Voiding Problems Research Articles

189 PARENTING STRESS IN BLADDER AND BOWEL DYSFUNCTION

You have accessJournal of UrologyPediatrics: Dysfunctional Voiding/Enuresis1 Apr 2013189 PARENTING STRESS IN BLADDER AND BOWEL DYSFUNCTION Cortney Wolfe-Christensen, Alexandra Manolis, William Guy, Natalija Kovacevic, Najeeb Zoubi, Mohammad El-Baba, Larisa Kovacevic, and Yegappan Lakshmanan Cortney Wolfe-ChristensenCortney Wolfe-Christensen Detroit, MI More articles by this author , Alexandra ManolisAlexandra Manolis Detroit, MI More articles by this author , William GuyWilliam Guy Detroit, MI More articles by this author , Natalija KovacevicNatalija Kovacevic Detroit, MI More articles by this author , Najeeb ZoubiNajeeb Zoubi Detroit, MI More articles by this author , Mohammad El-BabaMohammad El-Baba Detroit, MI More articles by this author , Larisa KovacevicLarisa Kovacevic Detroit, MI More articles by this author , and Yegappan LakshmananYegappan Lakshmanan Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1569AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Parents of children with medical conditions are at increased risk for maladaptive outcomes, such as higher levels of parenting stress. Additionally, elevated levels of parenting stress have been linked to higher levels of caregiver anxiety and depression, and can negatively affect medical decision-making and compliance with treatment recommendations. The current study sought to evaluate levels of stress in parents of children with bladder and bowel dysfunction. METHODS Participants included 72 parents (56 mothers, 16 fathers) of children seen for bladder and/or bowel dysfunction in either the Pediatric Urology or Pediatric Gastroenterology outpatient clinics in an urban Children's Hospital (Table 1). Parents completed the Parenting Stress Index ? Short Form (PSI), a 36-item, validated, self-report measure that assesses level of parental stress. Additionally, parents and their children completed the Dysfunctional Voiding Scoring System (DVSS), a 10-item, validated measure that assesses severity of voiding dysfunction. RESULTS Level of parenting stress was not significantly associated with any demographic variables (e.g., parent age, gender, or level of education, child age or gender, Urology or GI clinic, and annual household income). Bivariate correlations revealed significant relationships between level of parenting stress, and DVSS items #8 (i.e., ?child has to push to pee?, r(72)=.27, p=.020), #10 (i.e., ?child has experienced something stressful over last month?, r(72)=.33, p=.004) and Total Score (r(72)=.32, p=.006). Additionally, 15.3% (11/72) of the parents met the established cut-off for having a clinically significant level of stress, which is consistent with percentages reported in other pediatric illness groups (e.g., cancer, diabetes). CONCLUSIONS For parents of children with bladder and bowel dysfunction, level of parenting stress is related to the severity of the child's voiding problems. Given the system-wide effect of elimination dysfunction on the child's family, it is important that interventions be family-based. Early identification of significantly distressed families, and a program of inclusive therapy may yield better outcomes in the management of dysfunctional elimination disorders. Table 1. Demographic Characteristics of Sample Parent Gender 56 Mothers, 16 Fathers Parent Age (M +/− SD) 39.14 +/− 6.51 (range: 28-60) Race/Ethnicity Caucasian 62.5% (N=45) African American 20.8% (N=15) Other 12.5% (N=9) Not Provided 12.5% (N=9) Marital Status Married 72.2% (N=52) Single Parent 16.7% (N=12) Other 6.9% (N=5) Not Provided 4.2% (N=3) Child Gender 43 Males, 29 Females Child Age (M +/− SD) 9.56 +/− 3.70 (range: 4-17) © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e78 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Cortney Wolfe-Christensen Detroit, MI More articles by this author Alexandra Manolis Detroit, MI More articles by this author William Guy Detroit, MI More articles by this author Natalija Kovacevic Detroit, MI More articles by this author Najeeb Zoubi Detroit, MI More articles by this author Mohammad El-Baba Detroit, MI More articles by this author Larisa Kovacevic Detroit, MI More articles by this author Yegappan Lakshmanan Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Influence investigation of a void region on modeling light propagation in a heterogeneous medium

A void region exists in some biological tissues, and previous studies have shown that inaccurate images would be obtained if it were not processed. A hybrid radiosity-diffusion method (HRDM) that couples the radiosity theory and the diffusion equation has been proposed to deal with the void problem and has been well demonstrated in two-dimensional and three-dimensional (3D) simple models. However, the extent of the impact of the void region on the accuracy of modeling light propagation has not been investigated. In this paper, we first implemented and verified the HRDM in 3D models, including both the regular geometries and a digital mouse model, and then investigated the influences of the void region on modeling light propagation in a heterogeneous medium. Our investigation results show that the influence of the region can be neglected when the size of the void is less than a certain range, and other cases must be taken into account.

Management of Complications After Tension-Free Midurethral Slings

Since their introduction in 1996, tension-free midurethral slings (MUS) have been proven to have long-term efficacy and safety. They are considered the gold standard treatment of female stress urinary incontinence, especially in cases that are associated with urethral hypermobility. However, they are not free of complications and, although rare, some of these complications can be challenging for both patients and physicians. Some complications occur intraoperatively, whereas others appear in the early or late postoperative period. There is less controversy in the diagnosis and treatment of complications such as vaginal extrusion or urinary system erosion, whereas de novo voiding problems are at best not completely understood. Voiding dysfunction after MUS placement may vary in a wide range from urinary frequency or urgency to retention and is usually attributed to the obstructive or irritative effect of the sling. However, present urodynamic criteria for the diagnosis of female infravesical obstruction are not satisfactory, and the best management policy for de novo voiding dysfunction remains controversial. In the majority of cases, the diagnosis of obstruction leading to a urethral release surgery depends on a combination of several clinical findings. The timing of urethral release surgery varies depending on the preferences of the surgeon, and the outcome of this surgery is not always predictable. The purpose of this review was to assess the diagnosis and management of the immediate, short-term, and long-term complications of MUS in light of the current literature in an attempt to determine the best management policy.

Androgen deprivation therapy for volume reduction, lower urinary tract symptom relief and quality of life improvement in patients with prostate cancer: degarelix vs goserelin plus bicalutamide

Study Type--Therapy (RCT) Level of Evidence 1b. What's known on the subject? and What does the study add? Androgen deprivation therapy (ADT) is commonly used as a primary treatment for patients with prostate cancer (PCa) who are not eligible for radical treatment options. ADT is also used in patients with PCa as neo-adjuvant hormone therapy to reduce prostate volume and down-stage the disease before radiotherapy with curative intent. The present study showed that ADT with the gonadotropin hormone-releasing hormone (GhRH) antagonist degarelix is non-inferior to combined treatment with the LHRH agonist goserelin and bicalutamide in terms of reducing prostate volume during the treatment period of 3 months. Degarelix treatment evokes, however, significantly better relief of lower urinary tract symptoms in patients having moderate and severe voiding problems. • To assess the efficacy of monthly degarelix treatment for reduction of total prostate volume (TPV), relief of lower urinary tract symptoms (LUTS) and improvement of quality of life (QoL) in patients with prostate cancer (PCa) using monthly goserelin as active control. • This was a randomized, parallel-arm, active-controlled, open-label, multicentre trial on 182 patients treated with either monthly degarelix (240/80 mg) or goserelin (3.6 mg) for 12 weeks. • For flare protection, goserelin-treated patients also received daily bicalutamide (50 mg) during the initial 28 days. • Key trial variables monitored monthly were TPV (primary endpoint), serum testosterone, prostate-specific antigen (PSA), the International Prostate Symptom Score (IPSS) and the Benign Prostate Hyperplasia Impact Index. • In all, 175 patients completed the trial (96.1%). • At week 12, changes in TPV for degarelix and goserelin were similar (-37.2% vs -39.0%) and met the predefined non-inferiority criterion. • Decreases in IPSS were greater in degarelix than in goserelin-treated patients, differences being statistically significant in patients with baseline IPSS > 13 (-6.7 ± 1.8 vs -4.0 ± 1.0; P = 0.02). • The number of patients with an IPSS change of ≥ 3 over baseline was also significantly higher in patients treated with degarelix (61.0 vs 44.3%, P = 0.02). • Both treatments were safe and well tolerated. • Medical castration reduces TPV and could also improve LUTS in patients with PCa. • While the short-term efficacy of degarelix and goserelin + bicalutamide was the same in terms of TPV reduction, degarelix showed superiority in LUTS relief in symptomatic patients, which could highlight the different actions of these drugs on extrapituitary gonadotrophin-releasing hormone (GnRH) receptors in the bladder and/or the prostate.

Combining neural networks and genetic algorithms for optimising the parameter design of the inter-metal dielectric process

An inter-metal dielectric (IMD) is deposited between metal layers to provide isolation capability to a device and separate the different metal layers that are unnecessary in the conduction of electricity. Owing to the complicated input/response relationships of the IMD process, the void problem results in electric leakage and causes wafer scraping. In the current study, we combined neural networks, genetic algorithms (GAs) and the desirability function in order to optimise the parameter settings of the IMD process. Initially, a backpropagation (BP) neural network was developed to map the complex non-linear relationship between the process parameters and the corresponding responses. Moreover, the desirability function and GAs were employed to obtain the optimum operating parameters in respect to each response. The implementation of the proposed approach was carried out in a semiconductor manufacturing company in Taiwan, and the results illustrate the practicability of the proposed approach.

Just put a pad on: where is the dignity in that?

Thorough assessment and treatment of residents with urinary and faecal voiding problems must be carried out in the home. Wendy Keegan provides useful information on choosing products for management

Lower Urinary Tract Dysfunction in Children

Up to 10% of school-age children suffer from recurrent urinary tract infections (UTIs) and/or urinary incontinence. Lower urinary tract problems are, together with asthma, the most important chronic disease of the pediatric age group. Diagnosis must discriminate among those children with functional voiding problems, those with neuropathic bladders, and those with anatomic anomalies who may need surgery. In boys with overactive bladder (OAB) and incontinence, urethral obstruction must be evaluated as the possible cause. Functional incontinence with lower urinary tract symptoms (LUTS) is very common in girls and can be accompanied by UTI. In girls with dysfunctional voiding or underactive bladder, other anomalies need to be excluded because, for many of these girls, LUTS can be a chronic condition that requires lifelong attention to voiding behavior.

Improving Performance Analysis Of Routing Efficiency In Wireless Sensor Networks Using Greedy Algorithm

The void problem causing the routing failure is the main challenge of the greedy routing in the wireless sensor networks. The current research work still can not fully deal with the void problem since the excessive control overheads should be consumed so as to guarantee the delivery of packets. In this paper the solution to the void problem is taken up as the issue. This situation which exists in the currently existing greedy routing algorithms in wireless sensor networks. The GAR protocol is a new protocol proposed here to guarantee the delivery of packets and excessive consumption of control overheads is resolved.

Molding Flow Modeling and Experimental Study on Void Control for Flip Chip Package Panel Molding with Molded Underfill Technology

Moldability is a crucial aspect of flip chip technology. It is an increasing challenge to ensure moldability with rapid advances in flip chip technology such as decreasing bump pitch and stand-off height, especially when commercial molded underfill (MUF) is used and, in particular, during panel level molding. One key challenge faced is severe void entrapment beneath the die. Typically, large DOE matrix experiments are used to address this issue, which require significant time and process resources. 3D flow simulation can be used to optimize the process to reduce defects with a smaller number of actual runs. By correlating theoretical and experimental phenomena, flow simulation enhances the understanding of the complex fluid dynamics during the molding process. 3D flow simulation can assist in widening the process window, which is limited by the inherent machine and material challenges. This can be achieved by prediction of the effect of varying design, material, and process parameters on melt front behavior and void locations. 3D mold flow simulation using Moldex3D V10 is used to optimize the MUF transfer molding on selected flip chip devices. This paper proposes and verifies a systematic flow simulation methodology designed to save computational resources by using a three step analysis. The initial step, simplified panel level simulation, is to optimize the process parameters to obtain a balanced melt front. Next, on the package level, we studied the effect of various parameters. This analysis provides a prediction of the void location and an insight into the appropriate parameters to minimize the void problem. The optimized parameters from the preliminary simulation were used as guidelines. For the second step, a full validation was conducted. A complete full panel-level flow model was built, where the process and design parameters adopted in the actual molding were implemented. The actual void location and size from the experiment were captured by scanning acoustic microscope (SAM) machine and parallel lapping (p-lapping). Short shots were also obtained to study the melt front behavior. The panel mold filling simulations showed good correlation with the experimental short shots and actual void locations. The prediction capability is further enhanced by zooming in to the column level, and this enhanced model was able to predict the other lower risk voids away from the main problem areas. This was correlated with actual CSAM data and p-lapping. The 3D flow simulation enhances the understanding of causes of flow imbalance, void signature, void formation, and the effect of varying bump height, die thickness, mold cap thickness, gate height, die orientation, transfer profile, and mold temperature as potential enhancement measures. With a successful correlation between simulation and process data as shown in this paper, we have demonstrated that mold flow simulation is a reliable tool to effectively reduce the design-to-implementation cycle time, identifying potential key problems during actual fabrication and potential solutions to reduce defects.

Comparisons of hybrid radiosity-diffusion model and diffusion equation for bioluminescence tomography in cavity cancer detection

Bioluminescence tomography (BLT) has been successfully applied to the detection and therapeutic evaluation of solid cancers. However, the existing BLT reconstruction algorithms are not accurate enough for cavity cancer detection because of neglecting the void problem. Motivated by the ability of the hybrid radiosity-diffusion model (HRDM) in describing the light propagation in cavity organs, an HRDM-based BLT reconstruction algorithm was provided for the specific problem of cavity cancer detection. HRDM has been applied to optical tomography but is limited to simple and regular geometries because of the complexity in coupling the boundary between the scattering and void region. In the provided algorithm, HRDM was first applied to three-dimensional complicated and irregular geometries and then employed as the forward light transport model to describe the bioluminescent light propagation in tissues. Combining HRDM with the sparse reconstruction strategy, the cavity cancer cells labeled with bioluminescent probes can be more accurately reconstructed. Compared with the diffusion equation based reconstruction algorithm, the essentiality and superiority of the HRDM-based algorithm were demonstrated with simulation, phantom and animal studies. An in vivo gastric cancer-bearing nude mouse experiment was conducted, whose results revealed the ability and feasibility of the HRDM-based algorithm in the biomedical application of gastric cancer detection.

Positive virtual based geographic routing for wireless sensor networks

Communications void in geographical routing protocols effects the performance of these routing protocols. A geographic routing protocol usually uses a greedy forwarding scheme with a recovery policy to solve the void problem. In this paper, we propose a new positive virtual position (PViP) scheme, for solving the local minimum problem. Positive virtual position of nodes are considered when selecting the next optimum neighbor node. Positive virtual position of a node is the average positions of node's itself position and all single-hop neighbor nodes that are closer to the sink than itself. Simulation results demonstrate that proposed scheme increases the success delivery rate compared with other schemes without any significant overhead.

Animated Biofeedback: An Ideal Treatment for Children With Dysfunctional Elimination Syndrome

Animated biofeedback is an established treatment for pediatric dysfunctional voiding. Bowel dysfunction is closely associated with dysfunctional voiding. We evaluated the efficacy of animated biofeedback urotherapy in bowel and voiding dysfunction in children with dysfunctional elimination syndrome. A total of 80 children with dysfunctional elimination syndrome were randomly assigned to undergo animated biofeedback (group A, 40 patients) or conservative therapy (group B, 40 patients). Group A underwent animated biofeedback along with pelvic floor muscle exercises and behavioral modification (hydration, high fiber diet, scheduled voiding). Group B underwent behavioral modification only. Dysfunctional voiding symptom score, constipation and fecal soiling episodes per week (according to Paris Consensus on Childhood Constipation Terminology criteria), and uroflowmetry parameters were evaluated before and 6 and 12 months after treatment in both groups. Subjective and objective voiding problems were significantly improved. Vesicoureteral reflux resolved in 7 of 9 children (78%) and urinary tract infection did not recur in 10 of 14 children (71%) within 1 year. Bladder capacity and voided volume did not significantly improve. Post-void residual and voiding time decreased considerably, while maximum and average urine flow increased significantly. All children with fecal soiling and 17 of 25 with constipation (68%) in group A were symptom-free within 1 year after treatment. Animated biofeedback therapy was more efficient than nonbiofeedback management regarding objective and subjective voiding problems and bowel dysfunction (p <0.05). Animated biofeedback effectively treats bowel and voiding dysfunction in children with dysfunctional voiding. Pelvic floor muscle exercises coordinate breathing and pelvic floor muscle contractions, and are beneficial in improving bowel dysfunction.

New ideas in the cause of bladder dysfunction in children

The management of children with urinary incontinence and dysfunctional voiding problems can be very difficult at times. The present array of bladder-oriented treatments are marginally successful and for a long time patients were told that they would outgrow their symptoms. In this review, we look at the most recent findings in the urologic and psychiatric literature and try to piece together these two disparate fields and figure out how children who wet are best managed. It became clear that children with attention deficit disorder were always more difficult to manage than those without neuropsychiatric problems. As the years have progressed and imaging technology has improved, we have begun to look into the active brain. This research has been conducted primarily in the fields of psychiatry and neuroscience, but there have been some seminal studies that point to a link between defects in the brain and functional urinary problems in children. In this review, we will attempt to outline the reasons why the traditional bowel program works and why there are such a large number of patients with neuropsychiatric problems who have functional urinary problems as children. Utilizing an approach that focuses on a treatment paradigm that is neurocentric instead of vesicocentric allows us to treat children who do not respond to the usual treatments and target the brain with centrally active medications such as tricyclics and serotonin reuptake inhibitors. Understanding that it is a problem in the central nervous system, and that in some cases it is necessary to treat the underlying neuropsychiatric problems to be able to get these children to remain dry is a very important step in the management of children with refractory wetting problems.

Peripartum bladder care – room for improvement

IntroductionUnrecognised peripartum urinary retention may cause chronic voiding dysfunction and may be prevented by good bladder care. This audit studies the quality of peripartum bladder care in a London teaching...

DFR: an efficient directional flooding‐based routing protocol in underwater sensor networks

ABSTRACTUnlike terrestrial sensor networks, underwater sensor networks (UWSNs) have salient features such as a long propagation delay, narrow bandwidth, and high packet loss over links. Hence, path setup‐based routing protocols proposed for terrestrial sensor networks are not applicable because a large latency of the path establishment is observed, and packet delivery is not reliable in UWSNs. Even though routing protocols such as VBF (vector based forwarding) and HHVBF (hop‐by‐hop VBF) were introduced for UWSNs, their performance in terms of reliability deteriorates at high packet loss. In this paper, we therefore propose a directional flooding‐based routing protocol, called DFR, in order to achieve reliable packet delivery. DFR performs a so‐called controlled flooding, where DFR changes the number of nodes which participate in forwarding a packet according to their link quality. When a forwarding node has poor link quality to its neighbor nodes geographically advancing toward the sink, DFR allows more nodes to participate in forwarding the packet. Otherwise, a few nodes are enough to forward the packet reliably. In addition, we identify two types of void problems which can occur during the controlled flooding and introduce their corresponding solutions. Our simulation study using ns‐2 simulator proves that DFR is more suitable for UWSNs, especially when links are prone to packet loss. Copyright © 2011 John Wiley &amp; Sons, Ltd.

Molding Flow Modeling and Experimental Study on Void Control for Flip Chip Package Panel Molding with Molded Underfill Technology

Increasing challenges are faced to ensure moldability with rapid advances in flip chip technology such as decreasing bump pitch and stand-off height, especially when commercial Moldable Underfill (MUF) is used and in particular, during panel level molding. One key challenge faced is severe void entrapment under the die. Experiments involving a large DOE matrix, which require significant time and process resources, are typically used to solve this issue. 3D flow simulation can be used to optimize the process to reduce defects without doing actual runs. Mold flow simulation can effectively reduce the design-to-implementation cycle time, identifying key problems before actual fabrication. In this paper, 3D mold flow simulation using Moldex3DTM V10 is applied to transfer molding to optimize design and process parameters. This paper proposes and verifies a systematic method that can save computational resources by using 2 steps analysis: simplified panel simulation and single package simulation. The initial step, simplified panel level simulation, is to optimize the process parameters to obtain balanced melt front. The second step is to study on the package level the effect of various package-scale parameters. This analysis provides a prediction of the void location and an insight on the appropriate parameters to minimize void problem. The actual voids location and size from the experiment was captured by SAT machine and short shots were obtained. For final validation, a complete panel-level flow model is built, where the process and design parameters adopted in the actual molding were implemented. The mold filling simulation showed good correlation with the experimental short shots and actual void location. With optimized parameters from the simulation used as guidelines, experimental tests were conducted and the study showed that the simulation is a useful tool to optimize the molding process.

Lower Urinary Tract Conditions in Children With Attention Deficit Hyperactivity Disorder: Correlation of Symptoms Based on Validated Scoring Systems

We investigated whether certain voiding problems have a higher incidence in patients with attention deficit disorder with hyperactivity compared to age matched controls. We used the Conners Parent Rating Scale-revised for attention deficit disorder with hyperactivity and lower urinary tract symptom score to evaluate voiding problems. A total of 62 children with attention deficit disorder and 124 healthy controls were enrolled. We evaluated uroflowmetry patterns in both groups. Residual urine volumes and Bristol stool scale were noted. We examined the correlation between total Conners Parent Rating Scale-revised and lower urinary tract symptom score in patients with attention deficit disorder. Additionally we analyzed each index of the Conners Parent Rating Scale-revised separately in terms of correlation with symptom subgroups for lower urinary tract symptom scores. Mean ± SD total lower urinary tract symptom score was 11.1 ± 2.9 in patients with attention deficit disorder with hyperactivity and 3.2 ± 1.3 in controls, a difference that was statistically significantly (p <0.001). With the exception of constipation, mean scores of all lower urinary tract symptom subindices were significantly higher in patients with attention deficit disorder compared to controls. Symptoms evaluated in lower urinary tract symptom score were mostly correlated with attention deficit disorder index of the Conners Parent Rating Scale-revised. If a child with attention deficit disorder has a high index in the Conners Parent Rating Scale-revised, he or she is more likely to have urgency. Also, if a child with attention deficit disorder has a high hyperactivity subscale score, he or she is more likely to have enuresis. Voiding problems are more common in children with attention deficit disorder with hyperactivity than in age matched controls. Urgency and enuresis are the outstanding problems in children with attention deficit disorder. Simultaneous use of the Conners Parent Rating Scale-revised and lower urinary tract symptom score questionnaire should be encouraged in patients with attention deficit disorder to allow a structured and quantitative evaluation of these overlapping problems.

Silver or Nitrofurazone Impregnation of Urinary Catheters Has a Minimal Effect on Uropathogen Adherence

Bacterial adherence to the urinary catheter is an early step in biofilm formation and the pathogenesis of catheter associated urinary tract infection. We studied in vitro the effect of silver or nitrofurazone impregnation of urinary catheters on uropathogen ability to adhere to urinary catheters. We studied commercially available nitrofurazone-silicone, silicone only, silver-silicone-hydrogel, silicone-hydrogel, silver-latex-hydrogel and latex-hydrogel catheters. Catheters were incubated in sterile broth for 0, 3, 5, 7 and 10 days, respectively, before inoculation and overnight incubation with Escherichia coli or Enterococcus faecalis. Adherence of E. coli and E. faecalis to nitrofurazone catheters was significantly decreased compared to that of silicone-only catheters when catheters were fresh. The anti-adherence effect of nitrofurazone on E. coli decreased with time but was still significant at 5 days. For E. faecalis the effect of nitrofurazone was lost by 3 days of pre-incubation. E. coli adherence was not significantly decreased on silver impregnated catheters compared to that on control catheters of the same base material. Silver was associated with a significant decrease in E. faecalis adherence to latex-hydrogel catheters but not to silicone-hydrogel catheters. The adherence of each species to silicone catheters with hydrogel was significantly lower than that to silicone-only control catheters. Silver impregnation had little effect on bacterial adherence in our model and nitrofurazone impregnation had a significant effect only for the first 5 days. Our results do not support a role for silver urinary catheters to prevent catheter associated urinary tract infection by decreasing bacterial adherence.

Effects of postoperative analgesia on postpartum urinary retention in women undergoing cesarean delivery

Various analgesics and administration methods are used to provide women undergoing cesarean delivery pain relief after surgery. We compared three methods of postoperative analgesia regarding the incidence of postpartum urinary retention (PUR) in primiparous women undergoing elective cesarean delivery. We estimated post-void residual bladder volume after the first postpartum micturition among 150 parturient women. Risk factors stratified for PUR defined by 150-mL post-void residual bladder volume were analyzed. Obstetric parameters and prevalence of lower urinary tract symptoms after surgery were compared among three groups of parturient women given different postoperative analgesia: epidural bolus morphine (EBM), patient-controlled epidural analgesia (PCEA) with ropivacaine-fentanyl, and intramuscular pethidine. The incidence of PUR was higher in the group given EBM (33.3%) than the groups receiving ropivacaine-fentanyl by PCEA (15%) or intramuscular pethidine (16.7%) (P = 0.038). Eighteen (12%) parturient women needed bladder catheterization to resolve their urinary retention at 1 day postpartum but all achieved spontaneous micturition prior to hospital discharge. The need for catheterization was also increased in the group with EBM (21.7%) in comparison with the other two groups (6.7% and 3.3%, respectively, P = 0.011). At the 3-month follow up, six women (4%) had obstructive voiding problems and seven women (4.7%) had irritating voiding problems. At the 1-year follow up, only one woman in the EBM group had incomplete emptying and another in the PCEA group had urinary incontinence. Epidural analgesia with morphine was significantly associated with post-cesarean urinary retention. Nonetheless, it was not detrimental to later urinary function.

Types of urethral catheters for management of short-term voiding problems in hospitalized adults: a short version Cochrane Review

Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD004013. DOI: 10.1002/14651858.CD004013.pub3. Copyright O 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. This article is reproduced with the kind permission of the authors and the publisher. Background: Urinary tract infection (UTI) is the most common hospital acquired infection. The major associated cause is indwelling urinary catheters. Currently there are many types of catheters available. A variety of specialized urethral catheters have been designed to reduce the risk of infection. These include antiseptic impregnated catheters and antibiotic impregnated catheters. Other issues that should be considered when choosing a catheter are ease of use, comfort and cost. Objectives: The primary objective of this review was to determine the effect of type of indwelling urethral catheter on the risk of urinary tract infection in adults who undergo short-term urinary catheterization. Methods: We searched the Specialized Trials Register of the Cochrane Incontinence Group (searched September 11, 2007). We also examined the bibliographies of relevant articles and contacted catheter manufacturer representatives for trials. All randomized and quasi-randomized trials comparing types of indwelling urinary catheters for short-term catheterization in hospitalized adults. Shortterm catheterization was defined as up to and including 14 days, or other temporary short- term use as defined by the trialists (for example Results: Twentythree trials met the inclusion criteria involving 5,236 hospitalized adults in 22 parallel group trials and 27,878 adults in one large cluster-randomized cross-over trial. The antiseptic catheters were either impregnated with silver oxide or silver alloy. Silver oxide catheters were not associated with a statistically significant reduction in bacteriuria in short-term catheterized hospitalized adults but the confidence intervals were wide (RR 0.89, 95% CI 0.68-1.15) and these catheters are no longer available. Silver alloy catheters were found to significantly reduce the incidence of asymptomatic bacteriuria (RR 0.54, 95% CI 0.43-0.67) in hospitalized adults catheterized for 1 week of catheterization the risk of asymptomatic bacteriuria was still reduced with the use of silver alloy catheters (RR 0.64, 95% CI 0.51- 0.80). The randomized cross-over trial of silver alloy catheters versus standard catheters was excluded from the pooled results because data were not available prior to crossover. The results of this trial indicated benefit from the silver alloy catheters and included an economic analysis that indicated cost savings of between 3.3% and 35.5%. Antibiotic impregnated catheters were compared to standard catheters and found to lower the rate of asymptomatic bacteriuria in the antibiotic group at 1 week the results were not statistically significant. One of 56 men in the antibiotic impregnated group had a symptomatic UTI compared with 6 of 68 who had standard catheters (RR 0.20, 95% CI 0.03- 1.63). Three trials compared two different types of standard catheters (defined as catheters that are not impregnated with antiseptics or antibiotics) to investigate infection. Individual trials were too small to show whether or not one type of standard catheter reduced the risk of catheter related urinary tract infection compared to another type of standard catheter. Conclusions: The results suggest that the use of silver alloy indwelling catheters for catheterizing hospitalized adults short-term reduces the risk of catheter acquired urinary tract infection. Further economic evaluation is required to confirm that the reduction of infection compensates for the increased cost of silver alloy catheters. Catheters impregnated with antibiotics are also beneficial in reducing bacteriuria in hospitalized adults catheterized for Neurourol. Urodynam. 27:738-746, 2008. a2008 Wiley-Liss, Inc. Key words: UTI; urethral, catheter; short-term DOI: 10.4038/sljog.v31i2.1756 Sri Lanka Journal of Obstetrics and Gynaecology 2009; 31 : 110-121