Effects of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery / 中国实用护理杂志

Objective:To investigate the effect of optimized catheter clipping training and automatic balloon retraction ureteral catheter removal on first urination of patients after neurosurgery, and provide guidance for postoperative micturition of these patients.Methods:From August 2020 to August 2021, 208 patients admitted to Department of Neurosurgery, the Affiliated Hospital of Xuzhou Medical University, undergoing craniocerebral surgery under general anesthesia and indurating catheter were selected as the study subjects by convenient sampling. They were divided into control group ( n=69), observation group A ( n=69) and observation group B( n=70) by random number table method. The control group received routine catheter clipping training and routine ureteral catheter removal, the observation group A received optimized catheter clipping training and routine ureteral catheter removal, and the observation group B received optimized catheter clipping training and automatic balloon retraction ureteral catheter removal. The first micturition time, first micturition volume, micturition circumstance, pain score and urethral irritation sign of the three groups were observed and compared. Results:The first urination time in observation group A and B were (11.58 ± 6.59) min and (10.06 ± 5.91) min, respectively, lower than (37.14 ± 13.74) min in control group, and the difference was statistically significant ( t=13.94, 15.07, both P<0.05); there was no significant difference between observation group B and observation group A ( P>0.05). The first urine volume were (303.66 ± 43.74) ml in control group, (299.06 ± 41.26) ml in observation group A and (299.28 ± 43.17) ml in observation group B, and the difference was not statistically significant ( P>0.05). The incidence of urination (spontaneous urination, induced urination and urinary retention) in observation group A was better than control group ( χ2=16.47), while observation group B was better than observation group A and control group ( χ2=8.59, 37.83), the differences were statistically significant (all P<0.05). There was no significant difference in pain score of ureteral catheter removal between observation group A (2.71 ± 0.67) and control group (2.87 ± 0.78) ( P>0.05). The score of observation group B (1.41 ± 0.65) was lower than that of control group and observation group A, the differences were statistically significant ( t=11.93, 11.62, both P<0.05). There was no significant difference of the incidence of urethral irritation (grade 0, 1, 2, and 3) between observation group A and control group ( P>0.05). Observation group B was lower than control group and observation group A, the differences were statistically significant ( t=38.81, 25.27, both P<0.05). Conclusions:Optimized catheter clipping training and automatic balloon retraction ureteral catheter removal can effectively shorten the first urination time of patients after neurosurgery, reduce the pain of ureteral catheter removal and urethral irritation during the first urination, improve the success rate of the first urination, and effectively prevent the occurrence of urinary retention.

Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury / 华中科技大学学报（医学）（英德文版）

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries.Nine patients subjected to parotid gland and duct injuries with 1-to 3-month treatment delay were retrospectively evaluated with special reference of etiology,past medical history,and injury location.Conservative treatment,microsurgical anastomosis,and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury,time of repair and procedures.Assistant treatment as pressure dressing was adopted thereafter.All patients experienced an uneventful recovery at the time of finalizing the study.Two patients received Stensen's duct ligation,5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas,and no re-occurrence was found.Facial paralysis occurred after surgery in 4 patients,and 3 of them recovered after the nerve nutrition treatment.Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

Application of Delayed Surgical Managements in Patients with Stensen's Duct Injury / 华中科技大学学报（医学）（英德文版）

The study aimed to retrospectively evaluate surgical treatment outcomes after delayed parotid gland and duct injuries.Nine patients subjected to parotid gland and duct injuries with 1-to 3-month treatment delay were retrospectively evaluated with special reference of etiology,past medical history,and injury location.Conservative treatment,microsurgical anastomosis,and diversion of salivary flow or ligation were chosen for delayed parotid gland and duct injuries concerning to their site of injury,time of repair and procedures.Assistant treatment as pressure dressing was adopted thereafter.All patients experienced an uneventful recovery at the time of finalizing the study.Two patients received Stensen's duct ligation,5 received microsurgical anastomosis and 2 accepted salivary flow diversion for 5 patients with sialoceles and 4 patients with fistulas,and no re-occurrence was found.Facial paralysis occurred after surgery in 4 patients,and 3 of them recovered after the nerve nutrition treatment.Our study suggested that appropriate surgical treatment is efficient for the re-establishment of the tissue function and facial aesthetic for delayed injury of the parotid and its duct.

The clinical characteristics and perioperative management of complicated placenta increta / 实用医学杂志

Objective To study the clinical characteristicsand perioperative managementof complicated placenta increta, effectively reduce the maternal adverse perinatal outcomes. Methods Retrospective analysis 25 cases of complicated placenta increta between January 2013 and December 2015 in the Third Affiliated Hospital Of Guangzhou Medical University. Grouped into preoperative line 9 cases of ureteral catheter group and without catheter group 16 cases; Conventional hysterectomy group of 17 cases and the posterior hysterectomy group of 8 cases , compare the operation time , postpartum hemorrhage , blood transfusion amount , bladder injury or ureteral injury rate , rate of transferred to the ICU and hospital stay. Results 76% appear repeatedly painless vaginal bleeding during pregnancy , 56% appear bleeding before delivery. Prenatal diagnosis of 17 cases (68%). The preoperative line cystoscopy + bilateral retrograde ureteral catheter or after the posterior hysterectomy , shorter operation time , less postpartum hemorrhage , reduce blood transfusion volume , no urinary tract injury rate, transferred to the ICU rate is low, the difference was statistically significant (P < 0.05). Conclusions We should attach importance to repeated painless vaginal bleeding , improve prenatal diagnostic rate of complicated placenta increta. The perioperative managementis more comprehensive , effective and standard participation , preoperative ureteral catheter and the posterior hysterectomy can effectively reduce the maternal adverse perinatal outcomes.

The application of ureteral stents for prevention of ureteral injury in complex pelvic tumor operation / 实用肿瘤学杂志

Objective To investigate the clinical value and adverse reactions of indwelling ureteral stentsinthepreventionofureteralinjurybeforecomplexpelvictumorsurgery.Methods 145casesofpatients with rectal cancer ,cervical cancer ,ovarian cancer and pelvic sarcomas were retrospectively analyzed ,and 53 pa-tients with complex pelvic tumor surgery ,preoperative were under cystoscope unilateral or bilateral ureteral stent tube,pulled out according to the intraoperative situation after surgery or lien ,92 patients as control group .Results Ureteral injury was found in 10 of the 145 patients,2 cases in ureteral catheter group and 8 cases in control group .3 cases of postoperative ureteral fistula occurred in the control group .Indwelling ureteral stents could cause adverse reactions such as hematuria ,osphyalgia and urinary irritation ,and the adverse reactions of catheter group was obviously higher than that of control group (P<0.05).Conclusion Cystoscopic ureteral stent placement has important clinical significance for prevention of ureteral injury despite certain adverse reactions ,which can be used in operation of complex pelvic tumor .

Should We Place Ureteral Stents in Retroperitoneal Laparoscopic Ureterolithotomy?: Consideration of Surgical Techniques and Complications

PURPOSE: There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). MATERIALS AND METHODS: Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. RESULTS: The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p<0.001). Parenteral analgesic use and anticholinergic medication use were observed in the stent group only. The blood loss, drain removal day, and hospital stay were not significantly different between the two groups. No other significant complications occurred during or after the operation in any patients. CONCLUSIONS: RLU is a safe and effective treatment modality for large impacted ureteral stones. In this study, D-J stent placement was not necessary after RLU. In the future, large-scale studies of RLU without D-J stenting, especially on the frequency of the development of complications according to the surgical technique, may be needed.

Easily Removable Ureteral Catheters for Internal Drainage in Children: A Preliminary Report

PURPOSE: We review our experience using a new and easily removable ureteral catheter in patients who underwent complicated ureteral reimplantation. Our goal was to shorten hospital stay and lower anxiety during catheter removal without fear of postoperative ureteral obstruction. MATERIALS AND METHODS: Between April 2009 and September 2010, nine patients who underwent our new method of catheter removal after ureteral reimplantation were enrolled. Patients who underwent simple ureteral reimplantation were excluded from the study. Following ureteral reimplantation, a combined drainage system consisting of a suprapubic cystostomy catheter and a ureteral catheter was installed. Proximal external tubing was clamped with a Hem-o-lok clamp and the rest of the external tubing was eliminated. Data concerning the age and sex of each patient, reason for operation, method of ureteral reimplantation, and postoperative parameters such as length of hospital stay and complications were recorded. RESULTS: Of the nine patients, four had refluxing megaureter, four had a solitary or non-functional contralateral kidney and one had ureteral stricture due to a previous anti-reflux operation. The catheter was removed at postoperative week one. The mean postoperative hospital stay was 2.4 days (range 1-4 days), and the mean follow-up was 9.8 months. None of the patients had postoperative ureteral obstructions, and there were no cases of migration or dislodgement of the catheter. CONCLUSION: Our new method for removing the ureteral catheter would shorten hospital stays and lower levels of anxiety when removing ureteral catheters in patients with a high risk of postoperative ureteral obstruction.

Nefrolitectomía percutánea "Tubeless" con catéter pigtail versus catéter ureteral externalizado por una noche: estudio comparativo, prospectivo y randomizado / Comparison of tubuless percutaneous nephrolithothotomy with pigtail catheter versus one nigth externalized ureteral catheter: comparative, prospective and randomized study

La nefrolitectomía percutánea (NLP) es una técnica establecida para el tratamiento de nefrolitiasis de gran tamaño que finaliza dejando una nefrostomía para hemostasia, drenaje y facilitar una eventual revisión. Nuestro grupo publicó recientemente un estudio prospectivo y randomizado que demostró la factibilidad y seguridad de realizar NLP “tubeless” (sin nefrostomía y con catéter pigtail) en un grupo seleccionado de pacientes (sin litiasis residual ni sangrado intra operatorio significativo, con acceso percutáneo único y tiempo operatorio menor a 2 horas).Objetivo: Comparar el uso de catéter ureteral tipo pigtail versus catéter ureteral externalizado por 24 horas en pacientes sometidos a NLP “tubeless”. Métodos: Sesenta y ocho pacientes sometidos a NLP ¨tubeless” fueron prospectivamente randomizados para el uso de catéter pigtail (Grupo 1) o catéter ureteral externalizado por una noche (Grupo 2). Se evaluó el dolor pos operatorio, estadía hospitalaria, caída del hematocrito y desarrollo de hematomas perirrenales objetivados por tomografía axial computarizada no contrastada. Para el análisis estadístico un p value <0,05 fue considerado significativo. Resultados: Los grupos fueron comparables en edad, distribución de sexo, índice de masa corporal y carga litiásica. No difirieron en dolor pos operatorio ni incidencia de hematomas. El Grupo 1 tuvo una estadía hospitalaria y una caída del hematocrito significativamente mayor. Conclusión: Los resultados sugieren que ambas conductas son factibles y seguras. La mayor estadía hospitalaria del Grupo 1 y la posterior necesidad de cistoscopia para retirar el catéter pigtail favorecen el uso de catéteres ureterales externalizados. Además se validan los criterios utilizados para la aplicación de la técnica tubeless en NLP...

Percutaneous nephrolithotomy (PNL) is an established technique for the management of big renal calculi that finishes leaving a nephrostomy tube to provide hemostasia, drainage and access for a second look when needed. We have recently published a prospective and randomized study demonstrating the feasibility and safety of performing “tubeless” PNL (without nephrostomy and leaving a pigtail catheter) in a selected group of patients (no significant residual lithiasis nor significant intraoperative bleeding, single access and less of 2 hours of surgery).Objective: Compare the use of pigtail catheter versus night-externalized ureteral catheter in patients subjected to “tubeless” PNL. Methods: Sixty eight patients undergoing “tubeless” PNL were prospectively randomized for the use of pigtail catheter (Group 1) or 24 hours-externalized ureteral catheter (Group 2).Postoperative pain, hospital stay length, hematocrit drop and evidence of peri-renal hematomas in non-enhanced computarized tomography were evaluated. For statistical analysis a p value <0.05 was considered significant. Results: Groups were similar in age, sex distribution, body mass index and stone burden. No differences in postoperative pain or incidence of hematomas were observed. Group 1 had a longer hospital stay and a greater hematocrit drop. Conclusion: These results suggest that both alternatives are feasible and safe. The longer hospital stay in Group 1 and the further need of cystoscopy to remove the pigtail catheter favors the use of 24 hours-externalized ureteral catheter. In addition, we validate our intraoperative criteria for performing “tubeless” PNL...

A case of spontaneous rupture of kidney associated with multiple renal stones during pregnancy / 대한비뇨기과학회지

Spontaneous rupture of kidney is a rare condition which usually presents as an acute abdomen requiring prompt diagnostic evaluation and proper therapy. We experienced a 27-year-old pregnant woman hospitalized with complaint of right flank pain. Ultrasonography and DIP (shield lower abdomen) revealed multiple sandy renal stones and right caliectasis with extravasation of contrast media through renal fornices into perirenal space. We present a case of spontaneous rupture of kidney associated with multiple renal stones during pregnancy, successfully managed with temporary insertion of ureteral catheter.