Urinary catheterization of male rabbits: a new technique and a review of urogenital anatomy

Rabbits are widely used as an animal model for urologic research studies in which urinary bladder catheterization is required. However, standard manual retrograde urinary catheterization proved to be difficult to perform on anesthetized male rabbits in a research study, with frequent misplacement of the catheter into the vesicular gland. Attempts to reposition the catheter into the bladder after initial entry into the vesicular gland frequently failed and resulted in exclusion of the animal from the study. We assessed the normal anatomy of the lower urinary tract of male rabbits to determine the cause of catheterization misdirection into the vesicular gland and to develop a more reliable technique for urinary bladder catheterization. A modified 'digital (finger) pressure' catheterization technique was developed for successful urinary catheterization of male rabbits. Retrospective statistical analysis of 45 rabbits used for urinary catheterization studies showed improvement in the success rate of catheterization by using the digital pressure technique over the standard method of retrograde urinary catheter insertion. In addition, we here review the relevant gross and histologic anatomy of the urogenital tract of male rabbits.

Critical urologic skills and procedures in the emergency department

The evaluation and management of genitourinary emergencies is a fundamental component of the training and practice of emergency physicians. Urologic procedures are common in the emergency room. Emergency physicians play a vital role in the initial evaluation and treatment because delays in management can lead to permanent damage. This article discusses the most common urologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. An overview of each procedure is discussed as well as indications, contraindications, equipment, technique, and potential complications.

Intermittent self catheterisation with hydrophilic, gel reservoir, and non-coated catheters: a systematic review and cost effectiveness analysis

OBJECTIVE

To determine the most effective and cost effective type of catheter for patients performing intermittent self catheterisation in the community.

DESIGN

Systematic review and meta-analysis. Results were incorporated into a probabilistic Markov model to compare lifetime costs and quality adjusted life years (QALYs).

DATA SOURCES

We searched Medline, Embase, and Cochrane and Cinahl databases from 2002 to 18 April 2011 to identify studies comparing hydrophilic, gel reservoir, and non-coated intermittent catheters. Earlier guidelines were used to identify papers published before 2002. To capture studies comparing clean and sterile non-coated intermittent self catheterisation, each database was searched from its date of inception to 18 April 2011.

MAIN OUTCOME MEASURES

Clinical outcomes included symptomatic urinary tract infection (UTI), bacteraemia, mortality, patient preference or comfort, and number of catheters used. The economic model included downstream complications of UTI and cost effectiveness was calculated as incremental cost per QALY gained.

RESULTS

Eight studies were included in the systematic review. Most were conducted in patients with spinal cord injuries, and most of the included patients were men. People using gel reservoir and hydrophilic catheters were significantly less likely to report one or more UTIs compared with sterile non-coated catheters (absolute effect for gel reservoir = 149 fewer per 1000 (95% confidence interval -7 to 198), P=0.04; absolute effect for hydrophilic = 153 fewer per 1000 (-8 to 268), P=0.04). However, there was no difference between hydrophilic and sterile non-coated catheters when outcomes were measured as mean monthly UTIs (mean difference = 0.01 (-0.11 to 0.09), P=0.84) or total UTIs at 1 year (mean difference = 0.18 (-0.50 to 0.86), P=0.60). There was little difference in the incidence of one or more UTIs for people using clean versus sterile non-coated catheters (absolute effect = 12 fewer per 1000 (-134 to 146), P=0.86). Although the most effective, gel reservoir catheters cost >£54,350 per QALY gained and are therefore not cost effective compared with clean non-coated self catheterisation.

CONCLUSION

The type of catheter used for intermittent self catheterisation seems to make little difference to the risk of symptomatic UTI. Given large differences in resource use, clean non-coated catheters are most cost effective. However, because of limitations and gaps in the evidence base and the designation of non-coated catheters as single use devices, we recommend a precautionary principle should be adopted and that patients should be offered a choice between hydrophilic and gel reservoir catheters.

Efficacy and safety of oesophageal coins removal using a Foley balloon catheter without fluoroscopic control (blind method)

Although previously reported the method is not widely used despite its significant economic advantages. We evaluate safety and efficacy of the procedure of removing coins from the upper oesophagus in children by Foley catheter without fluoroscopic control (blind method). A retrospective case series study was undertaken among 58 consecutive paediatric patients in a district level medical college hospital during the period of 2009-2010. A total of 58 cases of coins impacted in oesophagus were divided into two groups. In group A (n=27), all the impacted coins were in upper oesophagus and they were subjected to Foley catheter removaL In group B (n=31), the patients were selected for endoscopic removal under anaesthesia. Coins were successfully removed in 24 cases in group A and 28 cases in group B. The results between both the groups were compared using Chi-square test. There was no statistically significant difference (p<0.05) between the two groups. Upper oesophageal coins can be safely removed by Foley balloon catheter without fluoroscopic control. This blind technique is cost effective, avoiding the need for hospital stay and anaesthesia. It is worth trying before resorting to endoscopy.

[Transurethral bladder catheterization in male patients: prevention and treatment of iatrogenic lesions]

Transurethral catheterization represents a common and frequent procedure performed on hospitalized patients. Although consequences can be disastrous, most of these procedures are performed by nurses or young medical doctors in training who are unfortunately not all specifically taught. In fact 45% of urethral strictures are from iatrogenic origin and expose patients tedious investigations and treatments with a relative high risk of recurrence. It is therefore fundamental to ensure the maximum education to health professionals in terms of transurethral catheterization techniques, indications and signs of complications to reduce the rate of iatrogenic lesions.

Indwelling urinary catheter management and catheter-associated urinary tract infection prevention practices in Nurses Improving Care for Healthsystem Elders hospitals

BACKGROUND

Indwelling urinary catheters (IUCs) are commonly used in hospitalized patients, especially elders. Catheter-associated urinary tract infections (CAUTIs) account for 34% of all health care associated infections in the United States, associated with excess morbidity and health care costs. Adherence to CAUTI prevention practices has not been well described.

METHODS

This study used an electronic survey to examine IUC care practices for CAUTI prevention in 3 areas-(1) equipment and alternatives and insertion and maintenance techniques; (2) personnel, policies, training, and education; and (3) documentation, surveillance, and removal reminders-at 75 acute care hospitals in the Nurses Improving the Care of Healthsystem Elders (NICHE) system.

RESULTS

CAUTI prevention practices commonly followed included wearing gloves (97%), handwashing (89%), maintaining a sterile barrier (81%), and using a no-touch insertion technique (73%). Silver-coated catheters were used to varying degrees in 59% of the hospitals; 4% reported never using a catheter-securing device. Urethral meatal care was provided daily by 43% of hospitals and more frequently that that by 41% of hospitals. Nurses were the most frequently reported IUC inserters. Training in aseptic technique and CAUTI prevention at the time of initial nursing hire was provided by 64% of hospitals; however, only 47% annually validated competency in IUC insertion. Systems for IUC removal were implemented in 56% of hospitals. IUC documentation and routine CAUTI surveillance practices varied widely.

CONCLUSIONS

Although many CAUTI prevention practices at NICHE hospitals are in alignment with evidence-based guidelines, there is room for improvement. Further research is needed to identify the effect of enhanced compliance with CAUTI prevention practices on the prevalence of CAUTI in NICHE hospitals.

Intermittent self-catheterisation: past, present and future

In the past, the only way to drain a bladder was to use intermittent catheterisation. For four millennia, intermittent self-catheterisation (ISC) was used to treat bladder dysfunction. That changed in the 20th century when Foley redesigned and improved on 19th century designs for an indwelling urethral catheter. While some patients benefit from indwelling catheters, long- and short-term indwelling catheters can increase infection risks and contribute to bladder dysfunction. NICE guidance on infection control recommends that intermittent catheterisation should be used in preference to an indwelling catheter if it is a clinically appropriate and practical option for the patient. NICE also recommends that patients should be offered a choice of either single-use hydrophilic or gel reservoir catheters for intermittent self-catheterisation. Voiding problems increase the risks of infection, bladder and renal dysfunction, and can impair quality of life. Individuals who have reasonable bladder capacity and sufficient dexterity and motivation can regain bladder control using ISC, which can make a huge difference to their health and wellbeing.

OptiLube Active. The role of lubricants in urinary catheterisation

Catheterisation is necessary for many patients but places them at risk of developing uncomfortable and potentially lethal infections. Catheter insertion can also be painful. It is essential that all staff who perform the procedure have a clear understanding of the measures they should implement to reduce discomfort, trauma and the risk of infection to the patient. The need for staff to be trained and competent and to use an aseptic technique when undertaking the procedure are core principles for practice. Guidance advises that lubricating gels are used in all patients undergoing urethral catheterisation to minimise the risk of urethral trauma and associated infection. Gels containing a local anaesthetic make the procedure less uncomfortable, but must be applied correctly to be effective. This article will consider the actions of these gels and the potential benefits and risks associated with each, focusing on use of OptiLube Active with case studies.

Urinary catheter policies for long-term bladder drainage

BACKGROUND

People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems.

OBJECTIVES

To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children.

SEARCH METHODS

We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 September 2011). Additionally, we examined all reference lists of identified trials.

SELECTION CRITERIA

All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children.

DATA COLLECTION AND ANALYSIS

Data were extracted by two reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated.

MAIN RESULTS

Eight trials met the inclusion criteria involving 504 patients in four cross-over and four parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials. Four trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection (UTI). Only one study found a significant difference in the frequency of UTI favouring prophylaxis. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria.

AUTHORS' CONCLUSIONS

No eligible trials were identified that compared alternative routes of catheter insertion. The data from eight trials comparing different antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from indwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria. These cannot be reliably estimated from currently available trials.

[Effect of painless urethral catheterization combined with lidocaine on urethral irritation]

OBJECTIVE

To evaluate the effect of placement of urethral catheter combined with lidocaine on urethral irritation caused by postoperative indwelling catheters.

METHODS

A total of 120 male surgical patients requiring postoperative indwelling catheters between June 2011 and January 2012 were divided into two equal groups for placement of painless urethral catheter combined with bladder washing with lidocaine on the first postoperative day, or for routine catheter placement only. The symptoms of urethral irritation such as urethral pain, urinary urgency, and perineal discomforts were observed and compared between the two groups.

RESULTS

In patients with painless urethral catheter placement combined with bladder washing with lidocaine, 11 developed urethral irritation symptoms, as compared to 24 in the patients with routine catheter placement only, showing a significant difference between the two groups (P<0.05).

CONCLUSION

Placement of painless urethral catheter combined with bladder washing with lidocaine can significantly reduce the incidence of urethral irritation due to postoperative indwelling catheters.

[Acute urinary retention in children]

Acute urinary retention is defined as failure to urinate in spite of an adequate amount of urine in the bladder. Acute urinary retention in children is rare, and may cause pain and distress. Diagnosis and urgent treatment are essential. Identification and treatment of underlying medical conditions such as constipation, neurological impairment or adverse reactions to medications may prevent recurrence of retention. We describe six cases of children who were hospitalized with acute urinary retention and review the medical literature on the subject.

Studying the Quality of Life and Life Satisfaction among Persons with Spinal Cord Injury Undergoing Urinary Management

The purpose of this survey was to investigate quality of life and life satisfaction among persons with spinal cord injury (SCI) who require various types of urinary management. A sample of 230 persons with SCI completed the Quality of Life Index (QLI), the Satisfaction With Life Scale (SWLS), and a demographic data form. Findings of this study indicated that there was no significant difference in QLI and SWLS with regard to the type of urinary management used (reflex voiding, indwelling catheter, suprapubic catheter, intermittent catheterization, external catheter or a combination of intermittent catheterization and external catheter). There also was no significant difference in QLI and SWLS with regard to the level of SCI or the incidence of hospitalizations for urinary infections. There were significantly higher QLI and SWLS scores for those with greater abilities to work, attend school, and participate in activities. There also was a significantly higher QLI for those without skin problems associated with urinary dysfunction.

Renal preservation in children with neurogenic bladder-sphincter dysfunction followed in a national program

PURPOSE

Neurogenic bladder-sphincter dysfunction (NBSD) constitutes the major reason for morbidity in children with spina bifida. The aim of this study was to identify risk factors for renal damage in children with NBSD followed according to the Swedish national guidelines.

MATERIALS AND METHODS

Records and cystometries from 6 to 16 years (median 11) follow up of 41 consecutive children born 1993-2003 with NBSD were evaluated. The children were divided into a high pressure group (baseline pressure above 30 cmH(2)O at maximal clean intermittent catheterization volume in at least two cystometries) and a low pressure group. Most children (34/41) were followed from birth.

RESULTS

Although renal scarring on DMSA-scintigraphy was found in 5/41 children, all but one had normal renal function. Two already had renal scars on entering the follow-up program at age 2.5 and 3 years. Renal scarring was more frequent in the high pressure group (P < 0.01). Most children with renal scars (4/5) had a combination of low compliant bladder and insufficient compliance with treatment and follow up.

CONCLUSION

High baseline pressure is confirmed as a risk factor that, in combination with complex social issues, creates a demanding situation for families and professionals. A structured early follow up with treatment compliance effectively prevents renal damage.

Successful management of urethro-ileal pouch fistula by cynoacrylate glue instillation

Uro-enteric fistulae are difficult clinical conditions that have a significant bearing on the patient's quality of life. Surgical correction, though challenging, is the usual mode of treatment offered to these patients. We describe a case of urethro-ileal pouch fistula which could be managed successfully without surgery with the help of cynoacrylate glue instillation.

Umbilical rotation: a new technique for the cutaneous fixation of continent catheterizable vesicostomies

PURPOSE

For cutaneous fixation of the continent catheterizable vesicostomy we present a new technique, in which the umbilicus is rotated caudally by 180° and the catheterizable channel is sutured to the umbilical cone. This procedure reduces the distance between the stoma entrance and the bladder.

MATERIALS AND METHODS

Between 2001 and 2008, 67 patients underwent construction of a continent catheterizable vesicostomy. In 82% (n = 55), this was an appendicovesicostomy according to the Mitrofanoff principle. For 21 of these patients, later in the series (2005 onwards), the procedure involved rotation of the umbilicus. We evaluated cosmetic outcome and channel-related complication rates and compared the results between the two groups, with and without umbilical rotation.

RESULTS

The overall complication rate was 22.4% (n = 15); stoma stenosis occurred in eight cases. In the majority of cases with complications, endoscopic treatment was sufficient. The complication rate was significantly lower in the group with umbilical rotation compared to the other group (14.3% vs 26.1%, P < 0.02).

CONCLUSIONS

Umbilical rotation always enables cutaneous implantation of the vesicostomy in the umbilical pit and is a safe and straightforward procedure.

Intermittent self-catheterisation in MS

People with multiple sclerosis may experience complex bladder problems; intermittent self-catheterisation can be used in cases of incomplete bladder emptying. This literature review examines the qualitative research on the use of ISC in patients with MS, focusing on concordance, training and quality of life.

[Urinary retention in women]

Urinary retention can be either acute or chronic. Its causes can be divided into obstructive, neurologic and other causes. A woman's urinary retention is most commonly due to weakened power of the detrusor muscle. Treatment of urinary retention is determined on an etiological basis. Basic treatment of acute urinary retention is catheterization. In chronic retention, intermittent catheterization is often the most effective option. Neuromodulation may result in prolonged relief for carefully chosen patients. Few patients benefit from pharmacological treatments or surgery.

Suprapubic bladder catheterization of male spinal-cord-injured Sprague-Dawley rats

The rat spinal-cord-injury (SCI) model is widely used to study the pathologic mechanisms that contribute to sensory and motor dysfunction in humans. This model is thought to mimic many of the negative outcomes experienced by humans after spinal contusion injury. We theorized that manual bladder expression contributed to the kidney and bladder lesions reported in previous studies using the rat SCI model. In the present study, rats were surgically implanted with bladder catheters after spinal contusion injury to provide continuous drainage of urine. After 72 h, the rats were euthanized and their kidneys and bladders examined histologically. BUN, serum creatinine, and urine protein were compared at 0 and 72 h after surgery. Kidney and bladder lesions were similar in SCI rats with and without implanted bladder catheters. BUN at 72 h was higher than baseline values in both groups, whereas serum creatinine was higher at 72 h compared with baseline values only in the catheterized rats. These findings indicate that suprapubic bladder catheterization does not reduce hydronephrosis in SCI rats and that the standard of care for bladder evacuation should continue to be manual expression of urine.

[The prevention of the acute urine retention and lower urinary tract infection after rectum surgery]

The possibilities of the prevention of the acute urine retention in patients with the prostatic enlargement after the rectum surgery. The method was successfully used in 106 patients.

Catheter policies for management of long term voiding problems in adults with neurogenic bladder disorders

BACKGROUND

Management of the neurogenic bladder has the primary objectives of maintaining continence, ensuring low bladder pressure (to avoid renal damage) and avoiding or minimising infection. Options include intermittent urethral catheterisation, indwelling urethral or suprapubic catheterisation, timed voiding, use of external catheter (for men), drug treatment, augmentation cystoplasty and urinary diversion.

OBJECTIVES

To assess the effects of using different types of urinary catheters and external (sheath) catheters in managing the neurogenic bladder, compared to alternative management strategies or interventions.

SEARCH METHODS

We searched the Cochrane Incontinence Group Specialised Register (searched 1 November 2011), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and CINAHL, and handsearching of journals and conference proceedings. We sought additional trials from other sources such as reference lists of relevant articles and contacting consultants in Spinal Cord Injury Centres throughout the United Kingdom.

SELECTION CRITERIA

All randomised and quasi-randomised controlled trials comparing methods of using catheters to manage urinary voiding in people with neurogenic bladder.

DATA COLLECTION AND ANALYSIS

Abstracts were independently inspected by the reviewers and full papers were obtained where necessary.

MAIN RESULTS

Approximately 400 studies were scrutinised. No trials were found that met the inclusion criteria, and five studies were excluded from the review.

AUTHORS' CONCLUSIONS

Despite a comprehensive search no evidence from randomised or quasi-randomised controlled trials was found. It was not possible to draw any conclusions regarding the use of different types of catheter in managing the neurogenic bladder.

Incidence of postoperative urinary retention (POUR) after joint arthroplasty and management using ultrasound-guided bladder catheterization

BACKGROUND

Postoperative urinary retention (POUR) following lower limb arthroplasty is a common complication. The aim of this observational study was to establish the incidence of POUR and assess the usefulness of an ultrasonographic nurse-driven protocol, thereby avoiding elective bladder catheterization.

METHODS

Two-hundred and eighty six consecutive patients undergoing elective hip and knee arthroplasty were retrospectively studied. None of the patients received elective bladder catheterization. Data on risk factors for POUR, urinary tract infections, length of hospital stay and analgesia were collected. Student's t, Wilcoxon rank-sum, ANOVA and Kruskall-Wallis tests were performed for comparison among two or more groups. Categorical variables were studied using Pearson's χ2 test. Results were considered significant when the P value <0.05.

RESULTS

Of the 286 patients studied, 49 (17%) required indwelling catheter for 24-48 h. Patients who had POUR had more risk factors (P<0.05) and had longer hospital stays (P<0.05). When comparing analgesia, continuous peripheral nerve block (CPNB) had the least impact on POUR (15.8%), while epidural analgesia had the greatest impact (48.1%).

CONCLUSION

Bladder scanners timely detect POUR following lower joint arthroplasty, making elective bladder catheterization unnecessary.

Medical interns' knowledge and training regarding urethral catheter insertion and insertion-related urethral injury in male patients

BACKGROUND

Improper catheterization can lead to urethral injury. Yet research from four continents suggests training of junior doctors in catheterization is insufficient. European research suggests a majority of catheterization related morbidities occur when the procedure is performed by interns.

METHODS

To assess the knowledge and practices of medical interns relating to urethral catheterization and iatrogenic urethral injury secondary to traumatic catheter insertion, a questionnaire survey was conducted of all first year medical interns at a tertiary national university hospital in the Philippines. The questionnaire contained 17 items covering 4 areas: methods of training in catheterization and level of experience; perceived adequacy of training; theoretical knowledge of catheterization; the mechanisms of catheter-related urethral injury.

RESULTS

225/240 interns (94%) completed the survey (130 (57.8%) female). 125 (55.6%) responded that they had adequate theoretical training and 150 (66.7%) adequate practical training. All had performed more than 10 catheterizations and 204 (90%) were supervised when they first performed catheterization. Despite relatively high levels of experience and confidence, deficits were identified in detailed knowledge of correct catheterization procedures and of risks associated with urethral injury.

CONCLUSIONS

More thorough training of incoming medical interns in urinary catheterization may help to reduce the risk of complications and injury. Training should be universal and thought given to its timing within the curriculum. Training should include step by step instruction in the process, emphasis on history taking and awareness of factors associated with increased risk of urethral injury.

Role of clean intermittent self catheterisation (CISC) in the prevention of recurrent urethral strictures after internal optical urethrotomy

BACKGROUND

Urethral stricture is one of the oldest diseases Urethral dilatation Internal optical urethrotomy,were the only treatment. Clean Intermittent Self Catheterisation was introduced by Lapides has greatly decreased the recurrence of stricture. Objectives were to determine the role of Clean Intermittent Self Catheterisation (CISC) in the prevention of recurrence of urethral strictures after Internal Optical Urethrotomy and to study the frequency of any postoperative complications and tolerability for the patients associated with this procedure.

METHODS

A randomised controlled study conducted in the department of urology and renal transplantation, Institute of Kidney Diseases Hayatabad Medical Complex, Peshawar from June 2007 to June 2010. Total of 60 patients with mean age 48 years (range 20-73) were selected and randomly divided into Treatment Group (30 patients) and Control Group (30 Patients). Eight "drop out" occurred in the treatment group and four "drop out" occurred in the controlled group. All the patients were treated with Internal Optical Urethrotomy using Sachse method followed by indwelling catheter for 5 days. The treatment group was then taught to perform Clean Intermittent Self Catheterisation by inserting a Classic Neleton Catheter (No. 16 or 18) twice a day for 1 week, then once a day for another 4 weeks and then once weekly continued for one year. All the patients were followed up regularly at 1 month intervals during the first 6 months and then every 2 months for the next 6 months.

RESULTS

Total of 48 patients completed the study, 22 in the treatment group and 26 in the control group. Within the first year, 4 patients (22%) in the treatment group developed urethral stricture. In the control group, 12 patients (46%) developed urethral stricture within the first year, showing a significant difference (p < 0.01). In the treatment group four patients developed simple UTIs while in the control group three patients developed UTIs, one with concomitant epididymitis. No other complications were noted up to one year follow up.

CONCLUSION

Clean Intermittent Self Catheterisation is a simple and effective way of reducing stricture recurrence after Internal Optical Urethrotomy and is associated with less morbidity and is cost effective. CISC is an important modality for maintaining the normal urethral calibre.

Bladder catheterization in Greek nursing education: An audit of the skills taught

INTRODUCTION

The auditing of nurse teaching is in its infancy in Greece. One area urgently in need of audit is the teaching of male catheterization.

AIMS

To assess the current educational model regarding male bladder catheterization at a sole tertiary education nursing establishment in a major Greek city and to improve nurse undergraduate training by implementing appropriate recommendations for change to the current educational module and support these changes in the long term.

METHODS

A systematic search of international databases for guidelines or best practice regarding bladder catheterization was conducted. Audit measures included direct observation of the teaching process and compilation of a checklist.

RESULTS

The shortcomings are discussed under the following headings: patient pre-preparation, choice and quality of materials used, appropriate aseptic techniques, catheter withdrawal, connecting and handling the drainage bag, diminishing risk of Catheter Associated Urinary Track Infections (CAUTIs), no problem solving trouble-shooting training, textbook and educational resources, lack of national guidelines, setting of the educational experience.

CONCLUSIONS

The main problem with the teaching process exposed by the audit is entrenched use of an outmoded textbook with little effort to enrich teaching with current evidence base practices.

Irrigation of continent catheterizable ileal pouches: tap water can replace sterile solutions because it is safe, easy, and economical

BACKGROUND

Continent catheterizable ileal pouches require regular irrigations to reduce the risk of bacteriuria and urinary tract infections (UTIs).

OBJECTIVE

Our aim was to compare the UTI rate, patient friendliness, and costs of standard sterile irrigation versus irrigation with tap water.

DESIGN, SETTING, AND PARTICIPANTS

Twenty-three patients participated in a prospective randomized two-arm crossover single-center trial. Aseptic intermittent self-catheterization (ISC) combined with sterile sodium chloride (NaCl) 0.9% irrigation was compared with clean ISC and irrigation with tap water (H(2)O) during two study periods of 90 d each.

INTERVENTION

Patients underwent daily pouch irrigations with NaCl 0.9% solution or tap water.

MEASUREMENTS

Urine nitrite dipstick tests were evaluated daily; urine culture (UC) and patient friendliness were evaluated monthly. Costs were documented.

RESULTS AND LIMITATIONS

A total of 3916 study days with nitrite testing and irrigation were analyzed, 1876 (48%) in the NaCl arm and 2040 (52%) in the H(2)O arm. In the NaCl arm, 418 study days (22%) with nitrite-positive dipsticks were recorded, 219 d (11%) in the H(2)O arm, significantly fewer (p=0.01). Of the 149 UCs, 96 (64%) were positive, 48 in each arm, revealing a total of 16 different germs. All patients preferred the H(2)O method. Monthly costs were up to 20 times lower in the H(2)O arm.

CONCLUSIONS

Pouch irrigation with sterile NaCl 0.9% solution and tap water had comparable rates of positive UC. Irrigation with tap water significantly lowered the incidence of nitrite-positive study days and was substantially less costly and more patient friendly than NaCl irrigation. We therefore recommend the use of tap water (or bottled water) instead of sterile NaCl 0.9% solution for daily irrigation of continent catheterizable ileal pouches.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN12610000618055, http://www.ANZCTR.org.au/ACTRN12610000618055.aspx.

Quality of documentation of urethral catheterization in a Nigerian teaching hospital

BACKGROUND

Urethral catheterization is a common minimally invasive procedure with well-known complications some of which may be severe. Quite often, a clinician is invited to manage the short and long-term complications of the procedure without adequate records of the procedure itself.

OBJECTIVES

This study aims to determine the quality of documentation of urethral catheterization in our health institution.

METHODS

This prospective study was carried out over a period of 1 month. The documentations in the medical notes and nursing records with respect to urethral catheterisation were assessed using 10 different parameters with the aid of a pro-forma. Statistical analysis was done with the Wilcoxon signed ranks test.

RESULTS

A total of 89 patients were catheterised in the wards, the emergency departments and the theatre. All the catheterizations were performed by doctors. The overall quality of documentation of catheterisation was poor: It was significantly worse in the medical notes than the nursing records with 28% of all cases documented by the nurses not documented by the physicians. Documentation in the theatre and emergency were worse, while there was no documentation of aseptic technique in any patient. An 11% incidence of complications was noted.

CONCLUSION

The quality of record keeping concerning urethral catheterization was inadequate. This is important not only for patients' care, but also for medico-legal purposes. We therefore recommend regular audit and introduction of protocols for proper documentation.

Clinical and cost effectiveness of urethral catheterisation: a review

Reducing the number of catheter-associated urinary tract infections (CAUTI) in the National Health Service (NHS) has the potential for large cost savings. This review identifies factors which affect the incidence rate of CAUTI, as well as the need for further studies investigating cost-effectiveness, particularly in the areas of silver alloy catheters and education.

[Quality of life evaluation in spinal cord injured patients comparing different bladder management techniques]

OBJECTIVES

This study examines quality of life among patients with spinal cord injury requiring bladder management techniques, according to the validated King s Health Questionnaire (KHQ).

MATERIAL AND METHODS

Prospective and observational study of 91 spinal cord-injured patients (21 women 23% and 70 men 77%). Mean age was 40 years (SD 13.4) and average time since spinal injury was 11.4 (SD 10.4) years. Patients completed the KHQ quality of life instrument and 10 additional questions related to urinary disturbance developed for the study, and filled in a form to subjectively rank their main concerns related to spinal injury. Patients were divided according to the bladder management techniques they regularly used: intermittent catheterization, condom catheter or indwelling catheter, and differences between the mean groups were assessed with de SPSS 13.0 statistic package.

RESULTS

The overall KHQ score for the sample was 39.9 (SD 54.4) with higher scores (poorer QoL) in patients using an indwelling catheter. A thorough analysis of the test showed no significant differences between the groups other than in the physical role limitation item (p<or=0.025). Patients using a condom catheter reported lower physical limitation scores (better QoL) than patients using an indwelling catheter or intermittent catheterization. Sexuality was the main concern of most patients, followed by bowel dysfunction, urinary incontinence and ambulation or gait problems.

CONCLUSION

Patients treated with condom catheters reported the best quality of life according to KHQ scores, although there were no significant differences versus the other urinary management techniques. The patients' main concern was related to sexuality.

[A case of emphysematous cystitis treated by clean intermittent catheterization : a case report]

Emphysematous cystitis is a rare condition characterized by air formation in and around the bladder wall by gas-forming organisms. An 89-year-old non-diabetic man with benign prostatic hyperplasia and neurogenic bladder presented at our hospital with fever and lower abdominal pain. Urinalysis and urine culture revealed pyuria and bacteriuria with Citrobacter freundii. Abdominal computed tomography revealed intramural gas, which suggested the diagnosis of emphysematous cystitis. He recovered and the intramural gas appeared to have disappeared on the abdominal computed tomography after urinary drainage and antibiotic therapy. Ninty-nine cases of emphysematous cystitis have been reported in Japan including this case.

[Percutaneous approach in postureteroenterostomy ureteral stenosis. Experience of the Urological Department of Sf. Ioan Emergency Hospital, Bucharest]

INTRODUCTION

Uretero-enteric stenosis may raise some specific problems due to difficulties concerning the retrograde access. The aim of our study was to evaluate the effectiveness of antegrade flexible ureteroscopic approach for this specific pathology.

MATERIAL AND METHODS

Between January 2002 and June 2008, a number of 7 patients underwent antegrade flexible ureteroscopy for uretero-enteric stenosis: 3 patients with stenosis of the uretero-neobladder anastomosis (Group I), 2 patients with stenosis of the uretero-sigmoidian implantation (Group II) and 2 patients with stenosis of the ureteral implantation in an ileal conduit (Group III). In Group I, we performed antegrade Nd:YAG laser star incision in 2 cases and balloon dilation in 1 case. In Group II, the antegrade Nd:YAG laser star incision was applied in 1 case and balloon dilation was performed in the other one. In Group III, we performed antegrade insertion of the guidewire followed by retrograde cold-knife incision in one case, and bipolar ureteral approach (cut-to-the-light technique) in 1 case.

RESULTS

The mean operative time was 58 min. (range 25 to 120 min). We didn't describe major intraoperative complications. Ultrasonography, IVP and isotopic renogram (in selected cases) have been the follow-up evaluation methods. Postoperatively, 2 cases from Group I and all cases from Groups II and III had a good evolution, with significant reduction of the hydronephrosis degree at 6, 12 and 18 months. One patient from Group I, in which balloon dilation of the stenosis was performed, developed recurrence at 6 months.

CONCLUSIONS

According to our experience, antegrade flexible ureteroscopic approach may represent an efficient and safe technique in uretero-enteric stenosis treatment. Being a minimally invasive approach, this procedure has a reduced rate of complications and good anatomical and functional results.