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Urethral Catheter (urethral + catheter)

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Medical Sciences	100%

Selected Abstracts

Quality of care for patients with indwelling urinary catheter in selected hospitals in Kashan, Iran 2007

INTERNATIONAL JOURNAL OF UROLOGICAL NURSING, Issue 2 2009
Mohsen Adib-Hajbaghery
ABSTRACT A cross-sectional study was conducted on 377 patients with indwelling urinary catheter to evaluate the quality of catheter care in three educational hospitals of Kashan University of Medical Sciences, Kashan, Iran. In this study, 331 patients expressed their views on the quality of care and 46 patients were observed. Indwelling urethral catheters were mostly used for immobile and bedrest patients (36·3%). In total, 45·77 ± 12·24% of the score was reached from the patients' view and 51·08 ± 10·83% from the observer's view. The total quality of care was low. The nurses' in-service education programmes should be reinforced. Strengthening the supervisory system and overcoming the staff shortage can also have beneficial effects on the quality of care for patients with indwelling urethral catheter. [source]

Clinical pathway for tension-free vaginal mesh procedure: Evaluation in 300 patients with pelvic organ prolapse

INTERNATIONAL JOURNAL OF UROLOGY, Issue 3 2009
Kumiko Kato
Objectives: To evaluate a clinical pathway of discharge on postoperative day 3 for the tension-free vaginal mesh (TVM) procedure in patients with pelvic organ prolapse (POP). Methods: Between May 2006 and December 2007, 305 consecutive women with POP quantification stage 3 or 4 were planned to undergo the TVM procedure in a single general hospital. Excluding five patients with concomitant hysterectomy, a pathway (removal of the indwelling urethral catheter on the next morning, discharge on postoperative day 3) was applied to the remaining 300 patients. The perioperative complications and postoperative hospitalization were prospectively evaluated in this case series. Results: Perioperative complications were: bladder injury (11 cases, 3.7%), vaginal wall hematoma (two cases, 0.7%), rectal injury (one case, 0.3%) and temporary hydronephrosis (one case, 0.3%). None needed blood transfusion. The indwelling urethral catheters were removed on the next morning as in the pathway in 287 cases (95.6%), and none required clean intermittent catheterization at home. Postoperative hospitalization was within 3 days in 280 cases (93.3%). The six cases (2.0%) with longer hospitalization were due to complications (two cases of bladder injury, one of rectal injury, one of blood loss over 200 mL, one of temporary urinary retention, and one of hydronephrosis). Two patients were re-hospitalized within one month due to vaginal bleeding or gluteal pain. Conclusions: Patients generally accepted the pathway of discharge on postoperative day 3 in spite of the Japanese culture preferring a longer hospital stay. [source]

Perinephric urinoma secondary to neurogenic bladder with vesicoureteral reflux: Report of an adult case

INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2004
KAZUTOSHI FUJITA
Abstract We report a case of infectious perinephric urinoma in a 73-year-old woman who had a neurogenic bladder with vesico-ureteral reflux. The patient was admitted to our emergency room with right lumbago and high fever. Ultrasounds and computed tomography demonstrated a right large perinephric cystic mass, bilateral hydronephrosis and much residual urine. Percutaneous drainage of the cystic mass was performed with an indwelling urethral catheter. The content of the mass was urine infected with Escherichia coli. Antibiotic therapy was performed successfully and we then examined the cause of the urinoma. A urodynamic study demonstrated a low-compliance small bladder and detrusor,sphincter dyssynergia. A voiding cystourethrogram revealed right grade III vesicoureteral reflux. The patient was unable to be cleared with intermittent catheterization and had an indwelling urethral catheter inserted. In 1 year, the voiding cystourethrogram showed no vesicoureteral reflux and the patient was well with no evidence of recurrent urinoma without the urethral catheter. There have been only two reported cases of urinoma caused by neurogenic bladder with vesico-ureteral reflux in children and this is the first case reported in an adult. [source]

Transcervical hysteroscopic sterilization using cyanoacrylate: A long-term experimental study on sheep

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 6 2009
Sergio Bigolin
Abstract Aim:, We investigated the transcervical hysteroscopy application of n-butyl-2-cyanoacrylate in the uterine tube lumen of a non-rodent animals (sheep) with fallopian tube dimensions similar those in humans. Methods:, Standard hysteroscopic procedures were performed on female Texel sheep (n = 26). The right and left ostia were identified. For each ewe, a urethral catheter (5Fr) was used for the delivery of 0.5 mL of saline or an equal volume of n-butyl-2-cyanoacrylate into the uterine tube. Following the procedure, ewes were housed with males of proven fertility for 90 days (equivalent to 5.5 estrous cycles). Postmortem (dye and burst pressure) and in vivo (hysterosalpingogram) testing for tube patency were both performed 90 days and 180 days following the procedure. Results:, All animals receiving the saline treatment became pregnant. Gross inspection of uterine tubes following n-butyl-2-cyanoacrylate treatment revealed no visceral adhesions or fibrosis. However, postmortem testing revealed total obstruction within the fallopian tubes. This was confirmed by hysterosalpingogram, in that iodine contrast did not escape into the abdominal cavity. Conclusion:, The cyanoacrylate promoted a reliable fallopian tube obstruction without fibrosis in an animal model exhibiting a similar tube diameter to that found in women. The technique can be evaluated for efficacy in vivo using hysterosalpingography. [source]

Catheter-Free 120W lithium triborate (LBO) laser photoselective vaporization prostatectomy (PVP) for benign prostatic hyperplasia (BPH)

LASERS IN SURGERY AND MEDICINE, Issue 8 2008
Massimiliano Spaliviero MS
Abstract Introduction and Objective We evaluate the safety and efficacy of catheter-free LBO laser PVP for the treatment of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). Methods We prospectively evaluated our initial LBO laser PVP experience and the need for urethral catheterization. Results Seventy consecutive patients were identified. 49 (70%) were discharged without (C,) and 21 (30%) were discharged with (C+) a urethral catheter. There were no significant differences in pre-operative parameters, including age (C,: 65±10 vs. C+: 69±9 years), AUASS (C,: 22±6 vs. C+: 21±6), Qmax (C,: 10±4 vs. C+: 8±3 ml/second), PVR (C,: 62±105 vs. C+: 57±82 ml) and prostate volume (C,: 65±35 vs. C+: 86±53 ml). There were no significant differences in laser time and energy usage. AUASS, Qmax and PVR values showed significant improvement within each group (P<0.05), but there were no significant differences between the two groups. All were outpatient procedures. 2/70 (2.9%) patients required catheter reinsertion in C+. The overall incidence of adverse events was low and did not differ between the two groups. Conclusions Our experience suggests that catheter-free LBO laser PVP is safe and effective for the treatment of LUTS secondary to BPH. Lesers Surg. Med. 40:529,534, 2008. © 2008 Wiley-Liss, Inc. [source]

Biochemical and morphological effects of bladder pumping on the urinary bladder in rats

NEUROUROLOGY AND URODYNAMICS, Issue 5 2002
Kimio Sugaya
Abstract Aims To study the influence of bladder pumping on the urinary bladder in 44 female rats. Methods Under halothane anesthesia, a urethral catheter was inserted into the bladder of 27 rats, and air (0.4,0.8 mL) was pumped in and out of the bladder at 0.5 cycles/second for a period of 5 minutes. Twenty-four hours after pumping, the bladder was harvested for measurement of the tissue levels of myosin, actin, and nerve growth factor, as well as for electron microscopy. In nine of the 27 rats, cystometry was performed without anesthesia before and 1, 7, 30, and 90 days after bladder pumping. The remaining 17 rats that did not undergo pumping were anesthetized and their bladders were harvested as a control. Results Bladder pumping increased the bladder capacity and decreased the maximum bladder contraction pressure, but did not increase the residual volume. Bladder pumping also increased the tissue level of nerve growth factor and decreased the levels of myosin and actin. Electron microscopy showed degeneration of bladder smooth muscle cells and nerve fibers after bladder pumping, as well as derangement and disruption of collagen fiber bundles in the bladder wall. These functional and morphological effects of pumping disappeared within 90 days. Conclusions Bladder pumping therapy appears to have various effects on the bladder wall collagen fiber bundles, smooth muscle cells, and nerves. Neurourol. Urodynam. 21:511,515, 2002. © Wiley-Liss, Inc. [source]

Long-term outcome of tension-free vaginal tape for treating stress incontinence in women with neuropathic bladders

BJU INTERNATIONAL, Issue 6 2010
Ahmad Abdul-Rahman
Study Type , Therapy (case series) Level of Evidence 4 OBJECTIVE To evaluate the long-term safety and efficacy of the tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with neuropathic bladder dysfunction. PATIENTS AND METHODS Twelve women (mean age 53.3 years, range 41,80) with neuropathic bladder dysfunction and SUI confirmed by video-cystometrography (VCMG) were treated with a TVT in one institution by an expert neuro-urologist between November 1997 and December 2000. The patient's notes, clinical annual follow-up and VCMG after the procedure, and the incontinence impact questionnaire (IIQ) forms (Urinary Distress Inventory, and IIQ-7) were assessed during the long-term clinical follow-up for SUI, in addition to a health-related quality of life assessment. The cure of SUI was defined as no loss of urine on physical exercise, confirmed VCMG after the procedure, and by clinical assessment. RESULTS The mean (range) follow-up was 10 (8.5,12) years. Nine patients were using clean intermittent self-catheterization before the insertion of TVT and continued to do so afterward. At 10 years of follow-up, one patient had died (with failed TVT initially), and two were lost to follow-up at 5 years after surgery, but up to 5 years they did not complain of UI and VCMG did not show SUI. The remaining seven of the nine patients were completely dry, and two improved and were satisfied with using one or two pads/day. Two patients showed neurogenic detrusor overactivity confirmed on VCMG, with no evidence of SUI. One patient needed a transient urethral catheter for urinary retention after surgery, one had a bladder injury that required leaving the catheter for 5 days, but no urethral erosions were reported during the follow-up. CONCLUSIONS In women with neuropathic bladder dysfunction secondary to a variety of spinal cord pathologies, and who have SUI necessitating a definitive intervention, insertion of TVT should be considered a desirable treatment, with very good long-term outcomes. [source]

The management of acute urinary retention in France: a cross-sectional survey in 2618 men with benign prostatic hyperplasia

BJU INTERNATIONAL, Issue 4 2006
FRANÇOIS DESGRANDCHAMPS
In an important study from France, the authors assessed the management of acute urinary retention in a cross-sectional survey of many patients in their country. They describe what has become standard practice for men with BPH who present in this manner. They also suggest that efforts should be made to reduce the duration of catheterization, to reduce morbidity. In an international study, a group of authors found that alfuzosin prevents BPH progression but not acute urinary retention. This was a 2-year study, and the authors also found that the drug improved LUTS and quality of life. OBJECTIVE To evaluate current practice in the management of acute urinary retention (AUR) in men with benign prostatic hyperplasia (BPH) in France. PATIENTS AND METHODS In all, 2618 men (median age 72 years) presenting with non-febrile AUR were enrolled by 658 French urologists in a prospective cross-sectional survey. The patients' demography, history of BPH, type of AUR and its management (trial without catheter, TWOC, use of ,1 -blockers, immediate or elective surgery, other alternatives) were collected. RESULTS Of the 2618 men analysed, 1875 (71.6%) had spontaneous AUR (sAUR) and 743 (28.4%) had precipitated AUR (pAUR), mainly after surgery with locoregional or general anaesthesia. BPH was revealed by AUR in 52.3% of men with pAUR and 25.9% of men with sAUR. A urethral catheter was inserted in most cases (82.7%) while only 16.7% had a suprapubic catheter. After initial catheterization, 72.8% of men had a TWOC (pAUR 89.4%, sAUR 66.2%, P < 0.001) after a median of 3 days of catheterization, 17.9% had elective surgery after a median of 8 days of catheterization (pAUR 7.1%, sAUR 22.1%, P < 0.001), 5.7% had immediate surgery after a median of 4 days of catheterization (pAUR 1.1%, sAUR 7.5%, P < 0.001), 0.4% had a urethral stent inserted and 1.1% had an indwelling catheter. Of the 1906 men who had a TWOC, 79% received an ,1 -blocker (mainly alfuzosin) before catheter removal. The TWOC was successful in 50.2% of men (pAUR 52.3%, sAUR, 49.0%, P = 0.17) and the success rate was significantly higher in men receiving an ,1 -blocker (53.0% vs 39.6%, P < 0.001) before the TWOC. If the TWOC failed, 33.4% had a second TWOC (pAUR 39.9%, sAUR 30.2%, P = 0.003) after a median of 7 days re-catheterization, 57.5% had elective surgery (pAUR 49.1%, sAUR, 61.7%, P < 0.001) after a median of 8 days re-catheterization, 1.5% had a stent inserted and 1.1% had an indwelling catheter. The overall success rate of a second TWOC was 25.9% (pAUR 32.2%, sAUR 21.9%, P = 0.04). Men catheterized for >3 days had a slightly lower success rate for TWOC, greater comorbidity and double the rate of prolonged hospitalization due to adverse events than those catheterized for ,,3 days. CONCLUSIONS TWOC after a median of 3 days of catheterization has become standard practice in France for men with BPH and AUR. ,1 -blockade before a TWOC significantly increases the chance of a successful TWOC. If the TWOC fails, only a quarter of men will have a successful second TWOC. All efforts should be made to reduce the duration of catheterization, to reduce the comorbidity. [source]

The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy

BJU INTERNATIONAL, Issue 6 2004
M. Menon
Much of the current interest in robotic surgery in urology has been caused by the results of the work from the Vattikuti Urology Institute in Detroit, and these authors describe their extensive experience in the technique of radical prostatectomy; specifically their modified single running suture urethrovesical anastomosis. They ascribe their ability to remove the urethral catheter at 4 days, and to have an excellent continence rate, to this technique, and to their apical dissection. The European Randomised Study for Screening of Prostate Cancer will generate much interesting information over the nest few years and will in itself become one of the landmark urological studies. The authors from Amsterdam evaluated (-7-5)proPSA and hK2 in a subset of patients from this study for detecting and grading prostate cancer, and found that their impact in these areas remains limited. Screening for prostate cancer is a controversial but very interesting topic for those involved in urological oncology. Although many countries have not advocated a national screening programme, and indeed some have advised against screening of any kind for this condition, "backdoor" screening does in fact take place. The authors from Belfast have reviewed PSA testing in Northern Ireland from 1990 to 1999, finding that many men have an elevated PSA level, with a resulting requirement for further evaluation. OBJECTIVE To describe the technique of dissecting the apex of the prostate and a modified single running-suture urethrovesical anastomosis in patients undergoing robot-assisted radical prostatectomy for organ-confined prostate cancer. PATIENTS AND METHODS Over 550 robot-assisted radical prostatectomies have been undertaken using Vattikuti Institute Prostatectomy (VIP) technique in patients with localized carcinoma of the prostate. We present a critical analysis of the first 120 procedures by one surgeon (M.M.) at our institution using this newly developed technique of urethrovesical anastomosis preceded by dissecting the apex of the prostate. RESULTS The mean time for the urethrovesical anastomosis was 13 min. All but 24 patients had their catheter removed 4 days after surgery, as indicated by a cystogram. The catheter was removed successfully at 7 days in the remaining 24 patients who had a mild leak on cystography. Two patients had urinary retention within a week of removing the catheter and had to be re-catheterized. Continence was evaluated using standardized criteria before and after the procedure. The patients also replied to a mailed validated questionnaire survey; 96% were continent at 3 months and the remaining 4% used a thin pad for security. CONCLUSIONS We report a technique of dissecting the apex of the prostate and prostatovesical junction for dividing the bladder neck, and a modified single running-suture urethrovesical anastomosis, in patients undergoing robot-assisted radical prostatectomy for organ-confined cancer of the prostate. The same principles can also be applied for the anastomosis during pure laparoscopic procedures and for urethro-neovesical anastomosis in patients undergoing robotic radical cystoprostatectomy for carcinoma of the bladder. [source]

A model to quantify encrustation on ureteric stents, urethral catheters and polymers intended for urological use

BJU INTERNATIONAL, Issue 4 2000
S.K.S. Choong
Objective To validate an encrustation model and to quantify encrustation on currently used urological devices and polymers intended for urological use. Materials and methods An encrustation model was validated: (i) to measure the amount of calcium leaching from the glass model and from the polymer used; (ii) to determine whether the use of a single-source or pooled urine produced similar results; (iii) to determine in vitro encrustation; and (iv) to compare the results of in vivo implantation of the same materials into the bladders of rodents with the in vitro results. A test polymer (a ureteric stent, a urethral catheter or a biomaterial) and a control silicone polymer were housed separately but received human urine from the same reservoir and under the same conditions (pH 6.0 and 37 °C) for 5 days. The amount of calcium encrustation on each polymer was measured using atomic absorption spectroscopy. Each experiment was repeated at least four times and the results expressed as an encrustation index, defined as the ratio of encrustation of the test and reference polymers. Results The amount of calcium leaching from the glass model and polymers tested was insignificant. The use of a single-source or pooled urine gave the same results in the encrustation model. The in vitro results correlated with in vivo implantation of disks into the bladders of rats. Among the commonly used ureteric stents tested, the Cook C-Flex ureteric stents encrusted least. Hydrogel-coated ureteric stents encrusted more than uncoated stents. The Bard polytetrafluoroethylene short-term urethral catheter encrusted more than the Bard hydrogel-coated long-term catheter. A plasma-activated surface modification of a synthetic biomaterial with hyaluronic acid encrusted less than silicone, a long-term biomaterial widely regarded as the ,gold standard'. Conclusion This validated encrustation model is the first to quantify encrustation on currently available ureteric stents and urethral catheters. A novel coating for a biomaterial was identified using the encrustation model, and which encrusted less than silicone. [source]

Quality of care for patients with indwelling urinary catheter in selected hospitals in Kashan, Iran 2007

Eliminating Catheter-Associated Urinary Tract Infections: Part I. Avoid Catheter Use

JOURNAL FOR HEALTHCARE QUALITY, Issue 6 2009
Melissa Winter
Abstract: This article is the first in a two-part series focusing on catheter-associated urinary tract infections. There is a convergence of factors necessitating zero tolerance toward catheter-associated urinary tract infections, including the risks associated with patient safety and to a lesser extent the changes in reimbursement. Part I of this series focuses on the most significant modifiable risk factor, avoiding use of urethral catheters. A quality improvement case study is highlighted along with a practice bundle for evidence-based practice. Part II focuses on the second most significant risk factor, reducing urethral catheter-days. [source]

Eliminating Catheter-Associated Urinary Tract Infections: Part II.

JOURNAL FOR HEALTHCARE QUALITY, Issue 6 2009
Limit Duration of Catheter Use
Abstract: This article is the second in a two-part series focusing on catheter-associated urinary tract infections. Part I of the series focused on the most significant modifiable risk factor, avoiding use of urethral catheters. Part II focuses on the second major modifiable risk factor, reducing catheter-days. A quality improvement case is provided to illustrate the strategies for limiting the duration of catheter use. Together, these two articles provide important information on the two most significant risk facts for eliminating the incidence of catheter-associated urinary tract infections. [source]