Transurethral Catheter Research Articles

075 How important is the preservation of nocturnal penile tumescense with daily low-dose sildenafil 6 weeks after nerve-sparing radical prostatectomy for the erectile function after 2 years? - Penile rehabilitation in the long term follow-up

Previous studies showed that daily low dose sildenafil leads to improvement of the preservation of nocturnal penile tumescense and rigidity (NPTR) 6 weeks after nerve-sparing radical prostatectomy (nsRP). Aim of this study was the evaluation of NPTR-preservation on further erectile function (EF) recovery in the long term follow-up. 24 sexual active patients were operated by nerve-sparing radical prostatectomy. An erectometer measurement of NPTR (Rigi-Scan®) was carried out on each patient after removal of the transurethral catheter and again 6 weeks after surgery. To maintain and support recovery of spontaneous erectile function 12 patients with preserved nocturnal erections detected during NPTR-recordings received sildenafil 25mg/d at night starting immediately one the day after catheter removal (group 1). A control of 12 patients underwent follow up without daily PDE-5-inhibitors (group 2). All patients completed an IIEF-5 questionnaire concerning erectile function preoperatively, 3, 6, 12, 18 and 24 months after surgery.

Accuracy of postvoid residual volumes after vaginal delivery: a prospective equivalence study to compare an automatic scanning device with transurethral catheterization

Introduction and hypothesisAbnormal postvoid residual volumes (PVRV) after delivery are common in daily clinical practice. By using an automatic scanning device, unnecessary catheterizations can be prevented. The aim of this study was to determine the accuracy of PVRV after vaginal delivery measured by an automatic scanning device through a comparison with transurethral catheterization.Materials and methodsThis prospective observational equivalence study was performed in patients who delivered vaginally between June 2012 and May 2017 in three teaching hospitals in The Netherlands. After the first spontaneous void after delivery, postvoid residual volume (PVRV) was measured with a portable automatic scanning device (BladderScan® BVI 9400). Directly afterward, it was measured by catheterization. Correlation between measurements was calculated using Spearman’s correlation coefficient and agreement plot. The primary outcome was to validate the correlation between the BladderScan® compared with the gold standard of transurethral catheterization.ResultsData of 407 patients was used for final analysis. Median PVRV as measured by BladderScan® was 380 ml (± 261–0–999 ml) and by catheterization was 375 ml (± 315–1800 ml). Mean difference between measurements was −12.9 ml (± 178 ml). There was a very good correlation between methods (Spearman’s rho = 0.82, p < 0.001). Using a cut-ff value of >500 ml, specificity and sensitivity were 85.4 and 85.6%, respectively.ConclusionsThe BladderScan® (BVI 9400) measures PVRV precisely and reliably after vaginal delivery and should be preferred over catheterization.

Prospective short-term feasibility study of perioperative suprapubic catheters in laparoscopic colectomy.

Here we report a prospective study on whether a temporary suprapubic catheter (SPC) can be safely inserted as a substitute for transurethral balloon catheterization during laparoscopy-assisted colectomy. Our subjects included 52 cases who gave informed consent to have an SPC inserted. These subjects were selected from cases who underwent laparoscopy-assisted surgery for primary colorectal cancer from October 2014 to August 2015. An SPC was inserted into 45 of the original 52 cases. The median surgical duration was 220 min (range, 11-438 min), and the SPC insertion was performed at a median of 133 min (range, 9-384 min) after the start of surgery. Insertion required a median duration of 116 s. In one case (2.2%), the bladder was perforated by the paracentesis needle, and in two cases (4.4%), hematuria was observed at the time of insertion; however, surgery was completed without any incident in these three cases. Six of the remaining 42 cases (13.3%) demonstrated neither micturition desire nor independent urination on the day the catheter was clamped. In these cases, the clamp was released two to four times, and draining of an average of 586-mL urine, micturition desire, and independent urination were confirmed 2-4 days later. Transurethral balloon catheterization is a simple procedure that is commonly used on surgical patients, but it can cause pain, discomfort, and infection. In contrast, SPC insertion is a procedure that avoids crossing the urethra and its associated disadvantages. Here we were able to demonstrate that the procedure can be safely used in laparoscopic surgery patients.

Wireless ambulatory urodynamic study: A 6‐year retrospective review in a tertiary paediatric urological referral centre

AimUrodynamic study is a functional assessment of the lower urinary tract. It has an essential role in the evaluation of paediatric patients with lower urinary tract symptoms, be it due to neurogenic or nonneurogenic causes. Since 2013, we have introduced wireless ambulatory form of the study. In the present study, we performed a baseline review of our paediatric urodynamic service within a 6‐year period to determine its indications, outcomes and complications.Patients and MethodsA retrospective review of all urodynamic studies performed between August 2011 and April 2017 in patients &lt;18 years of age was performed. Demographics, including age and sex, and indications were collected. Urodynamic parameters, including type of catheter used, presence of detrusor overactivity, bladder compliance, end‐fill detrusor pressure, maximum voiding detrusor pressure, postvoid residual bladder volume and bladder emptying efficiency, were collected. Complications from either catheter insertion or the urodynamic study itself were documented.ResultsSixty‐seven studies were done between the study period in 55 patients (16 females and 39 males). Fifty‐eight ambulatory studies with natural and conventional fill were performed since 2013. The median age at study was 2.1 years (range 0.1–17 years). Indications included myelodysplasia (61 per cent, n = 41 studies), bilateral high‐grade vesicoureteric reflux (18 per cent, n = 12), dysfunctional voiding (15 per cent, n = 10) and patient with posterior urethral valve (6 per cent, n = 4). Suprapubic catheters were used in 62 studies in patients with urethral sensation, and transurethral catheters were used in five studies. Overall, 53 studies were considered abnormal (79.1 per cent). No complications resulted from suprapubic catheter insertion or urodynamic studies.ConclusionAmbulatory urodynamic studies using our unit’s protocol remain safe and child friendly, with minimal complications and high patient and parent satisfaction.

Randomized Clinical Trial of Lidocaine Analgesia for Transurethral Bladder Catheterization Delivered via Blunt Tipped Applicator in Young Children

Transurethral bladder catheterization (TUBC) is a painful, frequently performed procedure for collecting sterile urine. We sought to determine if administration of intraurethral lidocaine before TUBC using a blunt tipped syringe decreases procedural pain in young children in the pediatric emergency department. Randomized clinical trial of children 0 to 36 months old requiring TUBC for collection of urine in a pediatric emergency department was performed. Patients received intraurethral 2% lidocaine jelly or usual care (no analgesia). Randomization was stratified by sex. Intraurethral lidocaine jelly was administered via Uro-Jet, 5 minutes before TUBC. Baseline child state, lidocaine application, TUBC, and child state 1 minute post-TUBC were videotaped. Neither providers nor parents were blinded to study arm. Videos were scored by a trained, independent, blinded reviewer using the Faces, Legs, Arms, Cry, and Consolability (FLACC) and Modified Behavioral Pain Score scales. Pain scores were compared using the Wilcoxon rank sum test. Our primary outcome was difference in FLACC scores between groups. Eighty children were enrolled in the study, and 73 had analyzable data. No differences were detected in pain by mean FLACC score between intervention (8; 95% confidence interval, 7-9) and control (9; 95% confidence interval, 8-10) groups. There were no differences between groups in mean FLACC score when stratified by age or sex or in mean Modified Behavioral Pain Score. Intraurethral lidocaine for TUBC for urine collection using a blunt tipped applicator did not improve procedural pain scores. Pain scores were high across groups. Further study should be performed to improve analgesia for this highly painful procedure.

MP09-16 PHARMACOLOGICAL INHIBITION OF THE NLRP3 INFLAMMASOME PREVENTS BLADDER DECOMPENSATION IN A RAT MODEL OF CHRONIC BLADDER OUTLET OBSTRUCTION

You have accessJournal of UrologyBladder & Urethra: Anatomy, Physiology & Pharmacology I1 Apr 2018MP09-16 PHARMACOLOGICAL INHIBITION OF THE NLRP3 INFLAMMASOME PREVENTS BLADDER DECOMPENSATION IN A RAT MODEL OF CHRONIC BLADDER OUTLET OBSTRUCTION Francis Hughes, Stephanie Sexton, Patrick Leidig, Huixia Jin, and J. Purves Francis HughesFrancis Hughes More articles by this author , Stephanie SextonStephanie Sexton More articles by this author , Patrick LeidigPatrick Leidig More articles by this author , Huixia JinHuixia Jin More articles by this author , and J. PurvesJ. Purves More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.342AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Bladder outlet obstruction (BOO), most often the result of benign prostatic hyperplasia, may lead to progressive voiding dysfunction. BOO can create an overactive bladder (OAB) phenotype defined by increased frequency of voiding and decreased voiding volume (VV)). We have previously shown in the rat that acute BOO (12 days) activates the NLRP3 inflammasome which mediates inflammation and the OAB phenotype. Initially, the bladder can compensate for the obstruction by generating higher voiding pressures. However, over time the bladder decompensates which results in an increase in post-void residual volume (PVR) and decreased voiding efficiency. In this study we have examined the role of NLRP3 on rat bladder function after chronic BOO (42 days) and investigated the utility of an NLRP3 inhibitor in preventing decompensation. METHODS 4 groups were examined: 1) control, 2) sham-operated, 3) BOO and 4) BOO + gly (glyburide; an NLRP3 inhibitor). BOO was created by inserting a 1 mm transurethral catheter, tying a suture around the urethra, and removing the catheter. Gly was provided via 50 mg, 21 day release pellet (s.c.) that was replaced after 21 days. Suprapubic tubes were implanted on Day 35 and urodynamics performed on Day 42. PVR was assessed immediately after the final micturition by drawing back on the catheter with a syringe. The rat was immediately sacrificed and any additional post void liquid remaining in the bladder removed by needle puncture and added to the total PVR volume. RESULTS Voiding pressures were increased and flow rates decreased in BOO and BOO + gly groups, demonstrating physical obstruction of the urethra. No difference in frequency or VV were detected among groups. However, PVRs were greatly increased in BOO rats while BOO + gly rats were not different than controls (Figure 1). Moreover, also shown in Figure 1, there was a dramatic decrease in voiding efficiency in the chronically obstructed rats which was completely prevented by glyburide treatment. CONCLUSIONS The results suggest a critical role for NLRP3 in the progression to bladder decompensation during chronic BOO and that treatment with an NLRP3 inhibitor preserves voiding efficiency. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e112-e113 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Francis Hughes More articles by this author Stephanie Sexton More articles by this author Patrick Leidig More articles by this author Huixia Jin More articles by this author J. Purves More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2018MP23-09 COMPARISON OF POSTOPERATIVE CATHETER-ASSOCIATED URINARY TRACT INFECTION (CAUTI) RATES IN THE UROLOGIC PATIENT WITH A SUPRAPUBIC CATHETER VERSUS TRANSURETHRAL CATHETER Jason Warncke, Brittan Sutphin, John Hohenmeyer, E. David Crawford, and Brian Flynn Jason WarnckeJason Warncke More articles by this author , Brittan SutphinBrittan Sutphin More articles by this author , John HohenmeyerJohn Hohenmeyer More articles by this author , E. David CrawfordE. David Crawford More articles by this author , and Brian FlynnBrian Flynn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.741AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infections (UTIs) are the most common type of healthcare-associated infection. Among UTIs acquired in the hospital, 75% are catheter-associated urinary tract infections (CAUTI). CAUTI has gained much attention, as in 2008 Medicare regulations ceased reimbursement for costs related to nosocomial CAUTIs. Traditional teaching has been that suprapubic catheters (SPC) are associated with less risk of CAUTI than transurethral catheters (TUC). However, studies directly comparing the CAUTI rate in patients with SPC versus TUC are lacking, particularly in the postoperative Urologic patient. Thus, in this study we aim to compare the CAUTI rate with SPC versus TUC in the postoperative Urologic patient. METHODS We retrospectively reviewed and compared the medical records of 354 patients over a 5-yr period that underwent Urologic surgery. The SPC group consisted of patients that underwent SPC placement at the time of concomitant autologous rectus fascia pubovaginal sling (PVS) by a single surgeon (BJF). SPC placement was accomplished using the T-Spec device from Swan Valley Medical. The TUC group consisted of patients that underwent TUC placement using an 18 Fr Foley at the time of open radical prostatectomy (RP) by a single surgeon (EDC). Patients without a SPC or TUC and patients with both were excluded from the study. The primary outcome of comparison was the CAUTI rate (defined by the 2017 CDC guidelines) between the SPC and TUC cohorts. A Fisher’s exact test was performed to determine if the difference in CAUTI rate between the two cohorts was statistically significant (p<0.05). RESULTS 252 patients were included, including 145 (57.6%) in the SPC group and 107 (42.5%) in the TUC group, mean age 54.5 and 61.5 yrs, respectively. The mean catheter duration at the time of CAUTI for the SPC and TUC groups were 21.3 and 16.0 days, respectively (p=0.79). The mean catheter duration for the TUC group with and without CAUTI was 25.4 and 14.7 days, respectively (p=0.14). The overall CAUTI rate when catheter duration was less than 15 days compared to greater than 15 days was 3.3% and 5.0%, respectively (p=0.39). The CAUTI rate for the SPC group was 2.1% versus the TUC group 7.5% (p=0.039; OR 3.82). CONCLUSIONS In this study of postoperative Urologic patients, SPC was found to have a statistically significant lower rate of CAUTI when compared to TUC. This information may help guide providers when choosing the appropriate bladder drainage modality for their patients, particularly in the postoperative Urologic setting. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e284 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Jason Warncke More articles by this author Brittan Sutphin More articles by this author John Hohenmeyer More articles by this author E. David Crawford More articles by this author Brian Flynn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Iatrogenic Injuries of Urinary Tract : Outcomes of Surgical Repairs

Iatrogenic urinary tract injuries are known complications of digestive and pelvic surgeries. We retrospectively reviewed 13 patients with bladder injuries and 16 patients with ureteral injuries requiring surgical repair or stent placement in our hospital between 2013 and 2016. Obstetric-gynecologic surgery accounted for 10 bladder injuries and 11 ureteral injuries on hysterectomy and Cesarean section. Digestive surgery led to 1 bladder injury and 5 ureteral injuries on colon resection, and urologic surgery resulted in 1 injury on biopsy of a retroperitoneal tumor. Regarding bladder injuries, 10 patients underwent cystorrhaphy, and 3 patients received indwelling of a transurethral Foley catheter alone. Concerning ureteral injuries, 7 patients underwent repair of the injured ureter (ureteroneocystostomy in 5, and ureteroureterostomy in 2), and 9 patients received ureteral stent placement after postoperative retrograde urography. Repair failure was defined when urine leakage, urinary fistula, or urinary stricture requiring ureteral stent placement still existed at 90 days after the repair treatment. The bladder injuries in all 13 cases were successfully repaired. The ureteral injury treatments in 7 out of 16 patients (43.8%) were judged as being unsuccessful because of the condition requiring a ureteral stent at 90 days. There was a correlation between the delayed diagnosis of ureteral injury and unsuccessful repair. The present study showed that the prompt identification of urinary tract injuries, especially ureteral injuries, can result in decreased morbidity andsubsequently improved outcomes.

201 Survey on the Contemporary Management of Intraoperative Urethral Injuries during Penile Prosthesis Implantation

Intraoperative urethral injury is an uncommon event during the placement of an inflatable penile prosthesis (IPP) with an estimated incidence of up to 3%. The conventional teaching is to perform primary repair, place a transurethral catheter, and abort the procedure. Recently, alternative management strategies have been proposed with continuation of the implant following urethral injury. The objective of this study is to evaluate surgeon practices in the management of intraoperative urethral injury and determine if fellowship training influences management. An online survey was sent to the society listservs of the Genitourinary Reconstructive Surgeons (GURS) and The Sexual Medicine Society of North America (SMSNA). Physicians were queried on their fellowship training, experience with IPP implantation, and management of urethral injuries during IPP placement. The response data was analyzed using SAS 9.4 (SAS Institute Inc., Cary, NC). Chi-squared test and Fisher's exact test were used to determine associations between variables.

Clinical Utility of Noninvasive Method to Measure Specific Gravity in the Pediatric Population

BackgroundClinicians rely on any combination of signs and symptoms, clinical scores, or invasive procedures to assess the hydration status in children. Noninvasive tests to evaluate for dehydration in the pediatric population are appealing. ObjectiveThe objective of our study is to assess the utility of measuring specific gravity of tears compared to specific gravity of urine and the clinical assessment of dehydration. MethodsWe conducted a prospective cohort convenience sample study, in a pediatric emergency department at a tertiary care children's hospital. We approached parents/guardians of children aged 6 months to 4 years undergoing transurethral catheterization for evaluation of urinary tract infection for enrollment. We collected tears and urine for measurement of tear specific gravity (TSG) and urine specific gravity (USG), respectively. Treating physicians completed dehydration assessment forms to assess for hydration status. ResultsAmong the 60 participants included, the mean TSG was 1.0183 (SD = 0.007); the mean USG was 1.0186 (SD = 0.0083). TSG and USG were positively correlated with each other (Pearson Correlation = 0.423, p = 0.001). Clinical dehydration scores ranged from 0 to 3, with 87% assigned a score of 0, by physician assessment. Mean number of episodes of vomiting and diarrhea in a 24-hour period were 2.2 (SD = 3.9) and 1.5 (SD = 3.2), respectively. Sixty-two percent of parents reported decreased oral intake. ConclusionTSG measurements yielded similar results compared with USG. Further studies are needed to determine if TSG can be used as a noninvasive method of dehydration assessment in children.

Urinary Tract Infection in a Small Animal Model: Transurethral Catheterization of Male and Female Mice

Urinary tract infections (UTI) are extremely common worldwide, incurring significant morbidity and healthcare-associated expenses. Small animal models, which accurately reflect disease establishment and progression, permit dissection of host-pathogen interactions and generation of immunity to infection. In mice, intravesical instillation of uropathogenic E. coli, the causative agent in more than 85% of community acquired UTI, recapitulates many of the stages of infection observed in humans. Until recently, however, UTI could only be modeled in female animals. This limitation has hindered the study of sex-related differences in UTI, as well as other bladder pathologies, such as cancer. Here, we describe a method to instill male mice that allows direct comparison between female and male animals and provide a detailed protocol to assess bladder tissue by flow cytometry as a means to better understand host responses to infection. Together, these approaches will aid in the identification of host factors that contribute to sex biases observed in UTI and other bladder-associated diseases.

Urinary Tract Infection in a Small Animal Model: Transurethral Catheterization of Male and Female Mice.

Urinary tract infections (UTI) are extremely common worldwide, incurring significant morbidity and healthcare-associated expenses. Small animal models, which accurately reflect disease establishment and progression, permit dissection of host-pathogen interactions and generation of immunity to infection. In mice, intravesical instillation of uropathogenic E. coli, the causative agent in more than 85% of community acquired UTI, recapitulates many of the stages of infection observed in humans. Until recently, however, UTI could only be modeled in female animals. This limitation has hindered the study of sex-related differences in UTI, as well as other bladder pathologies, such as cancer. Here, we describe a method to instill male mice that allows direct comparison between female and male animals and provide a detailed protocol to assess bladder tissue by flow cytometry as a means to better understand host responses to infection. Together, these approaches will aid in the identification of host factors that contribute to sex biases observed in UTI and other bladder-associated diseases.

Urinary Microbiome and Psychological Factors in Women with Overactive Bladder.

Objectives: Emerging evidence indicates that alterations to the urinary microbiome are related to lower urinary tract symptoms. Overactive bladder (OAB) is a common disorder with complex etiologies and usually accompanied by psychological diseases. More information concerning the urinary microbiome and psychological factors in OAB is required. The aim of this study was to characterize the female urinary microbiome associated with OAB and investigate the relationships between urinary microbiome and psychological factors.Methods: Thirty women with OAB and 25 asymptomatic controls were recruited and asked to finish the Overactive Bladder Symptom Score, Self-Rating Anxiety Scale and Self-Rating Depression Scale. Urine specimens were collected by transurethral catheterization and processed for 16S rRNA gene sequencing using Illumina MiSeq. Sequencing reads were processed using QIIME. LEfSe revealed significant differences in bacterial genera between controls and OAB patients. The relationships between the diversity of the urinary microbiome and psychological scores were identified by Pearson's correlation coefficient.Results: We found that bacterial diversity (Simpson index) and richness (Chao1) were lower in OAB samples compared to controls (P both = 0.038). OAB and control bacterial communities were significantly different (based on weighted UniFrac distance metric, R = 0.064, P = 0.037). LEfSe demonstrated that 7 genera were increased (e.g., Proteus and Aerococcus) and 13 were reduced (e.g., Lactobacillus and Prevotella) in OAB group compared to controls. There were negative correlations between scores on Self-Rating Depression Scale and both richness (Chao1, r = −0.458, P = 0.011) and diversity (Shannon index, r = −0.516, P = 0.003) of urinary microbiome in OAB group. Some bacterial genera of OAB women with anxiety or depression were significantly different from those without.Conclusions: The aberrant urinary microbiome with decreased diversity and richness may have strong implications in pathogenesis and treatment of OAB. Psychological conditions were correlated with characteristics of urinary microbiome in women with OAB. Further research is needed to understand the connection between central nervous system and urinary microbiome.

Functional Outcome of Completely Intracorporeal Robotic Ileal Ureteric Replacement

To assess perioperative, clinical, and functional outcomes following completely robotic ileal ureter. We retrospectively reviewed 7 consecutive patients undergoing completely intracorporeal ileal ureteric replacement between November 2015 and May 2017. One patient had a solitary kidney. A 4-arm technique was used. In 5 patients, additional psoas hitch procedure was performed. Patients had retrograde filling and removal of the ileal stent and transurethral catheter at an average of 14 days postoperatively. Renal ultrasonography, serum analysis, and diuretic renography were performed at follow-up 3 months postoperatively. Mean operative time was 328 ± 66.3 minutes and median estimated blood loss was 100 mL (range 50-200); mean length of the ileal substitute was 20.4 cm (range 18-24). No case was converted to open surgery. In 1 patient, there was a prolonged insufficiency of the pyeloileal anastomosis, requiring prolonged stenting. Apart from that, there were no major complications and no open surgical or endoscopic reinterventions. On 3-month follow-up, all patients presented symptom-free, with no signs of obstruction on ultrasound and significantly improved glomerular filtration rate, creatinine levels, and differential renal function (P = .02, 0.03, and 0.046, respectively). Five patients had a diuretic halftime <10 minutes, 2 had a halftime between 10 and 20 minutes. Completely intracorporeal robotic ileal ureteric replacement results in full functional restoration of the upper tract in cases of long defects of the mid and upper ureter.

Urinary microbiome and psychology in women with overactive bladder

Objective To characterize the female urinary microbiome associated to OAB (overactive bladder) and investigate relationships between urinary microbiome and psychological factors. Methods 30 women with OAB and 25 asymptomatic controls were recruited and required to finish the overactive bladder symptom score, self-rating anxiety scale, self-rating depression scale and quality of life questionaires. Urine specimens were collected by transurethral catheterization and processed for 16S rRNA gene sequencing. Sequencing reads were processed using QIIME. Analyses for bacterial genera biomarker was used LEfSe algorithms. Bivariate correlations were assessed using Pearson’s correlation. Results The two cohorts showed no significance difference in their demographic characteristics. OAB patients had significantly higher scores on overactive bladder symptom score, self-rating anxiety scale, self-rating depression scale and quality of life than controls (P<0.001). We found that bacterial diversity (Chao1 index: 1 854.09±1 239.34) and richness (Simpson index: 0.75±0.23) were decreased in OAB samples than those of controls (Chao1 index: 2 866.27±1 795.22; Simpson index: 0.86±0.12; P=0.02). At the family level, Enterobacteriaceae and (17.6% vs.8.1%; P=0.03) Bifidobacteriaceae (14.8% vs.3.6%; P=0.01) were significantly more abundant in the OAB samples than the controls. Compared to controls, 7 genera increased in OAB patients (e.g., Proteus and Aerococcus) and 13 reduced (e.g., Lactobacillus and Prevotella). There are negative correlations between scores on Self-Rating Depression Scale and both Chao1 (r=-0.458, P=0.011) and shannon indexes (r=-0.516, P=0.003) in OAB patients, which indicates that OAB patients with depression have further reductions in bacterial diversity and richness. Conclusions The aberrant urinary microbiome may serve as disease biomarkers and potential therapeutic targets of OAB. A negative correlation between depression scores and both bacterial richness and diversity in OAB patients indicated that there might be a connection between central nervous system and urinary microbiome. Key words: Overactive bladder; Urinary microbiome; Psychology

Management of Urinary Tract Infections in Children

Urinary Tract Infections (UTIs) are a common occurrence in paediatrics. UTIs present in children as fever, anorexia, vomiting, lethargy and dysuria. Approximately 80% of the time, Escherichia coli is the causative bacteria in paediatrics, however, fungal UTI caused by Candida species can occur in premature infants. With an estimated 150 million UTIs occurring worldwide annually, this paper aims to establish the ideal management of urinary tract infections in paediatrics. Clinical signs and symptoms of UTI in paediatrics are dependent on age of the child. Neonates (0–27 days old) present with sepsis, vomiting, fever, and prolonged jaundice, while school aged children present with symptoms similar to adults such as dysuria and urgency. Diagnosis of a UTI can be done by using a urine dipstick or using the midstream clean catch method in toilet trained children, and using the transurethral catheterisation or suprapubic aspiration method for infants and young children. In the wake of antibiotic resistance, choosing the best anti-microbial agent for treatment is imperative. Whilst asymptomatic bacteriuria does not require antibiotic treatment, amoxicillin and clavulanic acid combination, cephalexin, cefixime and cefpodoxime are the preferred oral antibiotics, provided there are no known allergies. Ceftriaxone, ampicillin, cefotaxime and gentamycin are the recommended parenteral antibiotics, provided age, allergic status and renal function are considered prior to use. Careful consideration needs to be given before using prophylaxis in UTIs and should be reserved for extreme cases.

Influence of nosocomial infections on activities of daily living in acute geriatric inpatients

Nursing home residents and older hospitalized patients have asignificantly higher risk to suffer from nosocomial infections (NI). It is still an unanswered question whether patients suffering from NI are at greater risk for deterioration of activities of daily living. In aretrospective observational study, we evaluated the prevalence of NI during hospitalization of acute geriatric inpatients of the geriatric department at Jena University Hospital by patient records. The study included data from 555 patients, hospitalized from 1August 2011 to 31August 2012. We included patients without acute complications and those who developed NI after the second day of hospitalization. Every third patient developed aNI during the observation period. Consequently, the incidence of NI was approximately 18patients with NI per 1000 days of hospitalization. This rate was considerably higher than the national average. The most frequent NIs were urinary tract infection, gastroenteritis and infections of the lower respiratory tract. Alow value of Barthel index at admission, high multimorbidity index and transurethral indwelling catheters promoted the development of NI. An improvement in activities of daily living, assessed by mean values of the difference in the Barthel index, was significantly lower in patients who developed NI (mean value14.5± 16.3) than in patients who did not (mean value 18.1± 14.8). Nosocomial infections were arelevant factor for deterioration of the Barthel Index, at least temporarily and NIs, in particular the combination of several NIs, jeopardized an improvement in the activities of daily living. This was particularly true for infections of the lower respiratory tract and gastroenteritis.

Резистентность уропатогенов к антибактериальным препаратам у пациентов с острым обструктивным пиелонефритом

Acute pyelonephritis is known to be the most complicated and severe urinary tract infection occurring in all age groups and accounting for 14% of all kidney diseases. The generally recognized standard antibiotic therapy cannot completely prevent the progression of the disease to its chronic form after relief of its acute manifestations thus leading to a high incidence of relapses. The aim of our study was to investigate the spectrum of uropathogens and their antibiotic sensitivity in acute obstructive pyelonephritis. The study comprised 72 patients who underwent semi-rigid ureteroscopy and ultrasonic lithotripsy for ureteral stones. In all patients, bladder urine samples collected by a transurethral catheter were tested bacteriologically using an extended set of culture media within 3 hours after hospital admission. Antibiotics used in antibiotic sensitivity testing for all uropathogens, were grouped into 4 classes (carbapenems, fluoroquinolones, cephalosporins, penicillins). Etiotropic treatment was started upon the availability of the spectrum of microbial patterns, the level of bacteriuria and antibioticogram of uropathogens, 5-6 days after administering initial empirical antibiotic therapy. The study patients had a high detection rate (83.3%) of canonical uropathogens in the bladder urine identified due to using an extended set of culture media, with a bacteriuria of more or equal 103 CFU/mL. Given the results of local antibiograms, a rational antimicrobial therapy should include carbapenems, namely ertapenem or meropenem as initial empirical antibiotics. Using fluoroquinolones as the first line treatment can lead to an inadequate effect in 15.0 to 67.0% of the cases. The findings of the antibiotic resistance testing of uropathogens to cephalosporins and semisynthetic penicillins showed that they should not be used as initial empirical antibiotic therapy for acute obstructive pyelonephritis in the given department of urology.

Lidocaine Gel for Urethral Catheterization in Children: A Meta-Analysis

To compare the efficacy and safety of lidocaine gel vs nonanesthetic gel (NAG) in reducing transurethral bladder catheterization (TUBC) procedural pain in children. A systematic literature search was done using electronic medical databases and trial registries up to September 2016 with no language restrictions. Randomized controlled trials (RCTs) that assessed the efficacy and safety of lidocaine gel vs NAG in reducing TUBC-associated pain in children were screened, identified, and appraised. Risks of bias and study quality of the eligible trials were assessed according to the Cochrane Collaboration recommendations. Various pain assessment scales from the included studies were extracted as mean differences and standard deviations for each treatment group. Standardized mean differences (SMDs) were generated with 95% CIs for between-group difference estimation. Effect estimates were pooled using the inverse variance method with a random-effects model. Subgroup analysis was performed for different age groups. Five RCTs (with a total of 369 children) were included. Overall pooled effect estimates showed that compared with NAG, lidocaine gel has no significant benefit in decreasing TUBC-associated pain in children (SMD, -0.22; 95% CI, -0.65 to 0.21). Effect estimates from 4 studies revealed no difference in pain reduction between the lidocaine gel and NAG in children aged <4 years (SMD, 0.01; 95% CI, -0.22 to 0.24). No serious adverse events from the lidocaine gel use were reported in any of the studies. Lidocaine gel does not appear to reduce TUBC pain compared with NAG, specifically in children aged <4 years. CRD42016050018.

Surgical Repair of Rectovaginal Fistula Using the Modified Martius Procedure: A Step-by-Step Guide

Study ObjectiveTo demonstrate the surgical repair of a rectovaginal fistula (RVF) using the modified Martius procedure. DesignA step-by-step presentation of the procedure using video (Canadian Task Force classification III). SettingRVF is abnormal epithelialized connections between the vagina and rectum. Causes of RVF include obstetric trauma, Crohn disease, pelvic irradiation, and postsurgical complications. Many surgical interventions have been developed, from the laparoscopic technique to muscle transposition and even rectal resection. However, the treatment of RVF is a great challenge to gynecologic surgeons because the incidence of RVF is low and there is no high evidence for the best surgical approach to this disease. When RVF is persistent or recurrent, the surrounding tissue is always scarred or damaged, so the interposition of a healthy and well-perfused tissue is an appropriate approach to fistula management. The modified Martius procedure using adipose tissue from the labia major places well-vascularized pedicle in the place of the RVF. Limited studies involving the procedure present favorable successful rates. PatientConsent was obtained from the patient. The study was approved by the local ethics committee. InterventionThe surgical repair of rectovaginal fistula by the modified Martius procedure is described as follows: The patient is placed in the high lithotomy position. A temporary transurethral urinary catheter is placed preoperatively to keep the operative site clean. The rectovaginal fistula is identified by a fistula probe. A 4-cm incision is made vertically over the left labium majus from the level of the mons pubis to the bottom of the labium to harvest pedicle. It is imperative to ensure adequate length on the flap before transection. Blood supply to the fat-muscle flap is provided superiorly by the external pudendal artery, posteriorly by the internal posterior and laterally by the obturator artery. The fat-muscle flap is dissected in a lateral-to-medial direction and divided in the upper section by two clamps, preserving its posterior aspect intact to maintain its blood supply. After that the fistula is circumcised with a scalpel through the vaginal wall with a margin of healthy tissue. During the process, the rectovaginal septum is opened and wide mobilized so that a multilayer closure can be performed without any tension. Then a subcutaneous tunnel is made from the labium majus to the fistula with a forcep. It is also important to make the tunnel wide enough to easily accommodate the flap. The fat-muscle flap is pulled through the tunnel gently, ensuring proper orientation without kinking the blood supply. The rectal mucosa is sutured in one layer with 3-0 Vicryl in interrupted fashion. The flap is then sutured down to the rectal wall with four single sutures in interrupted fashion. So the rectal and vaginal walls are separated with a healthy, well-vascularized pedicle. In addition, the flap fills in the dead space and enhances granulation tissue. The vaginal mucosa is then closed over the pedicle with 1-0 Vicryl in interrupted suture without tension. The labial incision is closed in layers with absorbable suture. Neither incision is drained. Measurements and Main ResultsIn this video, we describe the modified Martius procedure for the management of RVF. We present a 26-year-old woman who suffered from RVF caused by obstetric trauma. She complained of passing flatus and feces through the vagina 1 week after vaginal delivery. Clinical examination performed in the local hospital confirmed RVF 1 cm in diameter located in the lower third of the vagina. The fistula was present for about 6 months, which brought psychosocial dysfunction to the patient. She was transferred to our clinic. After examination, the anal sphincter was intact. After mechanical bowel preparation with polyethylene glycol solution, the patient was presented for surgery. The operating time was about 40 minutes. No recurrence or complications were observed at the 4-month follow-up. A protective ileostomy or colostomy was avoided. The patient reestablished intestinal continuity. The functional and cosmetic results were excellent with high patient satisfaction and greatly improved quality of life. ConclusionThe Martius flap is easy to harvest with minimal external disfigurement and a minimal recovery time. The modified Martius procedure is a feasible adjuvant technique for RVF with excellent postoperative outcomes.