Cystostomy Research Articles

Burden of Prolonged Urinary Catheter Use after Urinary Retention in a Tertiary Hospital, South-South Nigeria

Background: Urinary retention is a worldwide health problem mostly noted in elderly men who may have benign prostatic hyperplasia (BPH), cancer of the prostate (Cap), urethral stricture disease or bladder tumour. It has a negative impact on the quality of life (QOL) of the sufferer as well as national or global economy. Urethral catheterization is used to relief the retention and suprapubic cystostomy where the urethral route fails or it’s contraindicated. Complications have been reported especially when catheters are worn for prolonged periods of time. The aim of this work was to study the burden of prolonged use of catheters after urinary retention. Patients and Method: The study was conducted in March 2021 and lasted for four (4) weeks to prevent data duplication since our patients change their catheters once in 4 weeks. A questionnaire was designed and completed by all patients after informed consent was obtained. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 and results used for discussion. Results: Eighty two (82) patients with a mean age of 63.12±14.67 years were studied. Aetiology of urinary retention was BPH, Cap, and Urethral stricture in 58.5%, 19.5% and 23.0% respectively. More patients were in their 7th and 8th decades of life. Most patients had indwelling urethral catheter (65.9%), average duration of catheter use was 21.26 months. There was no statistical significant difference in the mean duration between those who used SPC and Urethral catheter (P= .411).Ninety-eight (98.7%) of patients had complications and 22% of them reported more than five (5) complications. Qol correlated poorly with those who had sexual issues due to prolonged catheter use. The estimated annual cost for catheter change was between N1.5million and N2.0 million in our facility. Conclusion: Prolonged catheter use is a source of concern to patients and poses serious health-related and financial burden to them.

Large, infected Cowper’s syringoceles: a rare cause of perineal sepsis in adult men

Urologists and general surgeons alike are familiar with assessing acute perineal pathology. A Cowper's gland syringocele is a rare cystic dilatation of the male bulbourethral gland, typically seen in children. We report the diagnosis and emergency management of two adult cases of large, infected Cowper's gland syringoceles. A comorbid 76-year old was diagnosed with sepsis and penile swelling, but there was no discrete superficial pathology. Magnetic resonance imaging (MRI) revealed a perineal collection communicating with the membranous urethra. A suprapubic catheter was inserted, and aspiration was attempted. Meanwhile, a 55-year-old diabetic presented with severe perineal pain. MRI revealed a deep perineal collection, involving the scrotum and proximal penis. He improved with antibiotics and aspiration of the collection. This rare diagnosis may be more common in older men than previously thought. Pelvic MRI is a key diagnostic tool. A minimally invasive approach is possible in those with considerable perioperative risk.

Efficacy and Safety of Percutaneous Cystolithalopexy in Children Under 5 Years of Age

Objectives: To assess the efficacy and safety of percutaneous cystolithalopexy in children under 5 years of age Study design: Retrospective study Place: Department of Paediatric Urology Institute of Kidney Diseases Hayat Abad Peshawar Methodology: Retrospective descriptive study was conducted in Institute of kidney diseases Peshawar between Jan 2020 and January 2022. After applying the inclusion and exclusion criteria all patients in the mentioned period were include in his study. Results were inferred as frequency and percentages. Results: Without observing any difference for age and gender 100% clearance was achieved in all patients with the most prominent complication being supra pubic catheter leakage which was treated conservatively. Conclusions: Percutaneous cystolithalopexy is safe and efficient for the management of bladder stone under 5 years Keywords: Bladder Calculi, Percutaneous Cystolithalopexy, Urolithiasis, Lithiasis

Pedicled dorsal penile skin tube as neourethra in total penectomy for primary male urethral carcinoma

Background: The aim of this article is to present our experience of pedicled dorsal penile skin tube as neourethra after radical penectomy due to invasive primary male carcinoma of anterior urethra. Methods: This is an observational descriptive study including seven men with primary urethral carcinoma who underwent radical penectomy between 2018 and 2021. Instead of urinary derivation with suprapubic catheter, perineal urethrostomy, or bladder orthotopic/heterotopic reconstruction, patients underwent reconstruction of the anterior urethra with a pedicled dorsal penile skin tube. In brief, before corpora amputation and radical urethrectomy, the dorsal penile skin is preserved to reconstruct the neourethra. The distal end of the skin is anastomosed with the proximal urethral stump (usually membranous urethra) to assure continuity of the urinary tract, without jeopardising urinary continence. Finally, the flap is tubularized with two layers of watertight running sutures. Results: Median age was 50 (35–70) years. Histology revealed squamous cell carcinoma in all patients. Almost 100% of patients presented locally advanced (pT3–4, G3) disease and received perioperative chemotherapy (MVAC). The median follow-up was 10 (5–24) months. Median operative time was 230 min (190–315). There were not severe (Clavien–Dindo III–IV) perioperative complications. All patients were able to void in standing position through the reconstructed neourethra. No patients reported post-operative incontinence. Two patients died after 8 and 11 months from surgery. Conclusion: This new technique of using the dartos-based dorsal penile skin tube urethroplasty offers the possibility to void in standing position after radical penectomy with no need of urinary derivations. Level of evidence: Not applicable.

An atraumatic technique for re-inserting the displaced suprapubic catheter using an intravenous cannula and sensor guidewire.

An atraumatic technique for re-inserting the displaced suprapubic catheter using an intravenous cannula and sensor guidewire.

Management of rectal injury and rectourinary fistula from radical prostatectomy

This study aimed to demonstrate our management of rectal injury (RI) and rectourinary fistula (RUF) from radical prostatectomy (RP) and identify a possible factor that increased the chance of developing RUF. Between January 2011 and December 2019, a total of 14 cases of RI were retrospectively reviewed and analyzed, including preoperative, perioperative, and postoperative information. In all 14 cases of RI, the average age at RP was 66.3 years (54-77). During the study period, 8 of 14 cases of RI occurred in our hospital, and the incidence of RI was 0.42%. RI was intraoperative recognition in 8 cases and delayed diagnosis in 6 cases. For immediate recognition, 4 of 8 cases were primarily repaired without developing RUF and did not require diverting colostomy and suprapubic cystostomy. RUF occurred in 10 cases including 4 cases of intraoperative recognition and all cases of delayed diagnosis. In a subgroup analysis of RI that occurred in our hospital, the timing for diagnosis was clinically and statistically significant difference (P = 0.029). Instantly detected RI during RP and intraoperative rectal repair resulted in no postoperative complication. Among all 10 cases of RUF, 5 cases were successfully repaired by modified York-Mason procedure with dartos tissue flap interposition. No major complications were reported. Incidence of RI was 0.42% and intraoperative recognition of RI was a key to prevent the development of RUF. Modified York-Mason procedure with dartos tissue flap interposition was an effective treatment for RUF.

Emergency Urology procedures during the COVID-19 pandemic in the UK: A 3-month prospective study.

COVID-19 resulted in Regional tiered restrictions being introduced across the UK with subsequent implications for planned and emergency surgical care. Specific to Merseyside, Tier 4, Tier 2 and Tier 5 restrictions were introduced in late 2020 and early 2021. The purpose of this study was to examine the nature and workload of emergency urological procedures during three different national lockdown Tiers in the North West of England. A 3-month prospective study examining all emergency urological activity was conducted from November 2020 when Tier 4 restrictions were introduced and included Tier 2 restrictions in December and then concluded at the end of January 2021 when Tier 5 restrictions were in place. Data was obtained by identifying patients using the electronic theatre listing system. A total of 71 emergency cases were performed (24 in November (Tier 4), 28 in December (Tier 2), 19 in January 2021 (Tier 5)) with 15 different types of procedures performed. The most frequently performed procedure was stent insertion (36), followed by scrotal exploration (10). The least commonly performed procedure was suprapubic catheter insertion under general anaesthesia (1). One patient required transfer to a different hospital. In total 6 calls were made by general surgery and 3 by gynaecology for urgent urological assistance in theatre. Three urology patients returned to the theatre as emergencies following elective procedures. Unlike the Spring lockdown, acute urological presentations requiring operative intervention still presented daily. Of the 71 cases performed, most occurred in Tier 2. Stent insertion was the most commonly performed procedure, with the majority of the cases performed by registrars.

Omitting routine cystography after RARP: Analysis of complications and readmission rates in suprapubic and transurethral drained patients.

Robot-assisted radical prostatectomy (RARP) has become the therapy of choice for local treatment of prostate cancer. Postoperatively, urologists perform cystography before removing urinary catheters due to concerns about the integrity of the vesicourethral anastomosis. This study aims to evaluate the safety of waiving cystography before early catheter removal after RARP. A total of 514 patients from two tertiary referral centers who underwent RARP were retrospectively included. Patients received postoperative urinary drainage by transurethral (TUC) or suprapubic catheter (SPC). During the first year, both centers performed routine cystography before removing TUC or SPC on postoperative day 5. In the following year, management changed and catheters were removed without cystography unless indicated by the surgeon. Demographic and perioperative data were analyzed. Postoperative complications and readmission rates were compared between standard cystography (StCG), no cystography (NCG), and selective cystography (SCG). Groups were comparable regarding demographic and oncological parameters. Analysis showed no significant difference regarding major complications and readmission rates between standard and no cystography (p= 0.155 and 0.998 respectively). Omitting routine cystography did not lead to inferior postoperative courses regardless of both urinary drainage used and tumor stage. Subgroup analysis showed an increase of major complications in SCG patients when compared with NCG (p= 0.003) while readmissions remained comparable (p= 0.554). Waiving routine cystography before early catheter removal after RARP appears to be safe and feasible regardless of urinary drainage. However, the selective cystogram at the surgeon's request still plays a role in monitoring patients with an elevated risk profile.

Ten-Year Follow-Up on 160 Patients Treated with Hypofractionated Prostate Salvage Radiation Therapy

<h3>Purpose/Objective(s)</h3> Patients with biochemical failure after prostatectomy are commonly treated with standard fractionation radiotherapy requiring 6.5-8 weeks of treatment. GU003 recently reported favorable short-term efficacy and acceptable toxicity using hypofractionated salvage radiotherapy after prostatectomy. However, follow-up for the study is short and questions remain regarding whether late toxicities will remain acceptable. Here, we report on long term outcomes of patients treated with a similar regimen. <h3>Materials/Methods</h3> We evaluated a consecutive cohort of patients treated from 2003-2013 with salvage RT to 65-70 Gy in 25-28 fractions using image-guided IMRT. Freedom from biochemical recurrence (FFBR), prostate cancer specific survival (PCSS), and overall survival (OS) were assessed using Kaplan-Meier analysis. Factors associated with biochemical failure were assessed using Cox regression analysis (surgical margins, Gleason score ≥8, PSA nadir, time to detectable PSA, PSA doubling time, and presalvage PSA). Late GU toxicities were scored based on a modified LENT/RTOG grading system. <h3>Results</h3> A total of 160 patients were identified with a median follow-up of 155 months. Twenty-six patients (16.3%) received androgen deprivation therapy following surgery or concurrently with radiation and 20 patients (12.5%) had lymph nodes electively treated. FFBR was 63% at 5 years and 56% at 10 years; PCSS was 99% at 5 years and 93% at 10 years; OS was 97% at 5 years and 85% at 10 years. Factors associated with increased biochemical recurrence included negative surgical margin status and higher pre-salvage PSA (p =0.025, 0.050). Total incidence grade ≥3 late toxicities was 21.9% (n=35, 33 GU, 1 GI, 1 lymphovascular) which were observed a median of 101 months after the end of radiation. There were four late grade 4 toxicities and three observed deaths potentially associated with radiation (urothelial cancer, urosepsis related to a suprapubic catheter, and pelvic sarcoma). <h3>Conclusion</h3> Prostate cancer has a long natural history as do many late RT toxicities. This cohort of patients with >10 years follow-up treated with hypofractionated salvage RT shows long-term control comparable to that seen in other salvage RT series with long-term follow-up. Although we do not have a comparator group treated with standard fractionation, these data illustrate the importance of long-term follow-up when considering toxicity from salvage RT.

Ureteral Obstruction Due to Inadvertent Placement of the Suprapubic Catheter and Bladder Indwelling Catheter: Presentation of Two Clinical Cases and Review of the Literature

Introduction: Suprapubic catheter (SPC) and bladder indwelling catheter (BIC) placement are among the most common urological procedures. Inadvertent misplacement of the catheter tip into the ureteral orifice is an infrequent event with potentially critical complications. Case Presentation: We describe two cases of inadvertent intraureteral misplacement of an SPC and a BIC. A 66-year-old man with chronic kidney disease (CKD) stage G3b, urethral stenosis, long-term SPC who attended the emergency room (ER) 6 hours after the last catheter replacement due to low back pain, fever, deterioration of the general condition, anuria, acute kidney injury (AKI); CT-scan revealed a left uretero-hydronephrosis secondary to obstruction of the catheter balloon misplaced inside the distal ureter. A 59-year-old woman with CKD stage G3b, post-radiotherapy cystitis, and small capacity bladder, long-term BIC who attended the ER a few hours after the last BIC replacement due to abdominal pain, anuria, AKI; CT-scan revealed left hydronephrosis secondary to catheter obstruction within the distal ureter. In both patients, management was conservative, consisting of removing the catheter and repositioning it inside the bladder, in addition to hydration and antibiotherapy. Conclusions: These cases illustrate that awareness of this rare complication can be prevented by confirming the correct positioning of SPC or BIC after its replacement. Early detection and management of this complication can prevent a serious clinical setting.

Is reducing the early postoperative complications of percutaneous suprapubic catheterization affected by the method of healthcare education in low-literacy patients? A prospective randomized comparative study

Abstract Background Suprapubic catheters (SPCs) are associated with a wide spectrum of undesirable symptoms and complications, ranging from skin overgranulation to septicemia. They can be effectively managed through various medical and healthcare interventions. We compared the impact of illustrated brochure healthcare education (IBHE) and verbal-only healthcare education (VOHE) on early postoperative complications of SPC in patients with low literacy levels. Materials and methods Eighty patients with low literacy levels who underwent SPC insertion were randomly allocated to receive either IBHE or VOHE between January 2019 and June 2020. Variables, including postoperative complications (within 30 days), were compared. This study was approved by our institutional review board (IRB number: 1780011/2019). Results The IBHE and VOHE groups included 40 patients each. The mean age ± standard deviation was 52.75 ± 16.46 and 53.25 ± 17.19 years, respectively. Acute urinary retention was the main presenting symptom (36 [90%] vs. 34 [85%]), and benign prostatic hyperplasia was the main underlying pathology (16 [40%] vs. 15 [37.5%]). The incidence of SPC obstruction (p = 0.000), urine leakage (p = 0.006), falling out (p = 0.003), suprapubic pain (p = 0.012), exit skin manifestations (p = 0.000), bleeding (p = 0.041), change (p = 0.003), and hematuria (p = 0.000) was significantly lower in IBHE than in VOHE. However, catheter-associated bladder discomfort (p = 0.247), bacteriuria (p = 0.154), and gross pyuria (p = 0.625) were not significantly different between the groups. The frequency of Clavien-Dindo grades was significantly higher in the VOHE group than in the IBHE group. Grade I (87.5% vs. 67.5%, p = 0.032) and grade IIIa (2.5% vs. 22.5%, p = 0.007) were significantly more frequent in the highest grade in IBHE and VOHE groups, respectively. Conclusions IBHE appears to be a suitable and effective method for educating low-literacy patients undergoing SPC insertion. It significantly reduced the incidence and grade of early postoperative SPC complications compared with VOHE, except for catheter-associated bladder discomfort, bacteriuria, and gross pyuria.

The benefits of circumcision in boys with posterior urethral valves.

Journal of Paediatrics and Child HealthVolume 58, Issue 10 p. 1908-1909 Heads UpFree Access The benefits of circumcision in boys with posterior urethral valves First published: 11 September 2022 https://doi.org/10.1111/jpc.16201 edited by Craig Mellis (craig.mellis@sydney.edu.au) AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Posterior urethral valves (PUVs) affect 1 in 4000 male births, with a life-time risk of end-stage renal disease of 28.5%. Despite post-natal management with valve ablation, PUVs still pose an increased risk of febrile urinary tract infections (fUTIs), and possible acquired renal injury. A collaboration between 13 French referral centres was recently published to determine the utility of circumcision in boys with PUVs.1 Neonates with a diagnosis of PUVs were recruited and randomised (93 in total) to either circumcision with prophylactic antibiotics, or prophylactic antibiotics alone. A fUTI was defined by a fever of >38.5°C with concomitant pyuria and culture-positive infection on urinalysis (obtained by suprapubic aspiration or catheterisation). Following two years of follow-up, the risk of febrile UTI was 3% among boys in the treatment arm, compared to 20% in the control group, translating to a tenfold risk reduction of fUTI, and a number needed to treat of six children to prevent one fUTI. This was a well-constructed study providing objective evidence for what has generally been considered a worthwhile procedure on an intuitive basis. The above French randomised trial provides valuable evidence to inform discussions of the benefits of medical circumcision in the context of PUV. Reference 1Harper L, Blanc T, Peycelon M et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: Result of the CIRCUP randomized trial. Eur. Urol. 2022; 81: 64– 72. CrossrefCASPubMedWeb of Science®Google Scholar Reviewers: Kiarash Taghavi, kiarash.taghavi@monashhealth.org and Chris Kimber, ckimber@bigpond.net.au, Department of Paediatric Urology, Monash Children's Hospital, Melbourne, Australia. Kai Zheong Lim, teddylimkz@outlook.com, Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia. Volume58, Issue10October 2022Pages 1908-1909 ReferencesRelatedInformation

Role and effectiveness of an information guide in improving catheter confidence and knowledge in junior clinicians

Objective: Referrals to the on-call urology team for catheter-related problems are common. Experience and previous studies highlight that urology exposure and catheter skills are unsatisfactory in undergraduate training as well as in subsequent junior clinical practice. These deficiencies may compromise patient safety and delay appropriate treatment. This study aimed to assess catheter insertion confidence and associated knowledge in junior doctors and advanced nurse practitioners in a single teaching hospital and evaluate whether this could be improved by introducing a freely available catheter information and problem-solving guide. Methods: An online survey assessing confidence inserting two and three-way urethral catheters, changing suprapubic catheters and assessing knowledge related to common catheter problems was delivered to all non-registrar junior clinicians. Based on these results, an information guide was created and made freely available to these clinicians. The survey was then repeated to check for catheter-related knowledge and confidence. Results: A total of 58 junior clinicians responded to the initial survey and 61 to the repeat survey. Catheterisation confidence and knowledge was generally low in the first survey but improved in all areas and across all grades after the introduction of the information guide. Of the respondents, 100% thought the guide was helpful and 93.4% said they would use it in future. Conclusions: A catheter information guide is a simple and effective method of improving junior clinician confidence with catheter insertion and managing catheter-associated problems. Level of Evidence: This study does not directly correlate with a defined level of evidence.

Machine learning-assisted fluoroscopy of bladder function in awake mice.

Understanding the lower urinary tract (LUT) and development of highly needed novel therapies to treat LUT disorders depends on accurate techniques to monitor LUT (dys)function in preclinical models. We recently developed videocystometry in rodents, which combines intravesical pressure measurements with X-ray-based fluoroscopy of the LUT, allowing the in vivo analysis of the process of urine storage and voiding with unprecedented detail. Videocystometry relies on the precise contrast-based determination of the bladder volume at high temporal resolution, which can readily be achieved in anesthetized or otherwise motion-restricted mice but not in awake and freely moving animals. To overcome this limitation, we developed a machine-learning method, in which we trained a neural network to automatically detect the bladder in fluoroscopic images, allowing the automatic analysis of bladder filling and voiding cycles based on large sets of time-lapse fluoroscopic images (>3 hr at 30 images/s) from behaving mice and in a noninvasive manner. With this approach, we found that urethane, an injectable anesthetic that is commonly used in preclinical urological research, has a profound, dose-dependent effect on urethral relaxation and voiding duration. Moreover, both in awake and in anesthetized mice, the bladder capacity was decreased ~fourfold when cystometry was performed acutely after surgical implantation of a suprapubic catheter. Our findings provide a paradigm for the noninvasive, in vivo monitoring of a hollow organ in behaving animals and pinpoint important limitations of the current gold standard techniques to study the LUT in mice.

Long-term follow-up of epidermolysis bullosa in real practice shows stability of the Epidermolysis Bullosa Disease Activity and Scarring Index and improvement with some off-label therapies

Long-term follow-up of epidermolysis bullosa in real practice shows stability of the Epidermolysis Bullosa Disease Activity and Scarring Index and improvement with some off-label therapies

Effect of Chronic Urinary Retention over Serum Prostate-Specific Antigen and Its Role in Histopathological Diagnosis

Background: Prostate-specific antigen (PSA) rises in all types of retentions and also in carcinoma prostate. The raised levels of PSA levels due to urinary retention may raise a false suspicion of carcinoma prostate in these patients. Unlike chronic urinary retention (CUR), the effect of acute urinary retention (AUR) on serum PSA levels had been studied in detail as evident from the past literature. Objectives: The objectives of the study were first to estimate and interpret serum PSA levels in adult males with CUR due to prostatic pathology, second to assess the need of taking prostatic biopsy based on the studied PSA trends, and finally to assess the prostatic histopathology in cases of persistently high PSA levels after 6 weeks. Materials and Methods: This was an observational follow-up study including 41 patients diagnosed with CUR due to prostatic etiology, matching the inclusion and exclusion criteria. On presentation, serum PSA levels were recorded. Retention was relieved by either per urethral catheterization or suprapubic catheterization. PSA levels were recorded after 24 hours, 1 week, 3 weeks, and 6 weeks and PSA trends were noted. Prostatic biopsy was advised for only those subjects in whom PSA did not attain the baseline value of 4 ng/mL within 6 weeks. The histopathological report of the biopsy was followed in each patient for studying its association with PSA trends. Results: Mean PSA at the time of presentation was 17.92 ng/mL. PSA trends showed that in the majority of the patients “Suspected benign group” (80.49%, n = 33), PSA returned to &lt;4 ng/mL within 6 weeks of catheterization. Six patients, the “Borderline group” (14.63%), showed a downtrend in their PSA trends but could not attain baseline value. PSA trends in only two patients, the “Suspected malignant group” (4.87%), showed a comparative constant or an uptrend. All patients in the “Suspected benign group” and a majority of the “Borderline group” patients (83.33%) had a histopathologically confirmed benign prostatic pathology. Out of the two highly suspected malignant cases, only one patient (50%) had carcinoma prostate on final histopathology. Conclusion: PSA rises mainly in carcinoma prostate, but it falsely rises in all urinary retentions. The relationship between AUR and PSA had been studied in detail as evident from the past literature but needs to be established in patients with CUR. A period of 4 to 6 weeks can be safely employed for waiting for PSA to fall back to normal in CUR. A biopsy is required only for patients in which PSA is constantly high to rule out carcinoma prostate.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

979 Emphysematous Pyelonephritis in a Diabetic Patient with Horseshoe Kidney: Case Study and Literature Review

Abstract We present to you the case of a 54-year-old female with a background of horseshoe kidney presenting with a fever, right-sided flank pain, and raised inflammatory markers. This presentation was on a background of recurrent urinary tract infections which were managed conservatively with antibiotics. CT-KUB revealed pockets of gas in both kidneys and within the pelvis, with wall thickening of the left renal pelvis. She subsequently received broad spectrum antibiotics and a suprapubic catheter. Bilateral JJ stents were inserted, and ultrasound was performed in the days following to rule out hydronephrosis. Subsequently, a nephrostomy tube was inserted. The patient clinically improved over time. Horseshoe kidney is a rare anomaly, presenting multiple challenges when managing emphysematous pyelonephritis in these patients. Emphysematous pyelonephritis (EPN) is a necrotising renal infection that leads to the formation of gas in the renal parenchyma, collecting ducts, and surrounding tissue. In the past, multiple eponyms have been used to describe these conditions: ‘renal emphysema’, ‘pneumonephritis’. The pathophysiology of this benign condition is multifactorial. The gas formation that occurs can be either focal or diffuse and has the capability of tracking into perinephric and paranephric spaces. Approximately 90% of these patients have an underlying diagnosis of uncontrolled diabetes mellitus with pathogens that can produce gas, whilst 10% have urinary tract obstructions. EPN is rare, and the occurrence in a diabetic patient with horseshoe kidney has rarely been reported. The presence of a horseshoe kidney makes management more difficult. Few cases have been reported in the literature.

Botulinum toxin A injection to the external urethral sphincter for voiding dysfunction in females: A tertiary center experience.

The aim of this study is to examine the functional outcomes of ona-botulinum toxin A (BTX-A) injection into the external urethral sphincter (EUS) for female patients with nonneurogenic nonrelaxing sphincter as the underlying cause of voiding dysfunction (VD). A retrospective analysis was performed for all the patients with the urodynamic findings of higher than expected maximum urethral closure pressure (MUCP) who received their first injection during the study period. All patients were evaluated with preoperative videourodynamic study and urethral pressure profilometry and received 100 U of EUS BTX-A. Patients aged less than 18 years and those with neurogenic bladder were excluded. All patients were followed up with the free flow, postvoid residuals (PVR), and patient global impression of improvement (PGI-I) scale at 6 weeks and then at 3 monthly intervals. We identified 35 female patients with a mean age of 37.5 ± 15 years (range 18-72 years) with a mean follow-up of 20 months. More than 50% of patients had a history of prior surgical intervention and 28 (80%) patients were catheter dependent, a suprapubic catheterization, or clean intermittent self-catheterization. Mean MUCP was 97.1 ± 22 cm of water. After treatment with BTX-A, 21 (60%) patients were able to void per urethral (p = 0.02). The mean maximum flow rate (Qmax) improved from 8.8 to 11 mls/s and the mean PVRdecreased from 200 to 149 mls (p &lt; 0.05). On multivariate analysis, we identified high preoperative PVR, high preoperative actualMUCP, and previous surgical intervention (urethral dilatation, sacral neuromodulation, and pelvic surgery) as predictors of successful voiding restoration. The mean duration of response was 4.7 months, 46% of patients requested repeat injection, and 29% were established on maintenance injections. On the 5-point PGI-I score, 13 (37%), 12 (34%), and 10 (29%) patients reported good, some, and no improvement, respectively. Quality of life was also improved in 60% of patients. Two patients had transient stress urinary incontinence (for&lt;6 weeks) and there were no significant long-lasting adverse events. EUS BTX-A is a valid treatment option for VD considering therapeutic options are limited. The patient must be made aware of the need for repeat treatments.

Understanding suprapubic catheter usage in the Canterbury population

Background:Suprapubic catheter (SPC) insertion is a common urological procedure, typically performed for individuals who are unable to drain their bladder via the urethra. While often considered to be safe and straightforward, our experience suggests this procedure may be associated with significant comorbidity, serious adverse events, and a higher length of stay than expected. This study aimed to understand current rates of SPC insertion, demographics, indications, complications, and length of stay. Methods:A retrospective review of all patients having undergone SPC insertion at Christchurch Hospital since the inception of the SPC synoptic note in 2017 was undertaken. Data was collected on demographics, indication, procedural details, in-hospital complications, length of stay and long-term outcomes. Patient groups were identified to determine if there were any predictive factors placing individuals at an increased risk of complications. Results:Data was analysed on 213 SPC insertions performed using the Add-a-Cath trocar technique (29.4% female); the mean age at insertion was 64.2 (range: 8–98). Overall, there were 2 intraoperative bowel perforations, in these patients neither had a previous abdominal incision or difficult to distend bladders and in both cases the bladder was filled with their existing urethral catheter. 47.7% of SPC insertions were associated with at least 1 complication following discharge requiring reattendance to hospital. The mean length of stay for those who presented to the hospital was 3.1 days. Infective factors were the most common complications, accounting for 43.3% of presentations. Long term complications were similar in patients whose bladder was filled via cystoscope (50.4%) versus urethral catheter (44.7%). Eight patients (3.79%) required surgical reinsertion of their SPC.Seven patients underwent open cut-down SPC insertion (42.9% female); of these, there was one intraoperative bowel perforation and 57.1% experienced at least one complication following discharge. The average number of visits relating to SPC complications following discharge was 8. Conclusion:While SPC insertions are commonly perceived to be well tolerated by patients and a simple solution to catheter-related issues, our study highlights a higher than previously understood rate of complications following discharge. This data will facilitate informed decision making between clinician and patient, recognising potential risk factors that increase an individual’s likelihood of experiencing adverse events leading to improved resource allocation.