Urology Ward Research Articles

The urostomy: The poor relation?

Aims/ObjectiveTo discuss the findings of a small research project about knowledge of urostomies amongst health care professionals (HCPs).BackgroundThe lead author's urostomy was formed in 2015. From early dealings with HCPs, it was clear that knowledge about urostomies was lacking. In particular, many do not know how to take an uncontaminated urine sample for testing. This has led to treatment delays, anxiety and frustration and caused the author to question care she had received. Discussions with other patients suggested a commonality in experience.Method and findingsWorking with a researcher from a UK‐based stoma charity, we conducted a small qualitative survey of urostomates via a Facebook support group. This asked the question: “How knowledgeable have you found Healthcare Professionals about urostomies?” 52 patients responded. Of these, 50 indicated that lack of knowledge was normal in encounters with HCPs. While in some clinical settings this is understandable, it was notable that some respondents recorded instances where staff on urological wards seemed to confuse a nephrostomy with a urostomy.ConclusionUrostomies are rare. It is estimated that 10 000 people in the United Kingdom have a urostomy, compared with between 110 000 and 120 000 with colostomies/ileostomies. HCPs encounter few during their career. Finding a way to embed knowledge and keep it up‐to‐date is therefore central to the problem. Our project has provided the impetus for larger scale research, with the aim of addressing this issue and improving the treatment and care that patients with urostomies receive.

Patient satisfaction with pain relief following major abdominal surgery is influenced by good communication, pain relief and empathic caring: a qualitative interview study.

Monitoring and improving the quality of care is an ever increasing concern for health care organisations. Measuring the effectiveness of clinical outcomes is done by looking at specific markers of high quality care. Pain management is considered one of the markers of high quality care and satisfaction with pain management is a crucial and important quality assurance marker; yet, we know little about what contributes to a patient's decision about satisfaction. A qualitative study drawing on phenomenological approach aiming to evaluate the perspective of patients experiencing post-operative pain. Patients undergoing major abdominal surgery were recruited from a Renal Transplant and Urology ward in the North of England, UK. Data were collected using in-depth semi-structured interviews and were analysed using Colaizzi's approach. Ten patients participated in the study and three themes emerged from the analysis. The findings of this study revealed that in order to achieve satisfaction with the management of pain, patient care has to include information delivery which is timely and adequate according to a patient's individual needs, nurses should have a caring attitude and pain should be well controlled. Satisfaction with pain management is influenced by good communication and information transfer, appropriate pain management and an empathic presence throughout.

Impact of pharmacist-led post-transplant medication management for kidney transplant recipients: A retrospective pre- and post-intervention study.

The roles of pharmacists in medication management for transplant recipients have received limited attention. This study comprehensively assessed the impact of pharmacist-led post-transplant medication management. A retrospective pre- and post-intervention study was conducted in the urology ward in a general hospital. Patients receiving kidney transplants from May 2015 to April 2017 were enrolled. Eligible subjects were assigned into two groups (pre-intervention group and post-intervention group) according to the date (1 May 2016) when the pharmacist commenced participation in the post-transplant management for kidney transplant recipients. The outcomes included intervention analysis, cost-saving effect, outcomes of immunosuppressive drug level monitoring, antibiotic outcomes, safety outcomes, and blood pressure (BP) and plasma glucose (PG) outcomes. A total of 299 patients were admitted to our hospital for kidney transplantation. Two hundred and four patients met inclusion criteria for this study (84 patients were in pre-intervention group, and 120 patients were in post-intervention group). Out of 630 pharmacist interventions in the medication order, 97.1% were accepted by the physicians. The average cost of medications per patient decreased from 4661.64 Ren Min Bi (RMB) to 3051.33 RMB. The percentage of patients who maintained tacrolimus (TAC) levels within the target concentration range was higher in the post-intervention group on post-operative day (POD) 7 (75.00% vs 87.50%, P=0.021). There was a significant decrease in antibiotic use density (AUD) and duration of antibiotic treatment in the post-intervention group. Post-intervention group showed lower levels in systolic blood pressure (SBP) (141.55±14.62 vs 136.04±13.17, P=0.01) with higher BP control rate (67.50% vs 90.70%, P=0.00) on discharge day compared to pre-intervention group. Pharmacists played a comprehensive role in the management of kidney transplant recipients in the inpatient setting, with some evidence of enhanced clinical outcomes.

Impact of an oral nutrition protocol in patients treated with elective radical cystectomy: a long term follow-up.

Background After radical cystectomy, delayed return of bowel function is relatively common. Although studies investigating on the best modality for delivering nutritional support to this patient group are limited, parenteral nutrition was standard of care in those patients at the urological ward of the University Hospitals Leuven. In 2015, we published the findings from our study conducted in patients undergoing elective regular radical cystectomy at the urological ward of the University Hospitals Leuven comparing the length of hospital stay in patients with early postoperative parenteral nutrition (n = 48) versus an immediate oral nutrition protocol (n = 46). It was demonstrated that the implementation of an oral nutrition protocol was associated with a significant reduced length of hospital stay (median [IQR] of 18 [15-22] to 14 [13-18] days (p < 0.001)). The sample size was however too small to investigate the impact of the oral nutrition protocol on the incidence of catheter-related bloodstream infection, a common parenteral nutrition related complication. Objective To investigate the long term impact of an oral nutrition protocol on the incidence of catheter-related bloodstream infection, duration of catheterization and the length of hospital stay. Method Retrospectively, before (parenteral nutrition group) and after the implementation of the oral nutrition protocol (since March 10th 2010), two cohorts of 549 patients who underwent an elective regular radical cystectomy were included. The incidence of a catheter-related bloodstream infection and the length of stay were compared. A central venous catheter was present in every patient, which is standard of care. Results Catheter-related bloodstream infection was reduced from 22 (4%) to 10 (1.8%) (p = 0.031). The median duration of catheterization was 10 [7-13] days for the parenteral nutrition versus 7 [7-7] days for the oral nutrition group (p < 0.001). The median length of stay between both groups, 20 [17-25] before versus 17 [14-21] days after the implementation of the oral nutrition protocol, also differed significantly (p < 0.001). Implementing the oral nutrition protocol resulted in a parenteral nutrition associated cost saving of €470 per patient. Conclusion This large follow-up study showed that the oral nutrition protocol is associated with a reduction in catheter-related bloodstream infection. Besides, postponing parenteral nutrition in favour of oral nutrition enhances recovery.

86 - Outcomes of an observational protocol to prevent healthcare-associated infections (HAIs) in a urology ward

86 - Outcomes of an observational protocol to prevent healthcare-associated infections (HAIs) in a urology ward

Study of Patient’s Satisfaction at Urology Ward of Shahid Beheshti Hospital, Hamadan University of Medical Sciences in the Second Half of 2018

Study of Patient’s Satisfaction at Urology Ward of Shahid Beheshti Hospital, Hamadan University of Medical Sciences in the Second Half of 2018

Prevention of healthcare-associated infections (HAIs) in a surgical urology ward: observational study—analysis of the problem and strategies for implementation

Our purpose is to present the results of our working group, with a view to reduce the incidence and improve the management of healthcare-associated infections (HAIs) in a urology ward. The study consists on an observational database designed with the view to analyse the incidence and characteristics of HAIs in Urology. Based on the results obtained, a critical evaluation was carried out and specific measures put in place to reduce HAIs. Finally, the impact and results of the implemented measures were periodically evaluated. The incidence of HAIs in urology decreased from 6.6 to 7.3% in 2012-2014 to 5.4-5.8% in 2016-2018. In patients with immunosuppression the incidence of HAIs decreased from 12.8 to 18% in 2012-2013 to 8.1-10.2% in 2017-2018, in those with a previous urinary infection fell from 13.6 to 4.8%, in those with a urinary catheter prior to admission from 12.6 to 10.8%, and in patients with a nephrostomy tube from 16 to 10.9%. The effect of the protocol also demonstrated a reduction in the percentage of patients with suspicion of HAIs for whom no culture was taken, from 6% in 2012 to zero in 2017 and 2018. Moreover, the implementation of protocols for empirical treatment has reduced the incidence of patients experiencing inadequate empirical antimicrobial therapy from 20 to 8.1%. It is essential to monitor the incidence of HAIs, and preventive measures play a useful role in reducing the rate of infection and in optimising their management.

Biochemical urinalysis of healthy kidney and stone-generating kidney in unilateral urolithiasis

Introduction: Oxalate, calcium, uric acid, and citrate are among the most widely known biochemical factors for urinary stone formation. In most cases, urolithiasis occurs as unilateral despite the role of systemic metabolic factors in kidney stone formation. Objectives: The present research aimed to compare these urinary biochemical factors in healthy and stone-generating kidneys in patients with unilateral urolithiasis. Patients and Methods: Forty patients with unilateral urolithiasis participated in this cross-sectional, descriptive-analytical study. The patients were hospitalized in kidney surgery and kidney urology ward of Kashani hospital of Shahrekord, southwest Iran. After the implementation of crushing stone using transurethral lithotripsy (TUL), 5-10 cc of urinary sample was collected from each kidney. An AutoAnalyzer (Mindray Company, Bs–360 model) and laboratory kits (Bionic Company) were used to measure calcium, uric acid, and creatinine. Moreover, a manual method and Darman Faraz Kave company kits were applied to measure the levels of oxalate and citrate. Results on the healthy and stone-generating kidneys of each patient were separately analyzed using the Stata 13 software. Results: The difference in the mean ratio of uric acid, oxalate, and citrate to creatinine in the healthy kidneys and stone-generating kidneys was not significant. However, the mean UCa/UCr ratio in the healthy kidneys was 0.27±0.07 and relatively greater than that in the stone-generating kidneys (0.11±0.04) (P=0.06). Conclusion: The studied topical factors and secretory disorders had not any significant relationship with unilateral urolithiasis. The cause of unilateral urolithiasis should be searched in other factors such as metabolic factors, main positions of individual during 24 hours and sleeping, and anatomic disorders of kidney stone, or multifactorial.

Management of Bladder Exstrophy: A Case Report in the Urological Ward at Saint Elizabeth General Catholic Hospital SHISONG

Bladder Extrophy is a rare urogenital malformation of the penis and bladder. This is an impressive fact at birth, due to the absence of the anterior bladder wall and the dorsal side of the penis. We report the clinical observation of a 21-month-old child who consults for urine incontinence from birth, when physical examination showed complete bladder extrophy. The reconstructive surgery allowed forming a bladder reservoir associated with a repair of the penis at the same time. Bladder extrophy is a benign condition whose operative consequences can be simple but urinary incontinence is not uncommon after reconstitution.

Levofloxacin for NIH Category II Chronic Bacterial Prostatitis: A Real-Life Study

Background: Mounting worldwide resistance trends make the use of fluoroquinolone (FQ) antibacterial agents increasingly difficult. This is felt more acutely in the case of urogenital infections, which are mainly caused by Gram-negative pathogens. For years, levofloxacin and other FQs have been the first-line drugs for treating National Institutes of Health (NIH) category II chronic bacteria prostatitis (CBP). Eradication rates achieved by levofloxacin in the frame of randomized trials vary greatly, ranging between 71 and 86%. Objectives: This was a retrospective observational study to investigate the efficacy of levofloxacin against CBP in a real-life setting (urological outpatient wards). Methods: A database including the clinical records of >2,500 CBP patients was reviewed. Patients were selected based on strict inclusion criteria. They were treated for 4 weeks with 500 mg levofloxacin per day, alone or combined with other antibacterials. Besides standard urological procedures including the 4-glass test for pathogen isolation, international symptom questionnaires (the NIH Chronic Prostatitis Symptom Index [NIH-CPSI] and International Prostate Symptom Score [IPSS]) were administered. Results: Pathogen eradication was achieved in 79% of the cases treated with levofloxacin as a single agent and 87.8% of patients who received a combination of levofloxacin and azithromycin. The 11% increase in the eradication rate in the latter group is statistically significant. In addition, the levofloxacin-azithromycin combination caused a significant decrease in prostate volume and significantly increased the bladder-voided volume. IPSS and NIH-CPSI values and the urinary peak flow rate decreased to a similar extent in both treatment groups. No adverse effects were reported by patients belonging to either treatment group. Conclusion: Levofloxacin retained its therapeutic efficacy in patients assessed in a real-life setting, and high eradication rates were attained when it was administered as a single agent. A combination of an FQ with azithromycin induced a significant improvement of eradication rates. This strategy may be an interesting option in both first-referral and relapsing cases, although caution should be exercised when patients are at risk of developing arrhythmias, tendinitis, or other adverse effects.

Dietary and fluid intake habits in nephrolithiasis patients presented to Ayub Teaching Hospital, Abbottabad

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Nephrolithiasis is the 3rd most common clinical problem worldwide. The dietary and fluid intake factors play an important role in its causation. The present study was conducted to determine the dietary and fluid intake habits in patients presented with nephrolithiasis to Ayub Teaching Hospital, Abbottabad.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional study enrolled 140 patients by convenient sampling. The study was carried out at the Urology ward of Ayub Teaching Hospital, Abbottabad from June 2017 to June 2018. In this study, a self-maintained structured questionnaire was used to interview 140 patients admitted in both male and female urology ward of Ayub Teaching Hospital, Abbottabad. The questionnaire covered the fluid intake and dietary habits of patients with relevance to determinants such as the number of glasses per day, level of education, physical activity, the occupation of patients and source of drinking water. Data was collected through questionnaires and was analyzed using SPSS-23. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total of 140 patients were enrolled, 80 (57.1%) were males whereas 60 (42.9%) were females. Most of them, i.e. 116 (82.9%) were from rural areas, 132 (94.3%) belonged to poor socioeconomic status, 60 (42.9%) patients used the tap water for drinking and 80 (57.1%) had vegetables in their daily diet. Most 100 (71.4%) of them were illiterate, 92 (65.7%) working indoor and 60 (42.9%) drinking 5 to 10 glasses per day.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study highlights the poor dietary and fluid intake habits of patients presenting with nephrolithiasis.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Prevalence of the Vascular Endothelial Growth Factor Receptor (VEGER) in Transitional Cell Carcinoma (TCC) of Bladder and its Relationship with Other Prognostic Factors

Background: Tumor growth, invasion, and metastasis are angiogenesis dependent; so, using anti-angiogenic therapies can block these procedures. Vascular endothelial growth factor (VEGF) is a strong proangiogenic factor that is expressed by many cancer cells like bladder cancer. Objectives: The aim of this study was to determine the prevalence of the VEGFR in transitional cell carcinoma (TCC) of bladder and its relationship with other prognostic factors. Methods: This cross sectional study was carried out on 61 patients with TCC of bladder after radical cystectomy (RC). These patients were referred to the Urology Ward in Labbafineazhad Hospital in Tehran, Iran. The relationship of VEGF and the prognostic factors was determined, using the Fisher's Exact and Chi-square for data analyzing by SPSS software version 17. Results: Among 61 patients with TCC of bladder, only 8 patients (13.1%) were VEGFR positive, and there was no significant relation between frequency of VEGFR expression and the other factors like age, gender, stage, lymph node involvement, lymphovascular, or perineural space invasion. Conclusions: According to this study, the most patients with TCC of bladder did not express VEGFR; also, none of the prognostic factors showed any relation with VEGFR expression.

Fournier gangrene: what’s new in treatment?

Fournier gangrene is necrotic, life-threatening fasciitis occurring in the perineal region and within external sexual organs and anus. It may extend to the abdominal cavity, leading to soft tissue necrosis and sepsis. The article presents current methods of diagnosis and treatment of necrotising fasciitis (Fournier gangrene being a part of this disease) based on the medical literature and experience of two urological wards. The following methods are discussed: isotonic salt and balanced crystalloid fluids, antibiotics, steroids, immunoglobulin, hyperbaric oxygen therapy, surgical debridement and split-thickness mesh grafting. At the beginning broad spectrum antibiotics were administrated for the patients, according with local guidelines therapeutic committee and results of specimens for Gram’s staining and culture and laboratory tests. After receiving antibiogram prompt antibiotic treatment was continued. Cystostomy was done for everyone. Active dressing was applied rarely. Mortality was not observed in this group of patients. Fournier gangrene frequently ends with death due to sepsis, ARDS, or insufficiency of the kidneys, liver or other organs. Early diagnosis, careful debridement and application of a proper antibiotic are the basic factors that reduce mortality and improve treatment outcomes.

Fournier gangrene – ward experience

Introduction. Fournier’s gangrene is a necrotising soft-tissue infection characterized by insidious and rapid onset. It belongs to the group of necrotising soft-tissue infections. The disease is more common in patients with systemic predispositions such as diabetes mellitus, obesity, hepatic cirrhosis, cancer, etc. Aim. The results of medical treatment thirtieths patients (man from 34 to 84 years old, middle age 67 years old) and co-morbidity with Fournier’s gangrene was presented. Material and methods. The co-morbidity was discussed and analized. The patients were treated by antishock therapy, proper antibiotic therapy was applied. The complications were presented during treatment, procedures with wounds, debridement and wounds treatment and final treatment skin deficiency. All patients had covered skin deficiency by mesh grafts, they were discharged from hospital with healed wounds or almost healed. Treatment from medical literature dealing with treatment and experience of Urological Wards was also presented (Fournier’s gangrene is a part of this disease). Results. Mortality was not observed in this group of patients. Conclusions. Fournier’s gangrene is a rapid-onset, life-threatening, acute urological disease requiring immediate diagnosis, as well as anti-shock and antibacterial therapy combined with intensive surgical debridement followed by the management of skin and soft tissue defects.

The effect of daily change of sterile urinary bag on bacteriuria and catheter–associated urinary tract infections

Introduction: One of the major healthcare measures in hospitals, is reducing the risk of infections. Since catheter-associated urinary tract infections (CA-UTIs) occur in 80% of cases, the prevention of these infections plays an important role in reducing infections related to the treatment care. Objectives: The present study aims to determine the effect of daily change of sterile urinary bag on the incidence of bacteriuria and CA-UTIs. Patients and Methods: This quasi-experimental study include all patients referred to the neurology, urology and surgery wards, as well as the ICU and CCU of Hajar and Kashani hospitals, Shahrekord, Iran. A total of 200 patients aged 18-75 years that required insertion of the urinary Foley catheter were divided into two groups: catheterization with the usual method (control group) and catheterization with daily change of sterile urinary bag (case group). In each of the two groups, immediately after insertion and during the removal of urethral catheter, the urine sample was collected using sterile method and was sent to the laboratory to conduct examinations for bacteriuria. The demographic information was prepared and collected using the researcher made questionnaire. Results: In this study, the average age of the patients was 49.81±15.11. The rate of CA-UTI was more in the control group than the case group (29% as compared with 16%) (P=0.04). The average age of patients with infection due to urethral catheterization was found to be higher (55.4±14.52 versus 48.4±14.92) (P<0.001). Conclusion: While a preference for closed drainage system existed, however in the present study, it was found that with daily change of sterile urinary bag even with opening of system, the rate of CA-UTI was reduced

Improving the quality of urology ward round documentation

Improving the quality of urology ward round documentation

Association and prognostic value of serum Cystatin C, IL-18 and Uric acid in urological patients with acute kidney injury

PurposeTo assess the role of serum Cystatin C, IL-18 and Uric acid in acute kidney injury (AKI) in urological patients, along with their prognostic significance. Materials and methodsProspective observational study included 61 cases, admitted in urology ward with baseline serum creatinine ≤1.5 mg/dL. All patients had at least one or more predisposing factors for AKI. Daily urine output and creatinine level were checked. Serum levels of biomarkers were measured at baseline and postoperatively after 24 h. Development of AKI and its outcome were analysed. ResultsThirty nine patients (63.9%) developed AKI in the study. Patients with AKI were found to have a greater percentage rise of Cystatin C (118.7% v/s 81.8%, p = 0.005), IL-18 (59.0% v/s 25.5%, p = 0.004) and Uric acid (34.3% v/s 19.2%, p = 0.008) after 24 h. Absolute Uric acid level at day 1 was also significantly associated with AKI (5.18 ± 0.91 v/s 4.45 ± 0.86, p = 0.003). Risk stratification of AKI was poor for all biomarkers. Area under curve for Cystatin C, IL-18 and Uric acid was 0.715, 0.696 and 0.734 respectively. Renal function after 3 months, had a positive correlation with baseline creatinine and baseline Cystatin C levels (r = 0.56 & 0.39). ConclusionsPostoperative serum Cystatin C, IL-18 and Uric acid after 24 h were significantly associated with AKI. Baseline Cystatin C had moderate capability to predict short term renal function.

The Correlation of Prostate Volume and Prostate-specific Antigen Levels With Positive Bacterial Prostate Tissue Cultures

To compare prostate volume and prostate-specific antigen (PSA) levels with bacterial growth in prostate tissue cultures. Fifty male patients who underwent transurethral prostate resection were investigated prospectively. Resection chips from the prostate gland were added to brain-heart infusion medium and incubated. PSA levels were determined preoperatively at our urology ward. The prostate gland volume was estimated by transabdominal ultrasound examination preoperatively. Persons with positive bacterial prostate tissue cultures have a greater prostate volume. This is significant in patients with and without histopathologic signs of prostatitis. Persons with positive bacterial prostate tissue cultures have higher PSA values. This is significant in patients without histopathologic signs of prostatitis. People with positive bacterial prostatic tissue culture have a higher prostate volume in comparison with patients with negative culture findings and show a tendency toward increased PSA levels as well.

Five-year prospective study evaluating risk factors for isolation of multiple-drug resistance (MDR) microorganisms in patients with healthcare-associated infections (HAIs) hospitalized in a urology ward

Five-year prospective study evaluating risk factors for isolation of multiple-drug resistance (MDR) microorganisms in patients with healthcare-associated infections (HAIs) hospitalized in a urology ward

Safer, faster, better: Improving the urology ward round &amp; handover process (iWRAHP)

Safer, faster, better: Improving the urology ward round &amp; handover process (iWRAHP)