Catheter Trauma Research Articles

Successful Management of Incompletely Resected Transitional Cell Carcinoma with Sorafenib Tosylate in a Dog.

Most urinary bladder (UB) tumors are malignant, and transitional cell carcinoma (TCC) is the most common neoplasm affecting the UB in dogs. Sorafenib may be a potential therapeutic agent for canine TCC. A 12 yr old spayed female Maltese dog weighing 3.6 kg and with a history of hematuria was referred for a suspected UB tumor. Abdominal ultrasonography revealed a UB mass attached to the cranioventral wall. The remaining abdominal examinations, including that of the lymph nodes, were unremarkable. Ultrasound-guided traumatic catheterization of the UB mass was performed, and the cytological evaluation of the UB mass indicated TCC. Excision was performed by partial cystectomy, and histopathology confirmed TCC, although the tumor had infiltrated the surgical margins. A chemosensitivity assay was conducted using tissue from the excised tumor. Sorafenib tosylate, a tyrosine kinase inhibitor, showed the greatest effect in the chemosensitivity assay. Therefore, adjuvant chemotherapy with sorafenib tosylate and piroxicam was administered postoperatively. The dog lived without any clinical signs, including hematuria or tumor relapse, for more than 2 yr after the surgery. This is the first report of successful long-term management of TCC with sorafenib tosylate in a dog.

Management of iatrogenic ascending aortic dissection after percutaneous intervention of chronic total occlusion.

This study highlights the prevalence and conservative management strategies of iatrogenic ascending aortic dissection after percutaneous intervention (PCI) of chronic total occlusion (CTO). Retrospective analysis on patients who underwent CTO PCI from one medical center from 2020 to 2022 was performed by two operators. Data was obtained from the Prospective Global Registry for the Study of CTO database. Out of 318 patients, there were six reported cases of iatrogenic ascending aortic dissection. The causes of dissection included guiding catheter trauma, antegrade injection, two retrograde injection, and two cases of balloon rupture after lithotripsy. IVUS-guided stenting of the coronary back to the origin to seal the entry of the dissection flap occurred in two patients. All patients had a conservative management approach. No patient had to undergo urgent surgery. While the incidence remains rare, complications, including aortic dissection, are more frequent in CTO PCI as compared to non-CTO PCI. IVUS can be used to complete coronary intervention so long as the patient remains clinically and hemodynamically stable. Patients should have formal imaging with either transesophageal echocardiogram or computed tomography angiography. The outcomes of patients who experience iatrogenic aortic dissection during CTO PCI with stable coronary disease seem to be better than in patients with acute coronary syndrome.

Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations

ObjectiveTo address the issue of traumatic foley catheterization we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs. MethodsA retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution. A nursing education program was implemented that included basic urological anatomy, coude urethral catheter insertion techniques, and catheter safety. We conducted our trial over a period of 2-months with all catheterizations tracked. Following the trial, the process and outcomes were reviewed and then implemented for all male patients >18 years old requiring indwelling catheter placement in the operating room. ResultsOn retrospective review there were 18 traumatic foley catheterizations of patients on the three surgical services out of a total 601 catheter placements (3% traumatic placement rate). The total cost of these traumatic catherizations was $27,793 when accounting for additional procedures, supplies, and additional OR time required for each traumatic catheterization. The average cost per patient was $1,544. After full implementation of the process across all operating room services in June 2021 there have been 2038 catheterizations performed using a coude catheter kit with 4 traumatic foley placements through May 2022 (0.2% traumatic catheterization rate). ConclusionImplementation of the nursing education program and utilization of the coude catheter for all male catheterizations reduces costs, decreases iatrogenic urethral injury, and improves patient safety.

Characterization and Outcomes of Iatrogenic Urethral Catheterization Injuries.

Iatrogenic injury during urethral catheterization is a common reason for inpatient urologic consultation and is associated with increased morbidity and resource utilization. Literature defining the patient population, interventions, or outcomes associated with traumatic catheterization is scarce. We performed a retrospective review of consults for adult urethral catheterization at a single tertiary care center (July 2017-December 2019), with focus on patient characteristics and complications. Traumatic urethral catheterization was defined as catheterization by the primary team with at least 1 of these conditions: gross hematuria, meatal blood, or cystoscopic evidence of urethral trauma. Characteristics collected included urologic history, catheterization circumstances, procedural intervention, and subsequent visits. Three hundred urology consults for urethral catheterization were identified, including 98 (33%) traumatic events (5.3 incidents/1000 catheters placed). All traumatic catheterization consults were in men (median age 69 years). Most (71%) patients sustaining injury had significant urologic history (eg, benign prostatic hyperplasia, urethral stricture). Sixty-three (64%) consults were determined to be uncomplicated (not requiring any procedural intervention for catheter placement). Gross hematuria was the most common sequela (50% of patients). The 30-day catheter-associated urinary tract infection rate was 13%, and 2 patients developed sepsis. Complications required a total of 52 additional hospital admission days, 19 of which were intensive-care level, as well 113 outpatient urology visits. Traumatic urethral catheterization is associated with increased need for procedural intervention, risk of catheter-associated urinary tract infection, and additional resource utilization. Further studies on traumatic catheterization are needed to guide systemic efforts for minimizing injury and cost.

Urologic Consultations for Urethral Catheter Placement: A Cost Analysis

To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P=.05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs.

MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP71-04 ADJUSTABLE ARTIFICIAL SPHINCTER VICTO IN THE TREATMENT OF URINARY INCONTINENCE: EARLY RESULTS IN A COHORT OF HIGH-RISK CASES IN A PROSPECTIVE SINGLE CENTER STUDY Ghazal Ameli, Peter Weibl, Michael Rutkowski, and Wilhelm Huebner Ghazal AmeliGhazal Ameli More articles by this author , Peter WeiblPeter Weibl More articles by this author , Michael RutkowskiMichael Rutkowski More articles by this author , and Wilhelm HuebnerWilhelm Huebner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Victo is an adjustable artificial urinary sphincter (AUS), consisting of three parts which are preconnected. A pressure regulating balloon, a cuff, and a pump, which includes a self-sealing port for adjustment. The objective of the present study is to test the efficiency and practicality of VICTO in the control of stress urinary incontinence (SUI) and to evaluate the short- and long-term complications. METHODS: A total of 32 patients were included between 1/2020 and 4/2022, the trial is still ongoing and estimated end of the clinical trial is May 2025.41% of the patients in this cohort has undergone prior procedures for SUI: sling n=4, ProACT n=4, AMS 800=1, 3 patients had multiple SUI surgeries. 38% of the patients had undergone secondary irradiation therapy. Additionally, 9 patients had undergone procedures for bladder neck pathologies or urethral strictures.All patients underwent artificial urethral sphincter (AUS) implant “VICTO” according to established technique. The mean age was 71.9 years, 41% of the patients had systemic arterial hypertension and 19% diabetes mellitus.Functional urinary outcomes were assessed according to daily pad use and a standardized questionnaire. Data were collected as part of the follow up care of these patients. RESULTS: The reduction in number of pads compared between baseline and Follow-Up was significant (p<0,001). Cure of urinary incontinence was defined as using either 0 or 1 p/d. All the index patients in this cohort (n=7) were cured. In total 64.5% of the patients reported to be dry and were cured by definition. Additionally, 19.4% patients reported improvement of ≥50 % according the PGI-I (Patients Global Impression of Improvement).Two erosions were reported over the FU-period (mean 4.6 months). One infection occurred after traumatic catheterization without deactivation of the device followed by urethral erosion, infection and explantation of the device. Both patients with erosion had previous pelvic irradiation.One explantation was reported at day 2 after implantation, the presumable cause of explantation was unrecognized intra-operative urethral injury and consequently urethral erosion and was excluded from the study. CONCLUSIONS: In this complex group with mostly high-risk patients, all men with uncomplicated SUI (no previous surgeries and no history of irradiation) were cured after device implantation. The overall treatment success was 84 % according PGI-I and 65% according to pad per day usage. Despite the above average number of patients with risk factors for failure in this cohort, the results of the current trial are consistent with the evidence in literature. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1014 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ghazal Ameli More articles by this author Peter Weibl More articles by this author Michael Rutkowski More articles by this author Wilhelm Huebner More articles by this author Expand All Advertisement PDF downloadLoading ...

Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians

Urologic trauma is a well-known cause of urethral injury with a range of management recommendations. Retrograde urethrogram remains the preferred initial diagnostic modality to evaluate a suspected urethral injury. The management thereafter varies based on mechanism of injury. Iatrogenic urethral injury is often caused by traumatic catheterization and is best managed by an attempted catheterization performed by an experienced clinician or suprapubic catheter to maximize urinary drainage. Penetrating trauma, most commonly associated with gunshot wounds, can cause either an anterior and/or posterior urethral injury and is best treated with early operative repair. Blunt trauma, most commonly associated with straddle injuries and pelvic fractures, can be treated with either early primary endoscopic realignment or delayed urethroplasty after suprapubic cystostomy. With any of the above injury patterns and treatment options, a well thought out and regimented follow-up with a urologist is of utmost importance for accurate assessment of outcomes and appropriate management of complications.

Ventral onlay glanuloplasty for treatment of fossa navicularis strictures.

ABSTRACTPurpose:Management of fossa navicularis (FN) strictures balances restoring urethral patency with adequate cosmesis. Historically, FN strictures are managed via glans cap or glans wings, and in severe cases, multi-stage procedures. Ventral onlay glanuloplasty (VOG) is an easily reproducible technique that involves a single-stage augmentation with buccal mucosal graft. We have been applying this technique for several years and present early promising outcomes of this novel approach.Materials and Methods:We retrospectively reviewed all patients with FN strictures who underwent VOG at our institution. Treatment success was designated by the absence of extravasation on voiding cystourethrogram and no need for further urethral instrumentation on follow up. Glans cosmesis was assessed by patients providing binary (yes/no) response to the satisfaction in their appearance. We also noted stricture length, stricture etiology, demographic characteristics and any post-operative complications and reported median, interquartile range (IQR) and count, frequency (%), accordingly.Results:Ten patients underwent VOG and fit our inclusion criteria. Median stricture length was 2.0 cm (IQR 1.6 -2). Success rate was 90% (9/10) with a median follow up of 30 months (IQR 24.3 – 36.8). The one recurrence was treated by dilation combined with triamcinolone injection at 419 days post-op. Stricture etiology included primarily iatrogenic causes such as transurethral prostate resection (4/10), greenlight laser vaporization (2/10), cystolitholapaxy (1/10), and traumatic catheterization (3/10). All patients were satisfied with penile cosmesis.Conclusion:VOG is a simple technique for treating FN strictures. Based on our preliminary series, VOG provides sustained distal urethral patency and patients are pleased with the appearance.

Case - The folly of a misplaced Foley.

Traumatic Foley catheterization and malplacement is a common urological consultation. Although most urethral injuries are self-resolving, there are reports of long-standing complications, including urethral strictures, false passage formation, fistulization, and penile necrosis.1 We present a case of a malpositioned Foley catheter leading to the formation of a dorsal penile artery pseudoaneurysm resulting in transfusion-dependent anemia and severe urethrorrhagia.

A CASE REPORT OF ASYMPTOMATIC SPONTANEOUS LEFT SUBCLAVIAN ARTERY DISSECTION: CLINICAL SIGNIFICANCE

TYPE: Case Report TOPIC: Cardiothoracic Surgery INTRODUCTION: Spontaneous subclavian artery dissection (SSAD) is rare. Often it is associated with a history of trauma or catheterisation. We are presenting an asymptomatic case of SSAD and its clinical significance. CASE PRESENTATION: 78 year old female with history of COPD, peripheral arterial disease presented after a mechanical fall. Initial workup showed a left hip fracture on x-ray. Patient underwent surgical repair, during the postoperative period, she experienced shortness of breath requiring additional oxygen. Computed tomography (CT) chest with contrast was negative for pulmonary embolism but noted to have left subclavian artery dissection involving the short segment before the origin of vertebral artery and small pleural effusions. Shortness of breath improved with diuretics. Vascular surgery recommended to manage conservatively as she didn’t have symptoms of stroke, MI, limb ischemia. She was discharged to a rehabilitation facility and remained asymptomatic after one month follow up. DISCUSSION: In our case, there is no neck or chest injury with fall. No history of hypertension or catheterization procedures. CT chest didn’t show any tortuous anatomy. It was an incidental finding with no symptoms. Uncontrolled hypertension, location of subclavian artery below clavicles can increase the risk for dissection apart from traumatic or iatrogenic catheterisation. Other presentations could be stroke, neck pain with cervical disk problems ; non ST segment elevation myocardial infarction or limb ischemia. CONCLUSIONS: If asymptomatic, SSAD can be managed conservatively, but in symptomatic cases causing acute limb ischemia or acute coronary syndrome or stroke they could potentially benefit from early surgical endovascular repair decreasing morbidity and mortality. DISCLOSURE: Nothing to declare. KEYWORD: subclavian artery dissection

Increased risk of transurethral and suprapubic catheter self-extraction in COVID-19 patients: real-life experience.

This study evaluated the prevalence of transurethral catheter self-removal in critically-ill COVID-19 non-sedated adult patients compared with non-COVID-19 controls. COVID-19 patients who self-extracted transurethral or suprapubic catheters needing a urological intervention were prospectively included (group A). Demographic data, medical and nursing records, comorbidities and nervous system symptoms were evaluated. Agitation, anxiety and delirium were assessed by the Richmond Agitation and Sedation Scale (RASS). The control group B were non-COVID-19 patients who self-extracted transurethral/suprapubic catheter in a urology unit (subgroup B1) and geriatric unit (subgroup B2), requiring a urological intervention in the same period. 37 men and 11 women were enrolled in group A. Mean RASS score was 3.1 ± 1.8. There were 5 patients in subgroup B1 and 11 in subgroup B2. Chronic comorbidities were more frequent in group B than the COVID-19 group (P<0.01). COVID-19 patients had a significant difference in RASS score (P<0.006) and catheter self-extraction events (P<0.001). Complications caused by traumatic catheter extractions (severe urethrorrhagia, longer hospital stay) were greater in COVID-19 patients. This is the first study focusing on the prevalence and complications of catheter self-removal in COVID-19 patients. An increased prevalence of urological complications due to agitation and delirium related to COVID-19 has been demonstrated-the neurological sequelae of COVID-19 must be considered during hospitalisation.

Outcomes of Different Ablation Approaches for Para-Hisian Accessory Pathway and Ablation Safety at Each Site.

BackgroundThis study describes the electrophysiologic characteristics of the para-hisian accessory pathway (AP), the outcome of different ablation approaches, and ablation safety at different sites.MethodA total of 120 patients diagnosed as para-hisian AP were included in this study. The electrophysiologic characteristics and outcomes at different ablation sites were analyzed.ResultsIn total, 107 APs and 13 APs were diagnosed as right anteroseptal (RAS) and right midseptal (RMS), respectively. The significant ECG difference between RAS and RMS was lead III, which mainly manifested as positive and negative delta waves, respectively. Catheter trauma to AP was recorded in 21 of 120 (17.5%) patients. The recurrence rate of direct ablation at the “bumped” sites was higher than the conventional ablation method (37.5 vs. 14.1 %, p = 0.036). For RAS APs, there was no significant difference in the success rate between the inferior vena cava (IVC) and superior vena cava (SVC) approaches (76.6 vs. 73.3%, p = 0.63). The RAS was separated into three regions: (1) Site 1: superior part above the real “His” recorded site with far-field “His” potential; (2) Site 2 (true para-hisian): the site with near-field “His” potential; and (3) Site 3: inferior part below the biggest real “His” with far-field “His” potential. Mid-septal was defined as an area that is bounded anteriorly by His recording location and posteriorly by the roof of coronary sinus (CS) ostium. The incidence of atrioventricular (AV) conduction injury at different sites was as follows: 3 of 6 (50%) at Site 2, 4 of 13 (30.8%) at RMS, 7 of 34 (20.6%) at Site 3, and 3 of 46 (6.5%) at Site 1. Even if ablation was performed at the atrial side of the para-hisian region, the right bundle branch block (RBBB) was caused in 6 patients (5%).ConclusionAblation via IVC or SVC was comparative for para-hisian APs, but not for the noncoronary cusp (NCC) approach. The AV conduction injury risk ranks as follows: Site 2 > RMS > Site 3 > Site 1. RBBB could be caused while ablating at the atrial side, which could further demonstrate the His bundle longitudinal dissociation theory.

What is your diagnosis? Peritoneal fluid from a dog.

What is your diagnosis? Peritoneal fluid from a dog.

Optimal clamping time in meatotomy procedure for children with meatal stenosis: Experience with 120 cases.

During meatotomy procedure for children with meatal stenosis (MS), a straight clamp used as a hemostat on the ventrum of the meatus before incised with scissors for clamping and holding bleeding from the site of operation. The aim of this study was to evaluate the optimum clamping time for meatotomy in children with MS. All the patients with MS between 2014 to 2019 were enrolled in this retrospective study. Patients with uncircumcised penis, traumatic catheterization, any kind of penile abnormality such as hypospadias or penile curvature, and active urinary tract infection (UTI) were excluded. The indication of meatotomy was a pinpoint meatus that develops with dorsal or lateral deflection of the urinary stream and high-velocity urine flow. During meatotomy procedure, clamping time was examined in different groups such as 2, 3, and 4 minutes. The main symptoms of presentation and ultrasonography (US) findings were recorded and compared between groups. To assess the optimum time clamping, postoperative bleeding was noted carefully in all groups. The success rate was recorded at onemonth postoperative follow-up in the clinic. Of the 120 patients with MS who underwent a meatotomy procedure, there were 40 (33.3%) participants in each group. The main symptoms were painful urination and urine stream deviation that represented in 54 (46%) patients. Bladder wall thickness was the main pre-operation finding in the US which was observed in 67 (55.8%) patients. In comparison between the groups related to clamping time, bleeding was observed and required suturing when clamping was applied for 2 minutes in 4 (3.3%) patients (p = 0.016). With a minimum follow-up of 12 months, no recurrent meatal stenosis was reported. Clamping time for more than 2 minutes may prevent bleeding during and after meatotomy.

Urinary System Iatrogenic Injuries: Problem Review

Introduction: From May to December 2019, a literature review of the urinary system iatrogenic injury problem was performed. The most cited, representative articles in PubMed, Scopus, and WoS databases dedicated to this problem were selected. Urinary system iatrogenic injuries include ureter, bladder, urethra, and kidney traumas. It is widely thought that the main causes of such injuries are urological, obstetric, gynecological, and surgical operations on the retroperitoneal space, pelvis, or perineum. Methods: The purpose of the study is to describe all aspects of the iatrogenic injure problem, under the established scheme and for each of the most damaged organs: the urethra, bladder, kidney, and ureter. The treatment of confirmed iatrogenic injuries largely depends on the period of its detection. Modern medical procedures provide conservative or minimally invasive treatment. An untimely diagnosis worsens the treatment prognosis. “Overlooked” urinary system trauma is a serious threat to society and a particular patient. Thus, incorrect or traumatic catheterization can lead to infection (RR 95%) and urethral stricture (RR ≥11–36%), and percutaneous puncture nephrostomy can cause the risk of functional renal parenchyma loss (median 5%), urinary congestion (7%), or sepsis (0.6–1.5%). Results: Lost gain, profits, long-term and expensive, possibly multistage treatment, stress and depression, and the risks of suicide put a heavy financial, moral, and ethical burden on a person and society. Also, iatrogenic injury might have legal consequences. Discussion/Conclusion: Thus, the significant problem of urinary tract iatrogenic injuries is still difficult to solve. There is a need to implement mandatory examining algorithms for patients at risk, as well as the multidisciplinary principle for all pelvic surgery.

A Nurse-Driven Protocol for Foley Catheter Utilization Decreases the Incidence of Traumatic Foley Catheterization.

Background: Traumatic urethral catheterization is a common reason for urologic consultation in hospitalized patients. The purpose of this study was to determine if a protocol designed to decrease Foley catheter use was effective and if implementation of the protocol decreased the incidence of Foley catheter–associated trauma.Methods: In an effort to decrease catheter use, our institution adopted a nurse-driven Foley catheter protocol in May 2015 that allowed nurses to remove Foley catheters that did not meet criteria. We conducted a retrospective medical records review of patients who had Foley catheter–associated trauma occurring between February 2013 and March 2018 and compiled data concerning Foley catheter use. Using t test statistical analysis, we compared rates of Foley catheter use and Foley catheter–associated trauma before and after protocol implementation.Results: During the 62-month study period, we documented 83 cases of Foley catheter–associated trauma. Prior to protocol implementation, our institution had mean of 2,903 patient-catheterization days per month. Following protocol implementation, the mean decreased to 2,604 patient-catheterization days per month (P<0.01). Prior to protocol implementation, the mean incidence of Foley catheter–associated trauma was 1.81 traumas per month. Following protocol implementation, the mean incidence decreased to 0.97 trauma per month (P<0.05).Conclusion: Implementation of the protocol was successful in decreasing Foley catheter use as well as Foley catheter–associated trauma.

Analysis of Risks and Consequences of Postcatheter Urinary Retention After Primary Total Hip and Knee Arthroplasty

BackgroundPostoperative urinary retention (POUR) in total joint arthroplasty (TJA) is common. However, risk factors for POUR and its consequences, specifically on postoperative renal function, have not been well defined. MethodsWe performed a review of prospectively collected data on consecutive adult patients undergoing primary total joint arthroplasty from August 2014 to December 2015. Catheters were placed preoperatively and removed on the first or second postoperative day. The exclusion criterion was traumatic catheter insertion or the presence of fracture or neoplasm. Univariate and multiple logistic regression identified associations with POUR and its invasive therapies. Subgroup analysis of renal function by incidence of preoperative bladder outlet obstruction (BOO) and POUR was performed with nonparametric testing. ResultsA total of 591 operations met inclusion criteria. The incidence of POUR was 6.4% and was directly related to a positive history of BOO (odds ratio [OR]: 4.15) and increased the duration of urinary catheterization (OR: 1.04). These factors, in addition to preoperative incontinence (OR: 8.36, 28.69) and lengthier hospitalizations (OR: 1.37, 1.30), were significantly associated with intermittent straight catheterization and reinsertion of an indwelling catheter to treat POUR. Serum creatinine increased with combined preoperative BOO and POUR (+0.22 mg/dL) but was preserved in others (+0.02-0.04 mg/dL) (P < 0.01). ConclusionsPreoperative BOO and longer catheterization increased the risk of POUR and were associated with the use of invasive modalities to treat POUR. POUR was associated with a longer hospitalization and impaired renal function in those with preoperative BOO; therefore, renal function should be monitored closely and nephrotoxic medications used cautiously when using urinary catheters in this patient population. Level of EvidenceRetrospective Analysis, Level IV.

A Simple and Quick Solution to the Retained Traumatic Urethral Catheter

A misplaced urinary catheter within the bulbar urethra in a medically complex patient could not be removed due to an undeflatable balloon. Simple bedside measures including flexible cystoscopy were unsuccessful in deflating this. Here we describe a simple and quick solution to this stressful situation using a transperineal ultrasound guided puncture. This method should be considered when the retained traumatic catheter lies distal to the prostate gland.

Long-term outcomes of urethral catheterisation injuries: a prospective multi-institutional study.

There are no prospective data describing the incidence and spectrum of long-term complications associated with traumatic urethral catheterisation (UC). We prospectively monitored the long-term clinical outcomes and complications of patients with traumatic UC injuries. A prospective study at two tertiary university hospitals was performed to record all referrals for iatrogenic urethral injuries caused by UC. Long-term follow-up was prospectively maintained by regular outpatient department visits and by monitoring all urological interventions and their outcomes from urinary catheter-related injuries. The incidence of traumatic UC was 13.4 per 1000 catheters inserted in male patients and 37 iatrogenic urethral injuries were recorded. The mean age was 74 ± 12years and the mean length of follow-up was 37 ± 3.7months. Urethral injuries were caused by inflating the catheter anchoring balloon in the urethra (n = 26) or by creating a false passage with the catheter tip (n = 11). In total, 29 patients (78%) developed urethral stricture disease during their follow-up; of which 11 have required at least one urethral dilation and two have required one urethrotomy. Three patients required long-term indwelling suprapubic catheter placement and seven patients opted for a long-term indwelling urethral catheter. There were eight patient mortalities; one of which was due to severe urosepsis resulting from catheter balloon inflation in the urethra. Catheter-related injuries are associated with significant long-term complications in this vulnerable patient cohort. In future, such injuries may be preventable if the safety profile of the urinary catheter is modified.

Application Value of Blunt Separation Method in the Modified Sytinger Technology PICC Catheterization in Hemopathic Patients

To explore the application value of blunt separation method in the modified sytinger technology peripherally inserted central catheter (PICC) catheterization in the hemopathic patients. One hundred and twenty cases of the hemopathic diseases used modified sytinger technology PICC catheterization were selected from January 2016 to July 2017 in our Hospital, and randomly divided into blunt and routine group, each with 60 patients. For the routine group, the routine longitudinal method was used to expand the skin, for the blunt group the blunt separation method was used to expand the skin. At the time point of 24 h after the blunt catheterization, the bleeding volume and exudation rate in the blunt group were significantly lower than those in the rouline group (P<0.05). At the 1, 3, 5 d after catheterization, pain visual analogue score (VAS) showed that the scores of blunt group were significantly lower than those of the routine group (P<0.05). in expanding skin, the successful rate of catheterization once in blunt group and routine group were not significantly different (P>0.05). Compared with the longitudinal method, the blunt separation method has considerable skin expansion and sheath feeding effect on the modified sytinger technology PICC catheterization for the hemopathic patients. This method can effectively reduce the patient's catheter trauma and percolation, and is helpful to relieve the patients' pain symptoms, worthing for further clinical promotion.