Construction of early warning classification of risk in bladder spasm and its intervention plans guided by the rate adjustment card of continuous bladder irrigation after transurethral resection of the prostate (TURP): development and usability study.

Background: Benign prostatic hyperplasia (BPH) is the most common benign disease causing voiding dysfunction in middle-aged and elderly men. the current "gold standard" for surgical treatment is transurethral resection of the prostate (TURP). Continuous bladder irrigation (CBI) is routinely given for 3 to 5 days after operation. However, this may induce bladder spasm. Bladder spasm not only brings physical and mental pain to patients, delaying the postoperative recovery process, but it also increases the medical economic burden. Therefore, it is important to take active measures to effectively warn and deal with bladder spasm. The color of the drainage fluid is an important indicator and requires close observation during CBI, as it can reflect real-time postoperative bleeding. When the color of drainage fluid is abnormal, effective measures should be undertaken. Grading nursing intervention divides patients into different conditions according to their possible changes, and then recommends targeted nursing intervention. Existing studies have formulated CBI programs from the perspective of quantifying the relationship between drainage fluid color and irrigation speed, but have yet to incorporate bladder spasm prevention and control levels or design corresponding grading nursing intervention programs according to different drainage fluid colors. This study aimed to construct the risk warning classification and intervention plan of bladder spasm under the guidance of CBI speed adjusting card after TURP. Methods: Based on the rate adjustment card of CBI after TURP, we formulated the first draft of an early warning classification of risk in bladder spasm and its intervention plans by combining methods suggested from a literature search with semi-structured interviews and results from 2 rounds of correspondence inquiries with 28 experts by the Delphi method. We further screened and revised grading standards and measures. Results: The positive coefficients of experts in 2 rounds of correspondence inquiries were both 100%, the authority coefficients were both 0.952, and the Kendall harmony coefficients were 0.238 and 0.326, respectively (P<0.01). In the second round of correspondence inquiries, the coefficient of variation of expert opinions was 0.000-0.154, and the coefficient of variation of all items was <0.25. Finally, a 3-level risk warning classification standard and 23 nursing measures for CBI complicated by bladder spasm was constructed. Conclusions: The early warning classification of risk in bladder spasm and its intervention plans guided by rate adjustment card of CBI after TURP are scientific and feasible, and can provide a basis and guidance for effective and standardized CBI in patients after TURP.

Construction of pelvic floor muscle rehabilitation training program for patients undergoing laparoscopic radical prostatectomy.

Background: Laparoscopic radical prostatectomy (LRP) is the standard treatment for early localized PCa, of which urinary incontinence is the most common postoperative complication. Pelvic floor muscle rehabilitation training is recognized as the first line of intervention measures, but the existing rehabilitation training programs are not clear in the formulation process, the content is not unified, and the clinical operability is not strong. In order to better guide clinical pelvic floor muscle rehabilitation training after LRP and prevent and control urinary incontinence, this study constructed a pelvic floor muscle rehabilitation training program for LRP patients. Methods: Literature analysis, qualitative interview, and an expert group meeting method were used to form the draft of pelvic floor muscle rehabilitation training program for LRP patients. On this basis, after 2 rounds of Delphi expert consultation, the research team modified and improved the program. Results: The consultation experts involved in the 2 rounds were the same, 15 questionnaires were sent out, and 15 were recovered with an effective recovery of 100%. The expert authority coefficient was 0.87. In the second round of consultation, Kendall's harmony coefficient was 0.14 (P<0.001), the mean coefficient of variation of expert opinion was 0.07 (P<0.001), and the mean value of importance assigned to each item was 4.53-5.00 points. Finally, the pelvic floor muscle rehabilitation training program for LRR patients was formed. Including rehabilitation training evaluation, rehabilitation training advanced time and content, rehabilitation training form of three first-level indicators, 12 second-level indicators, 53 third-level indicators. Conclusions: The pelvic floor muscle rehabilitation training program for LRP patients developed in this study is scientific, reliable, safe and feasible, which can provide reference for clinical pelvic floor muscle rehabilitation training after LRP and prevention and control of urinary incontinence.

Construction of a nursing solution to prevent and control urinary tract infection in the early stages of kidney transplantation.

BACKGROUND: To construct a nursing solution for the prevention and control of urinary tract infection (UTI) in the early stage after kidney transplantation, and to provide systematic and standardized nursing intervention measures for patients in the early stage after kidney transplantation. METHODS: The preliminary draft of intervention plan was formulated based on risk factor analysis research results of early UTI after kidney transplantation, combined with theoretical research, literature review, and research group meeting. The Delphi method was used to consult 15 experts for two rounds, and the entries were modified according to the opinions of the experts. RESULTS: After two rounds of consultation, the expert opinions tended to be consistent, and expert authority coefficient was 0.87. The Kendall harmony coefficient of importance and feasibility indexes of the two rounds of consultation were 0.407, 0.651 and 0.545, 0.686, respectively, with statistically significant differences (P<0.001). The nursing solution consisted of eight first-level indexes and 35 second-level indexes. The eight first-level indexes included admission symptom evaluation, UTI monitoring, health education, sports intervention, nutrition intervention, ward management, risk factor prevention and nursing, and psychosocial intervention. CONCLUSIONS: This study constructed a scientific and reliable nursing solution for the prevention and control of early UTI after kidney transplantation, which is hugely important for guiding clinical nursing work.

Hypoxia induces apoptosis of mouse spermatocyte GC-2 cells through activation of autophagy.

The aim of this study was to investigate the underlying mechanisms of hypoxia-induced apoptosis of GC-2spd (GC-2) cells. The GC-2 cells were treated with or without hypoxia for 12, 24, 48, and 72 h. Apoptosis of GC-2 cells was detected using TUNEL and flow cytometry. Fluorescence microscopic was used to observe the autophagy of GC-2 cells. Hypoxia-inducible factor-1alpha (HIF-1α), apoptosis-related protein and marker protein of autophagy levels were measured by Western blotting. Hypoxia induced apoptosis and autophagy of GC-2 cells, and increased expression of HIF-1α, LC3-II, Beclin-1, and pro-apoptotic protein, but reduced p62 and anti-apoptotic protein level. Meanwhile, hypoxia-induced HIF-1α mediated expression of apoptosis and autophagy-related protein in GC-2 cell. Furthermore, autophagy regulated hypoxia-induced apoptosis of GC-2 cell. Our data suggest that hypoxia induces apoptosis of GC-2 cell by activation of autophagy involving activation of the apoptosis signaling pathway under the hypoxic condition.