Indwelling Transurethral Catheter Research Articles

Cost Analysis of Bladder Catheterization After Pelvic Floor Surgery.

Approximately 15-45% of female patients develop transient postoperative urinary retention (POUR) following pelvic reconstructive surgery. Catheter options for bladder drainage include transurethral indwelling catheter (TIC), intermittent self-catheterization (ISC), and suprapubic tube (SPT). Each strategy has risks and benefits; none have been shown to be clinically superior, and to date, no comprehensive comparative economic analysis has been published. The objective of this study was to evaluate the cost of these different bladder catheterization strategies after transvaginal pelvic surgery. A Canadian universal single-payer (government funded) health system perspective was taken, and a decision tree model was constructed to evaluate the costs associated with each catheterization strategy over a 6-week horizon. Base-cases were set based on recently published clinical data of our institutions, 2 academic tertiary care centers, and based on systematic reviews and meta-analyses. Costs were established in consultation with process stakeholders, in addition to published values. The average cost calculated for management of transient POUR after outpatient pelvic reconstructive surgery was 150.69 CAD (median 154.86; interquartile range [IQR] 131.30-176.33) for TIC, 162.28 CAD (median 164.72; IQR 144.36-189.39) for ISC and 255.67 CAD (median 270.63; IQR 234.32-276.82) for SPT. In costing inpatient surgical data, the average cost calculated was 134.22 CAD (median 123.61; IQR 108.87-151.85) for TIC and 224.61 CAD (median 216.07; IQR 203.86-231.23) for SPT. TIC and ISC were found to be significantly less costly than SPT in managing transient POUR following transvaginal pelvic reconstructive surgery.

Short and Intermediate-Term Outcome of Robot-Assisted Inverted YV-Plasty for Recurrent Bladder Neck Stenosis - a Single Centre Study

ObjectiveTo report the technique and preliminary results for extraperitoneal robot-assisted laparoscopic YV-plasty (RAYV) for refractory bladder neck stenosis (BNS) and vesicoureteral anastomosis stenosis (VUAS). Materials and methodsIncluded were patients with recurrent BNS and VUAS who underwent RAYV at our institution. Primary outcome was short and intermediate-term functional results measured with urinary peak flow (Qmax), post-void residual urine (PVR) as well as quality of life assessment with the international prostate symptom score (IPSS) and short form health survey (SF-8). Short- and intermediate-term follow-up periods were defined as 1-6 months and 6-24 months, respectively. Secondary, all patients were reviewed for etiology as well as perioperative data. Treatment success was defined by absence of further treatment and/or need for intermittent or permanent catheterization. ResultsBetween March 2016 and October 2020 a total of 30 patients with a median age of 70.8 (64-77) years underwent RAYV with a median follow-up of 27 months. Median operative time (skin-skin) was 131 (112-145) minutes. The transurethral indwelling catheter was removed after 10 (5 – 16) days. There were no intraoperative complications but 2 postoperative major complications Clavien-Dindo IIIa and IV, respectively. Short- and intermediate-term results revealed significant improvement of IPS score from 17 (11-24) points to 11 (6-13) points and 6 (3-9) points, respectively. Further PVR decreased from 90 (5-302) mL to 0 (0-30) mL and 0 (0-90) mL, respectively, and Qmax increased from 7.4 mL/s to 13 (8-16) mL/s and 17 (12-4) mL/s, respectively. Improvement of SF-8 did not reach significance. A total of 5/30 (16.7%) patients had a treatment failure after 24 months whereof 2 had a re-stricture. ConclusionRAVY-Plasty for recurrent bladder neck stenosis is a safe and effective procedure with good functional short- and intermediate-term outcome.

Efficacy, safety, and perioperative outcomes of holmium laser enucleation of the prostate\u2014a comparison of patients with lower urinary tract symptoms and urinary retention

Holmium laser enucleation of the prostate (HoLEP) is a valid treatment option to relieve bladder outlet obstruction in patients with large prostate volumes (PV). Its efficacy, tolerability, and safety are comparable to the ones of other laser treatments of the prostate and resection techniques. However, safety and efficacy of HoLEP have not been compared between patients with and without preoperative urinary retention. We included 350 patients (mean age 71.2 years) who had undergone HoLEP due to lower urinary tract symptoms (LUTS) or urinary retention caused by prostatic hyperplasia. We evaluated the differences in peri- and postoperative outcomes and complications between patients with and patients without preoperative urinary retention. The mean PV was 115 cm3. PV was > 100 cm3 in 61.9% and < 100 cm3 in 38.1% of the patients. Perioperative complications occurred in 23 patients (6.6%), 15 of which (4.3%) required operative revision. We found no significant differences in terms of complication rates between patients with PV > 100 cm3 and patients with PV < 100 cm3. Mean catheterization-duration was 3.3 days. Preoperatively, 140 patients (40%) had a suprapubic or transurethral indwelling catheter; they did not differ from patients without preoperative catheter regarding postoperative catheter removal success rate, early postoperative complications, and functional outcomes. Prostate cancer was diagnosed in 43 patients (12.3%). Median postoperative PSA-decline was 6.1 ug/l (89.8% drop). HoLEP is a safe and effective treatment for patients with LUTS or urinary retention and large PV. PV > 100 cm3 was not associated with higher complication rates or successful catheter-removal. Furthermore, functional outcomes were independent of preoperative catheterization.

Optimal timing of a second postoperative voiding trial in women with incomplete bladder emptying after vaginal reconstructive surgery: a randomized trial

Rates of postoperative incomplete bladder emptying vary significantly after pelvic reconstructive surgery. With enhanced recovery protocols the paradigm is shifting towards same-day discharge and the rates of incomplete bladder emptying are expected to increase. The optimal length of time for postoperative catheter drainage has not been clearly established. There are no current studies that assess the optimal timing of a repeat voiding trial in women who have unsuccessful same day voiding trials. This study aimed to compare the outcomes of a second voiding trial performed 2-4 days (earlier group) vs 7 days (later group) postoperatively in women with incomplete bladder emptying after vaginal prolapse surgery. Secondary aims included postoperative urinary tract infection rates, total days with a catheter, and patient-reported catheter bother between groups. Across 2 sites, women undergoing multicompartment vaginal repair were enrolled. Within 6 hours postoperatively, subjects had an active retrograde voiding trial. Those who passed this voiding trial exited the study; those who had persistent incomplete bladder emptying (postvoid residual >100 mL) had a transurethral indwelling catheter placed and were randomized to return for an earlier (postoperative day 2-4) vs later (postoperative day 7) follow-up office voiding trial. Subjects were followed for 6 weeks after surgery. The primary outcome was the rate of unsuccessful repeat office voiding trial. Secondary outcomes included rates of urinary tract infection, total days with a catheter, and subjective catheter bother. A power calculation based on a projected 31% difference, a power of 0.8, and an alpha of 0.05 revealed that 30 subjects were needed in each group. A total of 102 subjects were enrolled; 38 exited on postoperative day 0, leaving 64 subjects for randomization (4 of whom withdrew after randomization). A comparison of data revealed that randomization was effective, with no differences between the earlier and later groups in terms of demographic data or surgical procedures. Using an intention-to-treat analysis, women in the earlier group were more likely to be unsuccessful in their follow-up office voiding trial (23.3%) than the later group (3.3%), with a risk difference of 20% (95% confidence interval, 3.56-36.44) and a relative risk of 7.00 (95% confidence interval, 0.92-53.47; P=.02). A number-needed-to-treat calculation found that for every 5 patients using a catheter for 7 days postoperatively, 1 case of persistent postoperative incomplete bladder emptying was prevented. Rates of catheter bother did not differ between groups at the time of the follow-up office voiding trial or at 6 weeks (P=.09 and P=.20, respectively). Urinary tract infection rates were higher in the earlier group but did not reach statistical significance (23% vs 7%, P=.07). Regression analysis revealed that subjects who required additional pain medication refills were 9.6 times (95% confidence interval, 1.24-73.77) more likely to have persistent incomplete bladder emptying after the follow-up office voiding trial. Women with incomplete bladder emptying after multicompartment prolapse repair had a 7-fold higher risk of an unsuccessful repeat office voiding trial if performed within 4 days of surgery than when performed within 7 days of surgery. In addition, requiring additional prescriptions for analgesia increased the risk of an unsuccessful follow-up office voiding trial.

The role of clean intermittent catheterization in rehabilitation setting: a survey of healthcare operators' perception in Italy.

Clean intermittent catheterization (CIC) is defined as the repetitive temporary placement of a catheter to empty the bladder. It has become the first-line and preferred method of drainage in patients with neurogenic lower urinary tract dysfunction. We investigated the use of CIC in the real-life setting in Italy. We administered interviews to health operators of centers for urinary rehabilitation. Overall, 110 healthcare professionals were invited to fill the questionnaire and 109 (72% males) answered it. Answers to the questionnaire showed that 65.2% of patients with urinary retention used CIC, 22.3% used a transurethral indwelling catheter, and 5.5% used a suprapubic catheter; 6.3% of patients used CIC during the daytime and used the indwelling catheter during the night. The most relevant factor, pertaining the patient, to decide to propose the use of CIC was manual ability, followed by good cognitive function, adequate anatomical condition, age, available adequate caregiver, psychological consistency and good socio-cultural level. Lubrification, usability and easy insertion were the most relevant characteristics of a catheter that favored the choice of the device for CIC. In addition, in the opinion of interviewed operators, the line of catheters with glycerin-water based lubrification had the main characteristics to be preferred for CIC. CIC is a preferential intervention for urinary retention in the clinical practice in Italy, is chosen on the basis of patient's characteristics, and lubrification, usability and easy insertion are the most important features of catheters.

MP41-11 OUTCOMES AND TECHNIQUE FOR EXTRAPERITONEAL ROBOTIC YV-PLASTY FOR RECURRENT BLADDER NECK STENOSIS

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Ureter (including Pyeloplasty) and Bladder Reconstruction (including fistula), Augmentation, Substitution, Diversion I (MP41)1 Apr 2020MP41-11 OUTCOMES AND TECHNIQUE FOR EXTRAPERITONEAL ROBOTIC YV-PLASTY FOR RECURRENT BLADDER NECK STENOSIS Nadim Abo Youssef, Fabian Obrecht*, Jan Brachlow, Christian Padevit, and Hubert John Nadim Abo YoussefNadim Abo Youssef More articles by this author , Fabian Obrecht*Fabian Obrecht* More articles by this author , Jan BrachlowJan Brachlow More articles by this author , Christian PadevitChristian Padevit More articles by this author , and Hubert JohnHubert John More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000890.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To demonstrate the outcomes and the technique of robot assisted Y-V (RAYV) plasty bladder neck reconstruction with preferable extraperitoneal approach for recurrent bladder neck stenosis (BNS). METHODS: We present our results and the technique of 22 patients who underwent RAYV March 2016 to July 2019 in our department. 22 cases of BNS emerged after transurethral resection of the prostate. The indications were residual volume, dysuria and attenuated urinary stream. Following an extraperitoneal approach with a three arm Da Vinci Si system, the perivesical space is cleaned. The bladder neck is located and the ventral part of the prostate is exposed. An anterior longitudinal incision is performed starting from the bladder neck over the ventral vesico-prostatic junction down through the stenotic area to the external sphincter. The incision is enlarged to an inverted Y-shaped opening and an indwelling catheter is inserted. The tip of the V-shaped bladder flap is brought to the base of the inverted Y and closed with a running barbed suture. RESULTS: 22 patients with BNS underwent RAYV (table 1). All patients had undergone at least 2 transurethral procedures for the initial treatment. No conversion to open surgery had to be performed. The median operative time (skin to skin) was 133 min (range 69-180), the estimated blood loss was median of 5 (range 0-200) ml. There were no intraoperative and four patients with Clavien Dindo III as postoperative complications. The transurethral indwelling catheter was removed after 8 (4-25) days. The hospitalization period was median 5 (3-14) days, as patients preferred to leave the hospital without an indwelling catheter. Most of the patients showed six weeks postoperative a significant improvement of dysuria and residual volume as well as an increasing uroflowmetry (table 2). There was no recurrence of BNS with a median follow-up of 19.4 (2-42) months. CONCLUSIONS: The extraperitoneal robotic YV-plasty is a feasible and minimally invasive approach for recurrent bladder neck stenosis. Still, long-term results must confirm the efficacy in the future. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e598-e599 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nadim Abo Youssef More articles by this author Fabian Obrecht* More articles by this author Jan Brachlow More articles by this author Christian Padevit More articles by this author Hubert John More articles by this author Expand All Advertisement PDF downloadLoading ...

Indwelling Versus Immediate Removal of Transurethral Catheter After Robotic Sacrocolpopexy: A Randomized Clinical Trial.

This study evaluates the necessity and effect of an indwelling transurethral catheter in the early postoperative period following a robotic-assisted laparoscopic sacrocolpopexy. This was a randomized clinical trial of patients who underwent a robotic sacrocolpopexy for pelvic organ prolapse. Patients were randomized to have their transurethral catheter removed 6 hours postoperative (intervention group) or the morning following surgery (control group). Our primary outcome was to compare the number of patients diagnosed with postoperative incomplete bladder empyting in each group. A sample size of 36 patients per group was needed to detect a 25% difference between the 2 groups. Anticipating a 20% patient withdrawal rate, we estimated that we would need a total of 88 participants. Outcome variable was analyzed using χ test, Fisher exact test, Mann-Whitney U test, 2-proportions test, and 2-sample t test. From December 2015 through May 2017, 88 women were randomized and analyzed: 44 in the intervention group and 44 in the control group. Women in the intervention group were more likely to be diagnosed with incomplete bladder emptying, 14 (31%) of 44, compared with the control group, 2 (4.5%) of 44, P <0.001. Rate of urinary tract infections within the 30-day postoperative period was also increased in the intervention group, 4 (9%) of 44, compared with 0 in the control group. Postoperative complications were similar between groups. In women undergoing a robotic sacrocolpopexy, early transurethral catheter removal (6 hours postoperative) is associated with an increased rate of incomplete bladder emptying, recatheterization, and urinary tract infections.

Is there a place for indwelling transurethral catheterization in women with febrile urinary tract infection? A prospective randomized trial.

To assess the common practice to transiently place an indwelling transurethral catheter in case of hospitalization of women with febrile urinary tract infections. So far, this intervention has not been scientifically investigated. Inclusion criteria were female gender, a leucocyte esterase-positive urine dipstick analysis (≥ 250) from urine obtained with a catheter and fever > 38°C. Patients were randomized 1:1 to either receive an indwelling catheter French 16 or not. The catheter was removed after 24h without fever (< 37.5°C). Principal exclusion criteria were a post void residual volume exceeding 50mL or abnormalities of the urinary tract. Hospital stay and fever in days, the amount of analgetic medication needed and the laboratory parameters WBC and CRP-measured on the day of admission and in predefined intervals thereafter-were study endpoints. 75 patients were included in the final analysis, 36 in the catheter group and 39 in the no-catheter group. Mean age was 39.4 ± 17.7years and 39.8 ± 15.5years, respectively (p > 0.05). The mean length of catheterisation was 3.6 ± 1.6days in the catheter group. There were no differences between the two groups regarding duration of hospitalization and fever, or the amount of analgetic medication needed (all p > 0.05). Additionally, there was no difference in time to WBC < 10G/L or CRP < 100mg/L (all p > 0.05). This prospective, randomized trial provides no evidence to support routine insertion of an indwelling catheter in women with febrile urinary tract infection requiring hospital admission.

Evaluation of meloxicam for the treatment of obstructive feline idiopathic cystitis.

Objectives The aim of the study was to investigate the effect of the non-steroidal anti-inflammatory drug meloxicam on the clinical course of obstructive idiopathic cystitis in cats in a placebo-controlled clinical study. Methods Thirty-seven cats with obstructive idiopathic cystitis were enrolled. Cats received supportive treatment and an indwelling transurethral catheter for 48 h. On days 0 and 1, all cats received buprenorphine 0.01 mg/kg subcutaneously every 8 h. On day 1, cats were randomly assigned to the meloxicam (n = 18) or placebo group (n = 19) and received meloxicam (0.1 mg/kg on day 1, 0.05 mg/kg on days 2-5) or placebo orally for five consecutive days. Cats were monitored by repeated physical examinations and urinalysis, and with a 5 day questionnaire filled in by the owners after discharge and a telephone interview 3 months after presentation. Parameters for evaluation of treatment success were the occurrence of recurrent urethral obstruction, results of physical examinations and questionnaires. Results Recurrent urethral obstruction occurred in 4/18 cats (22%) in the meloxicam group and 5/19 cats (26%) in the placebo group ( P = 1.000). General demeanour and pain on abdominal palpation during hospitalisation improved significantly in both groups ( P <0.001). After discharge, with regard to general demeanour, food intake and voiding behaviour, there were no significant differences within or between groups at different time points. Conclusions and relevance Orally administered meloxicam for 5 days did not influence the incidence of recurrent urethral obstruction and the recovery from clinical signs in cats with obstructive feline idiopathic cystitis. The persistence of clinical signs in most of the cats 1 week after initial presentation indicates that symptomatic treatment for a longer period of time is warranted.

Incidence, Cost, Complications and Clinical Outcomes of Iatrogenic Urethral Catheterization Injuries: A Prospective Multi-Institutional Study

Data on urethral catheter related injuries are sparse. To highlight the dangers inherent in traumatic urethral catheterization we prospectively monitored the incidence, cost and clinical outcomes of urethral catheter related injuries. This prospective study was performed during a 6-month period at 2 tertiary referral teaching hospitals. Recorded data included method and extent of urethral catheterization injury, setting and time of injury, number of catheterization attempts, urological management provided, additional bed days due to urethral injury and clinical outcomes after followup. The additional cost of managing urethral injuries was also calculated. A total of 37 iatrogenic urethral injuries were recorded during the 6-month period. The incidence of traumatic urethral catheterization was 6.7 per 1,000 catheters inserted. Thirty (81%) patients sustained a complication Clavien-Dindo grade 2 or greater. The additional length of inpatient hospital stay was 9.4± 10 days (range 2 to 53). Of these patients 9 (24%) required an indwelling suprapubic catheter and 8 (21%) have an indwelling transurethral catheter. In addition, 9 (24%) are performing self-urethral dilation once weekly and 4 (11%) have required at least 1 urethral dilation due to persistent urethral stricture disease. The additional cost of managing iatrogenic urethral injuries was €335,377 ($371,790). Iatrogenic urethral catheterization injuries represent a significant cost and cause of patient morbidity. Despite efforts to educate and train health care professionals on urethral catheterization insertion technique, iatrogenic urethral injuries will continue to occur unless urinary catheter safety mechanics are altered and improved.

Single-dose piperacillin/tazobactam as prophylaxis in transrectal prostate biopsy

BackgroundThe increasing resistance to quinolones has led to the consideration of other antibiotic options for the prevention of infectious complications in prostate biopsy. We present our experience using a single dose of piperacillin/tazobactam as prophylaxis. MethodsA retrospective study of transrectal prostate biopsies performed at our institution from 2008 to 2013 was conducted. All patients received enemas before biopsy and a single 4.5g dose of piperacillin/tazobactam was administered i.v. a few minutes before the biopsy. Clinical and microbiological variables were analyzed to find out risk factors for complications. ResultsA total of 543 biopsies were included. Ninety-two complications (16.9%) were reported in 74 (13.6%) patients, 4.2% of which were infectious complications. In these patients, the associated risk factors were a previous history of positive urine cultures within a 3-year period before biopsy, the presence of a transurethral indwelling catheter at the time of the biopsy, hospital admission within a month before biopsy, and a preoperative positive urine culture despite antibiotic therapy selected according to the resistance pattern. ConclusionsPhysicians and patients should be aware of the risk for complications, particularly if risk factors are present. A single dose of piperacillin/tazobactam is a reasonable option for prophylaxis, especially in countries with a high prevalence of quinolone-resistant pathogens.

Duration of transurethral indwelling catheter (TIC) following vaginal prolapse surgery

DOI: <a href="http://dx.doi.org/10.4038/sljog.v34i1.4820">http://dx.doi.org/10.4038/sljog.v34i1.4820</a> <em>Sri Lanka Journal of Obstetrics and Gynaecology </em>2012; <strong>34</strong>: 25-26

Algorithmus zur Behandlung von Anastomoseninsuffizienzen nach laparoskopischer Prostatektomie

Laparoscopic (transperitoneal) radical prostatectomy is a standard procedure for surgical management of locally advanced prostate cancer. Disagreement still prevails over how long the catheter should remain in place and whether cystography is indicated before catheter removal. Until recovery, the urine is drained through a transurethral indwelling catheter. Serious complications due to anastomotic leakage could be avoided in our patient cohort by applying the algorithm presented.

Effects of thoracic epidural analgesia on lower urinary tract function in women

The need for an indwelling transurethral catheter in patients with postoperative thoracic epidural analgesia (TEA) is a matter of controversy. Subjective observations are ambivalent and the literature addressing this issue is scarce. As segmental blockade can be achieved with epidural analgesia, we hypothesized that analgesia within segments T4-T11 has no or minimal influence on lower urinary tract function. Thus, we evaluated the effect of TEA on lower urinary tract function by urodynamic studies. In 13 women with no preoperative lower urinary tract symptoms undergoing open kidney surgery by lumbotomy under TEA, we prospectively assessed changes in urodynamic parameters the day before and 2-3 days after surgery with the patients under TEA. Before versus during TEA, there was a significant increase in postvoid residual (median, 5 ml vs. 220 ml, P<0.001) and a significant decrease in maximum detrusor pressure (median, 23 cmH(2) O vs. 5 cmH(2) O, P=0.001), detrusor pressure at maximum flow rate (median, 18 cmH(2) O vs. 5 cmH(2) O, P=0.001), maximum flow rate (median, 12 ml/sec vs. 3 ml/sec, P<0.001), and voided volume (median, 250 ml vs. 40 ml, P<0.001). In addition, maximum urethral closure pressure at rest decreased significantly under TEA from median 75 cmH(2) O to 56 cmH(2) O (P=0.002). Bladder sensation, maximum cystometric capacity, compliance, and functional profile length at rest were not influenced by TEA. TEA has a significant effect on bladder emptying with clinically relevant postvoid residual (PVR) necessitating (indwelling or intermittent) catheterization or monitoring of PVR.

Serum early prostate cancer antigen (EPCA) as a significant predictor of incidental prostate cancer in patients undergoing transurethral resection of the prostate for benign prostatic hyperplasia

Early prostate cancer antigen (EPCA), a nuclear matrix protein, has been recently suggested as a novel biomarker in malignant lesions of the prostate. This study was to determine whether preoperative serum EPCA levels predicted the presence of incidental prostate cancer (IPCa) in patients undergoing TURP for BPH. Serum EPCA levels were measured by ELISA in 449 consecutive patients with symptomatic BPH treated with TURP and 112 healthy men. Predictive performance of serum EPCA levels for IPCa were evaluated. With a cutoff of 10ng/ml, serum EPCA protein had a 100% specificity for the healthy men and a 98% specificity and a 100% sensitivity in separating men with IPCa from those without. Serum EPCA levels in patients with IPCa were significantly higher than in those without and in healthy controls (17.63±2.42ng/ml vs. 5.58±1.61 ng/ml and 4.95±1.43 ng/ml, all P<0.001), whereas an indwelling transurethral catheter presence and 5α-reductase inhibitor therapy had no effect on EPCA levels (P=0.144 and P=0.238, respectively). The area under ROC curves (AUC) showed that serum EPCA level had the best predictive accuracy of all IPCa (AUC: 0.952, 95% CI: 0.912-0.981, P<0.001). Univariate and multivariate Cox regression analyses further demonstrated the independently predictive performance by preoperative serum EPCA (Hazards Ratio: 4.23, 95% CI: 3.62-6.46, P<0.001). This study firstly shows that EPCA might be used as a highly sensitive and specific serum biomarker to predict IPCa presence and to help reduce the unnecessary biopsies taken before TURP in patients with BPH.

1534 EFFECTS OF THORACIC EPIDURAL ANALGESIA ON LOWER URINARY TRACT FUNCTION

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Non-Neurogenic Voiding Dysfunction I1 Apr 20101534 EFFECTS OF THORACIC EPIDURAL ANALGESIA ON LOWER URINARY TRACT FUNCTION Thomas M. Kessler, Patrick Y. Wuethrich, Bernhard Kiss, and Fiona C. Burkhard Thomas M. KesslerThomas M. Kessler More articles by this author , Patrick Y. WuethrichPatrick Y. Wuethrich More articles by this author , Bernhard KissBernhard Kiss More articles by this author , and Fiona C. BurkhardFiona C. Burkhard More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1285AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The need for an indwelling transurethral catheter in patients with postoperative thoracic epidural analgesia (TEA) is a matter of controversy. Since segmental blockade can be achieved with epidural analgesia, we hypothesized that analgesia within segments T4 to T11 should have no or minimal influence on lower urinary tract function. Here we evaluated the effect of TEA on lower urinary tract function by urodynamic studies. METHODS In 26 patients (13 women, 13 men) with no preoperative lower urinary tract symptoms undergoing open kidney surgery by lumbotomy under TEA, we prospectively assessed changes in urodynamic parameters the day before and 2-3 days after surgery with the patients under TEA. RESULTS Before versus during TEA, there was a significant increase in post void residual (median, 30 mL versus 275 mL, p<0.001) and a significant decrease in maximum detrusor pressure (median, 31 cmH2O versus 22 cmH2O, p<0.001), detrusor pressure at maximum flow rate (median, 27 cmH2O versus 9 cmH2O, p<0.001), maximum flow rate (median, 14 mL/s versus 3 mL/s, p<0.001), and voided volume (median, 340 mL versus 65 mL, p<0.001). Bladder sensation, maximum cystometric capacity, and compliance were not influenced by TEA (p>0.1). CONCLUSIONS In contrast to our initial hypothesis, TEA has a significant effect on bladder emptying with clinically relevant post void residual necessitating catheterization. Bern, Switzerland© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e592 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Thomas M. Kessler More articles by this author Patrick Y. Wuethrich More articles by this author Bernhard Kiss More articles by this author Fiona C. Burkhard More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Thulium:yttrium‐aluminium‐garnet laser prostatectomy in men with refractory urinary retention

To evaluate the feasibility and efficacy of thulium:yttrium-aluminium-garnet (YAG) laser prostatectomy in patients with an indwelling transurethral catheter due to recurrent urinary retention secondary to benign prostatic obstruction. Preoperative data and postoperative outcome, as well as complications, were recorded in 65 patients with a history of recurrent urinary retention before surgery (group A), who were compared with a group of 143 men with no recurrent urinary retention (group B). The mean (sd) volume of the prostate was 45.6 (22.5) and 43.1 (24.5) mL in groups A and B, respectively. The respective preoperative prostate-specific antigen levels were 3.6 (7.8) and 2.8 (6.4) ng/mL, the surgical duration 72.4 (28.9) and 65.6 (28.6) min, the mean laser time and energy 32.5 (11.8) min/140.7 (42.1) kJ and 29.4 (11.6) min/117.6 (11.6) kJ, the maximum urinary flow rate after surgery 19.6 (11.2) and 19.1 (9.6) mL/s, and the postvoid residual urine volume 26.7 (36.3) and 20.6 (27.3) mL. Recorded complications were: bleeding, at 3% in group A and 1.4% in group B; urinary tract infection 15.4% and 4.2%; and a second procedure, 3% and 2.3%. Overall, complications were more frequent in group A (P = 0.02). Thulium:YAG prostatectomy is feasible and effective, even in patients with potentially impaired detrusor function. The long-term durability of these promising results has yet to be confirmed.

Derivatives of prostate‐specific antigen as predictors of incidental prostate cancer

OBJECTIVE To search for an optimal derivative of prostate-specific antigen (PSA) identifying patients at risk of incidental prostate cancer. PATIENTS AND METHODS In all, 693 patients who underwent transurethral resection of the prostate (TURP) with a normal digital rectal examination, no history of prostate cancer and a PSA level of 2.5-10 ng/mL were studied. The total PSA (tPSA), percentage of free/total PSA (%fPSA), complexed PSA (cPSA), PSA density, cPSA density and the ratio of fPSA to cPSA were measured. Specificity, sensitivity, positive and negative predictive values were determined for all possible threshold values indicating the risk of incidental prostate cancer (T1a or T1b). Furthermore, the patients were subdivided according to age and the presence of an indwelling transurethral catheter. The areas under the receiver operating characteristic curves (AUC) were compared. RESULTS In the whole sample, the %fPSA was the best test predicting all incidental prostate cancers (AUC 0.618, reference: tPSA 0.494), whereas cPSA density was the best predictor of T1b disease (AUC 0.720, reference: tPSA 0.548). Stratification by age did not meaningfully alter the results, the presence of a transurethral catheter, however, was associated with a superiority of tests based on fPSA (AUC 0.620-0.670) compared with tests based on tPSA or cPSA (AUC 0.421-0.581). CONCLUSION Replacing tPSA by PSA derivatives (%fPSA or cPSA density) and stratifying by the presence of an indwelling transurethral catheter may improve the prediction of the risk of incidental prostate cancer and spare unnecessary biopsies before TURP in the tPSA range 2.5-10 ng/mL.

Dribbling Diversion in Y‐V Glanuloplasty Modified Mathieu Repair

Aim of the study was to determine the impact of an indwelling transurethral catheter on surgical outcome and postoperative micturation in Y-V glanuloplasty modified Mathieu repair for primary hypospadias. Fifty-nine consecutive boys underwent Y-V glanuloplasty modified Mathieu repair for primary distal hypospadias in our institution. The first 37 patients (group A) had catheterless repair. Due to significant painful postoperative urination, the next 22 children (group B) had an indwelling transurethral catheter (5 Fr feeding tube) for 24-48 hours. Adjunct caudal analgesia and penile block was given in both groups. Pain during postoperative voiding, urinary retention, meatal stenosis and fistula formation was statistically analysed with Wilcoxon's signed rank test. All patients in group A had distressing painful first micturation (p < 0.05). Eight children did not pass urine for more than 8 hours. Five (13.5 %) patients had urinary retention, 3 of whom required catheterisation (p < 0.05). Six (16 %) boys developed meatal stenosis and a further 5 (13.5 %) had urethrocutaneous fistula. In group B all patients had easy micturation after removal of the catheter. Only 1 boy developed a urethrocutaneous fistula and none of the boys in this group presented with meatal stenosis. An indwelling transurethral catheter obviates urinary retention and avoids distressing postoperative micturation. It minimises the chance of urethrocutaneous fistula and meatal stenosis in Y-V glanuloplasty modified Mathieu repair.

Prolonged Stenting Does Not Prevent Obstruction After TIP Repair when the Glans was Deeply Incised

To evaluate whether prolonged postoperative stenting may reduce the risk of obstruction of the neourethra after TIP repair with deep glanular incision. In a 1-year period 27 patients were operated for penile hypospadias using the TIP technique described by Snodgrass. In contrast to a previous study with 8 - 10 days of postoperative catheter drainage, the indwelling transurethral catheter was kept in place for 12 - 14 days. Deep incision of the urethral plate up to the tip of the glans is the most remarkable surgical detail, resulting in a meatus on top of the glans but in a defect on the dorsal rim of the neomeatus as well. After 3 - 6 months 22 patients were re-investigated during an outpatient visit using a scheme to describe the position of the neomeatus. Uroflowmetry was also performed. Information in three toddlers was gained by phone and 2 patients were lost to follow-up. Two patients returned with significant obstruction including an urethrocutaneous fistula in one. In contrast to the good assessment by parents and compared to the early appearance after catheter removal a change in meatal position was observed in the majority of patients. Only 6 patients presented with an unchanged meatal position whereas in 16 patients the meatus lost its oval or slit-like shape as well as its position on the tip of the glans. However, despite one obstructive meatus in the coronal position 15 patients showed a sufficient size and position of the meatus underneath the tip of the glans. Uroflowmetry revealed reduced peak-flow values (mean: 8.1 ml/s) in some of the 9 patients evaluated. Our data indicate that prolonged stenting does not give better results in those TIP repairs, in whom the urethral plate was incised across the rim of the neomeatus. The early excellent aspect of the glans after stent removal is often impaired by partial closure of the glans incision with a short-term change in size and position of the meatus. To prevent this, the rim of the meatus during reconstruction should be kept completely epithelialised.