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The aim of the study is to evaluate the feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy (LNSRH). The post-operative bladder catheterisation period of 30 patients who underwent LNSRH at two institutes in Egypt and Italy were prospectively evaluated with postoperative drainage of the bladder through a Foley catheter for two days without performing bladder-training exercise. The median duration for postoperative bladder catheterisation was 3.5 (3–5) days. Within the fifth postoperative day, 82.7% had a PVR urine volume less than 100 ml. None of the patients had PVR urine more than 100 ml more than 10 days after the operation with no need for self-catheterisation. These results support early postoperative bladder catheter removal without prior bladder-training exercises following LNSRH.IMPACT STATEMENTWhat is already knownon this subject? Bladder-training exercise was used routinely following radical hysterectomy (RH) operations before bladder catheter removal. Only two studies reported that these exercises could be omitted, but one study was done on both laparoscopic and open RH patients and the other did not show whether the operation was nerve-sparing and whether it was done by laparoscopy or open technique. Whatthe results ofthis study add? This study’s results support early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing RH. Whatthe implicationsare of these findingsfor clinical practice and/orfurther research? Excluding the unnecessary procedure of bladder training, which is time- and effort-consuming, after the operation.

Resume But Determiner la prise en charge a recommander apres une cesarienne concernant la surveillance et ses modalites, l’analgesie postoperatoire, le retrait de la sonde vesicale, la reprise de l’alimentation, le premier lever et les indications d’une thromboprophylaxie. Materiel et methodes Consultation de la base de donnees MEDLINE, de la Cochrane Library et des recommandations des societes savantes francaises et etrangeres. Resultats La surveillance postoperatoire immediate apres cesarienne (sous anesthesie locoregionale ou generale) doit se derouler en salle de surveillance post-interventionnelle (SSPI) a proximite de la salle de naissance (accord professionnel). Dans le cas ou les difficultes organisationnelles locales apparaitraient insurmontables pour assurer cette surveillance en SSPI, il conviendrait que la Commission medicale de l’Etablissement en soit saisie et que la direction informe l’Agence regionale de sante des solutions envisagees, des lors qu’elles contreviendraient au code la sante publique (accord professionnel). Une procedure de surveillance specifique comportant les modalites d’appel en urgence de l’equipe medicale doit etre mise en place (accord professionnel). La realisation d’une numeration formule sanguine (NFS) de facon systematique dans la periode post-cesarienne immediate n’est pas recommandee en population generale (accord professionnel). Un protocole antalgique elabore par l’equipe medicale devra etre prescrit et administre par voie orale de facon systematique pendant les premiers jours postoperatoires (accord professionnel). Concernant le sondage vesical, la prise en charge de reference reste le sondage vesical a demeure avant la realisation de la cesarienne et il doit etre maintenu pendant toute la duree de la cesarienne (accord professionnel). On privilegiera dans la mesure du possible son retrait avant la 12 e heure (accord professionnel). Il est recommande de verifier la reprise mictionnelle dans les 4 a 6 heures suivant l’ablation de la sonde vesicale. Le medecin doit etre averti en cas de retention urinaire de plus de 6 heures (grade C). Un lever precoce des j1 (voir plus precocement des la 6 e –8 e heure) postoperatoire avec aide de l’equipe soignante est conseille et encourage (accord professionnel). La realimentation doit etre precoce apres cesarienne programmee ou en urgence que celle-ci ait ete realisee sous anesthesie locoregionale ou anesthesie generale (grade B). Il est recommande de maintenir une voie veineuse peripherique pendant 24 h comme element de securite (accord professionnel). Une prevention anti-emetique systematique en cours de cesarienne par une bitherapie medicamenteuse est recommandee (grade B). Pour toute cesarienne, une thromboprophylaxie par bas antithrombose (BAT) systematique mis le jour l’intervention et a garder pour une duree d’au moins 7 jours est recommandee (accord professionnel) avec ou sans l’adjonction d’HBPM selon la presence ou non de facteurs de risque supplementaires, et selon le type de facteur de risque (majeur, mineur). Une adaptation des doses d’HBPM preventive selon le poids est recommandee chez les patientes obeses (grade C). Conclusion Une harmonisation des prises en charge au vu de ces recommandations a pour but de favoriser une recuperation physiologique rapide apres cesarienne.

Objetivo: Objetivou identificar a associação entre os escores da admissão e desfechos desfavoráveis em pacientes de UTI. Métodos: Trata-se de análise transversal de uma coorte prospectiva. Foram utilizados os escores: Simplified Acute Physiology III (SAPS III), Sequential Organ Failure Assessment (SOFA), Nursing Activities Score (NAS) e Índice de comorbidade de Charlson (ICC). Foram coletados dados de pacientes com idade maior ou igual a 18 anos no período de outubro de 2018 a julho de 2019. A amostra foi composta por 100 pacientes, com idade média de 68±19 anos. Os escores calculados na admissão foram: ICC (4±3), SAPS III (28±12) e SOFA (3±3) e no desfecho foram 2±4 (SOFA) e 29±16 (SAPS III). Resultados: A procedência prevalente foi emergência, com diagnóstico cardiovascular, antecedentes pessoais cirurgia prévia, HAS como comorbidade, suporte admissional noradrenalina e fentanil e dispositivo mais utilizado sonda vesical de demora. Conclusão: Pode-se evidenciar a associação de desfechos clínicos desfavoráveis ao paciente com escores assistências. Torna-se essencial sua utilização na prática clínica de modo a guiar a assistência prestada ao paciente crítico.

Purpose To describe the surgical treatment of a patient harboring a ureteropelvic junction obstruction (UPJO) in the lower unit of an incomplete duplicated collecting system. Methods A female patient with 32-years old presented a progressively increasing left lumbar pain for 1 year and urinary tract infections (UTI) for the past 10 years. Computed tomography demonstrated a UPJO in the lower unit of an incomplete duplicated urinary collecting system. Results The patient underwent a robot-assisted pyeloureterostomy. The surgical time was 118 minutes and there was no intraoperative complication. During surgery, anomalous vessels crossing to the lower pole of the kidney were identified. The bladder catheter and abdominal drain were removed at the first and second postoperative days. The length of the hospital stay was 2 days and the post-operative course was uneventful. The double-J stent was retrieved 4 weeks after surgery. At 18 months of follow-up, the patient had complete pain resolution and no new episodes of UTI. The control image exam revealed minimal residual hydronephrosis. Conclusion Robot-assisted pyeloureterostomy was an effective approach to the present case. Many times, the surgical strategy for patients with anatomic variants is determined intra-operatively. The surgeon must have a wide range of skills and be prepared for a timely decision.

Condom catheters are known to be discrete, reliable, comfortable and very easy to use which makes them preferable to bladder catheter (Saint et al. (Urinary catheters: What type do men and their nursesprefer? J Am Geriatr SOC 1999;47:1453–1457); Hirsh et al. (Do condom catheter collecting systems cause urinary tract infection? J Am Med Assoc 1979;2:0–1)). Condom catheters are widely used in the management of male urinary incontinence, bedridden patient and geriatric population. They are considered to be safe, however, they are associated with complications in care of an incorrect use. In our hospital setup a 73-year-old male bedridden patient attended the surgical opd with complain of penile skin erosion following condom catheter application for 4 days for which dressing was done to remove the slough for 2 days then circumcision was done. Henceforth, although a less known complications are associated with the condom catheter but if not attended promptly can lead to a grave condition like penile gangrene, necrosis, death (Özkan et al. (Penile strangulation and necrosis due to condom catheter. Int Wound J 2015;12:248–9. doi: 10.1111/iwj.12102. Epub 2013 Jun 11); Johnson (The condom catheter: urinary tract infection and other complications. South Med J 1983;76:579–82)).

Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children. It has been reported that VUR may be associated with reflux nephropathy. Ultrasound contrast-enhanced voiding urosonography (CeVUS) has become a routine diagnostic method for VUR in a number of European countries; however, it is not widely used in China. The aim of the present study was to analyze the clinical application and evaluate the safety of CeVUS as a diagnostic tool for VUR in children in order to establish a standardized operating procedure for CeVUS in pediatric VUR in China. Between August 2016 and October 2017, 90 children who were susceptible to VUR were admitted into the Pediatric Nephrology Department of Tongji Hospital and underwent CeVUS. The SonoVue second-generation USA contrast agent was administered intravesically via a transurethral bladder catheter at a dose of 1 ml. The occurrence of adverse events was monitored. Urine analysis and culture were performed. A total of 90 children (47 female, 43 male; mean age, 36.6 months) with 178 Pelvi-Ureteral Units (PUUs) underwent CeVUS to screen for VUR. VUR was detected in 44/90 pediatric patients (48.89%) and 65/178 PUUs (36.52%) by CeVUS. The grade distribution of the 65 PUUs with VUS was as follows: Grade I, 3; Grade II, 9; Grade III, 14; Grade IV, 22; and Grade V, 17. The accuracy of CeVUS in the present study were consistent with previous reports. No urethral anomalies were detected and there were no adverse events. CeVUS was demonstrated to be a safe, accurate and reliable imaging technique for detecting VUR in high-risk children, including neonates. Results of the present study indicated that CeVUS can be adopted as the primary screening and follow-up method for pediatric VUR diagnoses in China.

Colovesical fistula (CVF) is an uncommon complication of diverticulitis. Substantial heterogeneity exists in the perioperative management of this condition. We seek to evaluate the role of bladder leak testing, closed suction drainage, prolonged bladder catheter usage, and routine postoperative cystogram in the management of CVF. This is a retrospective study from a single academic health center investigation patients undergoing operation for diverticular CVF from 2005 to 2015 (n = 89). Patients undergoing operative repair for diverticular CVF resection had a mortality of 4% and overall morbidity of 46%. Intraoperative bladder leak test was performed in 36 patients (40%) and demonstrated a leak in 4 patients (11%). No patients with a negative intraoperative bladder leak test developed a urinary leak. Overall, five (6%) patients developed postoperative bladder leak. Three were identified by elevated drain creatinine and two by cystogram. The diagnostic yield of routine cystogram was 3%. All bladder leaks were diagnosed between postoperative day 3 and 7. Of patients with a postoperative bladder leak, none required reoperation and all resolved within 2 months. There is significant variability in the management of patients undergoing operation for CVF. Routine intraoperative bladder leak test should be performed. Cystogram may add cost and is low yield for routine evaluation for bladder leak after operation for CVF. Urinary catheter removal before postoperative day 7 should be considered.

Objective: Thousands of patients must carry Foley catheter during their hospital stay or at home. Sometimes it is impossible to remove it, due to the inability to deflate the balloon. There is no clear protocol about what to do, who should do it and in what order. We present a proposal for action to face this type of situation. Material and methods: We searched the databases of medical publications (Pubmed, Medline, Embase) using the following keywords: Bladder catheter removal, Non-deflatable, retained catheter, obstructed catheter. Results: Twentyfour articles that fulfilled the requirements of the search were detected. Only ten which propose stteped actions were finally included for review Discussion: The only standardized proposal for action was published 17 years ago and it has never been updated, probably because these problems are considered "isolated cases". We review the knowledge on the subject and propose an action algorithm that would reduce costs and avoid displacement if this situation arises.

OBJETIVOS: Establece la relación entre el diagnostico ecográfico de una colección en la cúpula vaginal luego de histerectomía vaginal y de las complicaciones que puedan devenir. LUGAR: Servicio de Ginecología del Pabellón 5 II del Departamento de Ginecología y Obstetricia del Hospital Arzobispo Loayza , entre agosto de 2001 hasta marzo de 2002.MATERIAL Y METODOS: Estudio con una muestra de 153 pacientes, con indicaciones para la cirugía electiva de histerectomía vaginal y que al tercer día del postoperatorio, se le realizo una ecografía pélvica, para determinar la existencia del alguna colección de la cúpula. De acuerdo a los diversos análisis estadísticos se consideró significancia estadística a un p< 0,05. RESULTADOS: En las pacientes estudiadas, la edad y el número de gestaciones promedio fueron 56 años y 7, respectivamente. Se presentaron 40,5% de complicaciones, siendo las dos terceras partes de índole infecciosa, a predominio de las infecciones urinarias atribuidas a la permanencia de la sonda vesical por mas de 72 horas, y el resto relacionadas a infección y hematoma de cúpula; en menor medida se presentaron fallas en la técnica operatoria. CONCLUSIÓN. La presencia de la colección de cúpula por ecografía en el postoperatorio inmediato de histerectomía vaginal indicó un aumento de 77 veces el riesgo de tener una complicación a ese nivel.

Objectives To develop a urodynamic model incorporating external urethral sphincter (EUS) electromyography (EMG) in awake rats. Materials and Methods Bladder catheters and EUS EMG electrodes were implanted in female Sprague Dawley rats. Assessments were performed in awake, lightly restrained rats on postoperative day 12–14. Measurements were repeated in the same rat on day 16 under urethane anaesthesia. Urodynamics and EUS EMG were performed simultaneously. In addition, serum creatinine and bladder histology was assessed. Results No significant differences in urodynamic parameters were found between bladder catheter only vs bladder catheter and EUS EMG electrode groups. Urethane anaesthesia evoked prominent changes in both urodynamic parameters and EUS EMG. Serum creatinine was within the normal limits in all rats. Bladder weight and bladder wall thickness were significantly increased in both the bladder catheter only and the bladder catheter and EUS EMG group compared with controls. Conclusions Our novel urodynamic model allows repetitive measurements of both bladder and EUS function at different time points in the same rat under fully awake conditions and opens promising avenues to investigate lower urinary tract dysfunction in a translational approach.

Resume Cet article rapporte un cas rare d’obstruction du meat ureteral gauche par une sonde vesicale compliquee d’une pyelonephrite obstructive. Il s’agissait d’un patient de 93 ans hospitalise aux urgences pour un tableau de fievre a 39 °C avec pyurie sur sonde a demeure. Il existait une hyperleucocytose avec syndrome inflammatoire biologique accompagne d’insuffisance renale aigue. Le diagnostic a ete confirme sur un scanner abdominopelvien sans injection montrant l’intubation du meat ureteral gauche par l’extremite de la sonde avec des signes d’obstruction d’amont. Le traitement a consiste en un remplacement de la sonde vesicale par une sonde double-courant avec des lavages vesicaux associes a une antibiotherapie parenterale. L’evolution clinico-biologique a ete favorable et un uro-TDM realise a j9 a retrouve une reprise normale de la fonction excretrice renale gauche sans sequelles au niveau de l’uretere. Au travers d’une courte analyse de la litterature, nous presenterons les differentes attitudes de prise en charge des obstructions ureterales par les catheters vesicaux.

Reasons of postponing a UDT are UTI, uncontrolled AD, difficult urethral catheterisation, etc.

Urinary tract infections affect many patients, especially those who are admitted to hospital and receive a bladder catheter for drainage. Catheter associated urinary tract infections are some of the most common hospital infections and cost the health care system billions of dollars. Early removal is one of the mainstays of prevention as 100% of catheters become colonized. Patients with ureteral stents are also affected by infection and antibiotic therapy alone may not be the answer. We will review the current evidence on how to prevent infections of urinary biomaterials by using different coatings, new materials, and drug eluting technologies to decrease infection rates of ureteral stents and catheters.

Indirect radionuclide cystogram (IRC) is a radionuclide technique that gives the possibility of detecting vesicoureteral reflux (VUR) without a bladder catheter (micturition is studied under physiological conditions) with a low effective radiation dose. Furthermore, the IRC is done following a dynamic renogram (early, after, or whenever the child wishes to void). In such a way, a unique tracer administration allows to achieve the overall function of the kidneys, drainage data from the upper tracts (by dynamic renogram) followed by VUR, and micturition evaluation under normal physiological conditions (by IRC). If necessary, IRC can be performed also after diuretic test, achieving better technical conditions: improving urinary drainage and bladder filling (i.e., helpful in case of megaureter).

Direct comparison of secondary muscle spindle afferent activity and motoneuron activity between the brain-dead human HT6 with a synergy of the bladder (A) and the paraplegic 9 with a dyssynergia of the bladder (B). A. Simultaneous measurements of activities of secondary muscle spindle afferents (a), parasympathetic preganglionic motoneurons (b) and oscillatory firing (high activity mode) of a sphincter motoneuron innervating the striated anal sphincter (c). Note that with the transient activity increase of the parasympathetic fibers (b) the secondary muscle spindle afferent fiber increased strongly its activity (a) for minutes, and the oscillatory firing sphincter motoneuron discontinued its oscillation (c) to reduce strongly its activity. bladder 3x = 3 times bladder catheter pulling. T ext. anal sphincter mot. = oscillation period of the sphincter α2-motoneuron innervating the anal sphincter. For further details, see Chapter V of [1].

Introduction The vapoenucleation of the prostate using green laser is an alternative hybrid technique between vaporization and enucleation. It consists of vaporizing the lateral lobes and enucleating the median lobe. The advantages compared with photoselective vaporization of the prostate (PVP) are: a fairly fast operation, low reoperation rates, it is suitable for large glands and provides pathology specimen. The aim of this video is to demonstrate the vapoenucleation technique step-by-step. Methods The surgery was performed with a 532-nm lithium triborate laser (GreenLight XPS 180W, American Medical Systems, Minnetonka, Minnesota), MoXy side-fire laser fiber at power settings: 180 W for cutting, 35 W for coagulation and a Piranha morcellation system (Richard Wolf GmbH, Germany). Case Report A 68-year-old patient presented with lower urinary tract symptoms secondary to benign prostatic obstruction. The prostate volume was 88 mL, PSA of 3.4 ng/mL, the peak urinary flow rate (Qmax) was 7 mL/s, the postvoid residual volumen was 160 mL and international prostate symptom score was 22. Results The total operative time was 72 minutes, total energy employed was 354 kJ and the pathology report showed no evidence of prostate cancer (35 g). The bladder catheter was removed at 24 hours postsurgery and the patient was discharged 48 hours postoperative without complications. Three months later all the parameters showed significant improvement (PSA: 1.02 ng/mL, international prostate symptom score: 4, Qmax: 43 mL/seg and postvoid residual volumen: 15 mL). Conclusion Green laser vapoenucleation of the prostate represents a safe alternative technique for the complete removal of adenomatous prostate tissue, regardless of gland size, and it is particularly advantageous for the treatment of large prostates. This technique can also be used as an intermediate step during the learning curve of "en bloc" green laser enucleation of the prostate (GreenLEP). These promising results warrant further studies to assess long-term outcomes.

Premature and extremely low birth weight (ELBW) neonates are at high risk of developing multiple co-morbidities and often require urinary catheterization for various medical indications. Intra-vesical knotting of bladder catheter is a known but uncommon complication of this procedure. We report a case of an ELBW baby boy with a knotted bladder catheter requiring surgical retrieval. After an elective operation for the closure of patent ductus arteriosus, a 4 French urinary catheter was inserted into an ELBW baby boy for urine output monitoring and left in-situ. Resistance was encountered in attempt to remove the urinary catheter. Abdominal X Ray confirmed intra-vesical knotting of the tube. Knot unravelling by interventional radiology was attempted but was unsuccessful. Open extra-peritoneal bladder exploration was performed for the retrieval of the tightly knotted catheter. A 6 French transurethral Foley catheter was inserted for bladder drainage. Upon removal of the Foley's catheter on day 5 post op, the baby was able to void spontaneously. With literature review, we postulated the potential risk factors resulting in this potentially avoidable iatrogenic unusual complication. Recommendations were suggested to avoid further incidences.

Sometimes a light bulb is used to masturbate. If the light bulb becomes stuck in the vagina, it can be a challenge to remove it. Traction on the light bulb creates a vacuum and risks breaking the glass into pieces. The entrance of the vagina is too small to use obstetric forceps. The trick is to insufflate air in the vagina and perform traction at the same time. This can be achieved by inserting a bladder catheter to insufflate air while simultaneously performing traction on the screw thread of the bulb. An alternative option is to perform an episiotomy to enlarge the entrance to the vagina.

Describing the trajectories of hospital-associated functional decline in older patients admitted to acute medical units and identifying predictors at the individual, nursing, and hospital levels, were the aims of the study. A longitudinal survey among 12 acute medical units in which 1464 patients were consecutively enrolled and evaluated using the Barthel Index (BI), was performed. Functional decline was defined as a decrease in the BI of at least 5 points from admission to discharge. In all, 17.1% participants (n = 251) demonstrated functional decline. In accordance with multiple logistic regression analysis, 28.8% (R(2)) of the variance in the functional decline was explained by: confusion/disorientation (RR = 4.684; 95% CI = 3.144-6.978), admission from nursing homes (RR = 2.464; 95% CI = 1.642-3.697), daily care expressed in minutes offered by nursing aides (RR = 1.535; 95% CI = 1.275-1.849), higher workforce skill-mix (RR = 2.221; 95% CI = 1.763-2.797), bladder catheter insertion (RR = 1.599; 95% CI = 1.128-2.268), and higher BI score at admission (RR = 1.019; 95% CI = 1.014-1.024). Increasing the amount of care delivered by competent nurses-having a bachelors degree-providing and supervising direct-care activities, may reduce the occurrence of functional decline in older patients admitted to medical units.

We investigate the hypothesis that intrafascicular stimulation of the pudendal nerve (PN) can be used to selectively activate the detrusor bladder muscle and the external urethral sphincter (EUS). Nine anesthetized male canines were used in this study. Muscle activations were measured via bladder catheter pressure transducers and EUS electromyography (EMG) wires. The PNs were exposed via dissection of the ischioanal fossa and implanted with Utah Slanted Electrode Arrays (USEAs). USEAs consist of 100, 0.5–1.5 mm long microelectrodes that project out from a 4 $\,\times\,$ 4 mm substrate. Intrafascicular stimulation was delivered via individual USEA microelectrodes in order to map the ability of each electrode to selectively or nonselectively evoke detrusor and/or EUS contractions. We were able to selectively activate the detrusor using 33 Hz stimulation of PN axons with an average of $4.57 \pm 3.82$ ( ${\rm mean }\pm {\rm sd}$ ) USEA electrodes per animal tested. Electrically-evoked and distention-evoked bladder contractions had similar kinetics. Sustained bladder contractions were evoked via 60 s of intrafascicular stimulation. The EUS was activated using 33 Hz stimulation via an average of $26.14 \pm 19.45$ electrodes per animal tested. High frequency ( $> {2}~{\rm kHz}$ ) stimulation delivered via EUS selective electrodes produced nonselective block of PN axons. Examples of how this selective axonal access could be used to restore continence and activate micturition were demonstrated in two animals. We report herein the first study demonstrating selective detrusor and EUS activation via microelectrodes implanted intrafascicularly in the PN. Such selective activation enables new therapeutic possibilities for controlling the muscles of micturition.

Megaprepuce is a congenital penile malformation that includes phimosis and severe ballooning of the internal prepuce. We combined the main technical details of 2 previously reported surgical techniques to simplify the surgical approach. We report the key points of this revisited surgical correction for megaprepuce and the long-term results.Penile reconstruction was performed between March 2004 and March 2009 in 26 children 2 to 19 months old (median age 6) with congenital megaprepuce. Surgical repair consisted of limited preputial resection of the phimotic ring, wide dissection of the outer prepuce to the base of the penis, fixation of the proximal outer prepuce to Buck's fascia to create a new penoscrotal junction, and unfurling and wide tailoring of the inner prepuce in the ventral midline to resurface the whole elongated penile shaft. A bladder catheter was left in place for 5 or 6 days. Only patients with at least 6 months of followup were included in analysis.All patients underwent surgery on an outpatient basis. Operative time was between 50 and 85 minutes. Median followup was 17.6 months (range 6 to 59). Two patients had slight dehiscence of the ventral suture, which healed spontaneously without a scar. In 1 patient transient urethral meatal stenosis developed. The final cosmesis result was adequate in all patients.It is possible to correct megaprepuce and achieve an adequate genital aspect with a simple approach of resurfacing the penis with the unfurled, tailored inner prepuce.

Aim. To synthesise the evidence available in the literature on the effectiveness of the ultrasound bladder scanner in reducing the risk of urinary tract infection. Background. Acute urinary retention is the inability to empty the bladder notwithstanding it being full and is frequent in the postoperative period. Using the ultrasound bladder scanner for the measurement of urinary residue, nurses are able to evaluate the presence of urinary retention, monitor the volume and the excessive relaxation of the bladder and avoid unnecessary catheterisations. The association between urinary catheterisation and urinary tract infection is well documented in the literature. Design. A meta-analysis was conducted. Method. An extensive review was carried out by two researchers using multiple databases, including all articles published from 1 January 1986–8 February 2008. No restrictions were adopted with regard to language. Studies on (1) documenting hospitalised patients with a need to evaluate bladder urinary volume, (2) comparing the use of the ultrasound bladder scanner vs. the clinical judgment of the nurses in the evaluation of acute urinary retention followed by a decision regarding whether or not to apply a bladder catheter and (3) those documenting the impact on urinary tract infection associated with catheterisation were included. Results. A total of 61 articles were retrieved, of which 58 were excluded because they did not meet the inclusion criteria. The overall effectiveness of the bladder ultrasound scanner in the reduction of urinary tract infection associated with catheterisation was OR 0·27 (IC95% 0·16–0·47; p-value 0·00000294, variance 0·08, weight 12·50). Discussion. The ultrasound bladder scanner helps to define and monitor bladder urinary volume and therefore, to catheterise patients only when necessary. Although there were numerous factors affecting the clinical heterogeneity of the included studies, the reduction in risk of urinary tract infection associated with catheterisation was consistent. Conclusion. The use of the ultrasound bladder scanner for evaluating and monitoring the residue volume in immediate postoperative patients, aged 18 or above, reduces unnecessary catheterisations and therefore the risk of urinary tract infection associated with catheterisation. Relevance to clinical practice. The systematic use of the ultrasound bladder scanner in the peri-operative period could increase the appropriateness of catheterisation and reduce patient discomfort, costs and days of hospitalisation associated with urinary tract infection associated with catheterisation.

A randomised comparison was made between high and normal diuresis during the primary session of extracorporeal shock wave lithotripsy (SWL) for removal of ureteral stones. High diuresis was accomplished by pressure infusion of approximately 1 L of Ringer acetate solution together with 20 mg of furosemide during the 30–40 min treatment session (Group D). These patients also had a bladder catheter. Patients in Group 0 had a normal diuresis and no bladder catheter. The mean (SD) number of treatment sessions for the 65 patients in Group D were 1.26 (0.51) and for the 60 patients from Group 0 1.35 (0.84) [p > 0.10]. 51 (78%) and 46 (77%) patients in Group D and Group 0, respectively, required only one SWL session. Stones were located in the proximal, mid and distal ureter in 22, 9, and 29 of the patients in Group D and in 22, 5, and 38 in Group 0. No difference in treatment outcome was observed with regard to stone localisation. The stone treatment index (STIGR) calculated for Group D and Group 0 were 4.77 and 4.70, respectively. In conclusion there was no obvious advantage of using a forced diuresis during the primary SWL-session for treating patients with ureteral stones. Although a high diuresis and bladder catheter might be beneficial in certain complicated cases, in most situations it seems appropriate to omit this step.

Background: Measuring GFR using exogenous markers without a bladder catheter, errors can be easily made due to incomplete urine collection. The aim was to quantify agreement for 125 I-iothalamate GFR measurements with and without a correction for inaccurate urine collection using 131 I-hippuran. Methods: The last available GFR measurement of adult patients was included. GFR was measured in two subsequent clearance periods with 125 I-iothalamate by the standard method with correction for inaccurate urine collections using 131 I-hippuran. The uncorrected and corrected GFR measurements were compared within and between the time periods for each individual patient. To study the agreement between both methods, intra-class correlation coefficients (ICC) were calculated and Bland-Altman plots, with accompanying accuracies and precisions, were used. Cohen's K was calculated to analyze the agreement of both methods for classifying patients according to the stages of chronic kidney disease (CKD). Results: For the 332 stable included patients, the mean GFR of the uncorrected measurements was 77.8 ml/min (34.7) and the mean GFR of the corrected measurements was 81.0 ml/min (34.9). The ICC was 0.80 for the uncorrected measurements with an accuracy of 7.3 ml/min and a precision of 21.7 ml/min. For the corrected GFR measurements the ICC was 0.98, with an accuracy of 2.1 ml/min and a precision of 6.5 ml/min. Comparison between the methods showed an ICC of 0.95, an accuracy of 3.2 and a precision of 11.0. In total, 86% of the patients were classified similarly into CKD stages with both methods, overall Co-hen's K was 0.81. Conclusion: Agreement was better for GFR measurements corrected for inaccurate urine collections. Therefore, GFR measurements with 125 I-iothalamate should be corrected for inaccurate urine collections using 131 I-hippuran. Without such correction the GFR is easily underestimated which may lead to overtreatment.

PURPOSE: The effect of transcranial duplex ultrasound (US) on the intraventricular temperature in patients was analyzed. Temperature increases during examination have been identified as a potential risk factor but only data from model studies is currently available. MATERIALS AND METHODS: Patients who had an intracranial pressure/temperature transducer implanted and underwent US assessment were included. In an examination series (B-mode, combined B- and color mode, combined B- and color mode plus Doppler, 3 min for each mode), the intracranial thermodilution thermistor was focused while intraventricular temperature and body temperature (bladder catheter or rectal probe) were recorded continuously and temperature changes were analyzed. RESULTS: Thirty-one US examinations were performed in 14 patients. Twenty-six examinations in 9 patients in which the intracranial temperature probe was depicted were included. Initial patient temperatures ranged from 35.1dgC to 38.7dgC. No significant increase or decrease in intracranial temperature was seen after the first (B-mode), second (B- and color mode) and third (B- and color mode plus Doppler) duplex US examination. T-test for paired samples showed a constant temperature throughout US examination (two-sided significance: 1.000, 1.000, 0.731). CONCLUSION: Routine transcranial duplex ultrasound does not increase the intracranial temperature in patients.

Background: Raised intra-abdominal pressure (IAP) or intra-abdominal hypertension (IAH) may induce many adverse effects including the abdominal compartment syndrome. We evaluated a new technique for continuous monitoring of intra-abdominal pressure (CIAP) using a standard three-way bladder catheter in a diverse group of intensive care unit patients. Methods: CIAP measured using a standard three-way bladder catheter was compared with five standard intermittent IAP (IIAP) measurements in 79 patients. Results: Mean (standard deviation) CIAP was identical (15.4 mm Hg [5.8]) for CIAP and IIAP one minute after saline injection. Mean differences between methods were less than 1 mm Hg, and similar whether IIAP was measured at 1 minute, 2 minutes, 3 minutes, 4 minutes, or 5 minutes. Bland-Altman analysis comparing CIAP and IIAP (1 minute) revealed a mean difference (95% confidence interval) of -0.06 mm Hg (-0.51, 0.39). Limits of agreement were -4.12 mm Hg to 4.00 mm Hg. Considering gradations of IAH defined by the World Society of the Abdominal Compartment Syndrome, CIAP was sensitive for detecting slightly elevated IAP (>11 mm Hg) but is less sensitive for distinguishing between higher grades of IAH (e.g., pressures >20 mm Hg or 25 mm Hg). Limits of agreement were best for patients with IAP less than 20 mm Hg, surgical or traumatic diagnoses and for patients with BMI less than 26. Conclusions: Overall, CIAP is an accurate and simple means of measuring IAP when compared with the current standardized method. Elevated CIAP measurements should be confirmed with IIAP measurements if accurate grading is required until further validation and experience is obtained.

In 14 healthy children contrast sonography of the bladder was performed with various solutions prior to voiding cystourethrography. The solutions were introduced into the bladder via a bladder catheter. The contrast effects which occurred with iothalamate injections in the urine-filled bladder, with urine injections in the iothalamate-filled bladder, with injections of 0.9% saline solution, and with air injections into the iothalamate-filled bladder were sonographically demonstrated. In echogenicity and duration the intravesical air contrast was superior to all mixture contrasts in the bladder resulting from injections of the respective fluids.

Summary Introduction: Intra-abdominal pressure (IAP) is increasingly being considered as an important physiologic parameter to be measured in critically ill patients. Traditional methods of monitoring IAP rely on intermittent IAP (IIAP) measurements using indwelling bladder catheters. Recently, a method of continuous IAP (CIAP) monitoring has been developed using a three-way bladder catheter. This study evaluates the reliability of IIAP and CIAP measurement techniques using an in vitro model. Methods: An in vitro model of the abdomen was constructed using a 50 l container with a 100 ml infusion bag at the base to simulate a bladder. A three-way catheter tip was centered within the infusion bag filled with 50 ml saline. To simulate IAP the container was filled with water at 5 cm H2O increments from 10 to 25 cm H2O. Pressures were recorded by observers from a bedside monitor interfaced with a three-way Foley catheter using alternating intermittent and continuous techniques. Each subject was blinded to the known pressure values. Descriptive statistics and a generalised estimating equation (GEE) was used to describe the relationship of IIAP and CIAP to known pressures. Results: One hundred and thirty-two (132) observations were made by 20 subjects for both IIAP and CIAP estimates. In 45.5% of IIAP measures, the estimate was correct, and it was never more than 1 cm H2O different from the actual. Similarly, in 38.6% of CIAP measures, the estimate was correct, and was never more than 2 cm H2O from the actual. The GEE regression coefficients comparing known pressures with IIAP and CIAP were 1.007 and 0.976 respectively. The minimum and maximum pressure deviations never exceeded more than 1.3 cm H2O from the actual. Conclusion: Intermittent IAP and CIAP are both reliable and reproducible methods to measure IAP in an in vitro model. There exists a direct and significant association between both measurements and the actual value. Neither measure was shown to be superior.

bladder catheter through the dome. In the CMG measurements in a decerebrated condition, mice underwent cystostomy formation and supracollicular decerebration under isoflurane-anesthesia. After recovery from the anesthesia (waiting for at least 2 hours), CMG was carried out with saline-instillation at 10 ml/min. RESULTS: In the FV measurements, in females, mean voided volume and mean flow rate in TRPM2-KO mice were significantly greater than those in WT mice. In males, similar tendencies were observed, but there were no significant differences (n 1⁄4 10, in each group). In the conscious CMG measurements, in females, threshold pressure, micturition pressure, intercontraction interval and mean voided volume in TRPM2-KO mice were significantly greater than those in WT mice. In contrast, in male mice, only threshold pressure in TRPM2-KO mice was significantly higher than that in WT mice (Figure 1A, n 1⁄4 8 in each group). In the CMG measurements in the decerebrated condition, only threshold pressure in TRPM2-KO mice was significantly higher than that in WT mice in both sexes (Figure 1B, male TRPM2-KO n 1⁄4 7, other groups n 1⁄4 8). CONCLUSIONS: The present study suggests that TRPM2 channels may have a role in modulating bladder mechano-sensation in mice, and also that this contribution might be more remarkable in females.

A new technology for intravascular temperature modulation increasingly is being used for severely ill neurosurgical patients in tertiary care centers in the United States. The goal of this intervention is to minimize secondary brain injury. Because a 1 degrees C temperature reduction reduces cerebral metabolic demand by 10%, an efficient means of both lowering and maintaining optimal body temperature is crucial. The CoolGard intravascular catheter can lower body temperature at the rate of 3-4 degrees C per hour and maintain a steady state via feedback from a bladder catheter thermistor.

Non-deflated balloon of a transurethral inserted bladder catheter is a problem that could be difficult to manage, especially in males. A variety of methods have been described to puncture the balloon and remove the catheter, though these can be associated with complications. We illustrate a simple and a safe method to overcome this problem using a flexible cystoscope under local anaesthesia.

Meningomyelocele (spina bifida) is a failure of prenatal closure failure of the neural tube. In most cases, it appears in combination with a hydrocephalus, disorders of the bladder and rectum and a paresis of the lower extremities in different stages. Sufficient folic acid levels in the very early gravidity stage are highly important to reduce the prevalence of this syndrome. With interdisciplinary treatment concepts, significant improvements in the quality of life can be reached, but a lifelong care in special ambulances is required.

UNLABELLED We describe a dynamic, bladder catheter-related obstructive bilateral hydroureteronephrosis in a newborn documented during ultrasound. The normal findings at foetal ultrasound and the absence of muscular hypertrophy of the bladder hereby served as indicators of the iatrogenic nature of the initial abnormal ultrasound findings. CONCLUSION A Foley bladder catheter can induce obstructive bilateral hydroureteronephrosis in newborns.

Aim To repair a urethrovaginal defect in childhood is a challenge for a pediatric surgeon. Martius fat-pad flap repair is being used in women successfully. Here, we report 2 girls who had Martius repair for their urethrovaginal defects. Method Topical estriol and asiaticoside perineally were administered for preoperative 3 weeks to reinforce the tissues. Martius repair was done using 1-sided labial fat-pad flap. Urethral and bladder catheters were inserted. Urethral catheter was removed on postoperative day 14 and bladder catheter on day 21 after controlling residual urine. Patients Patient 1, a 6-year-old girl, had lipomeningocele repair at the age of 18 months and had an iatrogenic urethrovaginal fistula that is caused by catheter insertion. She developed urinary incontinence, and 3 primary repair attempts were unsuccessful. Patient 2 is a 5-year-old girl who had pouch colon with persistent cloacal malformation and had posterior anorectovaginourethroplasty. The urethrovaginal septum did not heal, and she was incontinent. One attempt of primary repair was unsuccessful. The urethrovaginal wall was completely open at the time of Martius repair in both patients. Results Urethral wall was completely healed after Martius repair in both patients. Conclusion Martius fat-pad flap repair can be used to repair urethrovaginal fistulas in girls. It has both functionally and cosmetically good results, and neourethra is easily catheterizable.

The posterior wall of the bladder is easily approached by laparoscopy and allows for a nerve-sparing extravesical unilateral or bilateral reimplantation according to the Lich-Gregoir technique. It is performed with a 5 mm telescope and two 3 mm instruments. The exposure of the posterior wall is helped by transparietal bladder suspension. The postoperative period is comfortable without hematuria and bladder spasms. No bladder catheter is necessary, and it is possible to discharge the child quickly from the hospital. The success rate is about 95 % with no documented voiding dysfunction postoperatively. Furthermore, the ureteral meatus is always in its initial position, allowing easier endourology in the future if necessary.

The prevalence of erectile dysfunction (ED) in 114 patients with prostate cancer treated with radical prostatectomy was examined to determine the efficacy of an ED care program in which nurse-provided education plays a fundamental role in the detection and follow-up of ED as well as in treatment compliance. The nursing program consists of four visits during which specific treatment-related information, education and support, active listening, and selection of the treatment best suited to each patient (in consultation with the healthcare team) are provided. One month following bladder catheter removal, 77 of the 114 patients (69%) in the study had ED, with a majority suffering from severe ED. A nursing care program could help minimize ED and enable patients to adapt to their new situation.

Objectives Intra-abdominal pressure (IAP) is most commonly measured via the bladder with the patient in the supine position. In the ICU, patients are nursed with the head of the bed elevated at 30° (HOB30) to reduce the risk of ventilator-associated pneumonia. This study investigated whether gastric pressure at HOB30 can be used as a surrogate measure of IAP via the bladder in the supine position. Methods A prospective observational study was conducted in a single-centre intensive care unit. A total of 20 patients were included. IAP was recorded simultaneously via the bladder catheter (bladder pressure, IBP) and via nasogastric tube (gastric pressures, IGP) in the supine and HOB30 position. Each patient had three sets of IAP measurements performed at least 4 h apart. Results In the supine position, mean IBP was 12.3 ± 4.5 mmHg compared to IGP of 11.8 ± 4.7 mmHg. The bias between the two groups was 0.5 and precision of 3.7 (LA, -6.8 to 7.5 mmHg). At 30 degrees, mean IBP was 15.8 ± 4.9 mmHg compared to IGP of 13.1 ± 6.1 mmHg. The bias between both groups was 2.7 with a precision of 5.5 (LA, -8.0 to 13.5). Comparing IBP in the supine position with IGP at 30° showed a bias of -0.8 and precision of 5.6 (LA, -10.1 to 11.6 mmHg). Conclusion IAP measured via a nasogastric tube was less influenced by changing the body position from supine to HOB30 than was bladder pressure.

Today you are scheduled to anesthetize a 28-year-old female for removal of the right fallopian tube ectopic pregnancy. She is otherwise healthy and you give her an ASA 1 classification. She weighs 72 kg and is 5 ft 10 in. tall. A routine general anesthesia is induced and maintenance is with 1–2% sevoflurane and 70% nitrous oxide in oxygen. The surgeon places a transurethral bladder catheter and attaches it to a soft plastic collection bag. Pneumoperitoneum is created with insufflation of 100% carbon dioxide to a pressure of 16 mmHg. Fifteen minutes into the case you notice that the urinary collection bag has become very distended.

Digital tourniquets are frequently used during operations in the hand and foot. The commonest tourniquets used are the Penrose drain, the Jacques bladder catheter and a rolled up finger from a surgical glove. Generally, these are relatively safe and efficacious. However, complications related to them have been reported. Application and alteration of a Penrose type drain can be difficult during a procedure. A glove tourniquet once applied cannot be altered. We present here a unique way of using a Jacques catheter as a flexible digital tourniquet. We have found it very effective, user-friendly and extremely easy to apply and alter before and during surgery.