Urethral Route Research Articles

Modern Aspects of Suppositories: A Review

Suppositories are an underutilized dosage form. Suppositories are such types of dosage forms used to provide medication via the vaginal and rectal routes. Vaginal suppositories are commonly referred to as pessaries. It was developed from a formulation called Liquid Enema. Enema has a great disadvantage in that, it used to leak out of the cavity in which they were put. So, this led to the discovery of suppositories as an alternative method of medication. Suppositories can be described as semi-solid dose forms utilized to provide medications for therapeutic action via rectal, vaginal, or urethral routes, where they will melt or dissolve and deliver localized or systemic impact. It is composed of cocoa butter, PEG, and fatty base (and a few others) as main ingredients, and it comes in different shapes and sizes. Although suppositories were formulated it was not that stable inside the orifices and also used to draw out of it. So, in order to overcome the problem of leaking, researchers added some mucoadhesive substance to improve its stability. From here onward improvement in the suppositories started as an alternative medication other than oral dosage form. The current article aimed to fabricate descriptive information about the advancement of suppositories. These advancements are Bi-layered Suppositories, Homogeneous Plain Suppositories, Hollow Suppositories, Effervescent Suppositories, Gel suppositories, Sustained Release Suppositories, etc.

Bacteriophage Therapy for Escherichia Coli -Induced Urinary Tract Infection In Rats

Background: The present study evaluates the efficacy of bacteriophage therapy for urinary tract infection (UTI) in rats. Methods: UTI was established by inoculating Escherichia coli (100μl) at a concentration of 1.5×108CFU/ml per urethra via a cannula in different groups of rats. For treatment, phage cocktails (200μl) were administered at varying concentrations of 1×108PFU/ml, 1×107PFU/ml and 1×106PFU/ml. Results: The two doses of phage cocktail at the first two concentrations resulted in the cure of UTI. However, the lowest concentration of the phage cocktailwarranted more doses to eradicate the causative bacteria. Conclusion: The quantity, frequency and safety ofdoses could be optimized ina rodent model using the urethral route.

V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY

You have accessJournal of UrologyCME1 Apr 2023V03-04 FIRST HUMAN NOTES FOR BLADDER LEIOMYOMA ENUCLEATION AND CYSTORRAPHY Andreia Cardoso, Sara Anacleto, Catarina Laranjo Tinoco, Ricardo Matos Rodrigues, Ana Sofia Araújo, Mariana Capinha, Vera Marques, João Pimentel Torres, Carlos Oliveira, Miguel Mendes, and Emanuel Carvalho-Dias Andreia CardosoAndreia Cardoso More articles by this author , Sara AnacletoSara Anacleto More articles by this author , Catarina Laranjo TinocoCatarina Laranjo Tinoco More articles by this author , Ricardo Matos RodriguesRicardo Matos Rodrigues More articles by this author , Ana Sofia AraújoAna Sofia Araújo More articles by this author , Mariana CapinhaMariana Capinha More articles by this author , Vera MarquesVera Marques More articles by this author , João Pimentel TorresJoão Pimentel Torres More articles by this author , Carlos OliveiraCarlos Oliveira More articles by this author , Miguel MendesMiguel Mendes More articles by this author , and Emanuel Carvalho-DiasEmanuel Carvalho-Dias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder leiomyomas (BL) are rare benign tumors, with roughly 250 cases reported worldwide. Surgical excision is the recommended treatment, classically through open partial cystectomy. As alternatives, minimally invasive approaches, such as laparoscopic (lap), robot-assisted and transurethral (TU) resection (TUR), are arising. In parallel, TU cystorraphy has been reported for vesicovaginal fistulas or traumatic perforations. Thus, to the best of our knowledge, we report the 1st Human Natural Orifice Transluminal Endoscopic Surgery (NOTES) with a purely TU approach for BL enucleation and cystorraphy, without transvesical access, gas insufflation, neither extracorporeal knot tying. METHODS: A 68-year-old woman presented an incidental 22mm lesion on the left posterolateral bladder wall on MRI, highly suspicious for BL. After cystocopic confirmation of a submucosal lesion, TUR was proposed. We performed a pioneer NOTES with total TU BL enucleation and cystorraphy using: 30° lens, white light only, saline irrigation, 26Ch resectoscope, operative cystoscope, Collin’s knife and standard resection loop, bipolar energy, 5mm lap needle holder and 3-0 V-Loc 23cm length suture. RESULTS: BL complete enucleation was done with bipolar energy on Collin’s knife and standard resection loop. Then, V-Loc suture was completely placed inside the bladder through the operative cystoscope, and with the lap needle holder inserted through it, a total intravesical cystorraphy with single hand continuous suture was performed. Operative time was 40min. Patient was discharged on the next day, with bladder catheter for 5 days. There were no complications. CONCLUSIONS: TUR has been used for BL, but without cystorraphy, which is a limitation for bigger or more profound infiltrative lesions. Cystorraphy techniques combining TU, transperitoneal and/or transmural bladder access were reported. A purely TU cystorraphy recently reported required extracorporeal sliding knot techniques, so, it was only possible in women. Thus, our approach may be the most minimally invasive possible for the safest treatment of BL. We combined several techniques aiming to reach an ideal one. Using only regular material, a single urethral route, and no gas insufflation, we achieved a quick and safe procedure, with no need for continuous bladder irrigation and short catheterization. Yet, it requires advanced skills such as single hand lap suturing. Our technique seems also feasible in small bladder perforations, fistulas, or other lesions (e.g.: endometriosis). Additionally, with total intravesical suture, it may also be viable in men. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e247 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andreia Cardoso More articles by this author Sara Anacleto More articles by this author Catarina Laranjo Tinoco More articles by this author Ricardo Matos Rodrigues More articles by this author Ana Sofia Araújo More articles by this author Mariana Capinha More articles by this author Vera Marques More articles by this author João Pimentel Torres More articles by this author Carlos Oliveira More articles by this author Miguel Mendes More articles by this author Emanuel Carvalho-Dias More articles by this author Expand All Advertisement PDF downloadLoading ...

Burden of Prolonged Urinary Catheter Use after Urinary Retention in a Tertiary Hospital, South-South Nigeria

Background: Urinary retention is a worldwide health problem mostly noted in elderly men who may have benign prostatic hyperplasia (BPH), cancer of the prostate (Cap), urethral stricture disease or bladder tumour. It has a negative impact on the quality of life (QOL) of the sufferer as well as national or global economy. Urethral catheterization is used to relief the retention and suprapubic cystostomy where the urethral route fails or it’s contraindicated. Complications have been reported especially when catheters are worn for prolonged periods of time. The aim of this work was to study the burden of prolonged use of catheters after urinary retention. Patients and Method: The study was conducted in March 2021 and lasted for four (4) weeks to prevent data duplication since our patients change their catheters once in 4 weeks. A questionnaire was designed and completed by all patients after informed consent was obtained. Data collected were analyzed using statistical package for social science (SPSS) version 20.0 and results used for discussion. Results: Eighty two (82) patients with a mean age of 63.12±14.67 years were studied. Aetiology of urinary retention was BPH, Cap, and Urethral stricture in 58.5%, 19.5% and 23.0% respectively. More patients were in their 7th and 8th decades of life. Most patients had indwelling urethral catheter (65.9%), average duration of catheter use was 21.26 months. There was no statistical significant difference in the mean duration between those who used SPC and Urethral catheter (P= .411).Ninety-eight (98.7%) of patients had complications and 22% of them reported more than five (5) complications. Qol correlated poorly with those who had sexual issues due to prolonged catheter use. The estimated annual cost for catheter change was between N1.5million and N2.0 million in our facility. Conclusion: Prolonged catheter use is a source of concern to patients and poses serious health-related and financial burden to them.

Management of Putraghni Yonivyapada by Uttarbasti: A case study

Recurrent miscarriage is defined as a sequence of three or more consecutive spontaneous abortion before 20 weeks. This distressing problem is affecting approximately 1% of all women of reproductive age. In Ayurvedic literature, recurrent abortion may be correlated as Putraghni yonivyapad mentioned in Charak samhita, Sushruta samhita and Ashtanga Hridaya. To overcome this disconcerting problem; Ayurveda- an alternative system of medicine may be procured. According to Ashtanga Hridaya (one of the Brihattrayi), Uttarbasti (mode of administration of drug by urethral or genital route) is indicated in treatment of all types of Yoni vyapad (gynaecological disorders). In this particular case of recurrent miscarriage, we used Phalghrita Uttarbasti and Dashamula qwath niruha basti along with internal medications such as Shatavari- Ashwagandha siddha kshirapaka and Vrishya vati. Uttarbasti removes strotorodha and maintains hormonal balance in uterus and ovaries. Patient was conceived after 6 month course of treatment. She was further treated with Garbhini Paricharya and resulted into normal labour with healthy child.

Utility of Mitrofanoff as bladder draining tool: A single center experience in pediatric patients.

Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here. It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique. Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%). Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.

The usefulness of flexible cystoscopy for preventing double-J stent malposition after laparoscopic ureterolithotomy

BackgroundThe aim of this study was to evaluate the role of flexible cystoscopy in preventing malpositioning of the ureteral stent after laparoscopic ureterolithotomy in male patients.MethodsFrom April 2009 to June 2015, 97 male patients with stones >1.8 cm in the upper ureter underwent intracorporeal double-J stenting of the ureter after laparoscopic ureterolithotomy performed by four different surgeons. In the last 50 patients who underwent laparoscopic ureterolithotomy flexible cystoscopy was performed through the urethral route to confirm the position of the double-J stent, while in the first 47 correct positioning of the stent was confirmed through postoperative KUB. The demographic data and perioperative outcomes were reviewed retrospectively. Penalized logistic regression analysis was used to evaluate the effects of flexible cystoscopy.ResultsUpward malpositioning of the ureteral stent was found in 9 of the 47 (19.1%) patients who underwent surgery without flexible cystoscopy. Among the 50 most recent patients who underwent surgery with flexible cystoscopy through the urethral route, upward malpositioning was observed in 10 (20%) patients. The factors preventing upward malpositioning of the double-J catheter in multivariate analysis were surgeon (p = 0.039) and use of flexible cystoscopy (p = 0.008).ConclusionFlexible cystoscopy is a simple, safe, quick, and effective method to identify and correct malpositioning of double-J stents, especially in male patients.Trial registrationThis study was registered with ClinicalTrials.gov Registry on May 11, 2017 (retrospective registration) with a trial registration number of NCT03150446.

The Use of Multiple Foley Balloon Catheters for Treating Life-Threatening Radiation Induced Hemorrhagic Cystitis

Life-threatening hematuria from radiation induced hemorrhagic cystitis remains a difficult clinical problem for the urologists. We report the use of multiple inflated Foley balloon catheters for compression on the bleeding bladder mucosa via the suprapubic and urethral routes in a patient with hemorrhagic shock due to intractable bleeding of radiation induced hemorrhagic cystitis. This method is simple and quick to stop bladder bleeding for life saving.

Propionibacterium acnes infection induces upregulation of inflammatory genes and cytokine secretion in prostate epithelial cells

BackgroundThe immune stimulating bacterium Propionibacterium acnes is a frequent colonizer of benign and malignant prostate tissue. To understand the pathogenesis of the earliest phase of this infection, we examined the P. acnes triggered immune response in cultivated prostate epithelial cells.ResultsProstate epithelial cells are triggered to secrete IL-6, IL-8 and GM-CSF when infected with P. acnes. The secretion of cytokines is accompanied by NFκB related upregulation of the secreted cytokines as well as several components of the TLR2-NFκB signaling pathway.ConclusionsP. acnes has potential to trigger a strong immune reaction in the prostate glandular epithelium. Upon infection of prostate via the retrograde urethral route, the induced inflammatory reaction might facilitate bacterial colonization deeper in the prostate tissue where persistent inflammation may impact the development of prostate diseases as hyperplasia and/or malignancy.

Transurethral resection of prostrate and suprapubic ballistic vesicolithotrity for benign prostatic hyperplasia with vesical calculi.

Bladder calculi associated with benign prostatic hyperplasia are fairly common, and a popular treatment is transurethral resection of the prostate (TURP) with endoscopic lithotripsy as a combined procedure. We have been routinely using a Reuter's suprapubic trocar and cannula for continuous irrigation during TURP for medium-size and large glands. Rather than performing the vesicolithotripsy per urethra, we have found it easier and faster to use the suprapubic route, especially because the suprapubic tract was already partly made by the Reuter's trocar and half sheath. We describe the technique in detail and explain why we find it easier to extract the stone by the suprapubic rather than the urethral route.

Per-urethral endoscopic management of bladder stones: does size matter?

Large urinary bladder stones occupying the whole lumen are still encountered. Conventionally, an open suprapubic cystolithotomy (SPCL) has been the accepted treatment of choice. The other method described is suprapubic percutaneous lithotripsy. The present paper describes complete stone clearance in adults by the urethral route using a conventional nephroscope, a pneumatic lithotripter, and an evacuator. An additional procedure to treat outlet obstruction is performed when required. Although the procedure takes a long time, stone clearance is complete, and the procedure is free from any complications. This technique should be offered to all adults, as it has negligible morbidity.

Management of undeflatable Foley catheter balloons in women.

The inability to deflate a self-retaining balloon catheter is a rare problem but may be encountered by physicians. Many techniques have been described to solve the problem, some of which may be dangerous. The technique must not disturb the patient or create any additional morbidity. Those methods commonly used are the instillation of ether, liquid paraffin, chloroform or mineral oil through the inflation channel the use of a fine wire to burst the balloon or to recanalize the obstructed inflation channel; bursting or deflating the balloon through suprapubic, transvaginal or urethral routes: and the overinflation technique. The techniques which might be most appropriate for women are explained in a stepwise manner. First the catheter is cut in the proximal segment of the valve. If this is not successful, a ureteric catheter stylet is advanced through the inflation channel until it touches the balloon. If this is still unsuccessful, the balloon is deflated through the drainage channel using the technique proposed by Davies and Thomas. As a second choice, an intravenous cannula with its inner needle drawn back is advanced through the urethra next to the catheter; towards the balloon which, is then punctured with the inner needle. If these steps are followed, the patient will have no additional discomfort and no trauma to the surrounding tissues, and there will be no need for cystoscopy or any other expensive intervention.

Endoscopic trigonoplasty for primary vesico‐ureteric reflux

To investigate the surgical results of endoscopic trigonoplasty in patients with primary vesicoureteric reflux. Records were reviewed for 12 patients who underwent endoscopic trigonoplasty between February 1992 and February 1994. Of the 12 patients, 11 were female; one was a child and nine had unilateral disease. From 15 renoureteric units, grade I vesico-ureteric reflux was demonstrated in five, grade II in six and grade III in four. The ureteric orifices were approximated close to the midline via the urethral route and two trocars on the abdomen achieved pneumobladder. The mean surgical time was 178 +/- 52 min; this lessened as the learning curve developed. Intra-operative complications in three patients were all caused by trocar placement. Eleven patients required analgesics for one post-operative day only. No post-operative dilatation of the upper urinary tract was demonstrated. Vesico-ureteric reflux was eradicated in all patients. Endoscopic trigonoplasty is a minimally invasive procedure with a high cure rate. By not destroying the normal vesico-ureteric junction, post-operative obstruction cannot occur. We believe that endoscopic trigonoplasty is a feasible procedure for patients with vesico-ureteric reflux.

An Alternative to Manage a Nondeflating Foley Catheter in Women

The urologist is frequently called upon to remove a nondeflating Foley catheter. The basic strategies to accomplish removal involve relieving obstruction of the blocked balloon port channel, dissolving the rubber balloon chemically or rupturing the balloon percutaneously. A less invasive technique of balloon rupture in the female patient, using a peri-catheter urethral route, is described.

An Alternative to Manage a Nondeflating Foley Catheter in Women

The urologist is frequently called upon to remove a nondeflating Foley catheter. The basic strategies to accomplish removal involve relieving obstruction of the blocked balloon port channel, dissolving the rubber balloon chemically or rupturing the balloon percutaneously. A less invasive technique of balloon rupture in the female patient, using a peri-catheter urethral route, is described.

The invaginated sleeve technique for a continent cystostomy--five years' clinical experience.

To evaluate the invaginated sleeve technique for continent cystostomy in humans. Over the past 5 years six patients have undergone this operative procedure. An essential principle utilized in the technique is the property of partial thickness bladder grafts to stretch longitudinally, so that each tubularized pedicle graft could be directed transmurally and extended extravesically to reach the skin of the lower abdominal wall. As a consequence a urothelial-lined tract, both extravesically and through the bladder wall, was provided for intermittent self-catheterization. Apart from one woman, whose cystostomy tract was disrupted by inappropriate catheterization in the immediate post-operative period to attempt to stop leakage through exposed fenestrations in the suprapubic stent, this procedure provided robust, continent catheterizing routes for all patients for periods of 63, 52, 12, 7 and 1.5 months respectively. Two patients developed discrete stenoses at their mucocutaneous junctions at 3 and 5 months which were corrected easily. This simple, minimally morbid technique, which avoids the use of non-urinary tract epithelial structures and maintains bladder capacity, is strongly recommended for patients who need to practise clean intermittent self-catheterization and for whom the urethral route is impracticable.

Transurethral Thermotherapy of the Benign Prostate Hypertrophy Controlled by Radiometry

Up to now control of the microwave heating of the prostate was only possible with rectal or urethral surface catheters. This problem has finally been solved with the help of the Prostcare apparatus (Bruker Spectrospin, Wissembourg, France) and radiometry: the prostate can be treated by the urethral or endorectal route with a 915-MHz generator and coaxial antennae, a unique device which allows us to measure real intraprostatic temperature, to regulate the microwave emission power and to eliminate classic surface controls. A sole antenna is used for the urethral catheter; it is introduced within the Foley-type probe and allows us to heat and measure the heat (radiometry). In this preliminary report, we present clinical results of the first 105 treated patients over 18 months by the transurethral route in a single 1-hour session: 7 have a protuberant median lobe and the treatment is without any effect; 76 patients can be analyzed and the Madsen score before treatment, at 3 months and at 6 months moves from 11.2 to 2.5 and 3.1, the maximum flow rate from 9.6 to 12.3 and 12.5 ml/s, the residue decreases from 102 to 68 and 53 ml. The session is well tolerated and patients mention that the effects are better than those of medical treatment. Hyperthermia is a simple method that will find its place between medical and surgical treatment once the numerous randomized studies have determined the most suitable therapeutic procedures.

Urinary drainage following radical hysterectomy for cervical carcinoma - a pilot comparison of urethral and suprapubic routes.

Twenty-four patients who underwent radical hysterectomy and pelvic node dissection for cervical carcinoma were randomized in a pilot study to compare continuous postoperative drainage by urethral and suprapubic catheters. There were no statistically significant differences in either the duration of continuous catheter drainage before the return of spontaneous voiding or the incidence of urinary tract infection in the two groups. Power calculations reveal that 628 patients require to be entered into each arm of a future study in order to be able to detect the former difference should it exist (alpha = 0.05, beta = 0.2, difference = 16% of one s.d.) and 41 in the latter (alpha = 0.05, beta = 0.2, 92.9% urethral group had UTI, 70% suprapubic group had UTI). We conclude that differences in these objective measures of catheter efficacy and morbidity between the groups, if they exist, are clinically irrelevant. On this basis we suggest that individual gynaecological oncologists should continue to use whichever method of catheter drainage best suits their clinical practice.

Bacteriologically stressed animalmodel of new closed catheter drainage system with microbicidal outlet tube

We have used a catheterized rabbit model to test a newly developed catheter drainage system that incorporates a microbicidal outlet tube. In these tests, this new system was compared with a currently marketed closed drainage system, with daily challenge at the outlet tube using an auxotrophically marked uropathogenic strain of Escherichia coli. In the control series (silicone catheter connected to a standard drainage bag via a tamper-evidence seal) the challenge organism developed upstream biofilm colonization of the luminal surfaces of the catheter and drainage system that was complete in 4.6 +/- 2.1 days in 11 animals, while in 1 animal a rapid overgrowth of the system with Streptococcus faecalis developed. The presence of organisms other than the marked E. coli strain on the luminal surfaces of these control catheters showed that down stream colonization was also operative. In the test catheter drainage series, the microbicidal outlet tube insert precluded upstream colonization by the challenge organism in 12 of 16 catheters and significantly delayed (7.2 +/- 1.0 days) this colonization in the remaining 4 animals. When upstream colonization by exogenous bacteria was precluded by this effective device, downstream colonization of the drainage system by mixed populations of bacteria that probably migrated into the bladder via the extraluminal urethral route developed in some animals (6 of 16).

Bacterial Biofilms and Catheters: A Key to Understanding Bacterial Strategies in Catheter‐Associated Urinary Tract Infection

Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder's mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter-associated infection.