Bladder Catheter Removal Research Articles

How long is a transurethral catheter necessary in patients undergoing thoracotomy and receiving thoracic epidural analgesia? Literature review.

DESPITE THE AGING POPULATION and new lung cancer cases being on the rise, clinicians are forced to be more efficient and more productive without additional resources. Fast-track pathways have been described showing outstanding results, such as a faster recovery process and shorter length of hospital stay, but mainly for abdominal 1 Gravante G. Elmussareh M. Enhanced recovery for colorectal surgery: Practical hints, results and future challenges. World J Gastrointest Surg. 2012; 4: 190-198 Crossref PubMed Google Scholar , 2 Carli F. Charlebois P. Baldini G. et al. An integrated multidisciplinary approach to implementation of a fast-track program for laparoscopic colorectal surgery. Can J Anaesth. 2009; 56: 837-842 Crossref PubMed Scopus (71) Google Scholar and orthopedic 3 Kehlet H. Thienpont E. Fast-track knee arthroplasty—Status and future challenges. Knee. 2013; 20: S29-S33 Abstract Full Text PDF PubMed Scopus (93) Google Scholar surgeries. Although enhanced recovery paths might seem to be an excellent option to solve this problem, there is a scarcity of trials in thoracic surgery in general on this subject. 4 Jones N.L. Edmonds L. Ghosh S. et al. A review of enhanced recovery for thoracic anaesthesia and surgery. Anaesthesia. 2013; 68: 179-189 Crossref PubMed Scopus (72) Google Scholar Therefore, it is essential to implement recovery pathway programs for patients undergoing thoracic surgery. Thoracic epidural analgesia (TEA) is the gold standard to relieve pain after thoracotomy because of its association with severe pain. 5 Ochroch E.A. Gottschalk A. Augosutides J. et al. Long-term pain and activity during recovery from major thoracotomy using thoracic epidural analgesia. Anesthesiology. 2002; 97: 1234-1244 Crossref PubMed Scopus (150) Google Scholar Thus, a crucial point to implement a fast-track pathway in thoracic surgery is to offer TEA. It reduces significantly the incidence of postoperative morbidity compared with other types of analgesia. 6 Ng A. Swanevelder J. Pain relief after thoracotomy: Is epidural analgesia the optimal technique?. Br J Anaesth. 2007; 98: 159-162 Crossref PubMed Scopus (40) Google Scholar In contrast, TEA encompasses important side effects. Postoperative urinary retention (POUR) is one of the most frequent, with an average incidence of 26%. 7 Baldini G. Bagry H. Aprikian A. et al. Postoperative urinary retention: anesthetic and perioperative considerations. Anesthesiology. 2009; 110: 1139-1157 Crossref PubMed Scopus (404) Google Scholar To avoid this complication, it is a common practice to place a transurethral catheter, as long as the epidural is in situ and functioning well. 8 Zaouter C. Kaneva P. Carli F. Less urinary tract infection by earlier removal of bladder catheter in surgical patients receiving thoracic epidural analgesia. Reg Anesth Pain Med. 2009; 34: 542-548 Crossref PubMed Scopus (111) Google Scholar , 9 Ladak S.S. Katznelson R. Muscat M. et al. Incidence of urinary retention in patients with thoracic patient-controlled epidural analgesia (TPCEA) undergoing thoracotomy. Pain Manag Nurs. 2009; 10: 94-98 Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Nevertheless, a urinary bladder catheter impedes early ambulation and can lead to urinary tract infection (UTI), which increases patients’ hospital length of stay and governmental costs.

How Frequently Do Symptomatic Urinary-Tract Infections Actually Occur After Gynecologic Oncology Surgery?

Abstract Objective: The goal of this research was to evaluate the incidence and risk factors of postoperative symptomatic bladder infection in patients undergoing gynecologic oncology surgery. Symptomatic urinary-tract infections (UTIs) following insertion of indwelling bladder catheters is a common postoperative complication. The reported incidence varies from 1.3% 6.5% and even rises up to 42% when asymptomatic bacteriuria is included. Design: This was a retrospective and prospective cohort study. Materials and Methods: The current authors investigated 152 consecutive patients who underwent major surgery (grade 3 and 4) while under gynecologic oncology care. Demographic and clinical data on patient comorbidities, timing of insertion and removal of bladder catheters, intravenous antibiotic prophylaxis, and urinary symptoms and cultures were collected and evaluated statistically. Results: An incidence of 2% symptomatic UTIs postoperatively was identified. In 66% of cases Escherichia coli was the causative...

Clinical Pathway After Robotic Nephroureterectomy: Omission of Pelvic Drain With Next-day Catheter Removal and Discharge

To determine the feasibility of applying a postoperative clinical pathway after robotic nephroureterectomy (RNU) targeting safe omission of a pelvic drain and removal of the bladder catheter on the day after surgery with hospital discharge on postoperative day 1 (POD#1). We reviewed a prospectively collected database of all RNUs performed by a single surgeon (R.A.) since institution of our clinical pathway in 2008 that includes pelvic drain omission, bladder catheter removal the morning after surgery, and discharge on POD#1. Patient demographics, and perioperative and postoperative outcomes were evaluated. Ability to adhere to the pathway and achieving the described parameters and whether any resulting complications occurred were determined. RNU was performed in 29 patients with mean age and body mass index of 69 years (50-90 years) and 30 kg/m(2) (19-41 kg/m(2)), respectively. No patient required a pelvic drain, and 2 were discharged with a catheter. All but 2 patients (93%) were discharged on POD#1. Overall, successful pathway application was achieved in 26 of 29 patients (90%) including no drain, catheter removal on the morning after surgery, and discharge on POD#1. No patient developed urine leak or other complications related to early catheter removal. Our clinical pathway after RNU allows safe omission of a pelvic drain with early discontinuation of the bladder catheter and discharge on the POD#1 in most patients. To our knowledge, similar pathways have not been previously achieved with nephroureterectomy by any approach, but should be considered by surgeons treating urothelial carcinoma of the upper urinary tract.

Impact of a Nurse-Run Clinic on Prevalence of Urinary Incontinence and Everyday Life in Men Undergoing Radical Prostatectomy

To determine the prevalence of urinary incontinence (UI) in patients undergoing prostatectomy and to evaluate the impact of UI on the everyday life in order to select the patients eligible to enter a pelvic floor rehabilitation program. The sample comprised 114 consecutive men undergoing laparoscopic or open radical prostatectomy between April 2007 and April 2008. Participants' mean age was 59 years (range, 46-67 years). The research setting was a hospital-based clinic in Barcelona, Spain. Patients who required an indwelling urinary catheter due to other factors were excluded from the trial. During admission, nursing staff explained the study and obtained informed consent from patients willing to participate in the trial. The impact of UI on daily living was evaluated via administration of the International Consultation on Incontinence Questionnaire-Short Form. Impact of UI was evaluated before surgery, and after 1 and 12 months following indwelling catheter removal. A total of 95.5% patients developed UI 1 month following bladder catheter removal. Slightly less than 1 in 4 patients (24.8%) indicated that UI had no effect on activities of daily living. In contrast, 27.5% indicated that UI had a moderate impact and 47.7% indicated a severe impact. Ninety-one patients reported performing pelvic floor muscle exercises to improve UI, but only 45% were found to be performing them correctly. When evaluated at 1 year following catheter removal, 52.64% of the patients continued to experience UI. The majority (79.8%) indicated that UI did not impact their daily lives, 8.8% indicated a moderate impact, and 20.4% reported that UI had a severe impact on daily life. Seventy patients (61.4%) continued to perform pelvic floor muscle exercises; after 1 year, 93% were deemed to be correctly identifying, contracting, and relaxing their pelvic floor muscles. Urinary incontinence remains prevalent as long as 12 months following catheter removal. Incontinence exerts a moderate to severe impact on daily life in 27.5% to 20.4% of respondents. In order to minimize the negative impact as much as possible, we advocate a pelvic floor muscle training program overseen by RNs.

Retrograde ejaculation after anterior lumbar interbody fusion with and without bone morphogenetic protein-2 augmentation: a 10-year cohort controlled study

Retrograde ejaculation (RE) is a complication of anterior lumbar interbody fusion (ALIF) techniques. Most commonly, this results from mechanical or inflammatory injury to the superior hypogastric plexus near the aortic bifurcation. Bone morphogenetic protein-2 (BMP-2) has been used in spinal fusions and has been associated with inflammatory and neuroinflammatory adverse reactions, which may contribute to RE development after anterior lumbar surgery. While controlling for anterior approach technique, we compared the incidence of RE with and without rhBMP-2 exposure, in large, matched cohorts of patients after ALIF. Retrospective analysis of 10 years of prospectively gathered outcomes data on consecutive-patient cohorts having the same anterior exposure technique for ALIF with and without rhBMP-2 use. All male patients without baseline sexual incapacity and having ALIF for lumbar spondylosis or spondylolisthesis of the lowest one or two lumbar levels with and without rhBMP-2, from 2002 through2011. Diagnosis of RE as a new finding after ALIF compared against BMP-2 exposure, comorbid conditions, and other urological complications after ALIF surgery. From the comprehensive surgical database at a high volume, university practice, male subjects having ALIF at one (L5/S1) or two levels (L4/5, L5/S1) from 2002 to 2011 were identified. Baseline comorbid factors, postoperative urinary catheter/retention events, and RE events were recorded and comparative incidence compared. There were four consecutive-patient cohorts identified: one before rhBMP-2 use was adopted (n=174), two cohorts in which BMP-2 use was routine (n=88 and n=151), and one final cohort after BMP-2 use was discontinued from routine use (n=59). The cohorts with and without BMP-2 exposure were closely comparable for age, approach, levels of surgery, comorbid factors affecting RE. Of 239 patients with ALIF and exposure to BMP-2, RE was diagnosed in 15 subjects (6.3%), compared with an RE diagnosis rate of two of 233 control patients without BMP-2 exposure (0.9%; p=.0012). Urinary retention after bladder catheter removal was also more frequently observed in patients exposed to BMP-2 (9.7%) compared with control patients (4.6%; p=.043). Of the baseline comorbid factors, medical or surgical treatment for prostatic hypertrophy disease was associated with an increased risk of RE in the BMP-2 patients (p=.034). This study confirms previous reports of a higher rate of RE in ALIF procedures using rhBMP-2 and an open anterior approach to the spine. This effect may be associated with an increased risk of postoperative urinary retention after BMP-2 exposure. The magnitude of the RE effect may be increased with concomitant prostatic disease treatments.

Nursing Care Program for Erectile Dysfunction After Radical Prostatectomy

The prevalence of erectile dysfunction (ED) in 114 patients with prostate cancer treated with radical prostatectomy was examined to determine the efficacy of an ED care program in which nurse-provided education plays a fundamental role in the detection and follow-up of ED as well as in treatment compliance. The nursing program consists of four visits during which specific treatment-related information, education and support, active listening, and selection of the treatment best suited to each patient (in consultation with the healthcare team) are provided. One month following bladder catheter removal, 77 of the 114 patients (69%) in the study had ED, with a majority suffering from severe ED. A nursing care program could help minimize ED and enable patients to adapt to their new situation.

Fast-track colorectal surgery: protocol adherence influences postoperative outcomes

This single-center prospective cohort study, conducted outside of a clinical trial, tried to identify the importance of each fast-track surgery procedure and protocol adherence level on clinical outcomes after colorectal surgery. From a prospectively maintained database, 606 patients who underwent elective laparoscopic or open colorectal resection within a well established fast-track surgery (FT) protocol, between 2005 and 2011, were identified. Univariate and multivariate analysis were performed to assess the relationship between each FT procedure with an adherence rate <100% and the outcome variables (length of stay-LOS, 30-day morbidity and readmission rate). Patients were divided into four adherence level groups to FT procedures-100%, 85-95%,70-80%, and <65%. Each adherence group was compared with the other groups to evaluate differences in clinical outcome variables. Group comparisons revealed that higher levels of FT protocol adherence corresponded to significantly improved LOS and morbidity rates. Readmission rates were only significantly different between the full fast-track pathway and the less implemented groups. Multivariate analyses revealed that the fast removal of bladder catheter positively influenced length of stay (p < 0.0001) and 30-day morbidity (p < 0.0001). Laparoscopy surgery, no drain positioning and enforced mobilization improved LOS (p = 0.027, p < 0.0001, p = 0.002, respectively). Early solid feeding improved LOS (p < 0.0001), morbidity (p < 0.0001) and readmission rate (p = 0.011). Postoperative outcomes after colorectal surgery are directly proportional to FT protocol adherence. The early removal of the bladder catheter and early postoperative solid feeding independently influenced the length of hospital stay and 30-day morbidity rates.

V371 INTRAOPERATIVE URODYNAMIC CONSIDERATIONS IN BULBOURETHRAL SLING SURGERY FOR POST PROSTATECTOMY INCONTINENCE

You have accessJournal of UrologyMale Voiding Dysfunction (BPH & Incontinence), Oncology & Prostate Cancer1 Apr 2011V371 INTRAOPERATIVE URODYNAMIC CONSIDERATIONS IN BULBOURETHRAL SLING SURGERY FOR POST PROSTATECTOMY INCONTINENCE Marcus Horstmann, Christian Padevit, Christoph Schwab, Christian Vollmer, Isabelle Rauter, Kevin Horton, and Hubert John Marcus HorstmannMarcus Horstmann Winterthur, Switzerland More articles by this author , Christian PadevitChristian Padevit Winterthur, Switzerland More articles by this author , Christoph SchwabChristoph Schwab Winterthur, Switzerland More articles by this author , Christian VollmerChristian Vollmer Winterthur, Switzerland More articles by this author , Isabelle RauterIsabelle Rauter Winterthur, Switzerland More articles by this author , Kevin HortonKevin Horton Winterthur, Switzerland More articles by this author , and Hubert JohnHubert John Winterthur, Switzerland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.458AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Incontinence after prostatectomy remains a frustrating problem with a significant negative impact on quality of life. One possible option for moderate to severe incontinence is the implantation of a retropubic implant system, the bulbourethral suspension (J. Urology 171: 1866-70, 2004 and UROLOGY 71: 1191-5, 2008). This video demonstrates the improved technique with focus on intraoperative urodynamic measurements for optimal sling tension adjustment. METHODS The patient is first placed in a modified lithotomy position. A vertical perineal midline incision is performed to expose the bulbar urethra in a lithotomy position. The implant is positioned around the bulbar urethra and both ends of the sling are brought up strictly retropubically, lateral to the bladder neck to suprapubic skin incisions through two curved hollow needles. Bladder perforation is further excluded by 70° cystoscopy. Under general anaesthesia without relaxation sling tension is stepwise increased until an antegrade opening pressure of 60–65 cmH20 is reached. These measurements are repeated at least three times. Once a stable antegrade urethral opening pressure measurement is reached the polypropylene ends are tied off. Finally urethral pressure profile is repeatedly measured before and after sling implantation for further evaluation. The perineal and suprapubic incision lines are closed by interrupted sutures. A Foley bladder catheter is placed for 3 days. Antibiotics are stopped after bladder catheter removal. RESULTS With the use of intraoperative urodynamics the antegrade opening pressure was successfully increased to 65 cmH20. The urethral pressure profile revealed an increased functional length without an increase of the maximal urethral pressure. CONCLUSIONS The use of intraoperative urodynamics allows us to precisely determine the antegrade opening pressure and consequently reach urinary continence in most patients. Postoperative manipulations to adjust the sling tension can be avoided. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e151 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marcus Horstmann Winterthur, Switzerland More articles by this author Christian Padevit Winterthur, Switzerland More articles by this author Christoph Schwab Winterthur, Switzerland More articles by this author Christian Vollmer Winterthur, Switzerland More articles by this author Isabelle Rauter Winterthur, Switzerland More articles by this author Kevin Horton Winterthur, Switzerland More articles by this author Hubert John Winterthur, Switzerland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Optimal Duration of Urinary Catheterization After Thoracotomy in Patients Under Postoperative Patient-controlled Epidural Analgesia

Epidural analgesia is widely used for efficient pain relief after major surgery. However, it may cause urinary retention, leading to delayed removal of bladder catheters with prolonged patient discomfort. Using a specific regimen in patient controlled epidural analgesia (PCEA), we examined the optimal duration of urinary catheterization in patients undergoing major thoracic surgery. Seventy-eight patients scheduled for elective thoracotomy were prospectively randomized into two groups: Group 1, removal of the transurethral catheter on the first postoperative day (n = 38); Group 2, removal of the catheter after discontinuation of PCEA (n = 40). The PCEA regimen was a mixture containing low-dose morphine, bupivacaine and neostigmine and was given for 3 days after surgery in all subjects. Micturition problems, pain scores assessed by the visual analog scale (VAS), and side effects were evaluated during and after PCEA treatment. The average duration of urinary drainage after surgery was 30.2 + or - 5.1 hours and 78.5 + or - 7.3 hours in Groups 1 and 2, respectively. After removal of the bladder catheter, no patient in either group required re-catheterization for urinary retention or encountered catheter-related infection. VAS scores were significantly lower in Group 1 at rest and at 24, 36 and 48 hours after cessation of PCEA. VAS scores were significantly higher in Group 2 patients, possibly due to catheter-induced pain related to prolonged catheterization. Routine continuous bladder catheterization may not necessarily be required after thoracotomy in patients with ongoing continuous thoracic epidural analgesia.

Less Urinary Tract Infection by Earlier Removal of Bladder Catheter in Surgical Patients Receiving Thoracic Epidural Analgesia

It is common practice to catheterize the bladder in the presence of epidural analgesia and to leave the bladder catheter in situ to avoid postoperative urinary retention. However, bladder catheterization carries the risk for urinary tract infection (UTI). The objective of this randomized control trial was to assess whether the incidence of UTI will differ among patients receiving standard care and patients who have the bladder catheterization discontinued on the morning after surgery with the epidural still functioning. Patients at low risk for postoperative urinary retention, scheduled for thoracic and abdominal surgery and receiving continuous thoracic epidural analgesia, were randomized on the morning after surgery to 2 groups: in the early removal group (n = 105), the bladder catheter was removed on the same morning after surgery, whereas in the standard group (SG) (n = 110), the bladder catheter was removed when epidural analgesia was discontinued (3-5 days). Urinary bladder volume was assessed by ultrasound. Primary and secondary outcomes were the incidence of UTI and rate of recatheterization. Two hundred fifteen patients were randomized. There were 17 UTI cases in total, with 15 (14%) in the SG and 2 (2%) in the early removal group (P = 0.004). The incidence of recatheterizations was not different between the 2 groups (P = 0.09) and did not correlate with the site of epidural insertion. When matched for the types of surgery, the duration of hospital stay was longer in the patients who contracted UTI (P = 0.004). There were more patients older than 65 years in the SG. Leaving the bladder catheter as long as the epidural analgesia is maintained results in a higher incidence of UTI and prolonged hospital stay. Removal of the bladder catheter on the morning after surgery does not lead to higher rate of catheterizations.

Living donor renal transplant recipients tolerate early removal of bladder catheters

Recipients of living donor renal grafts enjoy numerous benefits compared with deceased donor kidney recipients. Bladder catheterization allows for the continuous determination of urinary output and, theoretically, may prevent urinary leaks. A series of 25 consecutive renal transplants was reviewed to evaluate the timing of removal of bladder catheters after transplantation. Removing urinary catheters as early as 24 h to 48 h post-transplant showed no increase in undesirable outcomes. More than 50% of the patients had invasive bladder catheters in place for only one or two days. Early removal was associated with a lower rate of urinary tract infections, decreased length of hospitalization and possibly less discomfort, in the absence of detrimental effects.

Cadaveric renal transplant recipients can safely tolerate removal of bladder catheters within 48 h of transplant

The ideal time to remove urinary catheters after renal transplantation has not been thoroughly established. It remains unclear whether the anastomosis is actually protected with prolonged bladder catheterization. In addition, the incidence of urinary tract infections may increase with prolonged catheterization. A series of 57 consecutive deceased donor renal transplants was retrospectively reviewed for outcomes associated with duration of bladder catheterization. Removing urinary catheters within 48 h post-transplant showed no increase in undesirable outcomes, and very likely improved patient satisfaction.

Retrograde Placement of Ureteral Stent and Ureteropelvic Anastomosis with Two Running Sutures in Transperitoneal Laparoscopic Pyeloplasty: Tips of Success in Our Learning Curve

We report our experience of transperitoneal laparoscopic dismembered pyeloplasties describing our step-by-step surgical technique, and we retrospectively analyze the impact on operative times of technical modifications that were introduced during the learning curve. From November 2002 to May 2008, 84 consecutive patients with ureteropelvic junction (UPJ) obstruction were selected for laparoscopic pyeloplasty (LP). The main steps of the surgical procedure are described. In the initial 14 patients who underwent LP, we performed intraoperative antegrade stenting, and we configured the ureteropelvic anastomosis with interrupted sutures; in the 25 following patients, anastomosis was performed with running sutures. In the latest 45 patients, the ureteral stent was positioned retrograde, and ureteropelvic anastomosis was performed with two running sutures. We evaluated the impact of technical modifications on the operative times, dividing patients into three groups (group A, first 14 patients; group B, following 25 patients; and group C, last 45 patients). Median operative times of each group were compared with the Student t test. No major complications occurred, while postoperative urinary leakage was seen in three patients at bladder catheter removal (two in group A and one in group B). Mean operative blood loss was 70 mL, and mean hospital stay was 1.6 days. Median operative time was 115 min (range 110-125 min) for group A, 100 min (range 95-115 min) for group B, and 85 min (range 65-95 min) for group C; differences between operative times of groups A and B and between groups B and C were statistically significant (both P < 0.001). At a median follow-up of 38 months, recurrent symptoms developed in three patients. Overall, the success rate of the procedure was 96.5%. In a retrospective analysis of our series, the retrograde placement of the ureteral stent and the ureteropelvic anastomosis with two running sutures seemed to be tips of success in reducing operative times.

Laparoscopic Approach for Artificial Urinary Sphincter Implantation in Women with Intrinsic Sphincter Deficiency Incontinence: A Single-Centre Preliminary Experience

BackgroundImplantation of an artificial urinary sphincter (AUS) is used as a last resort in women with stress urinary incontinence (SUI). ObjectiveTo assess the early functional outcome after laparoscopic placement of an AUS in women. Design, setting, and participantsTwelve women with type 3 SUI underwent a laparoscopic AUS placement between 2006 and 2008. Eleven (92%) had previously undergone anti-incontinence procedures. InterventionThe AUS was implanted with laparoscopic access either preperitoneally or intraperitoneally. The cuff was placed around the bladder neck between the periurethral fascia and the vagina. MeasurementsPerioperative complications were reviewed. To assess resolution of urinary incontinence, all patients were seen at 1, 3, 6, and 12 mo after the surgery and yearly thereafter. Results and limitationsThe mean age of subjects was 56.7±12 yr (33–78). The mean body mass index was 24±2.3 (20–25). The mean preoperative closure pressure was 22±10.9cmH2O (4–35). The mean operative time was 181±39min [110–240]. Intraoperative complications occurred in three women (25%), with bladder (n=2) and vaginal (n=2) injuries. These complications required open conversion. AUS implantation was postponed in one case. The mean hospital stay was 7±2.3 d (3–11). The bladder catheter was removed after a mean time of 10±8 d (2–30). Urinary retention was observed in five cases (45%) after bladder catheter removal. AUS activation was done 4–14 wk after implantation. Mean follow-up was 12.1±8 mo (5.2–27). Incontinence was completely resolved in eight women (88%) who underwent complete laparoscopic procedure. The main limitation of the study was the limited length of follow-up. ConclusionsAUS implantation can be successfully achieved by laparoscopy. It appears to be technically feasible. These results are still preliminary, and further studies of larger populations with longer follow-up are needed to make any statement regarding surgical strategy.

Résultats carcinologiques et fonctionnels de la prostatectomie totale laparoscopique robot-assistée

The current gold standard treatment for localized prostate cancer remains open radical prostatectomy. From 1992, several teams have tried to explore less invasive surgical access. The first robotically assisted laparoscopic prostatectomy (RALP) case was reported in 2000. Enhancement of the ergonomics and optimization of the surgical vision provided by the robotic interface, are some reasons that explain the worldwide widespread of RALP. Although this procedure accounted for the vast majority of radical prostatectomies performed in United States, its diffusion is still limited in Europe. The cost for robot purchase and maintenance are obvious limiting factors for its expansion. According to the literature, the operating time and the blood loss are, once the learning curve is completed, similar to those of open or laparoscopic procedures. Hospital stay and time before bladder catheter removal are shorter compared to other approaches. Intermediate oncological and functional outcomes do not show difference with the open or laparoscopic results. Given that these data are encouraging, the limited follow-up with RALP do not allow to draw any definitive statement in comparison with conventional techniques.

A Prospective, Randomized, Controlled Trial Comparing 3 Hour and 24 Hour Postoperative Removal of Bladder Catheter and Vaginal Pack Following Vaginal Prolapse Surgery

Use of an indwelling urinary catheter and vaginal pack is standard management after surgery for vaginal prolapse, but the catheter may cause urethral pain, detrusor overactivity, or urinary tract infection. There presently is no consensus about how long the pack and catheter should remain in place. This prospective, randomized study compared the clinical course in 66 women having surgery for vaginal prolapse in whom the vaginal pack and catheter were removed 3 hours postoperatively (group 1) and in 68 others whose pack and catheter were removed the following morning (group 2). Patients in both groups were discharged the day after surgery when they were able to void spontaneously. Similar types of surgery were carried out in the 2 groups. Urine cultures were done preoperatively, the day after surgery, and at 2 weeks. Only 2 patients, both in group 2, had hemorrhage that exceeded menstrual bleeding. No tendency was noted toward more bleeding after early removal of the vaginal pack and urinary catheter. No patient in either group was reoperated on within 48 hours, and only 1 after a longer interval. Four women, 3 in group 1 and 1 in group 2, required sterile intermittent catheterization postoperatively, 2 of them on only 1 occasion. No patient in either group was readmitted with urinary retention. Group 2 patients tended to have higher postoperative bacterial counts, but the group difference in frequency of bacteriuria 2 weeks postoperatively was not statistically significant. The researchers recommend that, following surgery for vaginal prolapse, the vaginal pack and urinary catheter be removed after 3 hours and that voiding be closely monitored. Time in hospital may be reduced as a result.

A prospective, randomised, controlled trial comparing 3 hour and 24 hour postoperative removal of bladder catheter and vaginal pack following vaginal prolapse surgery

The aim of this prospective, randomised, study was to determine whether or not there was a higher incidence of bleeding, reoperation, urinary retention or bacterial count in the urine, depending on whether urinary catheter and vaginal pack was removed 3 h or 24 h after vaginal prolapse surgery. Some 136 women were randomised into Group 1 (removal of catheter and vaginal pack after 3 h), and Group 2 (removal of catheter and vaginal pack after 24 h). Data on postoperative bleeding, reoperation, and urinary retention were collected. Preoperatively, day after operation, and 14 days after operation, a urine culture was performed. There was no tendency towards more bleeding with early removal of vaginal pack and urinary catheter. No patients in either group were reoperated during the first 48 postoperative hours. Three patients in Group 1 required sterile intermittent catheterisation postoperatively, however, only once in 2 patients. There was a trend towards a higher postoperative bacterial count in patients in Group 2 (p=0.306). We recommend removing the vaginal pack and urinary catheter after 3 h with careful monitoring of the patient's voiding.

Réhabilitation après chirurgie viscérale

A combined strategy of anesthetic and surgical care defines postoperative rehabilitation, which aims to accelerate recovery from surgery, shorten convalescence, and reduce postoperative morbidity. Preoperative and early postoperative oral feeding, a relatively "dry" fluid regimen, and the avoidance of or early removal of drains, gastric tubes and bladder catheters all contribute to decreasing postoperative morbidity after abdominal surgery. Postoperative pain control, prevention of nausea and vomiting, shortening the duration of postoperative ileus, and early ambulation can also help to decrease postoperative morbidity. The use of multimodal fast-track clinical rehabilitation programs should improve outcomes and quality of life, reduce hospital stays, and save money.

Estudio bacteriológico de la orina previa a la cirugía urológica endoscópica

ObjectiveThe objectives of this study are to know the incidence of preoperative bacteriuria in patients undergoing endoscopic urologic surgery, to analyze the most frequent microorganisms appearing in the cultures and their resistance to antibiotics in order to select the most appropriate prophylactic one for our population, and to determine the risk factors related to postoperative bacteriuria or sepsis of urologic origin Material and Methods449 patients undergoing endoscopic urologic surgery were included in the study. Urinary samples were collected for culture prior to prophylactic antibiotic administration and again a week after bladder catheter removal once the antibiotic treatment was finished. Variables related to an increase in infectious complications were analyzed. Special attention was paid to postoperatory incidences, mainly those of infectious nature ResultsPreoperative bacteriuria was found in 66 out of 428 patients (15.4%). It was found to be related to age, sex, previous infection episodes, diabetes mellitus, indwelling catheter and to the pathology for which operation was indicated. The most frequently found microorganism was Escherichia Coli. Resistance to prophylactic antibiotic was found in 37.9% of patients with preoperatory bacteriuria. Postoperatory bacteriuria, observed in 22.0% of the patients was exclusively related to preoperatory bacteriuria. 2.9% of patients showed sepsis of urinary origin criteria during hospital staying, and it was found to be exclusively related to length of surgery and neither to preoperatory bacteriuria nor to indwelling catheter time or the “inappropriate” prophylactic antibiotic use in these cases ConclusionsA good part of patients who underwent endoscopic surgery showed preoperatory bacteriuria, responsible for postoperative bacteriuria in less than 25% of the cases. The length of surgery seemed to be the only related cause whit sepsis of urinary origin

Minilaparotomy for type II and III radical hysterectomy: technique, feasibility, and complications

The objective was to assess the feasibility, the operative and postoperative outcome, and complications in the use of minilaparotomy for type II and III radical hysterectomy (RH) and pelvic lymphadenectomy (PLN) in early-stage cervical/endometrial cancer. A pilot study on 91 consecutive patients submitted to type II and III RH and PLN for early-stage cervical/endometrial cancer was performed between March 2002 and May 2003 in the Division of Gynecologic Oncology (UCSC, Rome). Thirty-two of 91 cases (35.2%) were eligible for minilaparotomy. The mean operative time was 156.7 min, whereas the mean intraoperative estimate of blood loss was 303.7 ml. A mean number of 32.7 pelvic lymph nodes and 6.2 common iliac nodes were removed. Ileus and removal of bladder catheter were on mean postoperative day 2.4 and 3.4, respectively. The mean number of postoperative days spent in the hospital was 3.7. Intra- and postoperative parameters were compared to laparotomy controls and literature data on laparoscopy and Pfannenstiel incision, showing substantially comparable results. Minilaparotomy is acceptable for selected patients undergoing radical abdominal hysterectomy (RAH) and PLN and does not compromise the adequacy of the procedure. It can be considered as an alternative to the classic midline vertical incision or even to the Pfannenstiel incisions and laparoscopy.