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Background Various washout policies are widely used in adults living with long-term catheters (LTC). There is currently insufficient evidence on the benefits and potential harms of prophylactic LTC washout policies in the prevention of blockages and other LTC-related adverse events, such as urinary tract infections. CATHETER II tests the hypothesis that weekly prophylactic LTC washouts (normal saline or citric acid) in addition to standard LTC care reduce the incidence of catheter blockage requiring intervention compared to standard LTC care only in adults living with LTC. Methods CATHETER II is a pragmatic three-arm open multi-centre superiority randomised controlled trial with an internal pilot, economic analysis, and embedded qualitative study. Eligible participants are adults aged ≥ 18 years, who have had a LTC in use for ≥ 28 days, have no plans to discontinue the use of the catheter, are able to undertake the catheter washouts, and complete trial documentation or have a carer able to help them. Participants are identified from general practitioner practices, secondary/tertiary care, community healthcare, care homes, and via public advertising strategies. Participants are randomised 1:1:1 to receive a weekly saline (0.9%) washout in addition to standard LTC care, a weekly citric acid (3.23%) washout in addition to standard LTC care or standard LTC care only. Participants and/or carers will receive training to administer the washouts. Patient-reported outcomes are collected at baseline and for 24 months post-randomisation. The primary clinical outcome is catheter blockage requiring intervention up to 24 months post-randomisation expressed per 1000 catheter days. Secondary outcomes include symptomatic catheter-associated urinary tract infection requiring antibiotics, catheter change, adverse events, NHS/ healthcare use, and impact on quality of life. Discussion This study will guide treatment decision-making and clinical practice guidelines regarding the effectiveness of various prophylactic catheter washout policies in men and women living with LTC. This research has received ethical approval from Wales Research Ethics Committee 6 (19/WA/0015). Trial registration ISRCTN ISRCTN17116445. Registered prospectively on 06 November 2019

Catheter-related bladder discomfort is frequent in the post-perative setting, due to an indwelling urinary catheter. It clearly causes discomfort for the patient with the potential consequences of prolonging the post-operative course. Effective treatment to prevent the condition is missing, and lots of different strategies have been investigated. In this review, we aim to address the current options for treatment with the purpose to encourage focus on the topic and suggest strategies to prevent the condition in order to facilitate a better patient course.

Urethral catheters are the most commonly deployed medical devices and used to manage a wide range of conditions in both hospital and community care settings. The use of long-term catheterization, where the catheter remains in place for a period >28 days remains common, and the care of these patients is often undermined by the acquisition of infections and formation of biofilms on catheter surfaces. Particular problems arise from colonization with urease-producing species such as Proteus mirabilis, which form unusual crystalline biofilms that encrust catheter surfaces and block urine flow. Encrustation and blockage often lead to a range of serious clinical complications and emergency hospital referrals in long-term catheterized patients. Here we review current understanding of bacterial biofilm formation on urethral catheters, with a focus on crystalline biofilm formation by P. mirabilis, as well as approaches that may be used to control biofilm formation on these devices. Significance and Impact of the Study: Urinary catheters are the most commonly used medical devices in many healthcare systems, but their use predisposes to infection and provide ideal conditions for bacterial biofilm formation. Patients managed by long-term urethral catheterization are particularly vulnerable to biofilm-related infections, with crystalline biofilm formation by urease producing species frequently leading to catheter blockage and other serious clinical complications. This review considers current knowledge regarding biofilm formation on urethral catheters, and possible strategies for their control.

PURPOSE: We define the risk of bladder cancer in multiple sclerosis related to the use of indwelling catheters and cyclophosphamide administered as an immunomodulating agent. MATERIALS AND METHODS: We retrospectively reviewed the records of 2,351 patients with multiple sclerosis referred to the National Center for Multiple Sclerosis. RESULTS: Of the 2,351 patients 2 women and 5 men (0.29%) had bladder cancer. Of the 850 chronically catheterized patients the incidence was 0.7%. One patient with cancer performed intermittent catheterization for a rate of 0.23% in this group. In a subgroup of 70 patients treated with cyclophosphamide 5 chronically catheterized patients (5.7%) had bladder cancer. Hematuria was the most common presenting symptom. These data were compared with those in the literature on bladder cancer in spinal cord injury. CONCLUSIONS: These data suggest a possible synergistic role of cyclophosphamide and chronic catheterization in the induction of secondary bladder cancer. Regular cystoscopy is warranted in these patients to allow early detection of bladder tumors. Nitric oxide metabolism may be an important factor in the carcinogenesis of this type of bladder cancer.

尿道内留置ステントをpoor riskの前立腺肥大症7例, 低緊張性膀胱2例, 過活動膀胱1例に使用した。経過は前立腺肥大症のうち2例が手術に移行し4例は継続中であり, 1例は全身状態の悪化に伴い尿道カテーテルに変更した。神経因性膀胱の3例は自己導尿, 膀胱瘻あるいは薬物療法に移行した。ステント留置による副作用としては, 留置時の尿道出血が4例, ステント内の結石形成2例を認めた, We reviewed our experience of using double Malecot polyurethane intraurethral catheters (IUC). Ten patients with dysuria were treated between April 1991 and April 1993. Seven patients with benign prostatic hypertrophy (BPH) were judged as in a high risk group for operation. The three other patients had neurogenic bladder (two had underactive bladder and 1 had overactive bladder). Under local anesthesia, 150 ml of 0.1% Povidone iodine solution was infused into the bladder through a Nelaton catheter. Under guidance by ultrasonography, an IUC was placed into the bladder neck and posterior urethra using the specially designed introduction set. An long-term follow up of the BPH patients, two IUCs were removed for operation and one was exchanged for an indwelling catheter because of deterioration in general condition. In the neurogenic bladder patients, all IUC were removed because of the increase of residual urine, formation of a pseudourethra, or dislocation into the bladder. Side effects were observed in 6 patients such as, urethral bleeding and stone formation in the stent. Erosion and bleeding tendency in the urethral mucosa were shown in the prolonged duration cases. We conclude that a urethral stent is an effective devise for a high risk patient with benign prostatic hypertrophy but we must keep each patient under strict observation for complications during IUC placement.

Background. Urinary tract infection is the most frequent health care—associated complication. We hypothesized that the implementation of a multifaceted prevention strategy could decrease its incidence after surgery. Methods. In a controlled, prospective, before-after intervention trial with 1328 adult patients scheduled for orthopedic or abdominal surgery, nosocomial infection surveillance was conducted until hospital discharge. A multifaceted intervention including specifically tailored, locally developed guidelines for the prevention of urinary tract infection was implemented for orthopedic surgery patients, and abdominal surgery patients served as control subjects. Infectious and noninfectious complications, adherence to guidelines, and antibiotic use were monitored before and after the intervention and again 2 years later. Results. The incidence of urinary tract infection decreased from 10.4 to 3.9 episodes per 100 patients in the intervention group (incidence-density ratio, 0.41; 95% CI, 0.20-0.79; P = .004). Adherence to guidelines was 82.2%. Both the frequency and the duration of urinary catheterization decreased following the intervention. Recourse to antibiotic therapy after surgery dropped in the intervention group from 17.9 to 15.6 defined daily doses per 100 patient-days (P < .005) because of a reduced need for the treatment of urinary tract infection (P < .001). Follow-up after 2 years revealed a sustained impact of the strategy and a subsequent low use of antibiotics, consistent with stable adherence to guidelines (80.8%). Conclusions. A multifaceted prevention strategy can dramatically decrease postoperative urinary tract infection and contribute to the reduction of the overall use of antibiotics after surgery

1)1975年から7年間に泌尿器科入院患者1, 773名中327名の尿よりSerratiaを分離した.2)過去7年間の入院と外来患者の尿より分離した細菌の年度別頻度は常にSerratiaが第1位を占めた.3) Serratiaを分離した例はすべてなんらかの基礎疾患を有し, 高齢者が多く, 大部分手術後に分離し, 感染防禦機能の低下した状態で出現した.4) Serratia発生に留置カテーテルが関与したと思われる例は327例中276例で, nosocomial infectionを示唆した.5)感受性はCPが86.1%ともっとも高く, ついでAMK 70.0%, ST 36.4%, FOM 31.3%であった.GM, DKB, KMは感受性が低かった, Recently, in many institutions, Serratia marcescens has been isolated more frequently. Therefore, we made a statistical analysis of S. marcescens infections. S. marcescens was isolated from the urine of 327 of the 1, 773 patients admitted to our Department between 1975 and 1981. S. marcescens was the most frequently isolated organism in the urine of both inpatients and outpatients all of the 7 years. S. marcescens was often isolated in patients with some underlying disease, elderly patients or postoperative patients, in which case the individual defense mechanism protecting the patient from infections is often low. Because 276 of the patients who had S. marcescens infection had urethral indwelling catheters, S. marcescens infection may be nosocomial. The most effective antibiotic against S. marcescens was chloramphenicol followed by amikacin, sulfamethoxazole-trimethoprim, and fosfomycin. The effectiveness of gentamycin, dibekacin and kanamycin was not as high as expected.

最近2年間の真菌性尿路感染症20例を集計し, 頻度, 菌種, 基礎疾患および誘因, 細菌感染との関係, 治療および結果につき調べた.1)頻度は入院患者総数の約5%で, 年齢のかたよりはなく, 男女比は12:8であった.2)感染部位は膀胱炎13例, 腎盂腎炎5例, 回腸導管2例であった.3)菌種はCandida albicansがもっとも多く, ついでTorulopsis glabrata, Gandida tropicalisであった.4)基礎疾患および誘因では抗生剤使用, 留置カテーテル, 尿路通過障害, 糖尿病, ステロイド投与などであった.5)真菌と細菌との共存は一部の例でみられたが, Pseudomonas, Proteusなどの尿素分解細菌との共存はみられなかった.6)治療は重ソウ投与, 5-fluorocytosine, amphotericin Bの尿路洗浄などで, 治療成績はおおむね良好であった, We analyzed 20 cases of urinary fungal infection experienced at our Department, during the last 2 years. Candida albicans was the most prevalent of the fungi affecting the urinary tract. Torulopsis glabrata and Candida tropicalis were also prevalent. Antibiotics, indwelling catheter and obstructive uropathy were the most prevalent predisposing factors of the fungal infection. Of 20 cases of fungal infection, 5 cases were cured only by elimination of the predisposing factors, and 15 cases were treated and resolved by administration of sodium bicarbonate, 5-fluorocytosine and or irrigation with amphotericin B. But one case of bilateral renal torulopsiosis developed into renal failure, and 4 cases died of the primary disease.

During the period of 8 years since 1955, 12, 043 ureteral c atheterizations were performed for the purpose of retrograde pyelography in the department of urology at Kyoto University Hospital. Among them, unexpected accidents, 8 cases of ureteral rupture with extravasation of contrast media, 1 case of foreign body due to breakage of catheter and 5 cases of intraureteral looping of catheter, occurred. The lesions of the uretera l rupture were in 'the lower portion of the ureter in all of 8 cases. The damaged portions were under the situations of presence of ureteral stone, hydroureter, wound after ureterolithotomy, ureteritis following passage of stone and ureteral tuberculosis in each one case and possibly normal ureter in 3 cases. Although the patients developed pain at pouring contrast media in 7 out of 8 cases, no serious residual damage was recognized in all cases. In the case of re m aining of breakage of cathater, the piece was operatively removed along with ureterolithotomy of the opposite side. All of cases resulted in intraureteral c atheter looping were possessed with either one of congenital, urolithiasic, tuberculous or neoplastic hydroureter. In one of them the loop turned in tangle formation. Discussions w e re made on the cause of accidents, and its prevention was stated.

尿管狭窄に対するステントカテーテルの留置は腎機能の保全に有効である.とくに, 悪性腫瘍にともなう尿路閉塞症例では外科的尿路変更術の代用法として十分にその機能を示す, ステントカテーテル留置中に問題がないわけではない.合併症, 副作用の中で3例のステントカテーテル閉塞は感染および出血によるものであった, Palliative ureteral stent placement is effective in relieving obstructive renal impairment, especially that precedent to malignant spreading, and can take the place of surgical intervention. Furthermore, cutaneous antegrade and/or endoscopic retrograde stenting can be indicated for other pyelo-ureteric operations and prevent their complications, but is has its consequences: We experienced three cases in which stenting had to be repeated because of its obstruction. The stent catheter blockage is discussed.

Padrin, 1 , 1-diethyl-3-(diphenylmethylene)-2-methylpy r rolidiniubmro mide, i s a newly developed parasympathetic blocking agent and is said to have an atropine like spasmolytic activity with little side-effect. The ag e n t was administeredt hrough intravenous route in a dose of 7.5mgt o 16 patients with pain due to ureterolithiasis and following retrograde ureteral catheterisation. A marked response was obtained in 5 patients with complete e liminationo f pain and a fair response in 7. This result is considered to be equal to or rather better than that obtained by previous authors using h yoscine-N-butylbromide. No significants ide- r e actionw as noticed.

Urol Int

INTRODUCTION: Routine use of perioperative indwelling urinary catheterisation in fast-track total hip arthroplasty (THA) and total knee arthroplasty (TKA) is still debatable, as urinary catheterisation may cause complications. The aim of this study was to describe the incidence of re-catheterisa-tion and urologic complications during the initial 30 days following THA and TKA fast-track surgery.METHODS: We conducted a prospective, observational study of 795 patients ≥ 50 years of age who had undergone elective fast-track THA or TKA with perioperative indwelling urinary catheterisation until the first post-operative morning. Primary outcomes were number of patients keeping their catheter the first post-operative morning and the incidence of re-catheterisations before discharge. Follow-up on post-discharge complications was done by phone 30 days after surgery.RESULTS: A total of 784 of 795 included patients (98.6%) were analysed for the primary outcomes, and follow-up data were available for 760 patients (95.6%). Three patients (0.4%) kept their catheter after the first post-operative morning and 25 patients (3.2%) were re-catheterised before discharge. The median length of stay was two days (interquartile range: 1-2). The incidence of post-operative urinary tract infections (UTI) was 4.2%, and about 30% of the patients experienced pre-to-post-operative aggravation of their lower urinary tract symptoms.CONCLUSIONS: Routine use of perioperative indwelling urinary catheterisation in fast-track THA and TKA may increase the risk of post-operative UTI and does not eliminate the need for subsequent re-catheterisation. These findings speak against routine use of perioperative indwelling catheterisation.FUNDING: The study was supported by the Lundbeck Foundation and registered with clinicaltrials.gov.TRIAL REGISTRATION: clinicaltrials.gov 8 April 2014 (NCT02133768).