Safe duration of silicon catheter replacement in urological patients

Objectives: This study compared the infection rates, degree of encrustation, symptoms, and complications in patients regarding the duration of urethral catheterisation (three weeks, six weeks, and eight weeks). Design: A cross-sectional study with stratified simple random sampling Setting: Urology Unit, Korle Bu Teaching Hospital Participants: One hundred and thirty-seven male patients with long-term urinary catheters Interventions: Participants were grouped into 3 weeks, 6 weeks, and 8 weeks duration of catheter replacementsPrimary outcomes measures: Symptoms due to the urinary catheters, urinalysis, urine and catheter tip cultures, sensitivity, and catheter encrustations were assessed. Results: Eighty-six patients had a primary diagnosis of benign prostatic hyperplasia (BPH), 35 had urethral strictures,13 had prostate cancer, two had BPH and urethral strictures, and one participant had bladder cancer. There was no difference in the symptoms the participants in the different groups experienced due to the urinary catheters (p > 0.05). The frequency of occurrence of complications (pyuria, p = 0.784; blocked catheter, p=0.097; urethral bleeding, p=0.148; epididymo-orchitis, p=0.769 and bladder spasms, p=1.000) showed no differences in the three groups. There was no statistical difference in the urinalysis for the three groups (p>0.05) and the degree of encrustations (3 weeks: 0.03 ± 0.06, 6 weeks: 0.11±0.27 and eight weeks: 0.12 ±0.27) with p=0.065. Conclusions: In this study, the duration of urinary catheterisation using silicone Foley's catheters did not influence the complication and symptom rates; hence silicon catheters can be placed in situ for up to 8 weeks before replacement instead of the traditional three-weekly change.

Ventriculostomy Infections at the Paediatric Neurosurgical Unit at Dr George Mukhari Academic Hospital

Background. External ventricular drains (EVDs) are essential to the clinical management and care of patients with neurosurgical complications; but EVD use is routinely associated with concomitant infection; sometimes resulting in mortality. Objective. To undertake an epidemiological study of ventriculostomy-related infections among paediatric neurosurgical patients at the Dr George Mukhari Academic Hospital; Pretoria; South Africa. Methods. Retrospective analysis was conducted on the clinical records of 92 children admitted to the neurosurgical unit at the hospital between 2010 and 2013. Records were included in the study only if they were complete; legible and accurate. Data were collected on the following variables: age; gender; frequency of catheter change; cerebrospinal fluid (CSF) sampling; use of prophylaxis; microbiology; Glasgow Coma Scale; glucose; chlorine; and other clinical; chemical and laboratory parameters routinely observed as part of patients' work-ups. Results. Two or more EVDs were placed on 45.7 (40) children; with a maximum of seven EVDs per child. Ventriculitis incidence was 28.3 (26 of 92). There was a significant association between the number of EVDs inserted and the incidence of ventriculitis (p=0.010). More frequent CSF sampling also increased ventricular-related infections (p=0.000); as did prolonged EVD retention (p=0.001). Using prophylactic antibiotics or impregnated catheters did not reduce ventriculitis incidence significantly. Conclusion. Evidence supports adherence to strict sterilisation protocols and techniques when inserting EVDs. Catheters should not be retained for extended periods; and CSF sampling can be limited to once in 3 days. Routine use of antibiotic-impregnated EVDs and antistaphylococcal prophylaxis is still recommended

Self-reported quality of life measures of patients with benign prostatic hyperplasia on indwelling urethral catheters

Objective To evaluate the self-reported quality of life (QoL) measures of patients with benign prostatic hyperplasia (BPH) who are managed temporarily with indwelling urethral catheters. Patients and Methods Between February and April 2005; 40 consecutive patients with BPH (mean age: 69.5 years) on temporary indwelling catheters were asked to complete an eleven-item questionnaire in order to measure their self-reported physical and mental health status. Result Eighty percent of the study population (n=32) did not feel more irritable than usual; 75(n=30) had no feeling of worthlessness; 72.5(n=29) had urethral pain which had little or no interference with their daily activities; 62.5(n=25) still derived leisure from the things they used to enjoy; 60(n=24) were much less interested in sex or had lost interest in sex completely; while 80(n=32) felt that their quality of life was not impaired as a result of long-term catheterization. Conclusion Generally; one would expect that people who are subjected to long-term indwelling catheterization would report a poor QoL However; the majority of our patients did not have the feeling that their QoL was significantly hampered by their obvious disease burden which was probably due to the fact that urinary catheter drainage relieved their lower urinary tract symptoms