Use Of Urethral Catheters Research Articles

New steps of robot-assisted radical prostatectomy using the extraperitoneal approach: a propensity-score matched comparison between extraperitoneal and transperitoneal approach in Japanese patients

BackgroundRobot-assisted radical prostatectomy (RARP) is commonly performed using the transperitoneal (TP) approach with six trocars over an 8-cm distance in the steep Trendelenburg position. In this study, we investigated the feasibility and the benefit of using the extraperitoneal (EP) approach with six trocars over a 4-cm distance in a flat or 5° Trendelenburg position. We also introduced four new steps to the surgical procedure and compared the surgical results and complications between the EP and TP approach using propensity score matching.MethodsBetween August 2012 and August 2016, 200 consecutive patients without any physical restrictions underwent RARP with the EP approach in a less than 5° Trendelenburg position, and 428 consecutive patients underwent RARP with the TP approach in a steep Trendelenburg position. Four new steps to RARP using the EP approach were developed: 1) arranging six trocars; 2) creating the EP space using laparoscopic forceps; 3) holding the separated prostate in the EP space outside the robotic view; and 4) preventing a postoperative inguinal hernia. Clinicopathological results and complications were compared between the EP and TP approaches using propensity score matching. Propensity scores were calculated for each patient using multivariate logistic regression based on the preoperative covariates.ResultsAll 200 patients safely underwent RARP using the EP approach. The mean volume of estimated blood loss and duration of indwelling urethral catheter use were significantly lower with the EP approach than the TP approach (139.9 vs 184.9 mL, p = 0.03 and 5.6 vs 7.7 days, p < 0.01, respectively). No significant differences in the positive surgical margin were observed. None of the patients developed an inguinal hernia postoperatively after we introduced this technique.ConclusionsThe EP approach to RARP was safely performed regardless of patient physique or contraindications to a steep Trendelenburg position. Our method, which involved using the EP approach to perform RARP, can decrease the amount of perioperative blood loss, the duration of indwelling urethral catheter use, and the incidence of postoperative inguinal hernia development.

Genitourinary involvement and management in children with Stevens–Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are devastating hypersensitivity disorders that cause epidermal cell death and can affect all epidermal surfaces, including the urethra, vagina, labial and scrotal skin. Despite the well-described ocular and orofacial manifestations of SJS/TEN, there is a paucity of reports on the genitourinary (GU) symptoms and their management. Specifically, consulting services often ask the pediatric urology team if it is safe to place a urethral catheter, but there is no data in the literature to help guide management. The present study sought to review all pediatric cases of SJS/TEN in a tertiary care hospital to determine the incidence and optimal management of GU manifestations, including the use of urethral catheters. With IRB approval, cases of SJS and TEN that were managed as an inpatient between January 2008 and June 2015 were retrospectively reviewed in order to identify the extent of GU involvement/manifestations, the treatment provided, use of urethral catheterization and long-term follow-up or complications. Thirty-one patients (15 female, 16 male; age range 2-18 years) presented with SJS or TEN over the study period. Etiologies for SJS/TEN included mycoplasma infection (48%) and medications (45%). Incidences of GU manifestations at presentation and their management are shown in Summary Table. Overall, 74% of patients had genital involvement of skin lesions. In 12 cases (39%), urology consultation was obtained. Twenty patients (61%) complained of dysuria and one child had gross hematuria in the setting of meatal lesion. Petroleum jelly was used in the majority of patients. A urethral catheter was placed in eight patients (25.8%, four female, four male) with a range of duration of 7-23 days. No patient developed hematuria or any other complications (i.e. strictures or urinary symptoms) after catheter removal. One boy required lysis of penile adhesions in the short-term. One of each gender developed penile and labial adhesions on long-term follow-up that self-resolved. GU involvement in SJS/TEN occurred in almost three-quarters of patients and was managed conservatively like other skin/mucosal manifestations. Long-term sequelae were rare and urethral catheterization appeared to be safe, without any short-term or long-term complications.

Infection Control in the Use of Urethral Catheter: Knowledge and Practises of Nurses

Objective: To identify knowledge and practises of nurses regarding infection control in the use of urethral catheter and associated urinary tract infection in private tertiary care hospital Peshawar. Purpose: The purpose of this study was to explore the current knowledge of nurses regarding urinary catheter care. The study was also focused on practises and standard guidelines about urinary catheter care of nurses in private tertiary care hospitals. Method: A descriptive cross sectional study was conducted among nurses in private tertiary care hospital Peshawar. Participants were selected through convenient sampling technique. The data was collected through a self-developed structured questionnaire. Results: Out of 70 participants the gender distribution was 11.1% (male) and 86.1% (female). The mean knowledge of participants was 66% with standard deviation 25.3%. The Mean practise was 56.43% with Standard deviation 14.94%. Independent t-test was applied to identify the association between knowledge of participants with year of experience which was not significant. One-way Analysis Of Variance (ANOVA) test was applied to identify association between knowledge with years of practise which was significant p=0.024. Conclusion: The study result was alarming to know that the nurses had low knowledge, and poor practises about infection control in the use of urethral catheter. This indicates that nurses need to be educated and trained more on infection control in the use of urethral catheter.

Experiencia en el manejo de la estrechez uretral en un centro de tercer nivel en Colombia

ObjectiveTo describe the sociodemographic and clinical characteristics, as well as the treatments performed, of patients with urethral stricture in a tertiary level hospital. MethodsA descriptive study was performed based on manual search of medical records of patients with urethral stricture, who were diagnosed, treated, and followed-up from June 2012 to June 2014. A description is presented of the demographic characteristics of patients, their risk factors, comorbidities, and clinical conditions, as well as re-interventions. The perioperative complications were reported according to the Clavien–Dindo system. A descriptive analysis was performed using STATA v. 14. ResultsA total of 35 cases were identified. The median of age was 58 years old. Eighteen patients (51%) had a history of urological instrumentation as a cause of urethral stricture. The most common anatomical site of the stricture was the bulbar segment, the median length of the narrow area of three centimetres. Diagnostic methods used were retrograde urethrogram, cystoscopy, and cystography (97%). As regards treatment, minimally invasive procedures were performed on 14 (40%) patients. Urethral dilation was performed in 40% of patients, with internal urethrotomy in 8 (23%) patients. End to end urethroplasty was performed in 20 patients, with posterior graft in 10 (29%) patients and with ventral graft in 4 (11%) patients. There was one minor complication (grade I) in one patient. There was a median urethral catheter use of 24 days. Patients were followed-up using a symptoms scale (100% of cases). Urethral stricture re-appeared in 16 patients, with median recurrence of 48 days. Recurrence was treated with internal urethrotomy in 7 (20%) patients. ConclusionUrethral reconstructive surgery is the procedure of choice for management of the condition, with adequate effectiveness, low incidence of recurrence, and minor complications. Performing minimally invasive procedures, such as internal urethrotomy and urethral dilation prior to reconstructive surgery, is a major risk factor for recurrences.

Investigation into the causes of indwelling urethral catheter implementation and its effects on clinical outcomes and health care resources among dementia patients with pneumonia: A retrospective cohort study.

There is a possibility that unnecessary treatments and low-quality medical care, such as inappropriate indwelling urethral catheter use, are being provided to older Japanese individuals.The aim of this study was to investigate contextual effects relating to indwelling urethral catheters in older people with dementia and to clarify the effects of indwelling urethral catheter use on patients' mortality, length of stay (LOS), and health care spending. This retrospective cohort study involved 4501 male and female Japanese participants. Those who were aged 75 or older with dementia and had a primary diagnosis of acute lower respiratory disease with antibiotics administered during hospitalization were eligible for inclusion. Patient mortality, LOS, and total charge during hospitalization were the main study outcomes. This study showed that indwelling urethral catheter use was significantly associated with higher mortality, longer LOS, and higher total charge for hospitalization. The pattern of indwelling urethral catheter use was clustered by care facility level. Physician density was significantly associated with indwelling urethral catheter use; the relationship was not linear but U-shaped, such that the approximate median had the lowest rate of urethral catheter use and this increased gradually toward both lower and higher physician densities. Our study found considerable variation in indwelling urethral catheter use between care facilities in older people with dementia. Additionally, indwelling urethral catheter use was related to poor outcomes. Based on these findings, we consider there to be an urgent need for constructing a framework to measure, report on, and promote the improvement of care quality for older individuals in Japan.

Use of bladder volume measurement assessed with ultrasound to predict postoperative urinary retention.

OBJECTIVE:Postoperative urinary retention (POUR) is a common complication after spinal anesthesia. Ultrasound (US) is a simple, non-invasive method to estimate bladder volume before and after surgery. Primary aim of the present study was to investigate utility of bladder volume measured before and after surgery in prediction of POUR risk. Secondary aim was to investigate necessity of urethral catheter use and risk of urethral catheter-related infections.METHODS:Eighty patients who received spinal anesthesia for arthroscopic knee surgery were included in the study. Level and duration of sensory and motor block; bladder volume measured preoperatively, in post-anesthetic care unit (PACU), and when discharged from PACU; use of urethral catheter; and incidence of urinary tract infection data were recorded.RESULTS:POUR was observed in 28.7% of patients. Length of time for sensory block regression was significantly shorter in patients without POUR (p=0.012). Spontaneous urination was not observed in 3 of 23 patients with POUR, although bladder volume was less than 600 mL. Bladder volume over 600 mL without urination was recorded in 20 patients. There was no statistical difference in preoperative bladder volume between patients who did or did not develop POUR. Bladder volume on admission to PACU was higher in patients with POUR (p=0.023). Urgency and dysuria were observed in 5 patients who required urethral catheterization during postoperative period. Urinary tract infection developed in 1 patient. There was no statistical difference in development of urinary tract infection between patient groups who did and did not undergo urethral catheterization.CONCLUSION:Assessment of patient bladder volume with US before arthroscopic knee surgery may be used to foresee development of POUR. Avoiding elective urinary catheterization may reduce urinary infections.

The effect of two weeks of treatment with dutasteride on bleeding after transurethral resection of the prostate.

PurposeDutasteride affects the prostate by reducing intraprostatic dihydrotestosterone and prostate tissue vascularity. We evaluated the effect of pretreatment with dutasteride for two weeks on perioperative and postoperative bleeding during transurethral resection of the prostate (TURP).Materials and MethodsEighty-three patients who had benign prostatic hyperplasia together with the criteria for eligibility for TURP were included. The dutasteride group consisted of 40 patients who were treated with dutasteride (0.5 mg/d) for two weeks before surgery, and the control group consisted of 43 patients who did not receive dutasteride. Blood loss was evaluated in terms of reduction in serum hemoglobin (Hb) and hematocrit (Hct) levels, which were measured before, immediately after, and 24 hours after surgery. We also measured the durations of indwelling urethral catheter use, continuous saline bladder irrigation, and hospitalization.ResultsLower mean blood loss was observed in the dutasteride group than the control group immediately after and 24 hours after surgery (ΔHb=0.65±1.27 g/dL vs. 1.16±0.73 g/dL, 1.30±1.00 g/dL vs. 1.86±1.05 g/dL respectively, p=0.019, p=0.011; ΔHct=1.89%±3.83% vs. 3.47%±2.09%, 3.69%±2.95% vs. 5.39%±3.23% respectively, p=0.016, p=0.011). In addition, there were fewer days of indwelling urethral catheter use (2.95±1.02 d vs. 3.92±1.14 d, p=0.000), continuous saline bladder irrigation (1.81±1.08 d vs. 2.36±1.06 d, p=0.016), and hospitalization after TURP (3.95±1.09 d vs. 4.76±1.19 d, p=0.001) in the dutasteride group.ConclusionsPreoperative treatment with dutasteride for two weeks before TURP reduces surgical bleeding and length of hospitalization after TURP. This pretreatment can be used to decrease surgical bleeding associated with TURP.

Purple urine bag syndrome in a patient with a urethral balloon catheter and a history of ileal conduit urinary diversion

A 72-year-old female bladder cancer patient presented with a history of ileal conduit urinary diversion; a urethral balloon catheter was inserted to control her urinary tract stoma. The patient, who reported a foul odor emanating from her urine for several days, visited our hospital as an outpatient when her urine bag developed a purple hue, although there was no change to the color of her urine. The patient’s body temperature was 36.8°C, her blood pressure was 124/68 mmHg, pulse rate was 74 beats per minute (regular), and respiratory rate was 18 breaths per minute. Urinalysis revealed white blood cells, urine nitrite, and gram-negative rod bacilli in her urine. Although voided urine color was normal, urine in the bag had developed a purple hue; therefore, purple urine bag syndrome was diagnosed due to a urinary tract infection (Fig. 1). Urine color improved after treatment with oral cefaclor. Escherichia coli was also detected in the urine culture. Purple urine bag syndrome, a clinical condition during which the bag develops a purple hue, is triggered by constipation or urinary tract infection during urethral catheter use and can occur even after urinary diversion. Tryptophan (an essential amino acid) is absorbed from the intestinal tract following degradation by intestinal bacteria, and is then excreted in the urine after being conjugated with sulfate in the liver. Tryptophan is also modified by the sulfatases or phos phatases produced by urine bacteria, resulting in an indigo (blue) or indirubin (red) hue. Tryptophan produces an indigo, purple, or red color according to the specific ratio of each pigment. Because these pigments are insoluble, urine bag coloration occurs when they adhere to the inside of the bag.

Clinical characteristics and risk factors of infections caused by Stenotrophomonas maltophilia in a hospital in northwest China.

Stenotrophomonas maltophilia infections have recently increased in importance in China, particularly in intensive care units (ICUs). The aim of this study was to investigate the clinical characteristics and risk factors of S. maltophilia infection in ICU of a hospital in northwest China. The characteristics and outcomes of patients with any type of S. maltophilia infection at Shaanxi Provincial People's Hospital, Shaanxi, China, over a two-year period (from July 2011 to June 2013) were studied. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. The risk factors for all-cause in-hospital mortality were assessed with multivariate logistic regression. Forty patients (median age, 72 years; 77.5% males) with S. maltophilia infection were identified. The main type of infection was lower respiratory tract infection (97.5%); one patient had a bloodstream infection. A total of 97.5% patients were infected with two or more organisms at the same time. The main characteristics of the patients were prolonged use of mechanical ventilation, urethral catheter, and central venous catheter before the infections occurred. The case number of infection was not different in the four seasons. High in vitro sensitivity was observed to minocycline (91.2%), levofloxacin (85.3%), and trimethoprim-sulfamethoxazole (79.4%). Most patients received therapy with a combination of agents. The crude mortality was 50%. By multivariate analysis, low albumin content and hypotension were the independent prognostic factors for mortality. Appropriate antimicrobial treatment had no positive impact on mortality. The impacts of albumin supplements and increasing blood pressure on mortality require further clinical studies.

Urinary tract infections in meningioma patients: analysis of risk factors and outcomes

Urinary tract infections (UTIs) account for about 35% of all nosocomial infections and 75% are associated with the use of urethral catheters. The goal of this study was to evaluate preoperative factors associated with the risk of UTI and to estimate the impact of UTIs on patient outcome and resource utilization. Adult meningioma patients treated with craniotomy in US hospitals between 2002 and 2007 were queried from the Nationwide Inpatient Sample (NIS) database. Univariate and multivariate analyses that correct for sample survey design data were used to study the association of perioperative UTIs and outcomes. In all, 46,344 patients were included. Women comprised the majority (70.0%), had lower mortality (1.2% vs 2.0%), shorter in-hospital stay (6.7 vs 7.5 days), lower hospital charges (US$76,682 vs 87,220) and higher UTI rates (6.3% vs 3.9%) than men. In multivariate analysis, female gender (odds ratio: 2.2; P<0.0001), older age (1.4; P<0.001), emergency room admissions (1.8; P<0.0001), total length of stay (1.08; P<0.0001), comorbidity score (1.04; P=0.0147), postoperative fluid abnormalities (1.96; P<0.0001) and pulmonary complications (1.3; P<0.0011) were associated with UTI. UTI was associated with an additional 2.3 days of hospital stay and an incremental US$18,920 in hospital charges. Perioperative UTIs are associated with specific comorbidities and postoperative complications. They significantly increase in-hospital length of stay and costs. Our data emphasize the need to support national efforts that are underway to reduce hospital-acquired UTIs within the neurosurgical population.

V252 TRANSVAGINAL BLADDER NECK CLOSURE

You have accessJournal of UrologyFemale Voiding Dysfunction (Pelvic Reconstruction and Incontinence)1 Apr 2012V252 TRANSVAGINAL BLADDER NECK CLOSURE Dennis Lee, Kenneth Faber, Vannita Simma-Chiang, and David Ginsberg Dennis LeeDennis Lee Los Angeles, CA More articles by this author , Kenneth FaberKenneth Faber Los Angeles, CA More articles by this author , Vannita Simma-ChiangVannita Simma-Chiang Los Angeles, CA More articles by this author , and David GinsbergDavid Ginsberg Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.308AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Transvaginal closure of the bladder neck is indicated in female patients with urethral destruction resulting from long-term use of chronic indwelling urethral catheters. The transvaginal approach avoids the morbidity associated with an abdominal incision and provides a viable option for the management of the incompetent urethra. METHODS This video shows our technique of transvaginal bladder neck closure. The patient is positioned in dorsal lithotomy position. After suprapubic catheter placement, a circumscribing incision is made around the urethra and an inverted U incision is made in the anterior vaginal wall to develop a vaginal flap. The urethra is mobilized down to the level of the bladder neck. This dissection includes the division of both the lateral (urethropelvic ligament) and anterior (pubourethral ligament) supporting structures of the urethra. The anterior urethra is then spatulated down to the bladder neck and the posterior urethra is mobilized upwards. The bladder neck is initially closed in two layers and an additional layer of closure is added with imbrication of the detrusor muscle. Lastly, the anterior vaginal flap is advanced to close the anterior vaginal wall to complete the repair. RESULTS The operative time was 2 hours and 15 minutes with an estimated blood loss of 760 cc. The patient was maintained on oxybutynin post-operatively to minimize post-operative detrusor overactivty. At 3 months postoperatively, she was doing well without evidence of urinary leakage. CONCLUSIONS Transvaginal bladder neck closure is a reasonable treatment option for patients with urethral destruction and avoids the morbidity of an abdominal incision. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e102 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dennis Lee Los Angeles, CA More articles by this author Kenneth Faber Los Angeles, CA More articles by this author Vannita Simma-Chiang Los Angeles, CA More articles by this author David Ginsberg Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

Protocolo basado en la evidencia de los cuidados de los catéteres urinarios en unidades de cuidados intensivos

Urinary Tract Infections (UTIs) account for 24.92% of ICU nosocomial infections investigated. They are associated with increased morbidity and mortality, increased hospital stay and hospital costs, jeopardizing patient safety. Prevalence of UTI in ICU is directly related to the widespread use of urethral catheter (UC).It has been estimated that between 17% and 69% of UTIs associated with the UC can be prevented through an evidence-based prevention program. The Centers for Disease Control and Prevention recommend, based on strong evidence for its implementation, the use of packages based on evidence and ongoing training of health personnel in the extrinsic risk factors of UTI associated with UC-related nursing care (technique of insertion, maintenance and drainage system).The development of an evidence-based UC protocol of care for, dealt with in the latest clinical guidelines, and the systematic reviews extracted from the Cochrane, where the clinical cares that are most clearly shown to have a direct relation to decrease of UTI asssociated with UC are described, will make it possible for us to reach a consensus on the guidelines of our care to avoid their variability. This will also make it possible to evaluate and compare the quality of our cares with other ICUs, using quality indicators established by the National Surveillance Study of Nosocomial Infection in Medical Services Intensive.

Retrospective Study of Laparoscopic Radical Prostatectomy for Localized Prostate Cancer after Transurethral Resection of the Prostate Compared with Retropubic Radical Prostatectomy at the Same Institution

Radical prostatectomy (RP) for localized prostate cancer after transurethral resection of the prostate (TUR-P) is technically difficult because of periprostatic adhesion and changes in the form of the prostate. The advantages of laparoscopic RP (LRP) over retropubic RP (RRP) include a less invasive operation through a small wound, a clearer field of vision, and reduced blood loss, and, therefore, LRP may represent the optimal method for RP after TUR-P. The present study compared clinical, oncological, and pathological outcomes between LRP and RRP after TUR-P at our institution. Twenty patients underwent TUR-P for benign prostatic hyperplasia, followed by LRP (12 patients) or RRP (8 patients) after localized prostate cancer was diagnosed at our institution from November 1998 through December 2006. Median patient age was 67.5 years (range, 52-73 years). The median duration of follow-up was 96 months (range, 60-144 months). Operative time, volume of blood loss, duration of indwelling urethral catheter use, degree of urinary incontinence, pathological findings, oncological outcomes, and complications were compared between LRP and RRP. No significant difference in operative time or amount blood loss was recognized between LRP and RRP. Urinary incontinence in the early and late postoperative periods was significantly more severe after LRP than after RRP. Oncological outcomes and results of pathological examinations were comparable between LRP and RRP. We found no significant differences in clinical, pathological, and oncological outcomes, except for urinary incontinence, between LRP and RRP.

Physician Knowledge and Practices of Urethral Catheterization in Jos, Nigeria

Background: The use of urethral catheter is common in medical practice with up to 25% of hospitalized adults having an indwelling Foley catheter at some point during hospital stay. Its use however, is not without complications. We sought to find out the knowledge and practice patterns of physicians regarding urethral catheterization. Methodology: Self-administered questionnaires aimed at elucidating knowledge of the indications of urethral catheterization and precautionary measures effective against catheter-associated urinary tract infection (CAUTI) were distributed to physicians in a teaching hospital. Results: The majority of respondents correctly identified hemodynamic instability necessitating fluid administration (94.9%), lower urinary tract obstruction (92.1%), and assisting the healing of perineal wounds (84.3%) as appropriate indications for urethral catheter use. Incontinence (89.1%), preoperative use (88.3%), and epidural anesthesia (66.9%) were also identified as indications for catheterization. Early catheter removal (94.9%), use of condom catheter (91%), use of antibiotic coated Foley catheter (79.6%), intermittent catheterization (76.2%) and the use of automated reminders (67.6%) were correctly identified as measures that can prevent CAUTI by the majority of the respondents. Routine change of catheter was identified as an effective measure by 84% of the respondents. Conclusion: Physicians in a teaching hospital in Jos, Nigeria have adequate knowledge of indications for urethral catheter use and effective measures aimed at preventing CAUTI. More surgeons identified epidural anesthesia as an appropriate indication for urethral catheter use when compared to those of the medical specialties.Key Words Foley Catheter, Indications, Physicians, Urethral catheterization

Pressão intra-abdominal em cães

Sob consenso recente em pacientes humanos, os valores basais da pressão intra-abdominal (PIA) e seus prováveis limiares em casos mórbidos, foram estipulados com intuito de favorecer a homogeneidade de estudos científicos, além de fornecer diretrizes para conduta diagnóstica e terapêutica destes pacientes. Valores basais e alterações na pressão intra-abdominal em animais não são ainda suficientemente conhecidos e cientificamente determinados. Médicos veterinários necessitam conhecer melhor os estados mórbidos que cursam com Hipertensão Intra-Abdominal (HIA) ou Síndrome de Compartimento Abdominal (SCA). O presente estudo objetivou testar em cães a técnica já descrita sob consenso na medicina como modelo de mensuração da pressão intra-abdominal, assim como determinar os valores normais para a espécie. Foram utilizados 15 cães hígidos, machos e fêmeas, homogêneos e todos sem raça definida. A mensuração da pressão intra-abdominal foi realizada por meio da técnica indireta de sondagem vesical e utilização de coluna de água com régua graduada em cm de H2O, sendo seu valor final convertido para a unidade de mm de Hg. Foi observado valor mínimo subatmosférico (abaixo de zero mm de Hg) até o valor máximo de 3,75 mmHg. Houve importante variação entre os valores encontrados individualmente em determinados cães, colocando sob discussão questões como massa corporal, freqüência/volume total de solução fisiológica a ser infundida e agitação destes pacientes no momento do exame. Os valores limítrofes encontrados são considerados fisiológicos, indicando confiabilidade da técnica e possibilidade do seu emprego clínico. A ausência de sedação e utilização de sonda uretral não inviabilizou a realização da mensuração, porém podendo culminar numa sub ou superestimativa dos valores encontrados.

Safer urethral catheters: how study of catheter balloon pressure and force can guide design

To better define urethral catheter balloon pressures and extraction forces during traumatic placement and removal of urethral catheters. To help guide design for safer urethral catheters. Measurements of balloon pressure were made upon filling within the urethra vs the bladder. Extraction forces were measured upon removal of a catheter with a filled balloon from the bladder. Models for the bladder and urethra included an ex vivo model (funnel, 'bladder', attached to a 30 F tube, 'urethra') and fresh human male cadavers. The mean (SEM) balloon pressures and extraction forces were calculated. In the ex vivo model, the mean (SEM) pressures upon filling the balloon with 10 mL were on average three-times higher within the ex vivo'urethra' (177 [6] kPa) vs 'bladder' (59 [2] kPa) across multiple catheter types. In the human cadaver, the mean balloon pressure was 1.9-times higher within the urethra (139 [11] kPa) vs bladder (68 [4] kPa). Balloon pressure increased non-linearly during intraurethral filling of both models, resulting in either balloon rupture (silicone catheters) or 'ballooning' of the neck of the balloon filling port (latex catheters). Removal of a filled balloon per the ex vivo model 'urethra' and cadaveric urethra, similarly required increasing force with greater balloon fill volumes (e.g. 9.34 [0.44] N for 5 mL vs 41.37 [8.01] N for 10 mL balloon volume). Iatrogenic complications from improper urethral catheter use is common. Catheter balloon pressures and manual extraction forces associated with urethral injury are significantly greater than those found with normal use. The differences in pressure and force may be incorporated into a safer urethral catheter design, which may significantly reduce iatrogenic urethral injury associated with catheterization.

Urethral catheters: can we reduce use?

BackgroundIndwelling urinary catheters are the main cause of healthcare-associated urinary tract infections. It can be expected that reduction of the use of urinary catheters will lead to decreased numbers of urinary tract infection.MethodsThe efficacy of an intervention programme to improve adherence to recommendations to reduce the use of urethral catheters was studied in a before-after comparison in ten Dutch hospitals. The programme detected barriers and facilitators and each individual facility was supported with developing their own intervention strategy. Outcome was evaluated by the prevalence of catheters, alternatives such as diapers, numbers of urinary tract infections, the percentage of correct indications and the duration of catheterization. The costs of the implementation as well as the catheterization were evaluated.ResultsOf a population of 16,495 hospitalized patients 3335 patients of whom 2943 were evaluable for the study, had a urethral catheter. The prevalence of urethral catheters decreased insignificantly in neurology (OR 0.93; 95% CI 0.77 - 1.13) and internal medicine wards (OR 0.97; 95% CI 0.83 - 1.13), decreased significantly in surgical wards (OR 0.84; 95% CI 0.75 - 0.96), but increased significantly in intensive care (IC) and coronary care (CC) units (OR 1.48; 95% CI 1.01 - 2.17). The use of alternatives was limited and remained so after the intervention. Duration of catheterization decreased insignificantly in IC/CC units (ratio after/before 0.95; 95% CI 0.78 - 1.16) and neurology (ratio 0.97; 95% CI 0.80 - 1.18) and significantly in internal medicine (ratio 0.81; 95% CI 0.69 - 0.96) and surgery wards (ratio 0.80; 95% CI 0.71 - 0.90). The percentage of correct indications on the day of inclusion increased from 50 to 67% (p < 0.0001). The prevalence of urinary tract infections in catheterized patients did not change. The mean cost saved per 100 patients was € 537.ConclusionTargeted implementation of recommendations from an existing guideline can lead to better adherence and cost savings. Especially, hospitals which use a lot of urethral catheters or where catheterization is prolonged, can expect important improvements.

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections.

Background Indwelling urinary catheterisation is a relatively common procedure in hospital settings, associated with potential risk of infection. Around 80% of urinary tract infections (UTIs) are associated with urinary catheters and the risk of infection increases in patients who are acutely ill. The objective of this review was to present the best available critically appraised evidence related to preventing infections associated with the use of short-term indwelling urethral catheters. This review is an update of a previous review published in 2004. Review methods The review considered randomised controlled trials that included adult patients with short-term indwelling urinary catheters. The main interventions related to catheterisation techniques, meatal care, catheter composition, bladder irrigation, drainage systems, care delivery practices and education programs. The primary outcome of interest was the difference in the rates of UTIs between the intervention group and control group. This review was limited to short-term urethral catheters, so studies that evaluated long-term or suprapubic catheters were excluded. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. Methodological quality The methodological quality of the included papers was assessed using a checklist developed by the Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction and any disagreements that arose were addressed through mutual discussion. Results The review found six new studies in relation to catheter composition and delivery care practices interventions. Studies from previous review have been reported on in the results, discussion and conclusion sections. No one type of catheter was found to be better than another in terms of reducing the risk of bacteriuria in hospitalised adults. The incidence of catheter associated bacteriuria and funguria (CABF) was lower in adult trauma patients when nitrofurazone-impregnated catheters were used. Nitrofurazone-coated and silver alloy-coated catheters reduced the development of asymptomatic bacteriuria during short-term (< 30 days) use when compared with latex or silicon control catheters. Studies that compared immediate versus delayed catheter removal following operations found that early removal of catheter after operation was safe and that there was a tendency for increased infection with longer duration of catheterisation. Stop (prewritten) orders for urinary catheters resulted in a significant reduction in duration of inappropriate catheterisation days. There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine TRUNCATED AT 600 WORDS

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections

A systematic review of the management of short-term indwelling urethral catheters to prevent urinary tract infections

Eliminating Catheter-Associated Urinary Tract Infections

This article is the first in a two-part series focusing on catheter-associated urinary tract infections. There is a convergence of factors necessitating zero tolerance toward catheter-associated urinary tract infections, including the risks associated with patient safety and to a lesser extent the changes in reimbursement. Part I of this series focuses on the most significant modifiable risk factor, avoiding use of urethral catheters. A quality improvement case study is highlighted along with a practice bundle for evidence-based practice. Part II focuses on the second most significant risk factor, reducing urethral catheter-days.