Postoperative Indwelling Catheter Time Research Articles

Perioperative outcomes of transvaginal natural orifice transluminal endoscopic surgery and transumbilical laparoendoscopic single-site surgery in hysterectomy: A comparative study.

This study aimed to compare the perioperative outcomes of patients who underwent hysterectomy for benign gynecologic diseases using transvaginal natural orifice transluminal endoscopic surgery (vNOTES) or transumbilical laparoendoscopic single-site surgery (TU-LESS). A total of 314 patients who underwent hysterectomy for benign uterine disease at West China Second University Hospital between October 2018 and December 2021 were enrolled in this retrospective study. vNOTES (n = 157) and TU-LESS (n = 157) recipients were matched 1:1 in terms of uterine volume. The operation time, blood loss, postoperative decrease in hemoglobin, uterus weight, postoperative hospital stay, postoperative pain score at 12 h, postoperative indwelling catheter time, and other clinical indicators were compared between the two groups. All 314 patients successfully completed the surgery, and the two groups had similar baseline characteristics, with no statistical difference. Regarding intraoperative outcomes, the operation time was shorter in the vNOTES group than in the TU-LESS group (80 vs 100 min, P = 0.04), and there were no significant differences in intraoperative blood loss, intraoperative blood transfusion rate, postoperative decrease in hemoglobin, or uterine weight. Concerning postoperative outcomes, vNOTES hysterectomy was significantly superior to TU-LESS hysterectomy in terms of the length of hospital stay (3 vs 4 days, P < 0.001), visual analog scale score for pain at 12 h after surgery (P = 0.04), postoperative indwelling catheter time (39.5 vs 64.0 h, P < 0.001), and postoperative exhaust time (24.0 vs 42.0 h, P < 0.001). There were no significant differences in postoperative complications between the two groups. vNOTES and TU-LESS seem safe and feasible for hysterectomy, but vNOTES hysterectomy was more conducive to the postoperative rehabilitation of patients, with less trauma, less pain, and better cosmetic effects than TU-LESS hysterectomy. As an emerging surgical approach, more studies, including large-sample, multicenter, randomized controlled trials, are needed to validate our findings.

Risk Factor Analysis of Gastroparesis Syndrome in 2652 Patients with Radical Distal Gastrectomy

ObjectiveThe aim of this study is to investigate the risk factors of postoperative gastroparesis syndrome (PGS) in patients with gastric cancer who underwent radical distal gastrectomy. MethodsThe clinical data of 2652 patients with gastric cancer who underwent radical distal gastrectomy in the past 10 years were retrospectively analyzed. Furthermore, the incidence of PGS was set as the dependent variable, and the risk factors for PGS were screened using univariate and multivariate logistic regression analyses. Risk factor analysis for the different digestive tract reconstruction methods was also performed. ResultsUnivariate analysis revealed that preoperative pyloric obstruction (p = 0.001), digestive tract reconstruction (p = 0.001), jejunum nutrition tube application (p = 0.001), intraperitoneal chemotherapy drug application (p = 0.002), age (≥ 66 years or < 66 years) (p = 0.042), operative time (≥ 184.5 min or < 184.5 min) (p = 0.049), and postoperative indwelling catheter time (≥ 4.5 days or < 4.5 days) (p = 0.045) were related to PGS. Multivariate logistic regression analysis showed that preoperative pyloric obstruction (odds ratio (OR) = 2.830, p = 0.004), application of a jejunum nutrition tube (OR = 3.309, p = 0.011), intraperitoneal chemotherapy (OR = 0.482, p = 0.010), and digestive tract reconstruction were independent risk factors for PGS. ConclusionThis study identified risk factors associated with PGS, which could be further applied in clinical practice.

MP63-03 EFFICACY AND SAFETY OF a NOVEL 450 NM BLUE DIODE LASER VERSUS PLASMAKINETIC ELECTROCAUTERY FOR THE TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER: THE PROTOCOL AND RESULT OF a MULTICENTRE RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP63-03 EFFICACY AND SAFETY OF a NOVEL 450 NM BLUE DIODE LASER VERSUS PLASMAKINETIC ELECTROCAUTERY FOR THE TRANSURETHRAL RESECTION OF NON-MUSCLE INVASIVE BLADDER CANCER: THE PROTOCOL AND RESULT OF a MULTICENTRE RANDOMIZED CONTROLLED TRIAL Kaijie Wu, Lianhua Zhang, Shuai Jiang, Tianhai Lin, YI Luo, and Dalin He Kaijie WuKaijie Wu More articles by this author , Lianhua ZhangLianhua Zhang More articles by this author , Shuai JiangShuai Jiang More articles by this author , Tianhai LinTianhai Lin More articles by this author , YI LuoYI Luo More articles by this author , and Dalin HeDalin He More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003321.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To be the first to apply a novel 450 nm blue diode laser in transurethral resection of bladder tumour (TURBt) to treat patients with non-muscle invasive bladder cancer (NMIBC) and evaluate its efficacy and safety during the preoperative period compared to the conventional plasmakinetic electrocautery. METHODS: Randomized controlled trials (RCTs) in five medical centres were conducted from October 2018 to December 2019. Patients with NMIBC were randomized to the blue laser or plasmakinetic electrocautery group for TURBt. As the first study to evaluate this novel blue laser device, the primary outcome was the effective resection rate of bladder tumours, including effective dissection and haemostasis. The secondary outcomes were the perioperative records, including operation time, postoperative indwelling catheter time, hospital stay length, blood loss, reoperation rate, wound healing and adverse events. RESULTS: A total of 174 patients were randomized to either the blue laser group (85 patients) or plasmakinetic electrocautery group (89 patients). There was no statistical significance in the clinical features of bladder tumours, including tumour site, number and maximum lesion size. Both the blue laser and plasmakinetic electrocautery could effectively dissect all visible bladder tumours. The operation time for patients in the blue laser group was longer (p=0.001), but their blood loss was less than that of patients in the control group (p=0.003). There were no differences in the postoperative indwelling catheter time, hospital stay length, reoperation rate or other adverse events. However, the patients undergoing TURBt with the blue laser showed a faster wound healing at 3 months after operation. CONCLUSIONS: The novel blue laser could be effectively and safely used for TURBt in patients with NMIBC, and this method was not inferior to plasmakinetic electrocautery during the perioperative period. However, TURBt with the blue laser may provide the benefit to reduce preoperative blood loss and accelerate postoperative wound healing. Moreover, longer follow-up to confirm recurrence-free survival benefit was required. Source of Funding: This study was fifinancially supported by the National Key Research and Development Program (2019YFC0121501) © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e871 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kaijie Wu More articles by this author Lianhua Zhang More articles by this author Shuai Jiang More articles by this author Tianhai Lin More articles by this author YI Luo More articles by this author Dalin He More articles by this author Expand All Advertisement PDF downloadLoading ...

Efficacy and safety of a novel 450 nm blue diode laser versus plasmakinetic electrocautery for the transurethral resection of non-muscle invasive bladder cancer: The protocol and result of a multicenter randomized controlled trial.

To be the first to apply a novel 450 nm blue diode laser in transurethral resection of bladder tumor (TURBt) to treat patients with non-muscle invasive bladder cancer (NMIBC) and evaluate its efficacy and safety during the preoperative period compared to the conventional plasmakinetic electrocautery. Randomized controlled trial (RCT) in five medical centers was designed as a non-inferiority study and conducted from October 2018 to December 2019. Patients with NMIBC were randomized to the blue laser or plasmakinetic electrocautery group for TURBt. As the first study to evaluate this novel blue laser device, the primary outcome was the effective resection rate of bladder tumors, including effective dissection and hemostasis. The secondary outcomes were the perioperative records, including surgical time, postoperative indwelling catheter time, hospital stay length, blood loss, reoperation rate, wound healing and adverse events. A total of 174 patients were randomized to either the blue laser group (85 patients) or plasmakinetic electrocautery group (89 patients). There was no statistical significance in the clinical features of bladder tumors, including tumor site, number and maximum lesion size. Both the blue laser and plasmakinetic electrocautery could effectively dissect all visible bladder tumors. The surgical time for patients in the blue laser group was longer (p=0.001), but their blood loss was less than that of patients in the control group (p=0.003). There were no differences in the postoperative indwelling catheter time, hospital stay length, reoperation rate or other adverse events. However, the patients undergoing TURBt with the blue laser showed a faster wound healing at 3 months after operation. The novel blue laser could be effectively and safely used for TURBt in patients with NMIBC, and this method was not inferior to plasmakinetic electrocautery during the perioperative period. However, TURBt with the blue laser may provide the benefit to reduce preoperative blood loss and accelerate postoperative wound healing. Moreover, longer follow-up to confirm recurrence-free survival benefit was required.

The Use of BT-ESD Technology under General Intravenous Anesthesia in the Treatment of Nonmuscle Invasive Bladder Cancer and the Effect of PI3K/Akt Signaling Pathway on Tumor Recurrence

Objective. The objective is to investigate the effect of minimally invasive treatment of nonmuscle invasive bladder cancer (NMIBC) by transurethral endoscopic submucosal dissection of bladder tumor (BT-ESD) under general intravenous anesthesia and the expression of Akt in NMIBC and to study the effect of upregulation of intracellular phosphatidylinositol kinase (PI3K)/protein kinase B (Akt) on tumor recurrence. Method. 130 patients with NMIBC were selected as the research subjects, including 101 males and 29 females. The patients were divided into transurethral resection of bladder tumor (TURBT) group, BT-ESD learning group A (early 20 cases of chief surgeon), and BT-ESD learning group B (follow-up cases of the chief surgeon). The general information (male and female prevalence ratio and average age), operation duration, postoperative bladder irrigation duration, postoperative indwelling catheter time, postoperative hospitalization time, and postoperative complications were compared among the patients in all groups. The normal bladder tissues and pathological tissues of NMIBC patients were stained by immunohistochemistry. Results. No significant difference is identified in age among the three groups (P&gt;0.05), but there are significant differences in the operation duration, postoperative bladder irrigation time, postoperative indwelling catheter time, and postoperative hospital stay (P&gt;0.05). At the same time, compared with BT-ESD group A and BT-ESD group B, the number of postoperative complications in TURBT group is statistically different (P&lt;0.05). Akt has a strong positive expression in the nucleus of patients, which indicates that Akt activated by cellular PI3K will form the PI3K/Akt signaling pathway and reduce the recurrence rate of bladder tumor.

Significant rate of lower urinary tract dysfunction in patients with sacrococcygeal teratomas

Sacrococcygeal teratoma (SCT) is the most commonly occurring presacral tumor and can affect the lower urinary tract by direct mass effect, or as a sequela from surgical resection. Despite the potential impact on urologic function, there is no current standard for urological involvement or follow-up for these patients. The purpose of this study was to evaluate the need for urologic involvement for lower urinary tract dysfunction (LUTD) in patients with SCTs at our institution. We performed a retrospective chart review of patients diagnosed with SCT and managed at our institution between 1990 and 2019. Data collected included: patient demographics, surgical and pathology reports, presence of tethered cord or anorectal malformation, and need for urologic involvement for LUTD. LUTD included acute urinary retention, need for chronic intermittent catheterization, and/or urinary incontinence. Acute urinary retention was defined as requiring catheterization to empty the bladder for a limited time (outside the standard post-operative indwelling catheter time period) and the eventual return to spontaneous voiding. Chronic intermittent catheterization was defined as those with urinary retention that has persisted and required continued catheterization at the time of chart review. Urinary incontinence was defined as urine leakage in children older than 3 years of age. Patients with unavailable records were excluded. Comparison between groups was performed with Mann Whitney and chi-squared tests. Forty-five patients with SCTs were identified. LUTD was identified in 23 patients (51%). The most common reason for LUTD was urinary retention (n=16, 70%): 9 patients had acute retention and 7 had chronic retention (Fig.1). Nine patients (39%) had urinary incontinence: 2 of these patients (4% of all SCT patients) had urinary fistulas (vesicovaginal (n=1) and urethrovaginal (n=1)). Only 5 patients (22%) had LUTD recognized preoperatively. Nine patients had concomitant tethered cord, and 7 of these (78%) had LUTD. Of patients with LUTD, Altman type IV was the most common location (n=10, 43%). There was no significant difference in tumor type between those with and without LUTD. Patients without LUTD had significantly shorter follow-up. Greater than 50% of patients with SCTs have known LUTD. Two of these patients were found to have urinary fistulas requiring urinary diversion. A multidisciplinary team including urology should be involved upfront in the management of patients with SCTs, and LUTD should be routinely assessed at follow-up visits. Evaluation for a urinary fistula should occur in the presence of urinary incontinence.

Characteristics and Drug Resistance of Pathogens in Urinary Tract Infection Patients Complicated with Urinary Calculi

Main objective is to explore the characteristics, drug resistance, and risk factors of pathogens in urinary tract infection patients complicated with urinary calculi. A total of 417 patients with urinary calculi who were treated in our hospital from January 2017 to December 2019 were enrolled in this study, including 234 patients with urinary tract infection and 183 patients without urinary tract infection. The midstream urine of 234 patients with urinary tract infection were cultured and used in the drug sensitivity test. Univariate and multivariate logistic regression analysis was used to analyze the risk factors of postoperative urinary tract infection in patients with urinary calculi. A total of 624 strains of pathogens were isolated from the urine samples of 234 patients with postoperative urinary tract infection, of which 386 strains were gram-negative bacteria (61.86 %), 169 strains were gram-positive bacteria (27.08 %), and 69 strains were fungus (11.06 %). In the drug resistance test, the resistance rates of Staphylococcus aureus to tetracycline, rifampicin, and levofloxacin, and the resistance rate of Enterococcus faecium to levofloxacin was low. Enterococcus faecalis had the lowest resistance rate to levofloxacin, followed by azithromycin and gentamicin. The resistance rates of Staphylococcus epidermidis to levofloxacin and vancomycin were low and the resistance rate to erythromycin was 100.00 %. The resistance rate of Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis to meropenem and amikacin, and the resistance rate of Klebsiella pneumoniae and Proteus mirabilis to etilmicin and ceftriaxone were low. Univariate analysis showed that the postoperative urinary tract infection in patients with urinary calculi was related to the age, operation time, postoperative indwelling catheter time, stone size, and preoperative prophylactic use of antibiotics. Multivariate logistic regression analysis showed that the age (≥65 y old), operation time (≥60 min), postoperative indwelling catheter time (≥7 d), and no preoperative prophylactic use of antibiotics were the risk factors of postoperative urinary tract infection in patients with urinary calculi. Patients with urinary calculi were prone to urinary tract infection after the operation. The main pathogens of infection were gram-negative bacteria and gram-positive bacteria, and they were resistant to some antibiotics. Antibiotics should be treated reasonably according to the risk factors of urinary tract infection and the results of the drug sensitivity tests to avoid further aggravation of bacterial drug resistances.

The comparion of the clinical efficacy between 1470 nm diode laser and transurethral resection of the prostate for treatment of benign prostatic hyperplasia

Objective To investigate the clinical efficacy of 1470 nm diode laser and transurethral resection of the prostate(TURP) for treatment of benign prostatic hyperplasia. Methods A total of 50 patients with benign prostatic hyperplasia were randomly assigned to 1470 nm semiconductor laser vaporization group (n=25)and TURP group (n=25). The preoperative clinical parameters of two groups were not statistically significant. Then operation condition and follow-up were compared between two groups.The clinical effect of two groups was recorded and analyzed. Results The operation time, intraoperative blood loss, postoperative indwelling catheter time and postoperative hospital were statistically significant between two groups(P 0.05). Conclusions Both surgical approaches of 1470 nm diode laser and TURP have good effect for treating BPH, but the 1470 nm diode laser vaporization demonstrates better efficacy with less blood loss, shorter catheter indwelling time.Although the operation time is longer, 1470 nm diode laser vaporization is better and safer than TURP for patients with higher risk of bleeding. Key words: Prostatic Hyperplasia; Transurethral Resection of Prostate; Lasers; Electrosurgery

Clinical application of red laser vaporization resection for benign prostatic hyperplasia

Objectives To investigate the application efficacy of red laser vaporization resection in the treatment of benign prostatic hyperplasia(BPH). Methods 42 BPH patients were treated by red laser vaporization resection from June 2010 and September 2014.The mean operative time, intra–operative bleeding, postoperative complications, international prostate symptom score(IPSS), quality of life(QOL) score, maximum urinaryflow rate(Qmax) and post void residual(PVR) before and after surgery were recorded and analyzed. Results The operation was completed successfully in 42 caces, and there was no complications.The mean operative time was(61.52 ± 18.48)min and mean postoperative indwelling catheter time was(4.57 ± 1.42)d.After 3 months, IPSS score dropped from(27.33±3.95) to(9.05±1.45), QOL scores decreased from(5.17±0.79) to (0.95±0.56), Qmax raised from(6.07±1.97) mL/s to (19.05±1.93) mL/s, PVR decreased from (107.76 ±66.99)mL to (17.05 ± 6.74) mL, and hemoglobin were no different between before surgery and after surgery. Conclusions Red laser vaporization treatment is a safe and effective treatment for BPH. Key words: Prostatic Hyperplasia; Lasers

Photoselective Vaporization with KTP 180-W Green Laser for the Treatment of Lower Urinary Symptoms Secondary to Benign Prostatic Enlargement: Effectiveness and Safety at Midterm Follow-Up

To determine safety, efficacy, and improvement in patient's quality of life (QoL) with 180-W green light laser prostate photovaporization in medium-term follow-up. Observational descriptive analysis. All the patients who were treated with photoselective vaporization with potassium titanyl phosphate crystal 180-W green laser between January 2012 and February 2014 were included. The primary outcome was the change of the International Prostate Symptom Score (IPSS). A descriptive analysis was conducted. Statistic inference was made using nonparametric measurements according to the findings. The Wilcoxon signed-rank test was applied to paired data. Finally, survival curves were used to determine the effectiveness. Two hundred one subjects were included. The mean follow-up was 13.1 months (2-28). Prostate volume was 75.46 ml (30-240). Mean surgical time was 73.29±29.74 minutes, laser time was 44.27±21.03 minutes, and the mean energy used was 271.5±140.1 kJ. Postoperative indwelling catheter time was 15.81±8.87 hours. IPSS decreased 12.79 points, from 19.13±7.79 to 6.34±5.91 (p=0.0001). QoL question of the IPSS shows improvement from 4.16 to 1.27 (p=0.00001). In a maximum follow-up period of 28 months, 85.2% of patients showed an improvement of four points in IPSS. Visual scale of improvement perception showed an increase from 36.49 to 89.84 (p=0.0001). No major complications were reported. Prostate photoselective vaporization with a 180-W green light laser is a safe and effective treatment option for patients with lower urinary symptoms secondary to benign prostate enlargement.

A Modified Nerve-Sparing Panhysterectomy for Benign Uterine Diseases: Techniques and Evaluation of Postoperative Pelvic Dysfunctions

Objective: To describe a modified nerve-sparing panhysterectomy and to investigate the feasibility and impact of this nerve-sparing technique in improving postoperative pelvic visceral dysfunctions of benign uterine disease patients. Methods: From January 2008 to January 2010, a total of 300 patients diagnosed with benign uterine diseases at the Second Affiliated Hospital of Nantong University were enrolled. Of those, 150 randomly selected patients underwent modified panhysterectomy (research group), while the other 150 patients underwent conventional panhysterectomy (control group). The surgery-related parameters, including operation time, intraoperative blood loss, length of hospital stay, postoperative indwelling catheter time, and first voiding and defecation time were compared between the two groups. The extent of nerve damage in both groups was examined using the nerve-specific marker S-100 via immunohistochemistry. Besides, postoperative assessments of bladder and bowel functions were conducted within 1 year after the operation. Results: The surgery-related parameters in the two groups showed no significant difference (p > 0.05). Immunohistochemistry results showed significantly reduced damage of the nerves in the research group. We also found a better bladder and bowel function in the research group (p < 0.05) and in younger patients (p < 0.05) compared with that in the control group. Recovery trends of the bladder and bowel function were found in both groups (χ² = 7.512, p = 0.006 in the research group; χ² = 7.299, p = 0.007 in the control group). Conclusion: Modified panhysterectomy for benign uterine diseases seems feasible and safe, with the main advantage of improving postoperative urocystic and rectal dysfunctions through the preservation of the pelvic autonomic nerves.

Impact of body mass index on radical prostatectomy

Objective To investigate the effect of body mass index (BMI) on laparoscopy and the open radical prostatectomy.Methods A retrospective analysis of 226 cases of radical prostatectomy from 2012 January to 2013 May was performed.106 patients underwent laparoscopic surgery,with aged 66.5±0.7,height (167.7±0.5) cm,weight (66.8±0.9) kg; 120 patients underwent open surgery,with aged (65.8±0.7) year,height (168.1±0.5) cm,weight (66.5±0.8) kg.Non-obese (BMI ＜25 kg/m2) and obese (BMI ≥ 25 kg/m2) were divided in each group.The preoperative serum PSA level,the operation time,the blood loss during operation,the preoperative and postoperative hemoglobin,Gleason score,and the postoperative indwelling catheter time were compared between non-obese group and obese group.In the laparoscopic surgery group including 76 non-obese cases (71.7％) and 30 obese cases (28.3％),no difference showed in PSA values and age before operation between the two sub-groups.In the open surgery group,including 84 non-obese cases (70.0％) and 36 obese cases (30.0％),no statistical difference of preoperative PSA values and age showed in the two sub-groups.Results In the laparoscopic group,the operation time is (nonobese 169.4±37.8 min and obese 188.5±42.3 min),and the blood Hb decrease(non-obese-22.8± 11.0g/L,obese-30.9±15.9 g/L) and the blood loss(non-obese 115.9±68.9 ml,obese 178.3±126.4 ml)showed significant difference in the two sub-groups (P＜0.05).The two sub-groups showed no statisticaldifference in postoperative indwelling catheter time and Gleason score (P＞0.05).In the open surgery group,the intraoperative hemorrhage (non-obese 413.7±289.4 ml,obese 594.4-±534.9 ml) and the hemoglobin decrease (non-obese-27.2± 13.3 g/L,obese-34.9± 15.8 g/L) showed significant difference (P＜0.05).The two sub-groups showed no significant difference in the preoperative hemoglobin,postoperative indwelling catheter time,Gleason score and operation time (P＞0.05).Conclusions For the patients who underwent prostatectomy,no matter by laparoscopic or open surgery,the blood loss was greater in obese subgroup than non-obese subgroup,and the operation time was much longer in obese group than non-obese group. Key words: Body mass index; Prostatectomy; Obesity; Laparoscopy; Radical prostatectomy

Duration of postoperative catheterization: A randomized, doubleblind trial comparing two catheter management protocols and the effect of bethanechol chloride

A randomized trial of two postoperative suprapubic catheter clamping protocols was undertaken to compare their effect on the duration of both postoperative indwelling catheter time and hospital stay. In addition, patients were given either bethanechol chloride or placebo in a double-blind fashion to test the proposal that the use of bethanechol chloride would enhance return of bladder function and shorten postoperative catheter time. Forty-nine patients who underwent an anterior repair, Burch colposuspension or Marshall-Marchetti-Krantz (MMK) procedure were preoperatively randomized to one of two catheter clamping protocols. Protocol I involved a continuous clamping regimen with residuals measured with each void. Protocol II involved an intermittent clamping (‘bladder training’) regimen with residuals measured at specified intervals while the catheter was in place. Each patient received either bethanechol chloride or placebo in identical capsules. Protocol I significantly shortened the duration of postoperative catheterization (P<0.01). The use of bethanechol chloride prolonged the duration of catheterization in Protocol I patients and made no difference in Protocol II patients. We would recommend our simplified catheter protocol and the avoidance of bethanechol chloride in the management of indwelling catheters after surgery for urinary incontinence.