Urethral False Passage Research Articles

V07-11 USE OF ULTRASOUND IN DIFFICULT URINARY CATHETERIZATION

You have accessJournal of UrologyCME1 Apr 2023V07-11 USE OF ULTRASOUND IN DIFFICULT URINARY CATHETERIZATION Jeffrey Lee, Dhaval Jivanji, Benjamin Shpeen, Elie Kaplan-Marans, Ariel Schulman, and Ruslan Mamedov Jeffrey LeeJeffrey Lee More articles by this author , Dhaval JivanjiDhaval Jivanji More articles by this author , Benjamin ShpeenBenjamin Shpeen More articles by this author , Elie Kaplan-MaransElie Kaplan-Marans More articles by this author , Ariel SchulmanAriel Schulman More articles by this author , and Ruslan MamedovRuslan Mamedov More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003288.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The use of point-of-care ultrasound (POCUS) has become ubiquitous within medicine and can be utilized in numerous clinical scenarios. Various studies have shown the benefits of training urologists to use ultrasound (US), but there is currently scant literature regarding its use in difficult urinary catheterization (DUC). The goal of this video is to demonstrate the equipment and US-guided techniques we used to aid in DUC. METHODS: We present the case of an 89-year-old who developed oliguria and fecaluria after placement of a urinary catheter. Two days later, he underwent a CT which showed evidence of a urethral false passage and urethrorectal fistula with the catheter balloon inflated within the rectum. Urology was consulted to evaluate the patient. Due to the trauma caused by initial failed catheter placement, the decision was made to place a new catheter under direct vision via flexible cystoscopy. For our US, we used a Mindray TE5 with a C5-2s convex transducer. After successfully advancing a sensor guidewire into the bladder under cystoscopy, we were able to visualize the wire as a hyperechoic structure under US. Next, the wire was exchanged for a 5 French open-ended catheter in order to obtain a clean urine specimen. To confirm appropriate placement of the open-ended catheter in the bladder, we injected 10ml of normal saline to visualize flow using the color doppler feature of the US. After we exchanged the open-ended catheter for a guidewire, we used a 16 gauge angiocatheter to bore a hole into an 18 French foley to create a council tip, which was advanced into the bladder. Lastly, we inflated the catheter balloon to the recommended maximum capacity of 30ml in order to aid in easier identification under US. RESULTS: The patient underwent successful placement of a urinary catheter using US assistance and he immediately drained of 700 ml of purulent urine. A CT obtained after the procedure showed a decompressed bladder with the catheter tip in appropriate position. Our video demonstrates three techniques using US guidance to help aid DUC: 1.) visualization of the wire, 2.) use of doppler flow, and 3.) visualization of the foley balloon. CONCLUSIONS: Our video demonstrates how POCUS can be used in a safe and reproducible manner to aid DUC. US-guided catheter placement may improve the likelihood of successful catheterization in other complex cases such as those where blind wiring or urethral dilation are used. More studies will be necessary to validate these techniques. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e599 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Lee More articles by this author Dhaval Jivanji More articles by this author Benjamin Shpeen More articles by this author Elie Kaplan-Marans More articles by this author Ariel Schulman More articles by this author Ruslan Mamedov More articles by this author Expand All Advertisement PDF downloadLoading ...

Current Evidence Related to Intermittent Catheterization: A Scoping Review.

The purpose was to summarize evidence related to adherence to intermittent catheterization (IC), complication rates, satisfaction with IC, and its effect on health-related quality of life. Intermittent catheterization is frequently used to manage lower urinary tract dysfunctions including urinary retention and urinary incontinence, but research suggests that care for patients using IC may not always be based on evidence. Scoping review. We searched the PubMed, EMBASE, CINAHL databases, and the Cochrane Database for Systematic Reviews to identify studies published between January 2009 and March 2019. Seventy studies met inclusion criteria and were evaluated for adherence, complication rates, satisfaction, and health-related quality in adults and children using IC for bladder management. Recent research was variable in both quantity and quality. The evidence suggests that (1) most patients can successfully master IC and that functional status is likely the most important predictor of success; (2) adherence to IC probably decreases over time; (3) urinary tract infections (UTIs) are the most common complication of IC and that prophylactic antibiotic therapy may reduce the risk of recurrent UTIs; (4) urinary incontinence is also a common complication; and (5) other complications such as urethral strictures, bladder stones, hematuria, and urethral false passage do occur but are less prevalent than UTIs and incontinence between catheterizations. Our review also revealed multiple gaps in the evidence to support care for patients using IC. Research priorities include a need for prospective studies of the epidemiology and risk factors for IC-related complications, along with intervention studies to determine how to improve outcomes for patients using IC to manage bladder function.

Posterior Urethroplasty Complexity and Prognosis Can be Described by a Novel Method: Posterior Urethral Stenosis Score

To develop a standardized PU-score (posterior urethral stenosis score), with the goal of using this scoring system as a preliminary predictor of surgical complexity and prognosis of posterior urethral stenosis. We retrospectively reviewed records of all patients who underwent posterior urethral surgery at our institution from 2013 to 2015. The PU-score is based on 5 components, namely etiology (1 or 2 points), location (1-3 points), length (1-3 points), urethral fistula (1 or 2 points), and posterior urethral false passage (1 point). We calculated the score of all patients and analyzed its association with surgical complexity, stenosis recurrence, intraoperative blood loss, erectile dysfunction, and urinary incontinence. There were 144 patients who underwent low complexity urethral surgery (direct vision internal urethrotomy, anastomosis with or without crural separation) with a mean score of 5.1 points, whereas 143 underwent high complexity urethroplasty (anastomosis with inferior pubectomy or urethrorectal fistula repair, perineal or scrotum skin flap urethroplasty, bladder flap urethroplasty) with a mean score of 6.9 points. The increase of PU-score was predictive of higher surgical complexity (P = .000), higher recurrence (P = .002), more intraoperative blood loss (P = .000), and decrease of preoperative (P = .037) or postoperative erectile function (P = .047). However, no association was observed between PU-score and urinary incontinence (P = .213). The PU-score is a novel and meaningful scoring system that describes the essential factors in determining the complexity and prognosis for posterior urethral stenosis.

Infrapubic versus Penoscrotal Approaches for Implantation of Semi-Rigid Penile Prosthesis

Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.

Urethral Foreign Bodies: Clinical Presentation and Management

To review a single institution's 15-year experience with urethral foreign bodies, including evaluation, clinical findings, and treatment. In total, 27 patients comprising 35 episodes of inserted urethral foreign bodies were reviewed at Cook County Hospital between 2000 and 2015. Retrospective chart review was performed to describe the clinical presentation, rationale for insertion, management, recidivism, and sequelae. Median patient age was 26 (range 12-60). Twenty-six patients (97 %) were male, 1 was female (3%). Items inserted included pieces of plastic forks, spoons, metal screws and aluminum, pieces of cardboard or paper, staples, writing utensils such as pens and pencils, as well as coaxial cable and spray foam sealant. Reported reasons for insertion were self-stimulation, erectile enhancement, and attention seeking. Presenting symptoms included dysuria, gross hematuria, urinary retention, urinary tract infection, and penile discharge. The most common technique for removal was manual extraction with extrinsic pressure (n = 19, 54%). Other methods include endoscopic retrieval (n = 8, 23%), open cystotomy (n = 1, 3%), and voiding to expel the foreign body (n = 7, 20%). Postremoval complications included urinary tract infection (n = 7), sepsis (n = 4), urethral false passage (n = 5), laceration (n = 5), and stricture (n = 1). We present the largest single-institutional series of urethral foreign bodies to date. Urethral foreign body insertion is a relatively rare occurrence and, commonly, is a recurrent behavior. Urethral trauma related to foreign body insertion is associated with significant risk of infection and urethral injury with long-term sequelae.

762 ENDOSCOPIC MANAGEMENT OF RECURRENT POSTERIOR URETHRAL STRICTURES (PUS) WITH VISUAL INTERNAL URETHROTOMY (VIU) AND INJECTION OF MITOMYCIN C (MMC)

You have accessJournal of UrologyPenis/Testis/Urethra: Benign & Malignant Disease (II)1 Apr 2013762 ENDOSCOPIC MANAGEMENT OF RECURRENT POSTERIOR URETHRAL STRICTURES (PUS) WITH VISUAL INTERNAL URETHROTOMY (VIU) AND INJECTION OF MITOMYCIN C (MMC) James Rybak and Laurence Levine James RybakJames Rybak Chicago, IL More articles by this author and Laurence LevineLaurence Levine Chicago, IL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.325AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recurrent posterior urethral strictures pose a challenging therapeutic dilemma. Surgery is complex and difficult. MMC has been shown to reduce fibroblast and scar proliferation. It has been previously studied to be a safe minimally invasive approach for recurrent bladder neck contractures (BNC) following radical prostatectomy. This study assessed patient outcomes following VIU and injection with MMC in a patient population with a variety of complex and radiation induced PUS. METHODS Retrospective chart review from our database of reconstructive surgery with PUS between 2010 and 2012 that had failed previous intervention with at least 1 prior VIU. Quadrant cold knife incisions of the scar were performed followed by 0.3-0.5mg/ml injections of MMC at each incision site; a total of 10 mL was used in each scar. Postoperative flexible cystoscopy and post void residual (PVR) assessed urethral patency postoperatively at 1,3,6,12 months. RESULTS 14 patients were treated with VIU and injection of MMC. All pt's had failed a mean of 2.5 prior procedures (1-4) Mean follow-up was at 8 months (1-14). Average scar length was 1.5cm (1-2.5cm). 42% (6/14) had post brachytherapy induced strictures. 2 patients had strictures from previous RALP, 1 had postoperative external beam radiation s/p RRP. 2 patients had a BNC after holmium laser ablation of the prostate, 1 after TUNA, 2 had strictures from prior failed urethroplasties. Complications were seen in 2/14 patients, 1 needed surgical intervention for a urethral false passage after self catheterization, 1 experienced gross hematuria necessitating clot evacuation. 11/14 patients were continent at baseline and 11/14 remained continent post procedure. 14/14 pt's had patent posterior urethral stricture confirmed by flexible cystoscopy at follow up. Average PVR improved from mean 148ml to 31.25ml post procedure. 3/14 (21%) needed repeat procedure for stricture recurrence. 2/14 patients had successful placement of artificial urinary sphincter with a patent urethra seen intraoperatively. CONCLUSIONS Management of recurrent proximal urethral strictures is one of the most challenging reconstructive problems. In our series it appears that VIU or resection of PUS with injection of MMC can provide a minimally invasive tool to manage these strictures without significant morbidity, even in patients with radiation-induced disease. In those men who have urinary incontinence, successful sphincter placement is offered when there is no stricture recurrence or > 6 months. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e313 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Rybak Chicago, IL More articles by this author Laurence Levine Chicago, IL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Bladder management methods and urological complications in spinal cord injury patients

Background:The optimal bladder management method should preserve renal function and minimize the risk of urinary tract complications. The present study is conducted to assess the overall incidence of urinary tract infections (UTI) and other urological complications in spinal cord injury patients (SCI), and to compare the incidence of these complications with different bladder management subgroups.Materials and Methods:545 patients (386 males and 159 females) of traumatic spinal cord injury with the mean age of 35.4±16.2 years (range, 18 – 73 years) were included in the study. The data regarding demography, bladder type, method of bladder management, and urological complications, were recorded. Bladder management methods included indwelling catheterization in 224 cases, clean intermittent catheterization (CIC) in 180 cases, condom drainage in 45 cases, suprapubic cystostomy in 24 cases, reflex voiding in 32 cases, and normal voiding in 40 cases. We assessed the incidence of UTI and bacteriuria as the number of episodes per hundred person-days, and other urological complications as percentages.Results:The overall incidence of bacteriuria was 1.70 / hundred person-days. The overall incidenceof urinary tract infection was 0.64 / hundered person-days. The incidence of UTI per 100 person-days was 2.68 for indwelling catheterization, 0.34 for CIC, 0.34 for condom drainage, 0.56 for suprapubic cystostomy, 0.34 for reflex voiding, and 0.32 for normal voiding. Other urological complications recorded were urethral stricture (n=66, 12.1%), urethritis (n=78, 14.3%), periurethral abscess (n=45, 8.2%), epididymorchitis (n=44, 8.07%), urethral false passage (n=22, 4.03%), urethral fistula (n=11, 2%), lithiasis (n=23, 4.2%), hematuria (n=44, 8.07%), stress incontinence (n=60, 11%), and pyelonephritis (n=6, 1.1%). Clean intermittent catheterization was associated with lower incidence of urological complications, in comparison to indwelling catheterization.Conclusions:Urinary tract complications largely appeared to be confined to the lower urinary tract. The incidence of UTI and other urological complications is lower in patients on CIC in comparison to the patients on indwelling catheterizations. Encouraging CIC; early recognition and treatment of the UTI and urological complications; and a regular follow up is necessary to reduce the medical morbidity.

How To Manage Acute Urethral False Passage Due To Intermittent Catheterization In Spinal Cord Injured Patients Who Refused Insertion Of An Indwelling Catheter

How To Manage Acute Urethral False Passage Due To Intermittent Catheterization In Spinal Cord Injured Patients Who Refused Insertion Of An Indwelling Catheter

How To Manage Acute Urethral False Passage Due To Intermittent Catheterization In Spinal Cord Injured Patients Who Refused Insertion Of An Indwelling Catheter

Acute urethral false passage is an important complication of clean intermittent catheterization in spinal cord injured patients. Temporary urethral stenting with an indwelling catheter is generally an excellent conventional therapeutic option to treat patients with acute false passage. However, how can acute false passage be managed in a patient who refuses insertion of an indwelling catheter? For 3 years 5 male patients with acute urethral false passage due to catheterization refused urethral stenting because indwelling catheter insertion would prevent sexual intercourse. We placed a nitinol prostatic stent successfully in the false urethral passage in all 5 patients. The stents were left in place for 3 to 6 months. The stent migrated in 1 patient and it was replaced. During a retention period of 3 to 6 months all patients continued clean intermittent catheterization without any difficulty and achieved sexual intercourse. On urethral cystoscopy we observed that all false passages disappeared without a gross tissue reaction. The stents were then removed without any complications. During a mean followup of 11.8 months (range 4 to 25) none of these patients had another false passage. All continued to perform clean intermittent catheterization without any further difficulty. Temporary placement of a removable endourethral stent is a safe and effective method for managing acute urethral false passage in patients on clean intermittent catheterization who refuse insertion of an indwelling catheter. This approach makes further clean intermittent catheterization possible and improves patient quality of life.

Urethral False Passage as a Complication of Intermittent Catheterization

Intermittent catheterization is used commonly to treat bladder dysfunction. We treated 10 patients who were experiencing difficulty with intermittent catheterization, 9 of whom had a false urethral passage. Of these patients 6 had previously undergone a bladder neck or urethral operation. Endoscopy was helpful to diagnose the condition. Treatment consisted of stenting in 3 patients, transurethral incision and stenting in 3, and fulguration and stenting in 4. An indwelling catheter was left in place for 2 to 3 weeks, after which intermittent catheterization was resumed with a softer catheter. Two patients again experienced severe difficulty with catheterization and they underwent a continent urinary diversion. When intermittent catheterization becomes difficult or impossible, the presence of a urethral false passage should be suspected as a possible cause. (J. Urol., 142: 1216-1217, 1989)