Effectiveness of the Maguerez Arch in nursing teaching on vesical catheterism: an almost experimental study / Eficacia del Arco de Maguerez en la enseñanza de enfermería en cateterismo vesical: un estudio casi-experimental / Efetividade do Arco de Maguerez no ensino de enfermagem sobre cateterismo vesical: estudo quase-experimental

ABSTRACT Objective To evaluate the effectiveness of the Arco de Maguerez in teaching nursing students about the Bladder Catheter. Method Quasi-experimental study conducted at a public university in northeastern Brazil, with 29 students, in a single group, in the period of october 2018. Data were collected before and after using the Arco de Maguerez in educational intervention, using validated instruments, referring to knowledge and practice. IBM SPSS Statistics software version 24 was used for statistical analysis. The level of significance was set at 5% and the 95% confidence interval. Data analysis was performed using the McNemar and Mann-Whitney test. Results The median of correct answers for knowledge was 7, in the pre-test, and 9 in the post-test (p> 0.001). Regarding practice, in the pre-test the median of correct answers was 28 and, in the post-test, it went to 36, p> 0.001. The academics explained that the AM technology based on the problematization of a fictitious clinical case made learning about Bladder Catheterization Delay clear and feasible. Conclusion The Arco de Maguerez was effective in improving the knowledge and skill of nursing students regarding the Bladder Catheter.

RESUMEN Objetivo Evaluar la efectividad del Arco de Maguerez para enseñar a los estudiantes de enfermería sobre el cateter vesical. Método Estudio cuasiexperimental realizado en una universidad pública del noreste de Brasil, con 29 estudiantes, en un solo grupo, en el período de octubre de 2018. Los datos se recopilaron antes y después de usar el Arco de Maguerez en la intervención educativa, utilizando instrumentos validados, en referencia al conocimiento y la práctica. Para el análisis estadístico se utilizó el software IBM SPSS Statistics versión 24. El nivel de significancia se estableció en el 5% y el intervalo de confianza del 95%. El análisis de los datos se realizó mediante la prueba de McNemar y Mann-Whitney. Resultados La mediana de las respuestas correctas para el conocimiento fue 7, en la prueba previa y 9 en la prueba posterior (p> 0.001). En cuanto a la práctica, en la prueba previa la mediana de las respuestas correctas fue 28 y, en la prueba posterior, fue a 36, p> 0.001. Los académicos explicaron que la tecnología AM basada en la problematización de un caso clínico ficticio hizo que el aprendizaje sobre el Retardo de Cateterización de la Vejiga fuera claro y factible. Conclusión El Arco de Maguerez fue eficaz para mejorar el conocimiento y la habilidad de los estudiantes de enfermería con respecto al cateter vesical.

RESUMO Objetivo Avaliar a efetividade do Arco de Maguerez no ensino de acadêmicos de enfermagem sobre o Cateter Vesical de Demora. Método Estudo quase-experimental realizado em universidade pública no nordeste brasileiro, com 29 discentes, em grupo único, no período de outubro de 2018. Os dados foram coletados antes e depois da utilização do Arco de Maguerez em intervenção educativa, a partir de instrumentos validados, referentes ao conhecimento e prática. Foi utilizado o software IBM SPSS Statistics versão 24 para análise estatística. O nível de significância adotado foi de 5% e o intervalo de confiança de 95%. A análise dos dados ocorreu a partir do teste de McNemar e Mann-Whitney. Resultados A mediana de acertos do conhecimento foi de 7, no pré-teste, e 9 no pós-teste (p>0,001). Em relação à prática, no pré-teste a mediana de acertos foi de 28 e, no pós-teste, passou para 36, p>0,001. Os acadêmicos expuseram que a tecnologia do AM baseada na problematização de caso clínico fictício tornou o aprendizado sobre Cateterismo Vesical de Demora claro e factível. Conclusão O Arco de Maguerez foi efetivo para melhorar o conhecimento e a habilidade dos acadêmicos de enfermagem, referentes ao Cateterismo Vesical de Demora.

Balloon dilation for failed pyeloplasty in children?

ABSTRACT Objective: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. Materials and Methods: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. Results: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. Conclusions: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.

Limpeza periuretral na realização do cateterismo urinário de demora: ensaio clínico randomizado / Periurethral cleansing in indwelling urinary catheterization: randomized controlled trial

O cateterismo urinário de demora é um procedimento amplamente utilizado em pacientes internados e está relacionado com altas taxas de bacteriúria assintomática e infecção do trato urinário. Para evitar essas doenças, a limpeza da região periuretral antes da inserção do cateter é uma importante conduta, com fins de reduzir a entrada de microrganismos dessa região através da uretra. Guias de prática clínica recomendam que o cateterismo urinário de demora deva ser realizado com técnica asséptica, porém não há consenso sobre qual solução é mais eficaz para sua realização, com vistas à redução das infecções do trato urinário e da bacteriúria assintomática. O objetivo é de avaliar o efeito da limpeza periuretral nas incidências de bacteriúria assintomática e de infecção do trato urinário com o uso de três soluções (água, sabão e gluconato de clorexidina aquosa 2%; gluconato de clorexidina degermante 2%, água bi-destilada e gluconato de clorexidina aquosa 2%; e povidona-iodo 10% degermante, água bi-destilda e povidona-iodo aquoso 1%) em pacientes adultos internados em hospital terciário submetidos ao cateterismo urinário de demora. Trata-se de uma pesquisa realizada em duas etapas: revisão sistemática da literatura e ensaio clínico randomizado sem mascaramento do pesquisador. Foi realizado em um hospital de grande porte de Belo Horizonte ­ Minas Gerais. A população foi constituída por pacientes internados e que foram elegíveis para serem submetidos ao cateterismo urinário de demora. A amostra foi de 28 pacientes, sendo alocados aleatoriamente nos grupos: sabão (n=11) e grupo antisséptico (n=17). Uroculturas foram coletadas no momento da inserção e 24h após. A incidência global de bacteriúria assintomática foi de 7,14%, no grupo sabão foi de 9,1% e no grupo antissépticos foi de 5,9%. Não houve nenhum caso de infecção do trato urinário. A regressão logística mostrou que não há diferenças estatisticamente significativas nas incidências de bacteriúria assintomática quando realizada a limpeza com sabão ou antisséptico (clorexidina ou povidona-iodo). A redução do risco relativo mostrou uma redução de 36% de adquirir bacteriúria assintomática.(AU)

Indwelling urinary catheterization is a procedure that is used in inpatients and is related to high rates of asymptomatic bacteriuria and urinary tract infection. To prevent these diseases, cleaning the periurethral region prior to catheter insertion is an important approach, reducing the entry of microorganisms from this region through the urethra. Clinical practice guidelines recommend that indwelling urinary catheterization should be performed with aseptic technique, but there is no consensus on which solution is most effective for reducing urinary tract infections. The objective is to evaluate the effect of periurethral cleansing on the incidence of asymptomatic bacteria and urinary tract infections with the use of three solutions (water, soap and 2% aqueous chlorhexidine gluconate; chlorhexidine gluconate 2%, distilled water and 2% aqueous chlorhexidine; and 10% povidone-iodine, distilled water and 1% aqueous povidone-iodine) in adult patients admitted to a tertiary hospital submitted to the indwelling urinary catheterization. This is a two-step research: systematic literature review and randomized clinical trial without researcher's masking. It was performed in a large hospital in Belo Horizonte - MG. The population was composed by inpatients who were eligible to undergo indwelling urinary catheterization. A sample of 28 patients was randomly allocated into groups: soap (n = 11) and antiseptic group (n = 17). Urine cultures were collected at insertion and 24h after. The overall incidence of asymptomatic bacteriuria was 7.14%, on soap group was 9.1% and on antiseptic group was 5.9%. There were no cases of urinary tract infection. Logistic regression showed no statistically significantly differences in the incidence of asymptomatic bacteriuria when cleaned with soap or antiseptic (chlorhexidine or povidone-iodine). A relative risk reduction showed a 36% reduction from acquiring asymptomatic bacteriuria.(AU)

Development and evaluation of a training model for paracentetic suprapubic cystostomy and catheterization

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.

Ureteroileal bypass: a new technic to treat ureteroenteric strictures in urinary diversion

ABSTRACT Objective: To present our technique of ureteroileal bypass to treat uretero-enteric stric- tures in urinary diversion. Materials and Methods: One hundred and forty-one medical records were reviewed from patients submitted to radical cystectomy to treat muscle-invasive bladder cancer between 2013 and 2015. Twelve (8.5%) patients developed uretero-enteric anastomotic stricture during follow-up. Five patients were treated with endoscopic dilatation and double J placement. Four were treated surgically with standard terminal-lateral im- plantation. Three patients with uretero-enteric anastomotic stricture were treated at our institution by "ureteroileal bypass", one of them was treated with robotic surgery. Results: All patients had the diagnosis of uretero-enteric anastomotic stricture via computerized tomography and DTPA renal scan. Time between cystectomy and diag- nosis of uretero-enteric anastomotic stricture varied from five months to three years. Mean operative time was 120±17.9 minutes (98 to 142 min) and hospital stay was 3.3±0.62 days (3 to 4 days). Mean follow-up was 24±39.5 months (6 to 72 months). During follow-up, all patients were asymptomatic and presented improvement in ure-terohydronephrosis. Serum creatinine of all patients had been stable. Conclusions: Latero-lateral ureter re-implantation is feasible by open or even robotic surgery with positive results, reasonable operation time, and without complications.

Can hydrophilic coated catheters be beneficial for the public healthcare system in Brazil? - A cost-effectiveness analysis in patients with spinal cord injuries

ABSTRACT Introduction Detrusor sphincter dyssynergia affects 70% to 80% of all spinal cord injury patients, resulting in increased risk of urinary tract infections (UTIs) and potential exposure to antimicrobial resistance. In Brazil, local guidelines recommend intermittent catheterization as the best method for bladder emptying, and two catheter types are available: the conventional uncoated PVC and the hydrophilic coated catheters. Objective To evaluate the cost-effectiveness of two types of catheters for intermittent catheterization from the perspective of the Brazilian public healthcare system. Materials and Methods A Markov model was used to evaluate cost-effectiveness in those with spinal cord injuries. A primary analysis was conducted on all possible adverse events, and a secondary analysis was performed with urinary tract infections as the only relevant parameter. The results were presented as cost per life years gained (LYG), per quality-adjusted life years (QALY) and per number of urinary tract infections (UTIs) avoided. Results The base scenario of all adverse events shows a cost-effective result of hydrophilic coated catheters compared to uncoated PVC catheters at 57,432 BRL (Brazilian Reais) per LYG and 122,330 BRL per QALY. The secondary scenario showed that the use of hydrophilic coated catheters reduces the total number of UTIs, indicating that an additional cost of hydrophilic coated catheters of 31,240 BRL over a lifetime will reduce lifetime UTIs by 6%. Conclusions Despite the higher unit value, the use of hydrophilic coated catheters is a cost-effective treatment from the perspective of the Brazilian public healthcare system.

Validation of self - confidence scale for clean urinary intermittent self - catheterization for patients and health - caregivers

ABSTRACT Objective To validate a measurement instrument for clean intermittent self-catheterization for patients and health-caregivers. Material and Methods Methodological study of instrument validation performed at a Rehabilitation Center in a University hospital for patients submitted to clean intermittent self-catheterization and their health-caregivers. Following ethical criteria, data were collected during interview with nurse staff using a Likert question form containing 16 items with 5 points each: “no confidence”=1, “little confidence”=2, “confident”=3, “very confident”=4 and “completely confident”=5. Questionnaire called “Self-Confident Scale for Clean Intermittent Self-catheterization” (SCSCISC) was constructed based on literature and previously validated (appearance and content). Results The instrument was validated by 122 patients and 119 health-caregivers, in a proportion of 15:1. It was observed a good linear association and sample adequacy KMO 0.931 and X2=2881.63, p<0.001. Anti-image matrix showed high values at diagonal suggesting inclusion of all factors. Screen plot analysis showed a suggestion of items maintenance in a single set. It was observed high correlation of all items with the total, alpha-Cronbach 0.944. The same results were obtained in subsamples of patients and health-caregivers. Conclusion The instrument showed good psychometric adequacy corroborating its use for evaluation of self-confidence during clean intermittent self-catheterization.

Intra-abdominal pressure: an integrative review / Pressão intra-abdominal: revisão integrativa

ABSTRACT There is a growing request for measuring intra-abdominal pressure in critically ill patients with acute abdominal pain to be clarified. Summarizing the research results on measurement of vesical intra-abdominal pressure and analyzing the level of evidence were the purposes of this integrative literature review, carried out based on the databases LILACS, MEDLINE and PubMed, from 2005 to July 2012. Twenty articles were identified, in that, 12 literature reviews, 4 descriptive and exploratory studies, 2 expert opinions, one prospective cohort study and one was an experience report. The vesical intra-abdominal pressure measurement was considered gold standard. There are variations in the technique however, but some common points were identified: complete supine position, in absence of abdominal contracture, in the end of expiration and expressed in mmHg. Most research results indicate keeping the transducer zeroed at the level of the mid-axillary line at the iliac crest level, and instill 25mL of sterile saline. Strong evidence must be developed.

RESUMO Em pacientes críticos com quadros abdominais agudos a esclarecer é crescente a solicitação da aferição da pressão intra-abdominal. Sintetizar resultados de pesquisas sobre a mensuração da pressão intra-abdominal pela via vesical e analisar o nível de evidência foram os objetivos desta revisão integrativa da literatura, realizada nas bases LILACS, MEDLINE e PubMed, no período de 2005 a julho de 2012. Identificaram-se 20 artigos, sendo 12 revisões de literatura, 4 estudos exploratório-descritivos, 2 opiniões de especialistas, 1 estudo de coorte prospectivo e 1 relato de experiência. O método vesical para mensuração da pressão intra-abdominal foi considerado padrão-ouro. Existem variações na técnica, entretanto pontos em comum foram identificados: posição supina completa, na ausência de contratura abdominal, ao final da expiração e expressa em mmHg. A maioria indica posicionar o ponto zero do transdutor na linha axilar média, ao nível da crista ilíaca e instilar 25ml de solução salina estéril. Evidências fortes precisam ser desenvolvidas.

Use and outcomes of amplatz renal dilator for treatment of urethral strictures

ABSTRACT Introduction Urethral stricture disease is still a major problem in men. Many procedures are available for the treatment of urethral strictures; urethral dilatation is one of the oldest. The blind dilatation of urethral strictures may be a difficult and potentially dangerous procedure. The purpose of this study was to describe safe urethral dilatation using amplatz renal dilator and to report outcomes. Materials and Methods From 2010 to 2014, a total of 26 men with primary urethral strictures were managed by urethral dilatation using amplatz renal dilators. The parameters analyzed included presentation of patients, retrograde urethrography (RGU) findings, pre-and postoperative maximum flow rate (Qmax) on uroflowmetry (UF) and post-void residual urine (PVR). Patients were followed-up at 1.6 and 12 months. The technique described in this paper enables such strictures to be safely dilated after endoscopic placement of a suitable guidewire and stylet over which amplatz renal dilators are introduced. Results The mean age of the patients was 57.6 (35–72) years. The median stricture length was 0.82 (0.6–1.5)cm. Pre-operative uroflowmetry showed Qmax of 7.00 (4–12) mL/sec and ultrasonography showed PVR of 75.00 (45–195)mL. Postoperatively, Qmax improved to 18.00 (15–22)mL/sec (p<0.001) at 1 month, 17.00 (13–21)mL/sec (p<0.001) at 6 months and 15.00 (12–17)mL/sec (p<0.001) at 12 months. The post-operative PVR values were 22.50 (10–60)mL (p<0.001), 30.00 (10–70)mL (p<0.001) and 30.00 (10–70) mL (p<0.001) at 1.6 12 months, respectively. The median procedure time was 15.00 (12–22) minutes. None of the patients had a recurrence during a 12-month period of follow-up. Conclusion Urethral dilatation with amplatz renal dilators avoids the risks associated with blind dilatation techniques. This tecnique is a safe, easy, well-tolerated and cost-effective alternative for treatment of urethral strictures.

Is Bladder Training by Clamping Before Removal Necessary for Short-Term Indwelling Urinary Catheter Inpatient? A Systematic Review and Meta-analysis

PURPOSE: Urinary catheterization is a common technique in clinical practice. There is, however, no consensus on management prior to removal of the indwelling catheter for short-term patients. This systematic review examined the necessity of clamping before removal of an indwelling urinary catheter in short-term patients. METHODS: A systematic literature review was conducted using eight databases and predetermined keywords-guided searches. Some 2,515 studies were evaluated. Ten studies that met the inclusion criteria were selected. RESULTS: The quality of the studies was assessed using the Jadad scoring system. Only 40.0% of studies were rated as high quality. This review found that catheter clamping prior to removal was not necessary for the short-term patient. When made a comparison with the unclamping group, there was no significant difference in recatheterization risk, risk of urine retention, patients' subjective perceptions and rate of urinary tract infection. CONCLUSIONS: This review indicated that bladder training by clamping prior to removal of urinary catheters is not necessary in short-term catheter patients. In addition, clamping carries the risk of complications such as prolonging urinary catheter retention and urinary tract injury. Further investigation requires higher quality methodologies and more diverse study designs.

Urine leak in minimally invasive partial nephrectomy: analysis of risk factors and role of intraoperative ureteral catheterization

Purpose To investigate risk factors for urine leak in patients undergoing minimally invasive partial nephrectomy (MIPN) and to determine the role of intraoperative ureteral catheterization in preventing this postoperative complication. Materials and Methods MIPN procedures done from September 1999 to July 2012 at our Center were reviewed from our IRB-approved database. Patient and tumor characteristics, operative techniques and outcomes were analyzed. Patients with evidence of urine leak were identified. Outcomes were compared between patients with preoperative ureteral catheterization (C-group) and those without (NC-group). Univariable and multivariable analyses were performed to identify factors predicting postoperative urine leak. Results A total of 1,019 cases were included (452 robotic partial nephrectomy cases and 567 laparoscopic partial nephrectomy cases). Five hundred twenty eight patients (51.8%) were in the C-group, whereas 491 of them (48.2%) in the NC-group. Urine leak occurred in 31(3%) cases, 4.6% in the C-group and 1.4% in the NC-group (p<0.001). Tumors in NC-group had significantly higher RENAL score, shorter operative and warm ischemic times. On multivariable analysis, tumor proximity to collecting system (OR=9.2; p<0.01), surgeon’s early operative experience (OR=7.8; p<0.01) and preoperative moderate to severe CKD (OR=3.1; p<0.01) significantly increased the odds of the occurrence of a postoperative urine leak. Conclusion Clinically significant urine leak after MIPN in a high volume institution setting is uncommon. This event is more likely to occur in cases of renal masses that are close to the collecting system, in patients with preoperative CKD and when operating surgeon is still in the learning curve for the procedure. Our findings suggest that routine intraoperative ureteral catheterization during MIPN does not reduce the probability of postoperative urine leak. In addition, it adds to the overall ...

Identifying unrecognized collecting system entry and the integrity of repair during open partial nephrectomy: comparison of two techniques

Purpose To compare retrograde dye injection through an externalized ureteral catheter with direct needle injection of dye into proximal ureter for identification of unrecognized collecting system disruption and integrity of subsequent repair during open partial nephrectomy. Materials and Methods We retrospectively reviewed the records of 259 consecutive patients who underwent open partial nephrectomy. Externalized ureteral catheters were placed preoperatively in 110 patients (Group 1); needle injection of methylene blue directly into proximal ureter was used in 120 patients (Group 2). No assessment of the collecting system was performed in 29 patients (Group 3). We compared intraoperative parameters, tumor characteristics, collecting system entry and incidence of urine leaks among the three groups. Results The mean tumor diameter was 3.1cm in Group 1, 3.6cm in Group 2, and 3.8 cm in Group 3 (p = 0.04); mean EBL 320cc, 351 cc and 376cc (p = 0.5); mean operative time 193.5 minutes, 221 minutes and 290 minutes (p < 0.001). Collecting system entry was recognized in 63%, 76% and 38% of cases in Groups 1, 2 and 3 respectively. (p = 0.07). Postoperative urine leaks requiring some form of management occurred in 11 patients from group 1 and 6 from group 2. (p = 0.2). No patient in Group 3 developed a urinary leak. Conclusions Identification of unrecognized collecting system disruption as well as postoperative urine leak rate in patients undergoing partial nephrectomy were not influenced by the intraoperative technique of identifying unrecognized collecting system entry. Postoperative urine leaks are uncommon despite recognized collecting system disruption in the majority of patients. .

Long-term results of permanent memotherm urethral stent in the treatment of recurrent bulbar urethral strictures

Purpose: To evaluate the long term outcomes of permanent Memotherm urethral stent in the treatment of recurrent bulbar urethral stricture. Materials and Methods: Twenty patients who underwent permanent Memotherm urethral stent implantation due to recurrent bulbar urethral stricture following previous unsuccessful surgical procedure from 1996 to 2002 were included in the study. Long-term outcomes of the patients were evaluated. Results: The overall success rate was 87.5% at the end of the tenth year. There was discomfort in implantation area in eight patients about 1 month following the procedure. These patients were treated with alpha-blocker and anti-inflammatory drugs. Stone formation was observed at the urethral stent implantation area in two patients. Post-void dripping has been observed in 15 patients up to the postoperative 3rd month. Stress urinary incontinence was observed in a patient with a 1-year follow-up. Partial stent migration was observed in two patients. None of the patients experienced pain during erection. Conclusion: Memotherm urethral stent is a minimal invasive surgical procedure which can be safely and effectively used in patients with recurrent urethral stricture. .

Endoscopic management of ureteral calculus in a patient with ureterosigmoidostomy diversion

Lithiasis after urinary diversion is an uncommon condition that poses therapeutic challenges. The authors report the case of a patient submitted to cystectomy and ureterosigmoidostomy 35 years ago due to bladder endometriosis. The patient presented with a ureteral stone and was treated by retrograde endoscopic extraction.

Integrative review: evidences on the practice of intermittent/indwelling urinary catheterization / Revisão integrativa: evidências na prática do cateterismo urinário intermitente/demora / Revisión integrativa: evidencias en la práctica del cateterismo urinario intermitente/demora

OBJECTIVE: to seek the best evidence available in the literature concerning the knowledge produced and related to the techniques of intermittent and indwelling urinary catheterization, so as to place the nursing care given to patients submitted to urinary catheterization on a scientific foundation and to prevent urinary tract infections. METHOD: the literature search was undertaken in the Pubmed and Cochrane databases for the development of the integrative review. The sample was of 34 articles. These were analyzed by two independent researchers using an instrument adapted for ascertaining the level of evidence and the grade of recommendation, in addition to the use of the Jadad scale. RESULTS: the evidence available related to the nursing care for patients submitted to urinary catheterization is: the infection rate in the urinary tract does not alter whether the perineum is cleaned with sterile water or not, or with the use of povidone-iodine solution or chlorhexidine; or using clean or sterile technique. The use of an intermittent catheter with clean technique results in low rates of complications or infections compared to the use of an indwelling catheter. The removal of the catheter in up to 24 hours after surgery and the use of an antimicrobial-impregnated or hydrophilic-coated catheter reduce urinary tract infection . CONCLUSIONS: there are controversies in relation to periurethral cleansing technique, the type of material the catheter is made of, and some procedures for the maintenance and removal of the catheter. This review's results represent an updating of the nurse's conducts and decision-making for the prevention of urinary tract infections in urinary catheterization.

OBJETIVO: buscar as melhores evidências disponíveis na literatura sobre o conhecimento produzido e relacionado à técnica de cateterismo urinário intermitente e de demora, para embasar cientificamente o cuidado de enfermagem prestado ao paciente, submetido ao cateterismo urinário, e prevenir infecção do trato urinário. MÉTODO: a busca foi realizada nas bases de dados PubMed e Cochrane para o desenvolvimento da revisão integrativa. A amostra foi composta por 34 artigos. Esses foram analisados por dois pesquisadores independentes, usando-se instrumento adaptado para verificar o nível de evidência e grau de recomendação, além da utilização da escala de Jadad. RESULTADOS: as evidências disponíveis, relacionadas aos cuidados de enfermagem aos pacientes submetidos ao cateterismo urinário, são: a taxa de infecção no trato urinário não altera com a higienização do períneo com água estéril ou não, com o uso de solução de iodo-povidine ou clorexidine, ou aplicando técnica limpa ou estéril. O uso do cateter intermitente com técnica limpa implica em menores taxas de complicações e infecções em comparação com a de demora. A remoção do cateter em até 24 horas após cirurgia e o uso do cateter impregnado com antimicrobiano e de revestimento hidrofílico reduz a incidência de infecção do trato urinário. CONCLUSÕES: existem controvérsias em relação à técnica de higienização periuretral, tipo de material do cateter e alguns procedimentos para a manutenção e remoção do cateter. Os resultados desta revisão representam atualização das condutas e tomada de decisão do enfermeiro para a prevenção de infecção do trato urinário no cateterismo urinário.

OBJETIVO: buscar las mejores evidencias disponibles en la literatura sobre el conocimiento producido y relacionado a la técnica de cateterismo urinario intermitente y de demora para apoyar científicamente el cuidado de enfermería prestado al paciente sometido al cateterismo urinario y precaver infección del trato urinario. MÉTODO: La busca fue realizada en las bases de datos PubMed y Cochrane para el desarrollo de la revisión integrativa. La muestra fue de 34 artículos. Éstos fueron analizados por dos investigadores independientes usando instrumento adaptado para verificar el nivel de evidencia y grado de recomendación, además de la utilización de la escala de Jadad. RESULTADOS: las evidencias disponibles relacionadas a la atención de enfermería a los pacientes sometidos al cateterismo urinario son: la tasa de infección en el trato urinario no altera con la higienización del perineo con agua estéril o no, con el uso de solución de iodo-povidona o clorhexidina; o aplicando técnica aseada o estéril. El uso del catéter intermitente con técnica aseada implica en menores tasas de complicaciones e infecciones en comparación con la de demora. La remoción del catéter en hasta 24 horas pos cirugía y el uso del catéter impregnado con antimicrobiano y de revestimiento hidrofílico reduce incidencia de infección del trato urinario. CONCLUSIONES: existen controversias con relación a la técnica de higienización periuretral, tipo de material del catéter y algunos procedimientos para el mantenimiento y remoción del catéter. Los resultados de esta revisión representan actualización de las conductas y tomada de decisión del enfermero para la prevención de infección del trato urinario en el cateterismo urinario.

Retrograde Renal Cooling to Minimize Ischemia

Objective: During partial nephrectomy, renal hypothermia has been shown to decrease ischemia induced renal damage which occurs from renal hilar clamping. In this study we investigate the infusion rate required to safely cool the entire renal unit in a porcine model using retrograde irrigation of iced saline via dual-lumen ureteral catheter. Materials and Methods: Renal cortical, renal medullary, bowel and rectal temperatures during retrograde cooling in a laparoscopic porcine model were monitored in six renal units. Iced normal saline was infused at 300 cc/hour, 600 cc/hour, 1000 cc/hour and gravity (800 cc/hour) for 600 seconds with and without hilar clamping. Results: Retrograde cooling with hilar clamping provided rapid medullary renal cooling and significant hypothermia of the medulla and cortex at infusion rates ≥ 600 cc/hour. With hilar clamping, cortical temperatures decreased at -0.9° C/min. reaching a threshold temperature of 26.9° C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.1° C over 600 seconds on average for combined data at infusion rates ≥ 600 cc/hour. The lowest renal temperatures were achieved with gravity infusion. Without renal hilum clamping, retrograde cooling was minimal at all infusion rates. Conclusions: Significant renal cooling by gravity infusion of iced cold saline via a duel lumen catheter with a clamped renal hilum was achieved in a porcine model. Continuous retrograde irrigation with iced saline via a two way ureteral catheter may be an effective method to induce renal hypothermia in patients undergoing robotic assisted and/or laparoscopic partial nephrectomy. .

Elaboração de protocolo e cartilha sobre autocateterismo intermitente limpo em pacientes com bexiga neurogênica secundária a infecção por HTLV-1 / Preparation of protocol and primer on self-clean intermittent catheterization in patients with neurogenic bladder secondary to HTLV-1

Um elevado número de pacientes portadores de HTLV-1 com infecção urinária é internado anualmente no Instituto de Pesquisa Clínica Evandro Chagas (IPEC/FIOCRUZ). O cateterismo intermitente limpo é uma técnica eficaz para o esvaziamento vesical diminuindo o resíduo pós-miccional em indivíduos com bexiga neurogênica. Este estudo trata-se do desenvolvimento de um Protocolo Operacional Padrão (POP) para o treinamento do autocateterismo intermitente limpo nos pacientes com bexiga neurogênica secundária à infecção pelo HTLV-1 e de uma cartilha de aprendizagem do auto-cateterismo intermitente limpo a ser utilizado por esses pacientes. O estudo foi desenvolvido em duas etapas: Etapa-1, revisão de literatura nas bases de dados virtuais e construção do POP de acordo com as normas de qualidade do IPEC; Etapa-2, com base no POP construção da cartilha de auto-cateterismo com ilustrações e instruções do procedimento. A elaboração desses dois instrumentos visa uniformizar os cuidados com os portadores de bexiga neurogênica, promover maior participação e independência dos pacientes em seu tratamento, reduzindo os episódios de infecção urinária e as internações hospitalares por este motivo...

A high number of patients with HTLV-1 with urinary infection is hospitalized annually in theClinical Research Institute Evandro Chagas (IPEC/Fiocruz). The clean intermittentcatheterization is an effective technique for bladder emptying decreasing post-voiding residuein individuals with neurogenic bladder. This study deals with the development of a StandardOperating Protocol (SOP) for the training of the self-clean intermittent catheterization inpatients with neurogenic bladder secondary to HTLV-1 and a primer for learning the selfcleanintermittent catheterization to be used by these patients. The study was conducted in twostages: Stage-1, literature review on virtual databases and building SOPs in accordance withthe quality standards of the IPEC, Step-2, based on the SOP construction of primer selfcatheterizationwith illustrations and procedure instructions. The preparation of these twoinstruments aims to standardize the care of patients with neurogenic bladder, promote greaterparticipation and independence of patients in treatment, reducing episodes of urinary tractinfection and hospitalizations for this reason...

Técnica de Yang-Monti en ostomías continentes para cateterismo intermitente: experiencia de 15 años en Hospital Carlos Van Buren / Yang-­Monti technique in continent ostomies for intermittent catheterization: experience of 15 years in Hospital Carlos Van Buren

Introducción: Existen situaciones en la práctica urológica, en que el daño al aparato esfinteriano, uretra o vejiga obliga a recurrir a algún mecanismo que permita derivar un reservorio o vejiga ampliada hacia la pared abdominal. Para ello, es posible realizar ostomías continentes, con distintos segmentos intestinales, para autocateterismo intermitente limpio. La técnica de Yang-Monti presenta ventajas con respecto a otras ostomías, como el uso de un segmento intestinal pequeño, la mayor facilidad en ubicar y fijar la ostomía. Objetivo: Describir la experiencia de la técnica de Yang-Monti para cateterismo intermitente limpio, su evolución a través del tiempo y sus principales complicaciones según la casuística de nuestro centro. Materiales y Método: Estudio observacional retrospetivo. Revisión de 31 casos de ostomías continentes para cateterismo intermitente con la técnica de Yang-Monti desde enero de 1996 a septiembre del 2011. Se evalúa el diagnóstico etiológico, segmento intestinal del reservorio, ubicación del extremo distal de la ostomía y sus respectivas complicaciones precoces, tardías y estado al final del seguimiento. Resultado: En relación al segmento intestinal utilizado para reservorio, en 14 casos (45 por ciento) se utilizó colon sigmoides, en 9 (29 por ciento) íleon y en 8 transverso (26 por ciento). Con respecto al lugar en que fue exteriorizado el conducto de Yang-monti, en 19 casos (61por ciento) fue al ombligo y en 12 (39 por ciento) a fosa iliaca. Hubo complicaciones precoces (antes de 3 meses) en 8 pacientes (25 por ciento), de los cuales 4 (12,9 por ciento) requirieron reintervención, 3 de estos fallecen precozmente a consecuencia de la cirugía, presentando los diagnósticos de evisceración, obstrucción intestinal e infección de herida operatoria...

Introduction: There are situations in urological practice, in that the damage to the sphincter apparatus, urethra or bladder makes it necessary to use some mechanism to derive an enlarged reservoir or bladder to the abdominal wall. It is therefore possible to use different intestinal segments as continente ostomies for intermittent self cathetherisation. Yang Monti technique presents advantages over other ostomies: use of a small intestinal segment, easier placement and fixation. Objective: To describe the experience of the Yang-­‐Monti technique for clean intermittent catheterization, its evolution over time and its major complications in our center. Materials and Methods: Observational retrospective study. Review of 31 cases of Yang‐Monti intermittent catheterization continente ostomies from January 1996 to September 2011. Etiologic diagnosis, intestinal segment of the reservoir, location of the distal end of the ostomy and their early and late complications, and follow-­‐up status are evaluated. Results: Regarding the intestinal segment used for reservoir: in 14 cases (45 percent) was used sigmoid colon, in 9 ileum (29 percent) and in 8 transverse colon (26 percent). The Yang‐Monti was externalized in the navel in 19 cases (61 percent) and in iliac fossa 12 (39 percent)...