acid was orally dosed to the calves. Calf health observations were made six times over a 48-h period, and any occurrence of vaginal discharge, tissue discharge in catheter, bleeding, inflammation, or abnormal urine was considered a localized reaction. The proportion of localized reactions for each age group was determined using Microsoft Excel, and the total Cr output was analyzed using PROC GLIMMIX. Localized reactions occurred for 20.0% of the 1-wk-old calves and 13.3% of the 6-wk-old calves. In the first 4 h, urine was collected every 15 min, and there were no overall Cr output differences (P = 0.38; 10.28 ± 3.21 mg Cr) when comparing 1- and 6-wk-old calves. However, 1-wk-old calves tended (P = 0.08) to have greater overall Cr output at 480 min (19.2%) and 1,440 min (41.9%) when compared with 6-wk-old calves. In summary, urinary catheterization is a viable urinary collection method for the determination of in vivo GIT permeability in preweaned Holstein heifer calves.

PD25-08 ADVANCED PRACTICE PROVIDERS AND UROLOGIC PROCEDURES: AN ANALYSIS OF MEDICARE AND COMMERCIAL CLAIMS

You have accessJournal of UrologyCME1 May 2022PD25-08 ADVANCED PRACTICE PROVIDERS AND UROLOGIC PROCEDURES: AN ANALYSIS OF MEDICARE AND COMMERCIAL CLAIMS Max Hyman, and Parth Modi Max HymanMax Hyman More articles by this author , and Parth ModiParth Modi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: As the population ages and the demand for urologic care increases, urology practices are hiring nurse practitioners and physician assistants (advanced practice providers [APPs]) to address the shortage of urologists. While the expanding role of APPs in urology is well-established, the types and extent of urologic procedures that these APPs perform are not. METHODS: For calendar years 2010 through 2019, we used Medicare and commercial insurance claims from the Physician/Supplier Procedure Summary and IBM® MarketScan® Commercial Database, respectively. We identified common urologic procedures using Current Procedural Terminology codes and grouped them into five categories: cystoscopy procedures, urgent procedures, voiding dysfunction, imaging procedures, and cancer procedures. For each year and category, we calculated the number and proportion of urologic procedures submitted by APPs. RESULTS: From 2010 to 2019, the number of urologic procedures submitted by APPs increased from 35,358 (0.8%) to 185,099 (3.2%) in the Medicare data and 2,855 (0.2%) to 8,147 (0.9%) in the MarketScan data. For both data sets, cystoscopy procedures and voiding dysfunction (cystometrogram, posterior tibial nerve stimulation, sacral neuromodulation programming, and pelvic biofeedback) revealed the largest absolute increases; however, the growth in the proportion of urologic procedures submitted by APPs was largest for voiding dysfunction and urgent procedures (abscess drainage, complicated urethral catheter placement, and intracavernosal injection/irrigation). CONCLUSIONS: Among publicly and privately insured patients, APPs are submitting an increasing number and proportion of common urologic procedures. This growth is driven primarily by cystoscopy procedures, voiding dysfunction, and urgent procedures. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e424 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Max Hyman More articles by this author Parth Modi More articles by this author Expand All Advertisement PDF DownloadLoading ...

Preventing Urinary Fistulae After Artificial Urinary Sphincter Removal: Outcomes of a Standardized Protocol

ABSTRACT Introduction The artificial urinary sphincter (AUS) is the standard treatment for moderate to severe stress urinary incontinence in male patients. Despite their efficacy, the AUS is not without risk. Patients with an AUS are susceptible to complications such as mechanical failure, device infection, and urethral erosion. Erosion of the urethra can result in negative sequelae such as urethral stricture disease and urinary fistulae. Objective While there is no debate that patients presenting with urethral erosion require removal of the AUS, there is a lack of consensus on how to manage the patient in the perioperative period. We present our experience using a standardized surgical technique and perioperative protocol used at our institution to manage patients with an AUS presenting with urethral erosion. Methods Using an IRB-approved prosthetic database we completed a retrospective review of 97 patients who underwent AUS explantation between 2009 and 2020. Indications for removal, patient demographics, AUS component characteristics, and post-operative outcomes were analyzed. Patients undergoing AUS removal in the setting of urethral erosion were treated with a standardized protocol. Upon presentation, cystourethroscopy is performed to confirm erosion and to facilitate safe passage of a urethral catheter. With the urethral catheter in place, all AUS components are removed. After urethral cuff removal, urethrorraphy is performed. A 10-French surgical drain is placed through a separate stab incision and made to lie in the perineum and the wounds are closed in multiple layers. The urethral catheter is left in place for 4 weeks. After 4 weeks, physical examination and cystourethroscopy is performed to confirm repair of the urethra and the absence of fistula. Patients are seen monthly and are deemed eligible for reimplantation only after a minimum of 3 months have elapsed after explantation and the patient is deemed to have sufficient healthy urethra. Results No intraoperative complications occurred during AUS explantation. 117 patients underwent AUS removal during the study period. 94 (80.3%) patients had AUS removal due to urethral erosion. After median follow-up of 18.1 months (IQR 6.5 – 48.2) after AUS removal, there were a total 6 (4.0%) patients who developed a urethrocutaneous fistula with median time from AUS removal to fistula resolution of 6.5 months. Each patient with fistulae had presented with erosion of the urethra as indication for AUS removal. 67 (57.3%) patients underwent successful AUS reimplantation after removal with median time between explant and reimplant of 3.5 months (IQR3-4.8). Risk factors for urinary fistulae include urethral erosion, prior treatment with pelvic radiotherapy, and increasing age at time of AUS removal. Conclusions Urinary fistula can be prevented after urethral erosion with standardized surgical technique and peri-operative management in patients with an AUS. Disclosure No

Implementation and Assessment of a Urology Education Curriculum for Nursing Residents.

Urethral catheter placement is a common hospital procedure, and the urology service is often consulted for difficult catheterizations. Simulation-based education is used to improve procedural proficiency and could be used to increase confidence and comfort with difficult catheter placement. This study provides simulation-based education to help new nursing residents learn to perform independent Foley catheter placement and maintenance. All incoming nursing residents at our institution prospectively participated in this curriculum beginning in January 2020 (n = 291). Participants watched an instructional video and participated in a hands-on simulation. Nursing trainees rated pre- to post-curriculum gains in content knowledge (p < .001) and confidence (p < .001). Participants reported that the curriculum increased their understanding of the procedure (p < .001) and that they would recommend it to peers (p < .001). This educational initiative is a partnership between the Department of Urology and Department of Nursing to introduce and reinforce best practices for the care of patients who need Foley catheter placement and maintenance. [J Contin Educ Nurs. 2021;52(11):511-516.].

PSI-2 A procedure for urine collection in pre-weaned heifer calves

Abstract Urine collection is a useful tool to analyze intestinal permeability in cattle for research and diagnostic purposes. However, urine sampling techniques often rely on total waste collection, which reduces the ability to perform more frequent sampling and obtain accurate and sterile urine volumes. A potential alternative is urethral catheters, which have been used in cows and weaned heifers. However, urethral catheters have not been thoroughly tested in pre-weaned dairy heifer calves. The study objective was to develop a urethral catheter placement procedure in pre-weaned heifer calves for continuous and accurate urine collection. Fifteen Holstein heifer calves had catheters placed at 8 ± 2 days (37.5 ± 3.38 kg BW) and 40 ± 2 days (59.3 ± 5.38 kg BW) of age. During the procedure, calves were individually housed (1.87 m2/calf) and restrained. The vulva was cleaned using betadine and 70% ethanol and then a sterile, lubricated 8.9 cm speculum was inserted into the vagina. A sterile guidewire (145 cm x 0.89 cm) was inserted into a lubricated sterile 10 FR catheter. The catheter was inserted into the urethral opening (~5–7 cm into vagina), guided into the bladder, and the catheter balloon was filled with water (10 mL). The guide wire was removed, and urine flow confirmed correct placement before a 4 L urinary drainage bag was attached to the catheter. Individual calf health observations were made twice over a 24-hour period and included vaginal discharge, bleeding, redness or inflammation, and tissue discharge in the urine. Occurrence rate was determined using PROC FREQ in SAS 9.4. Regardless of catheterization timing, bleeding and tissue discharge occurred at a rate of 3.33% ± 0.18, and vaginal discharge and inflammation occurred at a rate of 6.70% ± 0.25. In summary, this procedure is a viable method for total urine collection in pre-weaning heifer calves.

Bladder management in patients undergoing spine surgery: An assessment of care delivery

BackgroundLower urinary tract dysfunction is common in the early postoperative phase after spine surgery. Although it is essential for an optimal patient management to balance benefits and harms, it is not known which patient benefit from a perioperative indwelling catheter. We therefore evaluated urological parameters prior and after spine surgery performing a quality assessment of our current clinical practice in bladder management. MethodsPreoperatively, all patients completed the International Prostate Symptom Score and were interviewed for urological history. Decision for preoperative urethral catheter placement was individually made by the responsible anesthesiologist according to an in-house protocol. Within and between group analyses using univariate and probability matching statistics were performed for patients with intraoperative urethral catheter-free management (n = 54) and those with a preoperatively placed catheter (n = 46). Post void residual (PVR) was measured prior and after surgery or after removal of the urethral catheter, respectively. The outcome measures consisted of postoperative urinary retention (POUR) and postoperative urological complications (PUC), defined as POUR and any catheter-related adverse events. ResultsHundred patients undergoing spine surgery were prospectively evaluated. Sixteen of the 54 (30%) patients with urethral catheter-free management developed POUR. Length of surgery and volume of intravenous infusion were associated with POUR (p < 0.05). In the 46 preoperatively catheterized patients, re-catheterization was required in 6 (13%). In a fairly homogenous subgroup of 72 patients with a probability of PUC between 15 and 40%, no significant association between intraoperative urethral catheter-free management and the occurrence of PUC was found (odds ratio 2.09, 95% confidence interval 0.69 to 6.33; p = 0.193). ConclusionsIn case of postoperative PVR monitoring allowing de novo catheterization as appropriate, urethral catheter-free management seems to be a valuable option in spine surgery since it does not to increase PUC but minimizes unnecessary catheterizations with their related complications.

Urinoma: Saviour of beleaguered kidney

Introduction: Spontaneous extravasation of urine due to High Pressure Chronic Retention is a rare entity. Most cases of urinoma are secondary to ureteric calculi. We present a case of left spontaneous perinephric urinoma with right hydroureteronephrosis with high pressure chronic retentiondue to benign enlargement of prostate. Summary: A 70 years male, with no comorbid illness, presented with left flank pain with overflow incontinence. On radiological evaluation, he was found to have distended urinary bladder, with right hydrouretronephrosis and left perinephric collection. Renal function tests were deranged. Patient was managed with per urethral catheter placement, antibiotics and ultrasound guided aspiration. Retention volume was more than one litre. Creatinine content of aspirated fluid was ten times higher to serum creatinine. Transurethral resection of prostate was done. The patient voided well after surgery. The urinoma resolved completely in 2 weeks. Follow up Contrast study revealed preserved left renal function; however the right hydroureteronephrotic kidney shrank in size. Conclusion: Spontaneous perinephric urinoma formation due to High pressure chronic retention was a blessing in disguise for the patient. It saved the affected kidney from getting knocked out. The other side hydroureternephrotic kidney suffered anatomical and functional loss.

Prostat Spesifik Antijenin Akut Üriner Retansiyon Sonrası Üretral Kateter Yerleştirilen ve Benign Prostat Hiperplazisi Olan Hastalarda Prostat Adenokarsinomu Saptamadaki Rolü

Objective : Acute urinary retension (AUR) is one of the most important complications in benign prostate hyperplasia (BPH) patients and its treatment is generally urethral catheterization in acute period. There are studies showing that AUR and urethral catheter placement may cause an increase in serum PSA levels. Our objective in this study was to investigate the relation between increased PSA levels and prostate cancer (PCa) incidence in the patient group after AUR and urethral catheter placement. Materials and Methods : 77 patients who had an indwelling urethral catheter due to AUR, performed prostate biopsy due to high PSA levels and then surgical treatment for clinic BPH were retrospectively examined. Age, prostate volumes, pre-biopsy total serum PSA and PSA densities were noted. Total serum PSA rates, PSA densities and prostate volumes were compared for the groups that PCa was detected (n=6) and not detected (n=71) according to biopsy or surgical specimen results. Results : Mean age of the patients was 65.2±3.9 years. Mean prostate volume was measured as 64.1±12.8 g, mean serum total PSA level as 9.2±4.2 ng/mL and mean serum PSA density as 0.15±0.08 mg/mL/g. In PSA groups with a serum total PSA level of ≤4.0, 4-10, 10-20 and >20, PCa prevalence rates were detected 0%, 4.3%, 13.4% and 20%, respectively. Total PSA levels and PSA densities were found statistically higher in PCa detected group. Conclusion : PCa incidence is low in patients who were placed urethral catheter after AUR. For these patients prostate biopsy should be performed only in chosen cases.

Factors Related To The Standard Of Care And Installation Of A Dower Cateter In A Hospital

Background: Urethral catheter placement is a form of nursing care performed by nurses, a standard for catheter placement is required. Urinary tract infections often occur around 40% of all hospital infections each year. In addition, from some researchers, 80% of urinary tract infections occur due to the use of catheterization instruments, because almost 10% of all hospitalized patients, at Bantul Hospital in 2017 There are 21% of patients are infected with the urinary tract. Nurse compliance uses standards based on various factors.&#x0D; Research Objectives: To determine the factors associated with the participation of nurses in the implementation of the standard installation of urethral catheters&#x0D; Research Methods: Descriptive analytic research by discussing the cross-sectional study. The sample used was total sampling with a sample of 43 nurses according to inclusion criteria. Data collection tools using questionnaires and observation sheets. Chi-Square data analysis with α &lt;0.05.&#x0D; Results: The gender of female respondents was 76.7%. Age of respondents received 18-40 years 76.7%. The level of knowledge of respondents in the good category is 65.1%. The attitude of respondents in the positive category was 83.7%. The working period of respondents &lt;5 years 51.2%. There is a significant relationship to age with the implementation of the standard implementation of urethral catheters, (P = 0.003 with an OR value of 2.54). There is a significant relationship between knowledge and the implementation of standard urethral catheter placement (P = 0,000 with an OR value of 19.50). There is a significant relationship between attitude with the agreement on the implementation of the standard urethral catheter installation (P = 0.007 with an OR value of 0.361). There is a significant relationship between a work period and the implementation of the standard implementation of urethral catheters (P = 0,000 with an OR value of 20.40).&#x0D; Conclusion: There is a significant relationship between age, knowledge, attitudes, and years of service to the approval of nurses in the implementation of the standard installation of urethral catheters in care in Bantul Hospitall&#x0D; Keywords: Working period of a nurse, and catheter installation standards&#x0D;

Factors Related to Nurse's Compliance in Implementation of Standard Operating Procedures for Urethral Catheter Insertion

ABSTRACT The act of catheterization in patients with urinary elimination disorders must be based on science and carried out in accordance with the installation sequence or fixed procedure. The purpose of this study was to determine the factors related to nurses' compliance in the implementation of standard operating procedures for urethral catheter placement in Ambon Living Resources Hospital. The analytical descriptive design with cross sectional study was used. The population is all nurses who provide nursing services in the Emergency Room and inpatient rooms of Ambon Life Sources Hospital, which number a population of 40 nurses. Sampling using total sampling technique. The sample in this study amounted to 40 people. There is a correlation between knowledge with nurses 'compliance in the implementation of fixed catheter installation procedures with values (p = 0.013), there is a relationship between attitudes and nurses' compliance in the implementation of fixed catheter installation procedures with a value (p = 0.000), there is a long working relationship with compliance nurses in the implementation of fixed catheter installation procedures with a value (p = 0,000). It is expected that nurses can apply and run in nursing practice regarding compliance with running a Standard Operating Procedure (SOP) for catheter insertion. Keywords: Knowledge, Attitude, Length of Work, SOP Catheter