ABSTRACT
Introduction: It is a common observation patients with large prostatic have smaller visible length of the catheter. Study questions: Does extraurethral catheter length (EUCL) have correlation with ultrasound prostate measurements? Can EUCL and clinical parameters predict need for prostate surgery?. Adult men on catheter for retention due to BPH were included. The EUCL was measured from the external urethral meatus to the end of the catheter. Detailed clinical and Ultrasound measurements like intravesical prostate protrusion (IPP), transverse prostate width (TPW), axial prostate length (APL), sagittal prostate maximum length (SPL), prostate weight (PW) were performed. Retention while on alpha blockers and failed voiding trial with alpha blockers were the indications for surgery. Need for surgery was classified as pass/fail. Machine learning decision tree analysis in 80/20 fashion was done using python and scikit. Ethics committee approval taken. Result(s): 110 patients were recruited (Jul 18-Mar 20, recruitment stopped due to COVID related restrictions) EUCL had a negative relationship with IPP, TPW, APL, SPL, PW. Retention episode while on alpha blocker and EUCL smaller than 169 mm were the strongest predictors for need for surgery. Conclusion(s): As the prostate increased in size EUCL decreased. Retention while on alpha blocker and EUCL <169 mm predicted the need for surgery. EUCL may be used at primary healthcare setting especially in resource poor setting as surrogate marker for prostate size and need for surgery.
ABSTRACT
Introduction: The COVID-19 pandemic has changed the lives of many in the past year. As of writing this article, the virus has claimed over half a million American lives and has infected millions more. It has affected many people regardless of age, gender, race, religion, or medical history. We have noticed a unique sequence of events in urology patients with a prior history of inflatable penis prothesis implantation who have gotten critically ill from the SARS-CoV-2 virus. Objective: We report our experience with patients with an inflatable penile prothesis who suffered respiratory failure due to the SARS-CoV-2 virus and findings that would help limit the risk of implant infection and/or erosion if prolonged urethral catherization is needed. Methods: We have encountered 3 patients with a very similar history in the past year. They were all men aged 57-72 years old who had a functioning inflatable penile prothesis (IPP) for many years (3-13) and were intubated for a prolonged period of time (2-4 weeks) after suffering respiratory distress from the SARS-CoV-2 virus. During this time, they all had a prolonged urethral Foley catherization for urinary drainage while in the ICU. They were all subsequently found to have urethral erosion of a penile implant cylinder which was not present prior to hospitalization. Their charts were reviewed. Results: Two patients underwent explantation of their IPP during their hospital stay and one presented to our outpatient office 2 months after discharge with the complaint of urethral cylinder erosion and underwent subsequent explantation. Conclusions: Urethral catheterization is commonly used in the intensive care unit and spinal cord injury patients due to their convenience and efficacy. The friction and inflammation created by prolonged transurethral catheterization can be disastrous for IPPs by increasing the likelihood of infection and/or device erosion. In fact, Steidle and Mulcahy found that five out of their nine patients (55%) with IPPs who had an indwelling or intermittent transurethral catheterization were eventually found to have erosion of their IPP. In addition, indwelling transurethral catheters also confer a higher risk of urinary tract infection. Han et al. found that suprapubic tube placement conferred a statistically significantly lower risk of urinary tract infection when compared to indwelling transurethral catheterization for over five days at an odds ratio of 0.142 (95% CI 0.073-0.0276). Another alternative to bladder drainage in the intubated IPP patient is clean intermittent catherization (CIC), however this poses a unique challenge in the intubated COVID positive patient as it repeatedly exposes healthcare staff the virus-carrying patient. When compared to indwelling transurethral catherization, suprapubic tube placement has been shown to confer a lower risk of urinary tract infection and IPP infection/erosion. This can primarily be explained by its ability to drain the bladder without creating inflammation and friction in the urethra. Therefore, we propose that any team caring for a patient with an IPP and a planned, prolonged indwelling transurethral catheterization consult urology services to have a suprapubic tube temporarily placed. This will ensure that the risk of urinary tract infection and/or IPP erosion is kept as low as possible. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, Neotract