Three-way Catheter Research Articles

Comparing the incidence of postoperative painful bladder spasm between malecot catheter and 3-way Foley catheter: a clinical trial.

In this study, the effect of Pezzer (as a Pezzer catheter) and three-way Foley catheters, used for suprapubic catheterization after open prostatectomy, was investigated in terms of early incidence of painful bladder spasms. In this single-blind clinical trial study, 160 patients diagnosed with LUTS/BPH were placed in two groups of 80 Pezzer catheter (Pezzer(size 28)) and three-way Foley catheters (size 24) for suprapubic catheterization. The evaluated variables in this study are age, prostate weight, narcotics dose, Spasm frequency, International Prostate Symptom Score (IPSS), visual analogue scale (VAS), catheterization period. The frequency of spasm in Foley group was significantly lower (4.4±7.26 vs. 6.28±4.4; P value=0.000). There was no significant difference between the two groups regarding the frequency of dysuria (P value=0.3). The findings of our study showed that despite slightly favourable results in using suprapubic Foley catheter compared to Pezzer catheters in patients with open prostatectomy in terms of pain and spasm frequency, there was no significant difference between the use of these two types of catheters.

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Minimal Invasive percutaneous tube cystostomy using three-way Foley Catheter for management of obstructive urolithiasis in goats

Ultrasound-guided suction curettage followed by cervico-isthmic placement of foley threeway catheter for cesarean scar pregnancy's treatment. Retrospective study

ObjectivesCesarean scar pregnancy (CSP) is a rare dangerous condition with still no consensus on standard treatment. Suction curettage has been used as the first-line treatment for CSP with controversial outcomes. This study evaluates efficacy of ultrasound-guided suction curettage (UGSC) followed by cervical-isthmic placement of silicon semirigid three-way foley catheter. Materials and methodsThis study included 24 women with CSP. Preoperative ultrasound study was conducted. UGSC followed by placement of catheter was performed in all patients. The success rate and incidence of major complication, surgical time and hospital stay were recorded. ResultsThe success rate of UGSC followed by placement of foley catheter was 100 %, effectively reduced major complications and none of the patients had a blood loss higher than 900 ml. Median hospital stay was 2 days and median foley stay was 1 day. Surgery had limited last with a median of 17 min. ConclusionUGSC followed by foley placement is a safe effective treatment for CSP with a clinical resolution of 100 %. The catheter is easy to place under ultrasound guidance and prevents bleeding, reducing major procedures to solve the bleeding. Suction curettage in CSP treatment should be performed under ultrasound guidance and followed by cervical-isthmic placement of foley balloon.

Cystoscopic application of PuraStat® in the treatment of radiation-induced haemorrhagic cystitis.

The use of radiotherapy has increased in recent years, especially for pelvic neoplasms, and this can result in long-term complications such as recurrent haemorrhagic radiation cystitis (RHC). A 73-year-old male patient presented to a hospital emergency department multiple times with visible haematuria and clots leading to urinary clot retention; he was finally diagnosed with RHC. During the last presentation, the bladder was irrigated continuously with saline using a three-way catheter. During hospitalisation, a cystourethroscopy was performed for bladder evaluation and clot evacuation. Multiple bleeding ulcers were recognised on the bladder wall, biopsies were taken for histopathology, and the ulcers cauterised. Packed red blood cell transfusions were required, and sodium hyaluronate (CystiStat®) bladder instillations were tried. There was no clinical improvement following any of these interventions. In light of the patient's deteriorating condition, cystoscopic application of PuraStat® 3ml was administered, which led to remission of the urinary bleeding in the short term. We continue to monitor the effects in the medium and long term. Based on current data, PuraStat® haemostatic agent therapy may be considered for RHC, when traditional treatments are ineffective or infeasible, potentially eliminating the need for more aggressive therapy such as cystectomy.

A case of life-threatening hematuria.

A 66-year-old male with a past medical history of hypertension and benign prostatic hypertrophy, not on anticoagulation, presented with difficulty voiding and hematuria. He was seen at an outside hospital earlier in the day and received a straight catheterization for urinary retention, he was prescribed antibiotics for a urinary infection, and he was discharged home. Subsequently, after discharge, he developed hematuria with inability to void, prompting a visit to our emergency department (ED). On arrival, the patient was uncomfortable appearing, tachycardic with a heart rate of 116 beats per minute and a blood pressure of 114/67 mm Hg. His lower abdomen was tender to palpation. A point-of-care ultrasound (POCUS) of the bladder was performed. The ultrasound demonstrated a distended-appearing bladder containing a large area of layering mixed echogenicity with intrinsic turbulent Doppler signal (Video 1). The patient had a three-way Foley catheter placed in the ED for continuous bladder irrigation. He had a computerized tomography (CT) angiography of the abdomen and pelvis that did not reveal any active hemorrhage. He also had a CT urogram. Initially, the hematuria improved, however, following the abnormal ultrasound Doppler images, the patient was admitted to the urology service. Although he was admitted, his hemoglobin declined from 12 to 7.9 g/dL, and he suffered a cardiac arrest. The reason for the arrest was presumed to be from hemorrhagic shock. There was return of spontaneous circulation after initiation of massive transfusion protocol. He underwent cystoscopy showing an enlarged median prostate lobe with active extravasation, requiring embolization of the prostatic artery by interventional radiology (IR). Hematuria and urinary obstruction are common causes of ED visits with multiple underlying etiologies.1 Emergency physicians are tasked with the challenge of determining which patients can be managed as outpatients. In this case, gross hematuria from an actively bleeding prostate led to the hemorrhagic shock requiring multiple transfusions and need for IR embolization. The most common etiologies of prostatic hematuria are benign prostatic hyperplasia, iatrogenic urologic trauma, prostate cancer, and radiation therapy.2 In this patient, POCUS showed turbulent Doppler flow within the bladder (Figure 1A), which was concerning for active bleeding, and ultimately led to the patient's admission and emergent urologic consultation. Additionally, the POCUS also showed layering mixed echogenicities seen within the distended bladder, indicating a clot at various stages (Figure 1B). This case illustrates the importance of considering POCUS in patients with urinary retention and hematuria, especially in the setting of recent catheter placement.

Case report of avascular necrosis of the glans penis after PAE embolization

BackgroundProstate artery embolization (PAE) is a relatively safe and effective alternative method for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia. The adverse events caused by PAE are primarily mild, including urinary tract infection, acute urinary retention, dysuria, fever, etc. Severe complications, such as nontarget organ embolism syndrome or penile glans ischemic necrosis, are rare. Here, we report a case of severe ischemic necrosis of the glans penis after PAE and review the literature.Case presentationAn 86-year-old male patient was admitted to the hospital due to progressive dysuria with gross hematuria. The patient underwent placement of a three-way urinary catheter to facilitate continuous bladder flushing, hemostasis, and rehydration. After admission, his hemoglobin decreased to 89 g/L. After an examination, the diagnosis was benign prostatic hyperplasia with bleeding. During communication with the patient regarding treatment, he requested prostate artery embolization due to his advanced age and concomitant disease status. He underwent bilateral prostate artery embolization under local anesthesia. His urine gradually turned clear. However, on the 6th day after embolization, the glans gradually showed ischemic changes. On the 10th day, there was partial necrosis and blackening of the glans. The glans completely healed, and the patient was able to urinate smoothly on the 60th day after local cleaning and debridement, the administration of pain relief, anti-inflammatory and anti-infection agents, and external application of burn ointment.ConclusionPenile glans ischemic necrosis after PAE is rare. The symptoms include pain, congestion, swelling, and cyanosis in the glans.

An Easy Solution for Difficult Urethral Catheter: Three-Way Urethral Catheter Insertion Using a Guidewire Technique.

Urethral catheter insertion is a skill taught to all medical students but often not practised for a multitude of reasons. The difficult catheter can be a clinical nightmare for the junior doctor, especially on call, and can lead to significant mortality and morbidity with suboptimal repeated attempts. The incorporation of a soft-tipped hydrophilic guidewire technique for the insertion of a two-way urethral catheterhas been described in the literature and has the potential to reduce the morbidity and mortality of patients by making the insertion of a catheter less traumatic. Here, we propose and describe the insertion of a three-way urethral catheter, performed using the technique employed for the insertion of a two-way urinary catheter via the use of a hydrophilic guidewire, with similar outcomes. A hydrophilic soft-tipped guidewire to insert a three-way urethral catheter can be used in the wards, in the emergency department, and in a theatre setting. The district hospital in which this method was employed demonstrated a 100% success rate in the insertion of a urethral catheter (N = 15), with 26% of cases (four patients out of 15) having a three-way urethral catheter inserted using the soft-tipped hydrophilic guidewire method. Follow-ups of these patients showed that there were no complications or adverse effects experienced by the patients. The use of a soft-tipped guidewire approach to insert a difficult urethral catheter can reduce the financial burden on the healthcare system by eliminating costs due to harm/trauma caused by repeated unsuccessful urethral catheter attempts or those attempts that have been performed suboptimally and have led to potential patient harm. The use of a hydrophilic guidewire-assisted technique to insert a three-way urinary catheter is a safe and easy option for those who have had repeated unsuccessful attempts. The hydrophilic guidewire approach has the potential to reduce morbidity and mortality associated with urethral catheterisation and improve patient safety.

A ten-year observational study of the use of two-way catheters post-transurethral resection of the prostate without the use of post-op irrigation

Background: Over 15,000 transurethral resections of the prostate (TURP) are performed annually in the United Kingdom. It is therefore vital that every aspect of peri-operative care be optimised. Our centre favours the use of two-way catheters post-operatively without the use of continuous bladder irrigation (CBI). Objectives: To evaluate our practice of using two-way catheters without irrigation post-TURP and to determine impact on patient care compared with standard three-way catheterisation. Our primary outcome was duration of admission, but multiple secondary outcomes were also analysed. Design, setting, and participants: This was a prospective observational study. Every patient undergoing TURP at our centre from 2009 to 2019 was included. Following TURP patients were catheterised with two-way catheters. Prospective patient data were collected pertaining to peri-operative factors. These data were then compared with the data published in the literature. Results: 687 patients underwent TURP at our centre between 2009 and 2019. The average age of patients was 71.42 (±7.89). 87.17% ( n = 598) had two-way catheters placed post-operatively. Average duration of admission was 1.61 (±1.35) days, increasing to 2.20 days if patients required three-way catheters or 2.53 days if requiring CBI. TWOC was successful in 97.71% of patients. Complication rate was 8.73% ( n = 60). When compared with other centres, our method reduced lengths of admission and transfusion rates (1.6 days versus 3.1 days and 0.87% versus 2.83%, respectively). Conclusion: Our method is safe and is associated with a reduced length of admission. We recommend this practice to the wider urological community. Patient summary: This study looked at whether there was any impact on patients if two-way catheters were used following TURP. We found that use of two-way catheters reduced length of admission and duration of catheterisation. We also found that it did not increase likelihood of peri-operative complications in comparison with other centres.

Can tranexamic acid in irrigation fluid reduce blood loss during monopolar transurethral resection of the prostate? A randomised controlled trial

ABSTRACT Objective To assess the efficacity and safety of using tranexamic acid (TXA) in the irrigation solution during transurethral resection of the prostate (TURP). Patients and Methods A total of 50 patients undergoing TURP for benign prostatic hyperplasia were prospectively randomised in a controlled clinical trial and distributed into two groups. Group A received 0.1% TXA 1000 mg (10 mL) in 1 L of irrigation solution of sterile wash (glycine) during surgery, while Group B received 10 mL distilled water (placebo) in 1 L of irrigation solution of sterile wash (glycine) during surgery. At the end of surgery, a three-way catheter was inserted in the bladder. Group A received local 500 mg of TXA (5 mL), which was dissolved in 100 mL of normal saline solution, while Group B received distilled water (5 mL) dissolved in 100 mL of normal saline solution after which the catheter was clamped. The serum haemoglobin (Hb) concentration, haematocrit (HCT), blood loss volume, Hb concentration in the irrigation fluid, and bladder irrigation volumes were compared between the two groups at three time-points: preoperatively and at 4- and 24-h postoperatively. Coagulation function, complications, thromboembolic events, quality of endoscopic view, surgery duration, and hospital stay were also noted. Results Group A had significantly lower blood loss intraoperatively, and at 4- and 24-h postoperatively compared to the control group (P < 0.05). The serum Hb concentration, HCT, Hb concentration in the irrigation fluid, and bladder irrigation volumes were significantly lower in the TXA group vs the control group (P < 0.001). The shortening of the surgery duration and improvement in the quality of the endoscopic view were significantly noted in the TXA group (P = 0.001). However, no thromboembolic events occurred in either group. Conclusion The use of TXA in the irrigation fluid during TURP and injection into the bladder postoperatively can reduce blood loss and the need for blood transfusion without increasing the risk of thrombosis.

V06-01 WHAT TO DO WHEN UNABLE TO REACH THE BLADDER DURING HOLMIUM LASER ENUNCLEATION OF THE PROSTATE (HOLEP): AN INCISION-FREE APPROACH

You have accessJournal of UrologyBPH & Infection & Imaging (V06)1 Sep 2021V06-01 WHAT TO DO WHEN UNABLE TO REACH THE BLADDER DURING HOLMIUM LASER ENUNCLEATION OF THE PROSTATE (HOLEP): AN INCISION-FREE APPROACH Deepak Agarwal, and Marcelino Rivera Deepak AgarwalDeepak Agarwal More articles by this author , and Marcelino RiveraMarcelino Rivera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002021.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The situation of not being able to reach the bladder during HoLEP is a rare situation. Currently, this situation requires some external incision (temporary perineal urethrostomy (PU) or conversion to open/MIS simple prostatectomy) which requires additional catheterization time. We present an alternative, incision-free technique for this situation to complete HoLEP transurethrally. METHODS: We present a case of HoLEP in a 73 year old male with a 225 ml gland on preoperative imaging in which the laser scope could not reach the bladder due to urethral length. We utilized the early apical release technique, and dissected to the bladder through the anterior plane. As this is the shortest distance across the prostate to the bladder endoscopically, we were able to reach the bladder anteriorly and complete the HoLEP without additional incisions. This also enabled us to perform catheter removal promptly after surgery. RESULTS: The total procedure time was 146 minutes, enucleation time was 97 minutes and morcellation time was 24 minutes. All of the 199 grams of enucleated tissue was benign adenoma on final pathology. In the 15 minutes between procedure end time and extubation, continuous bladder irrigation was run through a 22 french three-way urinary catheter. The catheter was removed prior to extubation and the patient voided within 2 hours. At two week follow-up, the patient was voiding without issue, having only minimal stress urinary incontinence, and no hematuria. CONCLUSIONS: We propose the technique of first following anterior plane to the bladder after early apical release as an when the laser scope cannot reach the bladder transurethrally at the time of HoLEP. The shorter distance of the anterior plane from the apex of the prostate to the bladder neck, opposed the longer distance through the urethral lumen is the likely reason for the success of this approach. This anterior-first technique may avoid external incisions and prolonged catheter time from a temporary PU or open/MIS prostate enucleation in these rare cases. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e449-e449 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Deepak Agarwal More articles by this author Marcelino Rivera More articles by this author Expand All Advertisement Loading ...

Post-operative day 2 versus post-operative day 4 foley catheter removal after trans urethral resection of prostate

Background: Usually after TURP surgery for BPH, a three-way foleys catheter is placed transurethrally and removed post-operative day 4. This study done at our institute is to help decide the interval for removal of foley catheter following TURP, which is most beneficial to the patients. The objective is to know whether the POD-2 removal of the catheter in post TURP patients will be beneficial compared to the traditional POD-4 removal.Methods: This is a prospective study on 100 patients with BPH who underwent TURP. Patients were assigned to POD-2 and POD-4 groups. A standard TURP was performed on all the patients. After removing the catheter on POD-2 and POD-4, the patients were observed, and outcomes were carefully recorded in the two groups.Results: The highest incidence of the disease was in the age group of 60 - 75 years (70%). The majority of patients had nocturia present in 80 out of 100 patients (80%).55% of patients had grade III prostatomegaly. Most of the patients, 55 (55%), had prostate volume between 30 and 50 grams. No statistical significance noted in terms of retention of urine, post-void residual urine. The average duration of hospital stay post-surgery for group I was 3.7 days, and in group II was 5.1 days which is statistically significant.Conclusions: Our study shows that early catheter removal after two days following Transurethral Resection of Prostate (TURP) is safe, cost-effective to the patient, reduces the post-operative hospital stay.

Multidisciplinary cooperative mode led by infusion nurse specialists used to ensure the nursing quality of peripherally inserted central catheters in China: A 5-year retrospective study.

To analyze the effect of multidisciplinary cooperation mode (MCM) led by infusion nurse specialists (INSs) on peripherally inserted central catheters (PICC) catheterization and indwelling nursing quality. Participants' demographic information, catheter types, catheterization approaches, puncture site, tip position, professional title of nurses, success rate of catheterization, consultation rate, detection rate of complications and outcome improvement rate of 6576 outpatients and hospitalized patients with PICC were analyzed retrospectively by a software named "questionnaire stars," in a large tertiary general hospital in Shanghai, from January 2015 to December 2019. SPSS 26.0 for Windows was used for data collection and description, Chi-square test were used for statistical analysis of enumeration data, and p < 0.05 was statistically significant. According to the catheter types' data, the use rate of three-way valve catheters decreased from 79.9% to 14.5%, while the use rate of three-way valve solo catheters increased from 12.7% to 51.6%, and the use rate of power injectable and open-ended catheters increased from 7.4% to 33.9%. According to the data of PICC catheterization method, conventional technology decreased significantly from 16.8% to 1.1%, modified Seldinger technique (MST) increased gradually from 26.1% to 51.3%, while ultrasound guided modified Seldinger technique (US and MST) decreased slightly from 57.2% to 47.6%. 7.5% catheter tip ends were malpositioned while nine indwelled PICCs were traced to have tip end malposition. The consultation rate was significantly higher than that before applying MCM led by INSs (x2 = 151.713, p < 0.05). After applying MCM led by INSs, the detection rate of complications was significantly higher than before (x2 = 5.499, p < 0.05), the rate of successful insertion at one time was significantly higher than before (x2 = 187.589, p < 0.05). After the application of INSs-led MCM, progresses have been achieved. The nursing quality of patients' PICC was significantly improved than before.

Intravesical Blood Clot Retention? How We Manage It, a Tertiary Hospital Preference

Intravesical blood clot retention is one of the Urological emergencies. Ongoing haematuria and blood clot formation in the bladder obstruct the urine outflow and lead to urinary retention, abdominal pain, anemia, urinary tract infection (UTI), and renal function deterioration. Most of the cases required cystoscopy blood clot evacuation and definitive surgery to stop the ongoing bleeding. This study aimed to discover the demography, characteristics, management, and complication of patients with intravesical blood clot retention in Dr. Soetomo General Acadenic Hospital, Surabaya from January 2017 until April 2020. This is an observational study, a retrospective-descriptive design. We conducted a review on the medical records of 97 patients, 76 males and 21 females with an average age of 54.9 years old. Of all patients initially treated conservatively using normal saline irrigation with a large three-way catheter (22-24 fr), four were successfully treated without surgery, and 89 patients underwent cystoscopy and definitive surgery. The mean operation time was 69,6 minutes, with an average blood clot volume of 167,7 ml (25-600 ml). Sources of bleeding were mostly originated from malignancy (58%), Benign Prostatic Hyperplasia (BPH) (10%), and hemorrhagic cystitis (7%). The most common comorbidity found was hypertension (13) and chronic kidney disease (10). Based on our experience, managing intravesical blood clot retention with cystoscopy continued with definitive surgery in a one-step procedure is a good approach. Urological malignancy is the most frequent abnormality that causes intravesical blood clot retention.

Hyperthermia, bladder pressure, and intravesical drug delivery.

469 Background: Little is known about the pharmacokinetics of intravesical chemotherapies. Various parameters can be altered including temperature, dwell time, drug concentration, and bladder pressure. Here, we hypothesize that increasing bladder pressure during instillation will improve drug delivery. Methods: An ex-vivo porcine model was developed to evaluate determinants of drug penetration into the bladder wall. Porcine bladders were suspended in isotonic saline at 37°C with a three-way Foley catheter in the bladder. Temperature probes were positioned in the extravesical bathing solution, bladder lumen, and sutured to the detrusor to ensure maintenance of desired temperatures. 2g gemcitabine in 100mL normal saline was heated to 43°C and circulated through the bladder using the Combat Bladder Recirculation System. Bladder pressures were monitored throughout each trial. After 60 minutes of dwell time, rapid dissection was performed to obtain full-thickness bladder samples from the bladder dome, posterior wall, trigone, and left and right lateral walls. Tissue was homogenized and liquid chromatography with tandem mass spectrometry (LC/MS/MS) was performed to measure gemcitabine concentration within the bladder wall. Linear regression and Pearson correlation were performed to determine the association between mean bladder pressure during instillation and drug concentration within the bladder wall. Multiple linear regression was conducted to control for bladder location and thickness. Results: Gemcitabine concentration within the bladder wall was measured 25 times across five trials. Mean gemcitabine concentration within bladder wall was 3.68 mg/g (sd 1.35). Pressure ranged from 149.8 mmHg to 277.7 mmHg (mean 194.8, sd 22.0). On univariate analysis, higher pressure was associated with increased gemcitabine concentration within the bladder wall (correlation = 0.49, p = 0.013). This result persisted after adjusting for bladder location (ß = 0.49, p = 0.006) and thickness (ß = 0.70, p = 0.03). Unstandardized regression coefficient in each of the models was 0.099 (mmHg x g)/mg, demonstrating that for each pressure increase of 10mmHg there was an associated increase in gemcitabine concentration of approximately 1 mg/g (Table). Conclusions: Data suggest that bladder pressure dramatically improves the extent of gemcitabine penetration into the bladder wall. Future research is needed to evaluate the therapeutic effect of increased gemcitabine delivery to target tissue in patients with bladder cancer. [Table: see text]

Knowledge, skills, and confidence among healthcare staff in urinary catheterization.

There is an increasing volume of urology referrals for urinary catheterization (UC). The aim of this study was to determine the confidence and knowledge among healthcare staff on UC. We also assessed their satisfaction with training and support received during catheter education and clinical practice. This was a mixed-methods model using an anonymous, online survey circulated among all hospital staff. Weekly reminders were sent, quantitative data was obtained from closed-ended questions, and thematic analysis was performed for qualitative, open-ended questions. The response rate was 26% (n=90/350), from a heterogenous group of doctors and nurses from various specialties and grades in the hospital and community frequently dealing with UC. There was decreasing confidence levels in female UC (54%, n=47/87), three-way catheters (33%, n=29/89), and managing suprapubic catheters (25%, n=21/85). Female UC was reported as the most difficult of catheter insertions (35%, n=31/90). Although 83% (n=74/89) of respondents received catheter education, 53% (n=48/90) felt this was insufficient for clinical practice. Fifty-one percent (n=45/89) believed more support with UC in clinical practice was required and 64% (n=57/89) recommended changes in catheter education. The most common theme identified was the need for ongoing education and more practical supervision in clinical practice. Catheter training should focus on different types of catheters and management of difficult catheter scenarios. Standardizing safe catheter education during undergraduate training and including this as a part of regular annual or biannual mandatory training for healthcare staff involved in dealing with catheters in clinical practice would be the way forward.

Same sized three-way indwelling urinary catheters from various manufacturers present different irrigation and drainage properties

Background:The three-way indwelling urinary catheter (IUC) is used for continuous bladder irrigation and is considered the cornerstone for clinical treatment of patients with macroscopic hematuria. Although there seems to be a logical relationship between catheter size and efficacy of irrigation and drainage, we often observe relevant variations in these parameters between different brands of catheters available on the market. The aim of this study was to compare the mechanical properties of different models of latex and silicone three-way catheters in an in vitro setting that resembles clinical use.Methods:Three different three-way catheters were evaluated: Gold Silicone-Coated Rusch® (Model A), 100% Silicone Rusch® (Model B) and X-Flow Coloplast® (Model C). Irrigation channel, drainage channel, and overall cross-sectional areas were all digitally measured. Irrigation and drainage channel flow rates were measured and correlated with their corresponding catheter cross-sectional area values.Results:Different catheter models of the same caliber have different internal irrigation port diameters, internal drainage port diameters and internal cuff port diameters. The Model C IUC internal irrigation port diameter is significantly larger than models A and B. When flows were evaluated, we found that in the same model, the increase in caliber of the IUC was related to an increased drainage flow, but not to an increased irrigation flow.Conclusion:Precise measurements of the internal architecture of the three-way catheter, rather than relying on the caliber itself, could assist surgeons in choosing the best product for each specific patient, while minimizing complications.

Intravesical application of platelet-rich plasma in patients with persistent haemorrhagic cystitis after hematopoietic stem cell transplantation: a single-centre preliminary experience.

Haemorrhagic cystitis (HC) after allogeneic transplantation (HSCT) is a condition characterized by diffuse inflammation and bleeding from the bladder mucosa. Treatment of HC is not standardized and clinical Guidelines are elusive. The aim of this study was to evaluate the safety and efficacy of intravesical treatment with platelet-rich plasma (PRP) in patients with HC after allogenic HSCT. Data from ten consecutive patients with BK virus-induced HC between 2013 and 2017 were collected. HC was classified into four grades. Inclusion criteria were (a) grade 3 or 4 BKV-induced HC after allogenic HSCT; (b) HC refractory to conservative therapy. All patients underwent transurethral cystoscopy and PRP treatment under general anaesthesia. Mean patients' age was 33.6years. Four patients (40%) presented a grade 3 BKV-induced HC and six patients (60%) a grade 4. No intraoperative complications occurred. Postoperative complications were recorded in six patients: three patients required blood transfusion while three patients endovenous antibiotic therapy. Median time to catheter removal was 6days (IQR 2-10). Median length of hospitalization was 35days (IQR 6-73). At 30days after surgery, a three-way catheter was repositioned in one patient for grade 4 haematuria, six patients had a complete response, and three a partial response. Our preliminary experience suggests that intravesical administration of PRP should be considered as a feasible and safe option for the treatment of BK-induced HC after HSCT. Future studies are needed to assess its potential value in other forms of haemorrhagic cystitis.

‘A perfect Example of the Strong Ion Difference: Hyperchloraemic Acidosis due to 0.9% Normal Saline Irrigation, in a Patient with a Ruptured Bladder’

An 81-year-old male presented to the Emergency Department with urinary retention, subsequent to passing blood clots. A three-way catheter was inserted for continuous bladder irrigation. 48 hours later he deteriorated, with worsening tachypnea and hypoxaemia. Clinical examination and chest x-ray suggested pulmonary odema, managed with intravenous furosemide, and non-invasive ventilation. His irrigation circuit-chart showed he had received 10 litres Normal Saline via the afferent limb, but only 3 litres recorded at the efferent limb. It was suspected the catheter was adjacent to a vascular-cystic interface, however an urgent contrast CT revealed the irrigating catheter perforating the bladder, being situated in the abdominal cavity (see 3 images). His arterial blood-gas analysis demonstrated the expected normal anion-gap academia, however his Strong Ion Difference calculations, sodium-chloride difference of 13 and a normal albumin level, perfectly demonstrated the expected calculated BE of -13. The catheter was withdrawn, and the patient made a full recovery.

Robot-Assisted Simple Prostatectomy: Illustration of a Simplified Extraperitoneal Transcapsular Technique.

Introduction and Objectives:Robot-assisted simple prostatectomy (RASP) performed with the extraperitoneal (EP) technique (RASP-EP) minimizes the risk of bowel injury, particularly when bowel adhesions may be expected to be prominent, by negating the need to be in the transperitoneal space. However, there is a perception of its technical difficulty owing to the limited space that can be expanded within the space of Retzius. We aimed to describe, in the accompanying video, the step-by-step approach for a technically proficient procedure.Methods: From January 2010 to July 2018, 33 consecutive patients who had undergone RASP-EP were identified from our institutional database. Procedures were performed as described stepwise in the accompanying video. In RASP-EP, a 3 cm paraumbilical incision is made, anterior rectus sheath incised, muscle pushed laterally, and the EP space is entered. The EP space is expanded in the retropubic area using a balloon dilator and a blunt ended trocar, enabling the placement of further three ports for robot docking. A transverse capsulotomy, 2 cm from the bladder neck, is performed a la Millin's. Prostate adenoma is resected circumferentially. Electrocautery hemostasis is performed. Posterior bladder neck and urethra are sutured onto the prostatic fossa with 2-0 Vicryl. A 22F three-way catheter is placed. Anterior capsulotomy is closed in two layers with 2-0 and 0-0 Vicryl sutures. A drain is left in the retropubic space. Patient is discharged within 1–2 days with the catheter in situ, which is then removed 10 days later.Results: Of the 33 patients, median values were age (68), American Society of Anesthesiology (3), Charlson Comorbidity Index (3), and body mass index (28.5 kg/m2). Eight (24.2%) patients had prior abdominal surgeries. Twenty-five (75.8%) patients were catheter dependent. Adjunctive procedures were cystolithotomy (5), umbilical hernia repair (2), and ureteroscopy (1). Median values were operative time (178 minutes), estimated blood loss (200 mL), hemoglobin change (2.8 g/dL), and hematocrit change (9%); only one patient (3.0%) required 1 U transfusion. Median length of stay was 2 days. Clavien–Dindo complications were 0 (21), I (7), II (3), IIIa (1), IIIb (1), IV, and V (0). Median resected prostate weight was 122 g. Incidental prostate cancer was found in three patients (9%); one patient required adjuvant radiotherapy. No patients were catheter-dependent postoperatively; mean postvoid residual was 29 mL (range 0–250 mL). Median follow-up was 4 months.Conclusions: RASP-EP is a safe and efficacious technique that should form the repertoire of a urologist's armamentarium when dealing with large adenomas, particularly when entry into the peritoneal cavity is to be avoided.No competing financial interests exist.Runtime of video: 7 mins 5 secs

Inducing intravesical hyperthermia of the ex-vivo porcine bladder wall: radiofrequency-induction versus recirculation using a custom-made device

Introduction: Several techniques can be used to treat intravesical chemohyperthermia (ChHT). We compared radiofrequency-induced hyperthermia (RF-HT) with conductive hyperthermia (C-HT) for their ability to induce bladder wall temperatures of >40.5 °C, the target temperature for ChHT.Materials and Methods: Fresh porcine bladders (n = 12) were placed in a temperature-controlled saline bath to simulate body temperature and circulation. HT was induced with RF-HT (43 °C) or C-HT (inflow temperature 44 and 46 °C) using a custom-made device. In two additional bladders, we varied intravesical solution and volume. Temperatures were recorded with a three-way catheter containing three mucosal and two urethral thermocouples (TCs) and a 915 MHz RF antenna, and with external TCs in the bladder wall at three different levels and three different locations.Results: Target temperature (40.5 °C) was reached in the submucosa at all locations by both techniques. In the detrusor, target temperature was reached by RF-HT at the bladder neck and side wall. C-HT46 reached significantly higher submucosal temperatures at the side wall. The bladder dome seemed best heated by C-HT, although a high inflow temperature (46 vs. 44 °C) was required (ns). Intravesical saline resulted in higher temperatures than sterile water for RF-HT. A volume of 100 mL resulted in higher bladder dome temperatures for RF-HT, and higher bladder neck with lower dome temperatures for C-HT.Conclusion: Our results indicate a slightly superior heating capacity for RF-HT compared to C-HT, whereas for the bladder dome, the reverse seems true. Comparative studies are warranted to evaluate whether HT efficacy differs between both techniques, with emphasis on tumor location.