Prospective, multicentre, randomized controlled trial of bladder filling prior to trial of void on the timing of discharge.

BACKGROUND: The objective of this study was to investigate whether bladder filling with saline prior to trial of void (TOV) was safe and whether it reduced time to discharge compared with standard TOV in the urology inpatient setting for patients post-transurethral resection of prostate, bladder neck incision or an admission with urinary retention. METHODS: Prospective, multicentre, randomized controlled trial at Hawkes Bay and Waikato hospitals with local ethics committee approval. All consecutive, consented patients requiring TOV were randomized into filling and control groups. The filling groups were filled with normal saline prior to TOV (up to 500 mL or first sensation of fullness). The control group had their catheter removed at 06.00 hours without filling. Time taken between catheter removal and discharge was recorded in minutes. Complications were recorded. RESULTS: Fifty-two patients were recruited and randomized with 27 and 25 patients in the filling and control groups, respectively. The mean time taken from catheter removal to discharge was 300.6 min in the filling group and 340.1 min in the control group. The filling group reduced the time to discharge by 39.5 min (P = 0.304). Furthermore, 2/27 and 2/25 patients in the filling and control groups, respectively, developed urinary retention after TOV and required re-catheterization prior to discharge. CONCLUSION: Bladder filling prior to TOV showed a non-statistically significant reduction in the time to discharge of 39.5 min. Despite the fact that bladder filling is a safe and cheap procedure, it cannot be recommended for use in an attempt to reduce time to discharge in an inpatient setting.

Chlorhexidine in urethral gel: does it cause pain at flexible cystoscopy?

OBJECTIVES: To investigate the effect of chlorhexidine gluconate in urethral local anesthetic gel on patients undergoing outpatient flexible cystoscopy. We postulated that chlorhexidine was contributing to the pain and urgency that occurs during and after cystoscopy. METHODS: A prospective randomized single-blinded study was conducted. A total of 141 patients undergoing outpatient flexible cystoscopy participated in the study. They were randomized to receive 10 mL of 2% lignocaine gel with 0.05% chlorhexidine gluconate (group 1, n = 72) or 10 mL of 2% lignocaine and aqueous gel mixture (group 2, n = 69). Pain scores were recorded on a numerical visual analog scale from 0 to 10. RESULTS: The groups were well matched for the purposes of comparison. The mean pain scores were not significantly different between groups 1 and 2 at the insertion of the scope (2.1 versus 2.2, P = 0.7), during cystoscopy (1.8 versus 1.9, P = 0.759), and immediately after cystoscopy (1.4 versus 0.8, P = 0.06). However, a significant difference was found in the mean pain scores between groups 1 and 2 during the first void (1.8 versus 1.0, P = 0.031) and after the first void (2.4 versus 1.2, P = 0.007). A significant increase occurred in the reported levels of urgency after cystoscopy in group 1 (P = 0.018). No difference was found in the level of culture-proven symptomatic infection. CONCLUSIONS: Chlorhexidine appears to contribute to significant levels of pain and urgency after outpatient flexible cystoscopy.

Allergy to chlorhexidine gluconate in urethral gel: report of four cases and review of the literature.

Chlorhexidine is a bis-biguanide molecule widely used in many preparations as a disinfectant and an antiseptic. We describe four confirmed cases of allergy to chlorhexidine gluconate in urethral gel and review the existing published reports. Pertinent issues in the treatment and investigation of these patients are discussed.