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.

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.

Does ureteral access sheat usage lead to permanent damage in the ureter? A placebo controlled trial in a rabbit model

Abstract Purpose: To evaluate the clinical stenosis or precursor histological changes that ureteral access sheaths commonly used in ureteroscopic surgeries may cause in the long term in ureter. Methods: In this study, the animals were divided into 9 groups and according to their groups, ureters of the rabbits were endoscopically fitted with 2F and 3F ureter catheters. The catheters were left in place and withdrawn after a specified period of time. All the ureters were excised and evaluated macroscopically, microscopically and histologically. Ureter diameters were measured and FGF-2 (+) labeled fibroblasts were counted in connective tissue as stenosis precursors. Results: Macroscopically or microscopically, no stenosis was found in any group. The ureter diameter of the group that were catheterized for the longest time with the catheter that had the widest diameter was significantly lower than the group with the shorter duration and the catheter with the narrower diameter and the control group. When the groups were compared in terms of their FGF values, there was a significant difference in FGF-2 counts at all three ureter levels (p <0.05). Conclusion: The use of ureteral access sheath may lead to histological changes, as its diameter and duration increase.

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.

Do Foley Catheters Adequately Drain the Bladder? Evidence from CT Imaging Studies

The Foley catheter has been widely assumed to be an effective means of draining the bladder. However, recent studies have brought into question its efficacy. The objective of our study is to further assess the adequacy of Foley catheter for complete drainage of the bladder.

Rapid intraoperative tissue expansion with Foley catheter in a challenging cripple Hypospadias

Failed hypospadiass cases may result in hypovascular, scarred penis with residual penile chordee and leave the patient with minimal residual skin for penile resurfacing and urethroplasty. Local tissue expansion has become a good alternative to provide skin for penis by using expanders however they require long periods of time for expansion. Besides, rapid tissue expansion was also described in different tissues. We used rapid intraoperative expansion technique by using a Foley catheter in a failed hypospadias case who had minimal residual skin secondary to infection and we concluded that rapid intraoperative tissue expansion with Foley catheter is an effective, feasible reconstructive method for easy dissection and penile resurfacing in failed hypospadiass cases.

Modified Peritoneal Dialysis Catheter Insertion: Comparison with a Conventional Method

PURPOSE: The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS: Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS: Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min+/-16 min vs. 1 h 36 min+/-19 min, p<0.01), immediate post-procedural pain (2.43+/-1.80 vs. 3.14+/-2.07, p<0.05), and post-procedure days until ambulation (3.95+/-1.13 days vs. 6.17+/-1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71+/-7.05 days vs. 13.86+/-3.7 days). CONCLUSION: Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.

Tratamento não cirúrgico do traumatismo renal contuso / Non-surgical treatment of blunt renal trauma

Os rins são os órgãos do trato geniturinário (TGU) mais acometidos por traumas acidentais. Excluindo-se os pacientes com indicação de cirurgia imediata, todos os demais deverão ser submetidos a um correto estadiamento da lesão renal, visando instituir a terapêutica adequada e como fator deprognóstico da sua doença.

The kidney is the most commonly injured urologic organ and may be treated success fully without operative intervention. Blunt renal trauma continues to promote discussion in trauma and urology circles. Renal exploration is reserved for those patients who become unstable or who develop complications.

A percepção emocional do cuidador familiar frente à técnica do cateterismo intermitente limpo na mielomeningocele / Emotional perception of family-member caregivers regarding the clean intermittent catheterization in myelomeningocele cases

Os cuidados do trato urinário necessários à criança com mielomeningocele demandam auxílio constante de um cuidador, que frequentemente é um membro da família e que por vezes vivencia dúvidas, angústias e dificuldades com relação à técnica do cateterismo intermitente limpo que se faz necessário para essas crianças. Objetivo: Dessa forma, esta pesquisa tem como objetivo investigar pensamentos e sentimentos do cuidador familiar sobre a realização dessa técnica na criança e analisar se o cuidador visualiza a possibilidade da criança fazer o autocateterismo no futuro. Método: O estudo tem abordagem quantitativa e qualitativa, observacional e transversal. Realizado com 15 cuidadores familiares provenientes de uma instituição de reabilitação da cidade de São Paulo, de abril a agosto de 2012, por meio de entrevista estruturada gravada em áudio. Para a análise de conteúdo e léxica das questões abertas usou-se o software SPAD-T® versão 1.5. Resultados: As categorias encontradas foram: Impressões do cuidador sobre o cateterismo; Tempo de adaptação ao procedimento; Percepções do cuidador sobre as impressões da criança; Referências à intervenção do profissional; Percepções do cuidador sobre o autocateterismo; Percepções do cuidador sobre o potencial da criança; Referências à (in)dependência na relação cuidador-criança. Para a análise estatística utilizou-se o software SPSS® 15.0. Conclusão: Todos os cuidadores apresentaram sentimentos e pensamentos negativos a respeito do cateterismo, apesar de alguns também mencionarem conteúdos positivos. Além disso, a maior parte dos cuidadores não soube responder com clareza se a criança realizará o autocateterismo futuramente.

There are many special needs of the urinary tract of a child with Myelomeningocele, who requires constant help from a caregiver who is often a family member that can face doubts, fears, and difficulties related to the clean intermittent catheterization that is necessary in these cases. Objective: This study investigates the thoughts and feelings of family-member caregivers regarding their performing this technique on children, and analyzes how the caregiver feels about the possibility of the child carrying out the procedure him/herself later in life. Method: This observational and transversal research uses both qualitative and quantitative approaches. Also, structured interviews were made and recorded in audio with 15 family-member caregivers from a rehabilitation institution located in the city of Sao Paulo between April and August of 2012. Lexical and content analyses of the open questions was made using the software SPAD-T® version 1.5. Results: The categories found where: the caregiver?s general impression of the catheterization, how long it took to get used to the procedure, the caregiver's perception of the child's general impressions, references to the professional's intervention, the caregiver's perception of the auto-catheterization, the caregiver's perception of how capable the child could be (to conduct the procedure him/herself), and references to the (in)dependence in the caregiver-child relationship. The statistical analysis was made using the software SPSS® 15.0. Conclusion: All caregivers showed negative feelings and thoughts about the catheterization even though some of them mentioned positive points as well. Moreover, most caregivers could not answer clearly whether the child would perform the self-catheterization by itself in the future.

O emprego do cateter duplo J diminui as complicações na ureterolitotomia retroperitoneoscópica / The use of double-J catheter decreases complications of retroperitoneoscopic ureterolithotomy

OBJETIVO: Avaliar os resultados da ureterolitotomia retroperitoneoscópica no tratamento do cálculo ureteral e a necessidade do cateter duplo J para reduzir complicações relacionadas ao procedimento. MÉTODOS: Estudo retrospectivo comparativo de 47 pacientes operados pela técnica de ureterolitotomia retroperitoneoscópica, dos quais 31 foram selecionados e divididos em dois grupos: Grupo 1, cujos pacientes não receberam cateter duplo J, e Grupo 2, que foram submetidos ao implante de cateter duplo J transoperatório. Foram coletados dados de urografia excretora pré e pós-operatória, tempo cirúrgico, analgesia pós-operatória, tempo de internação e retirada do dreno. RESULTADOS: Os grupos foram semelhantes quando comparados na idade e sexo, grau de dilatação do trato urinário, posição e tamanho médio do cálculo (Grupo 1= 15,5 ± 6,6mm; Grupo 2= 16,3 ± 6,1mm). O tempo operatório também não teve diferença significativa (Grupo 1= 130 ± 40,3min; Grupo 2= 136,3 ± 49,3min). O Grupo 1 apresentou seis pacientes (37,5 %) com complicações precoces (quatro casos de fístula urinária) e tardias (um caso de estenose de ureter, um caso de exclusão funcional do rim operado), enquanto o Grupo 2 não teve complicações, sendo esta diferença estatisticamente significativa (p=0,011). CONCLUSÃO: O emprego do cateter duplo J foi associado a um número significativamente menor de complicações na ureterolitotomia retroperitoneoscópica. Tempo cirúrgico, analgesia pós-operatória e tempo de internação foram semelhantes entre os grupos com e sem cateter.

OBJECTIVE: To evaluate the retroperitoneoscopic ureterolithotomy in the treatment of ureteral calculi and the need for double-J catheter to reduce the procedure-related complications. METHODS: We conducted a retrospective study with 47 patients submitted to retroperitoneoscopic ureterolithotomy, of which 31 were selected and divided into two groups: Group 1, whose patients did not have double-J catheter placement, and Group 2, who underwent perioperative double-J catheter implantation. Data collected comprised pre-and post-operative excretory urography, operative time, postoperative analgesia, length of hospital stay and catheter removal. RESULTS: The groups were similar as for age and gender, degree of dilation of the urinary tract, position and average size of the calculi (Group 1 = 15.5 ± 6.6 mm, Group 2 = 16.3 ± 6.1 mm). Operative time was also not significantly different (Group 1 = 130 ± 40.3 min, Group 2 = 136.3 ± 49.3 min). Group 1 had six patients (37.5%) with early (four cases of urinary fistula) and late complications (one case of stenosis of the ureter, one case of functional exclusion of the operated kidney), while Group 2 had no complications. This difference was statistically significant (p = 0.011). CONCLUSION: The use of double-J catheter was associated with significantly fewer complications in retroperitoneoscopic ureterolithotomy. Surgical time, postoperative analgesia and length of stay were similar between groups with and without catheter.

Anatomical features of the urethra and urinary bladder catheterization in female mice and rats. An essential translational tool / Características anatômicas da cateterização da uretra e bexiga de camundongos e ratos fêmeas. Instrumento essencial na pesquisa pré clínica

PURPOSE: To present fundamental anatomical aspects and technical skills necessary to urethra and urinary bladder catheterization in female mice and rats. METHODS: Urethral and bladder catheterization has been widely utilized for carcinogenesis and cancer research and still remains very useful in several applications: from toxicological purposes as well as inflammatory and infectious conditions to functional aspects as bladder dynamics and vesicoureteral reflux, among many others. RESULTS: Animal models are in the center of translational research and those involving rodents are the most important nowadays due to several advantages including human reproducibility, easy handling and low cost. CONCLUSIONS: Although technical and anatomical pearls for rodent urethral and bladder access are presented as tackles to the advancement of lower urinary tract preclinical investigation in a broaden sight, restriction to female animals hampers the male microenvironment, demanding future advances.

OBJETIVO: Apresentar aspectos anatômicos fundamentais e habilidades técnicas necessárias para cateterismo da uretra e bexiga em ratos e camundongos fêmeas. MÉTODOS: Cateterismo vesical tem sido amplamente utilizado na pesquisa do câncer e carcinogênese, além de várias outras aplicações, desde fins toxicológicos, condições inflamatórias e infecciosas até aspectos funcionais como a dinâmica vesical e refluxo vesico-ureteral, entre muitos outros. RESULTADOS: Os modelos animais estão no centro da investigação de translação e os roedores são os mais importantes devido a várias vantagens, incluindo reprodutibilidade humana, o fácil manuseio e baixo custo. CONCLUSÕES: Apesar de permitir o desenvolvimento da investigação pré-clínica do trato urinário inferior, o modelo se restringe aos animais do sexo feminino, de modo que avanços futuros são necessários.

The approach to the difficult urethral catheterization among urology residents in the United States

PURPOSE: To determine the prevalence of different approaches to the difficult urethral catheterization (DUC) among urology residents (UR) in the United States (US). MATERIALS AND METHODS: An email invitation to participate in an online survey regarding DUC was sent to 267 UR and to 22 urology program coordinators for them to forward to their residents. 142 UR completed the survey. RESULTS: After the initial unsuccessful attempt by a nurse, 92 percent of UR attempted a catheter prior to resorting to other modalities. The most common choice of the first catheter was a Coude (76 percent) size 18F (51 percent). For situations where multiple sizes and types of catheters (12 - 20F) were used without success, 3 scenarios were proposed: 1) Catheter passed the bulbomembranous urethra (BMU) and patient had previous history of transurethral resection of the prostate or radical retropubic prostatectomy, 2) Catheter passed the BMU and no urologic history, 3) Catheter did not pass the BMU and no urologic history. Flexible cystoscopy was used in 74 percent, 62 percent and 63 percent; blind passage of a glidewire was second with 15 percent, 23 percent and 20 percent; and blind use of filiforms and followers was chosen in 7 percent, 9 percent and 9 percent of the scenarios respectively. CONCLUSIONS: The most common approach to the DUC among UR in the US involves using an 18F Coude catheter first. After trying one or more urethral catheters, UR most commonly resort to flexible cystoscopy as opposed to the blind placement of glide wires or filiforms/followers.

Urethral catheter insertion forces: a comparison of experience and training

Purpose: This study was undertaken to evaluate the insertion forces utilized during simulated placement of a urethral catheter by healthcare individuals with a variety of catheter experience. Materials and Methods: A 21F urethral catheter was mounted to a metal spring. Participants were asked to press the tubing spring against a force gauge and stop when they met a level of resistance that would typically make them terminate a catheter placement. Simulated catheter insertion was repeated fives times, and peak compression forces were recorded. Healthcare professionals were divided into six groups according to their title: urology staff, non-urology staff, urology resident/ fellow, non-urology resident/ fellow, medical student, and registered nurse. Results: A total of fifty-seven healthcare professionals participated in the study. Urology staff (n = 6) had the lowest average insertion force for any group at 6.8 ± 2.0 Newtons (N). Medical students (n = 10) had the least amount of experience (1 ± 0 years) and the highest average insertion force range of 10.1 ± 3.7 N. Health care workers with greater than 25 years experience used significantly less force during catheter insertions (4.9 ± 1.8 N) compared to all groups (p < 0.01). Conclusions: We propose the maximum force that should be utilized during urethral catheter insertion is 5 Newtons. This force deserves validation in a larger population and should be considered when designing urethral catheters or creating catheter simulators. Understanding urethral catheter insertion forces may also aid in establishing competency parameters for health care professionals in training.

Difficult male urethral catheterization: a review of different approaches

PURPOSE: To review and compare the different methods for difficult male urethral catheterization described in selected literature. MATERIALS AND METHODS: A PubMed search was done with the terms "difficult", "failed", or "complications" and "urethral catheterization", "transurethral catheterization", "Foley catheter", "urethral catheter" or "filiforms and followers". All articles addressing the issue of difficult adult male urethral catheterization were included. RESULTS: Six main approaches were identified on the 14 articles included for review: 1) Passage of either a Glidewire, guide wire or filiform under direct vision; 2) Blind passage of a filiform, guide wire, Glidewire or hydrophilic catheter; 3) "The Peel-away® sheath placed on a cystoscope/resectoscope technique"; 4) "The rigid ureteroscope placed inside the 22F Foley technique"; 5) Suprapubic catheterization; and 6) "The instillation of 60 cc of saline through the catheter as it is advanced technique". CONCLUSION: There is a paucity of prospective data comparing the benefits, risks, success rates and complications of the different approaches for difficult Foley catheter placement. Our suggested approach starts with the initial attempt at urethral catheterization with an 18F coude and a 12F silicone catheter. If these fail, using a flexible cystoscope or the blind Glidewire technique are reasonable alternatives. If dilatation of a stricture is necessary, ureteric dilatators or a urethral balloon dilatator are recommended.

Hiperplasia prostática benigna gigante-prostatitis: a propósito de un caso: Hospital Patrocinio Peñuela Ruíz mayo 2007 / Benign prostatic hyperplasia giant-prostatitis: a purpose of a case: Hospital Patrocinio Peñuela Ruíz may 2007

La hiperplasia prostática benigna (HPB) se observa un aumento de estroma, aunque existen diferencias morfológicas de un individuo a otro. Es un crecimiento no maligno de la glándula prostática, debido a un excesivo crecimiento celular de los dos componentes prostáticos, componente epitelial-glandular y componente estromal-músculo liso, con una disminución del índice apoptósico. Es importante destacar que el tamaño de la próstata, no se correlaciona con el grado de intensidad en los síntomas. Los factores de riego principalmente se asocian son: raza, nivel socieconómico, actividad sexual, vasectomía, alcohol hepatopatias (CIH), tabaquismo e hipertensión y la Dieta.

Urethral catheter removal 7 or 14 days after radical retropubic prostatectomy: clinical implications and complications in a randomized study

OBJETIVO: Avaliar a hipótese de que um período de sete dias de sonda vesical de demora após prostatectomia radical retropúbica é efetivo e seguro, sem a necessidade da realização de cistografia. MÉTODOS: Entre janeiro de 2000 e julho de 2002, setenta e três pacientes submetidos à prostatectomia radical retropúbica foram prospectivamente randomizados em dois grupos: grupo 1 ù 37 pacientes em que a sonda vesical foi removida 7 dias após o procedimento e, grupo 2 ù 36 nos quais a sonda foi removida 14 dias após a cirurgia. Os dois grupos apresentavam características clínicas similares, os cirurgiões e técnicas foram as mesmas, e nenhuma cistografia foi realizada para avaliar a presença de vazamentos. RESULTADOS: Dois pacientes no grupo 1 apresentaram sangramento e retenção por coágulos após a retirada da sonda no sétimo dia pós-operatório, e foram manejados através da recolocação da sonda vesical por mais 7 dias. Dois pacientes do grupo 2 desenvolveram esclerose do colo vesical e foram tratados através de incisão do colo vesical com sucesso. A taxa de continência foi a mesma, com dois casos de incontinência em cada grupo. Em torno de duas fraldas por dia eram utilizadas pelos pacientes com incontinência. O seguimento médio foi de 17.5 meses (2 ù 30 meses). Não houve formação de fístula urinária, urinoma ou abcesso pélvico após a retirada da sonda vesical. Dois pacientes foram excluidos da análise desta série: um faleceu devido a embolia pulmonar no terceiro dia pós-operatório, e o outro desenvolveu fístula urinária suprapúbica antes da retirada do cateter, que foi mantido por 16 dias. CONCLUSÃO: A retirada da sonda vesical 7 dias após a prostatectomia radical retropúbica, sem realização de cistografia, tem uma baixa taxa de complicações de curto prazo, equivalentes às da retirada da sonda aos 14 dias de pós-operatório.

Cateterización ureteral anterógrada: una indicación actual / Antegrade ureteral catheterization: a present indication

Existen situaciones de obstrucción del tracto urinario superior, en las cuales no es posible la cateterización ureteral en forma retrógrada (forma clásica) y se hace necesario realizar una nefrostomía. La instalación de un catéter pigtail en forma anterógrada, utilizando la vía percutánea, logra un adecuado drenaje de la vía urinaria, evitando así la necesidad de una nefrostomía. En este trabajo exponemos nuestra experienciaal instalar 10 catéteres ureterales tipo pigtail en 6 pacientes, vía percutánea y describiendo la técnica utilizada. Concluimos que esta técnica logra un adecuado drenaje de la vía urinaria, es segura y da una mejor calidad de vida, la que puede ser realizada en forma ambulatoria.