Risk factors of video urodynamics and bladder management for long-term complications in patients with chronic spinal cord injury.

This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.

The Impact of Urinary Catheterization on the Antibiotic Susceptibility of ESBL-Producing Enterobacterales: A Challenging Duo.

INTRODUCTION: Antimicrobial resistance (AMR) is currently a growing concern among healthcare providers, underscoring the importance of describing the regional susceptibility profile for common microorganisms that are associated with urinary tract infections (UTIs). This knowledge serves as the foundation for proper empirical therapeutic recommendations tailored to local susceptibility patterns. RESULTS: We found a high prevalence of ESBL-producing strains (36.9%), with Escherichia coli and Klebsiella spp. being the most prevalent isolated bacteria. Among the catheterized patients, Klebsiella spp. emerged as the primary etiology, with a significant correlation between catheterization and Proteus spp. (p = 0.02) and Providencia stuartii (p < 0.0001). We observed significant correlations between urinary catheterization and older age (68.9 ± 13.7 years vs. 64.2 ± 18.1 years in non-catheterized patients, p = 0.026) and with the presence of an isolate with extensive drug resistance (p < 0.0001) or even pandrug resistance (p < 0.0001). Susceptibility rates significantly decreased for almost all the tested antibiotics during the study period. Notably, susceptibility was markedly lower among catheterized patients, with the most pronounced differences observed for carbapenems (59.6% versus 83.4%, p < 0.0001) and aminoglycosides (37.1% versus 46.9%, p = 0.0001). MATERIALS AND METHODS: We conducted a retrospective study analyzing the susceptibility profiles of 724 extended-spectrum beta-lactamases (ESBL)-producing Enterobacterales isolated from urine cultures. Our focus was on highlighting susceptibility profiles among isolates associated with urinary catheterization and assessing the shifts in the susceptibility rates over time. CONCLUSIONS: The constant rise in AMR rates among Enterobacterales presents significant challenges in treating severe infections, particularly among urinary catheterized patients. This trend leaves clinicians with limited or no effective treatment options. Consequently, the development and implementation of personalized treatment protocols are imperative to ensure efficient empirical therapies.

Evaluation of the use versus nonuse of urinary catheterization during laparoscopic adnexal surgery: A randomized controlled trial.

We conducted a randomized controlled trial to assess the feasibility and safety of performing gynecological single-port transumbilical laparoscopic-assisted adnexal surgery without urethral catheterization in a day surgery setting. A total of 153 patients with adnexal disease were enrolled in this prospective randomized controlled trial (RCT). All subjects performed single-port transumbilical laparoscopic-assisted adnexal surgery between March 2021 and July 2022 in a day surgery center. After completion of the baseline survey, participants were randomized into one of three groups. Participants were randomized into one of three groups: uncatheterized (n = 51), intermittent catheterized (n = 51), or indwelling catheterized (n = 51). The primary outcomes were the incidence of lower urinary tract symptoms (LUTS) and microscopic hematuria, and the secondary outcomes included the incidence of urinary tract infection (UTI), the incidence of urinary retention, the incidence of bladder injury, the time till first urination, the time till first ambulation, the time till first exhaust, the time till first feeding and Kolcaba comfort score. The incidence of postoperative LUTS in the uncatheterized group (17.65%) was lower than that in the intermittent catheterized group (52.94%) and the indwelling catheterized group (84.31%), and there was significant difference between the two catheterized groups (P < 0.001). In the patients without vaginal manipulation, the incidence of microscopic hematuria in the uncatheterized group (0%) was lower than that in the intermittent catheterized group (37.50%) and the indwelling catheterized group (38.89%) (P < 0.05). There were no significant differences in the first urination time, first ambulation time, first exhaust time, first feeding time, and comfort score among the three groups (P > 0.05). Moreover, no urinary retention, UTI and bladder injury were recorded in the three groups. Gynecological single-port laparoscopic adnexal surgery without urinary catheter is safe and feasible in a day surgery ward, which can reduce the incidence of postoperative LUTS and microscopic hematuria.

A catheterizable serous-lined urinary outlet associated with the ileal bladder augmentation Abol-Enein and Ghoneim procedure: a safe and reliable procedure in children.

Purpose: This study aims to evaluate the long-term outcome of the serous-lined extramural continent catheterizable outlet procedure (SLECCOP) associated with ileal bladder augmentation in children. Methods: This was a monocentric and retrospective study (2002-2021) that included children (<18 years) undergoing the SLECCOP associated with W-shaped ileocystoplasty with a catheterizable channel (Abol-Enein and Ghoneim procedure). Patients who received other types of bladder augmentation or W-shaped ileocystoplasty without a catheterizable channel were excluded. Patient records were reviewed for demographic information, surgical data, and long-term outcomes. Results: This study included 52 children [33 boys, median age: 8.5 (0.8-18) years]. Pathological conditions included 28 children with the bladder exstrophy and epispadias complex (BEEC), 11 with neurogenic bladders, and 13 with other pathologies. Two patients underwent total bladder substitution. Thirty-four (65%) patients had bladder neck reconstruction (BNR), with 23 undergoing the SLECCOP and ileocystoplasty and 11 having prior BNR. All stomas, except for two, were umbilical, and were associated with omphaloplasty in 28 patients with the BEEC. A total of 40 stomas were created using the appendix (77%) and 12 with a Monti tube (23%). Stoma-related complications included cutaneous strictures (n = 2, 4%) and leaks (n = 10, 19%), all treated by dextranomer/hyaluronic acid copolymer injection (n = 10). A redo surgery was required in three patients: extraserosal wrapping was performed for persistent leakage (n = 2, 4%), and surgical revision was required for the Monti tube procedure (n = 1, 2%). Three patients (6%) underwent dilatation for transient stoma stenosis. Leakage occurred in 20% of appendix channels (n = 8/40) and 17% of Monti tubes (n = 2/12). Strictures were reported in 3% of appendix channels (n = 1/40) and 8% of Monti tubes (n = 1/12). Bladder stones developed in four patients (8%). Channel leakage persisted in one patient (2%) at a median follow-up of 4.4 years (IQR 1.4-9.7). Conclusion: W-Ileal bladder augmentation with the SLECCOP is an efficient technique for treating children with incontinence caused by different etiologies. The rate of channel complication is very low, specifically for strictures, in this complex population of patients.

Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters.

BACKGROUND: Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes. METHODS: Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios. RESULTS: In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections. CONCLUSIONS: The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.

The color purple: Purple urine bag syndrome: Identifying the phenomenon to ease unnecessary anxiety, fear, and distress.

OBJECTIVES: Purple urine bag syndrome (PUBS) is a condition that causes an intense purple discoloration of the urine, predominately in frail, dependent, and bedridden persons who are chronically catheterized and have urinary tract infections. Despite being considered a benign syndrome, PUBS can cause great anxiety, fear, and distress in health professionals, chronically ill persons, and caregivers or family members who provide care. METHODS: We report the case of a 98-year-old institutionalized woman with Alzheimer's dementia with a long-term urinary catheter who developed PUBS. RESULTS: Although alarming and distressing for the resident and the health-care team, PUBS was resolved by treating the underlying urinary tract infection and applying good genital hygiene and catheter replacement. SIGNIFICANCE OF RESULTS: Identifying PUBS and its clinical features and management proved to be significantly helpful in ameliorating the anxiety, fear, and distress around the phenomenon.

Cateterismo urinário e as técnicas para prevenção de hematúria: revisão integrativa / Cateterismo urinario y las técnicas para prevención de hematuria: revisión integradora / Urinary catheterization and techniques for preventing hematuria: integrative review

Resumo Objetivo Analisar e sintetizar as evidências científicas disponíveis sobre o cateterismo urinário e as técnicas utilizadas para prevenir a hematúria no esvaziamento da bexiga, na retenção urinária aguda e crônica, em adultos e idosos. Métodos Revisão integrativa realizada nas bases de dados Pubmed, LILACS, Embase, Cochrane, Web of Science e Scopus; e busca manual nas listas de referências dos estudos incluídos. Um período ilimitado foi usado para revisar estudos em português, inglês, francês, alemão e espanhol. Aplicado estratégia PICOS na elaboração da pergunta de pesquisa e instrumento Joanna Briggs Institute (JBI) para avaliar qualidade metodológica dos estudos. Resultados Foram incluídos 11 estudos, com um total de 659 pacientes. A retenção urinária ocorreu principalmente em homens, tendo como principal causa a hiperplasia prostática benigna. As técnicas utilizadas para descompressão vesical, por cateterismo urinário, foram a descompressão rápida e a gradual, sendo as principais complicações, independente da técnica, hematúria e hipotensão. Os resultados mostraram que não houve diferença significativa entre as duas técnicas quanto ao desfecho prevenção da hematúria. Conclusão O esvaziamento gradual da bexiga não previne a hematúria em comparação com o esvaziamento rápido e completo. Mas os estudos, principalmente os relatos de casos, descrevem quadros clínicos que merecem atenção diante da ocorrência de hematúria após cateterismo urinário e as implicações no tratamento dos pacientes. Destaca a importância da enfermagem na identificação e prevenção do diagnóstico de Retenção Urinária, a fim de evitar intervenções posteriores e complicações clínicas, inclusive hematúria pós-cateterismo.

Resumen Objetivo Analizar y sintetizar las evidencias científicas disponibles sobre el cateterismo urinario y las técnicas utilizadas para prevenir la hematuria en el vaciado de la vejiga, en la retención urinaria aguda y crónica en adultos y personas mayores. Métodos Revisión integradora realizada en las bases de datos Pubmed, LILACS, Embase, Cochrane, Web of Science y Scopus y búsqueda manual en las listas de referencias de los estudios incluidos. Se utilizó un período ilimitado para revisar estudios en portugués, inglés, francés, alemán y español. Se aplicó la estrategia PICOS en la elaboración de la pregunta de investigación y el instrumento Joanna Briggs Institute (JIB) para evaluar la calidad metodológica de los estudios. Resultados Se incluyeron 11 estudios con un total de 659 pacientes. La retención urinaria ocurrió principalmente en hombres, principalmente a causa de la hiperplasia prostática benigna. Las técnicas utilizadas para la descompresión vesical por cateterismo urinario fueron la descompresión rápida y la gradual, y las principales complicaciones, independientemente de la técnica, fueron hematuria e hipotensión. Los resultados mostraron que no hubo diferencia significativa entre las dos técnicas respecto al resultado de prevención de la hematuria. Conclusión El vaciado gradual de la vejiga no previene la hematuria en comparación con el vaciado rápido y completo. Sin embargo, los estudios, principalmente los relatos de casos, describen cuadros clínicos que necesitan atención ante los episodios de hematuria después del cateterismo urinario y las consecuencias en el tratamiento de los pacientes. Se destaca la importancia de la enfermería en la identificación y prevención del diagnóstico de retención urinaria, a fin de evitar intervenciones posteriores y complicaciones clínicas, inclusive hematuria poscateterismo.

Abstract Objective Analyze and synthesize the available scientific evidence on urinary catheterization and techniques used to prevent hematuria in bladder emptying and acute and chronic urinary retention in adults and the elderly. Methods This integrative review was carried out in the PubMed, LILACS, Embase, Cochrane, Web of Science, and Scopus databases. Hand searching was used in the reference lists of included studies. An unlimited period was used to review the studies published in Portuguese, English, French, German, and Spanish. The PICOS strategy was applied to develop the research question and the Joanna Briggs Institute (JBI) instrument was used to assess the methodological quality of studies. Results Eleven studies were included, with a total of 659 patients. Urinary retention occurred mainly in men and the main cause was benign prostatic hyperplasia. Rapid and gradual decompressions were the techniques used for bladder decompression by urinary catheterization, and hematuria and hypotension were the main complications regardless of the technique. The results showed that there was no significant difference between the two techniques in terms of the outcome of hematuria prevention. Conclusion Gradual bladder emptying does not prevent hematuria compared to rapid and complete emptying. Case reports describe clinical conditions that deserve attention when hematuria occurs after urinary catheterization and the respective implications in the treatment of patients. We highlight the importance of nursing in identifying and preventing the diagnosis of Urinary Retention to avoid subsequent interventions and clinical complications, including post-catheterization hematuria.

Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort.

Objectives: Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. Design and methods: For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Results: Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. Conclusion: CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.

Urinary catheterization of patients with acute heart failure in a hospital emergency department: a factor associated with prognosis. / El sondaje vesical de los pacientes con insuficiencia cardiaca aguda en un servicio de urgencias hospitalario se asocia al pronóstico.

OBJECTIVES: To analyze whether urinary catheterization in a hospital emergency department (ED) affects short-term prognosis in patients with acute heart failure (AHF). MATERIAL AND METHODS: We prospectively recorded baseline and other clinical data in a consecutive cohort of ED patients treated for AHF. Crude and adjusted associations were calculated between catheterization and a primary composite outcome (30-day readmission for AHF and/or death) and secondary outcomes (in-hospital mortality, urinary tract infection [UTI], and duration of hospital stay.). RESULTS: Nine hundred ninety-one patients were admitted for AHF. The mean (SD) age was 66 (10.5) years; 71% were women. Catheterization was required for 29.2% in the ED. The primary composite outcome was observed in 7.7% of the patients who were not catheterized and 12.8% of the catheterized patients (P = .02). In-hospital mortality occurred in 5.9% and 9.7% of non-catheterized and catheterized patients, respectively (P = .04), and UTIs occurred in 19.1% and 26.6% (P = .01). Twelve of the non-catheterized patients (1.7%) were readmitted for AHF (vs 11 (3.8%) of the catheterized patients (P = .06), and there were no differences between the groups in hospital stay (11 vs 10.9 days, P = .78). In the adjusted analysis of associations between catheterization and the primary outcome the odds and hazard ratios (OR and HR, respectively) were OR, 1.7 (95% CI, 1.1-2.7) (P = .02) and HR, 1.6 (95% CI, 1.1-2.5) (P = .03). For secondary outcomes, significant associations emerged between catheterization and UTIs (OR, 1.8 [95% CI, 1.1-2.2]; P = .008) and readmission for AHF (OR, 2.9 [95% CI, 1.2-7.3]; P = .02). CONCLUSION: Routine insertion of a urinary catheter in patients with AHF in the ED is associated with worse 30-day clinical outcomes.

OBJETIVO: Analizar si el sondaje vesical (SV) rutinario en un servicio de urgencias hospitalario (SUH) de pacientes diagnosticados de insuficiencia cardiaca aguda (ICA) está asociado con la evolución a corto plazo. METODO: Se recogieron prospectivamente datos basales y clínicos de una cohorte de pacientes consecutivos que ingresaron por ICA. Se analizó la asociación cruda y ajustada del SV con el evento combinado de muerte o reingreso por insuficiencia cardiaca a 30 días (objetivo primario), así como mortalidad intrahospitalaria, infección del tracto urinario (ITU) y estancia hospitalaria (objetivos secundarios). RESULTADOS: Se incluyeron 991 pacientes hospitalizados por ICA, la edad media fue de 66 años (DE 10,5) y el 71% fueron mujeres. Un 29,2% de los pacientes requirieron SV en el SUH. El evento combinado fue del 7,7% para el grupo no SV y 12,8% para grupo SV (p = 0,02); mortalidad intrahospitalaria fue del 5,9% en el grupo no SV y 9,7% en el grupo SV (p = 0,04); se diagnosticó ITU en el 19,1% de pacientes en el grupo no SV y en el 26,6% en el grupo SV (p = 0,01). A 30 días, 12 pacientes (1,7%) reingresaron por insuficiencia cardiaca en el grupo no SV versus 11 (3,8%) pacientes en el grupo SV (p = 0,06). No hubo diferencias en la estancia hospitalaria (11 versus 10,9 días); p = 0,78). En el análisis ajustado, el SV se asoció con el objetivo primario; [OR = 1,7 (IC 95%: 1,1-2,7; p = 0,02); HR = 1,6 (IC 95%: 1,1-2,5; p = 0,03)]; con la ITU (OR = 1,8; IC 95%: 1,1­2,2; p = 0,008) y con el reingreso por insuficiencia cardiaca (OR = 2,9; IC 95%: 1,2-7,3; p = 0,02). CONCLUSIONES: La inserción rutinaria del SV en el SUH en pacientes con ICA se asoció a peores resultados clínicos a los 30 días.

Uso de la ultrasonografía en la evaluación de la retención urinaria en pacientes críticos / Use of ultrasonography in the evaluation of urinary retention in critically ill patients / Utilização da ultrassonografia na avaliação de retenção urinária em pacientes críticos

Objetivo: medir el volumen urinario por medio de la ecografía vesical, realizado por una enfermera en pacientes críticos, después de la retirada de la sonda urinaria permanente y verificar los factores relacionados en la retención urinaria. Método: estudio cuantitativo, observacional y transversal, realizado con 37 pacientes críticos de ambos sexos, mayores de 18 años, con retiro de catéter vesical permanente en las últimas 48 horas. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Se utilizó un cuestionario con variables sociodemográficas y clínicas y el examen ecográfico. Los datos fueron presentados a través de distribución de frecuencias, medidas de centralidad y variabilidad, asociación mediante la prueba exacta de Fisher y, para el análisis, regresión logística binomial múltiple. Resultados: de los 37 pacientes, en su mayoría fue de sexo masculino, con una edad média de 54,9 años. La medición del volumen urinario por ecografía osciló entre 332,3 y 950 ml, y el 40,54% de los pacientes presentó retención urinaria. La retención urinaria se asoció significativamente a la aparición de infección urinaria, estreñimiento intestinal y diuresis por rebosamiento espontáneo. Los pacientes con infección del tracto urinario tenían 7,4 veces más probabilidades de tener retención urinaria. Conclusión: la ecografía vesical fue eficaz para medir el volumen urinario después de retirar el catéter urinario permanente y puede contribuir a la detección de retención urinaria.

Objective: to measure urinary volume through bladder ultrasound, performed by a nurse in critically ill patients, after removal of the indwelling urinary catheter and to verify the related factors on urinary retention. Method: quantitative, observational and cross-sectional study, carried out with 37 critically ill patients of both sexes, over 18 years of age, with removal of indwelling urinary catheter in the last 48 hours. A questionnaire containing sociodemographic and clinical variables and an ultrasound examination were used. Data were presented through frequency distribution, centrality and variability measures, association using Fisher`s exact test and, for analysis multiple binomial logistic regression analysis. Results: the 37 patients were mostly male, with a mean age of 54.9 years. The measurement of urinary volume by ultrasound ranged from 332.3 to 950 ml, and 40.54% of patients had urinary retention. Urinary retention was significantly associated with the occurrence of urinary tract infection, intestinal constipation and spontaneous overflow diuresis. Patients with urinary tract infection were 7.4 times more likely to have urinary retention. Conclusion: bladder ultrasonography was effective in measuring urinary volume after removal of the indwelling urinary catheter and and may contribute to the detection of urinary retention.

Objetivo: mensurar o volume urinário por meio da ultrassonografia de bexiga, realizada por enfermeiro em pacientes críticos, após a remoção do cateter vesical de demora, e verificar os fatores relacionados na retenção urinária. Método: estudo quantitativo, observacional e transversal, realizado com 37 pacientes críticos de ambos os sexos, idade superior a 18 anos, com retirada de cateter vesical de demora nas últimas 48 horas. Foram utilizados um questionário contendo as variáveis sociodemográficas e clinicas e o exame de ultrassonografia. Os dados foram apresentados por meio da distribuição de frequência, medidas de centralidade e de variabilidade, associação pelo teste exato de Fisher e, para análise a regressão logística binomial múltipla. Resultados: dos 37 pacientes, a maioria era do sexo masculino, com média de idade de 54,9 anos. A mensuração do volume urinário pela ultrassonografia variou de 332,3 a 950 ml, sendo que 40,54% dos pacientes apresentaram retenção urinária. A retenção urinaria apresentou associação significativa para a ocorrência de infecção do trato urinário, constipação intestinal e diurese espontânea por transbordamento. Pacientes com infecção urinária tiveram 7,4 vezes mais chance de apresentar retenção urinária. Conclusão: ultrassonografia de bexiga foi eficaz para mensurar o volume urinário após a remoção do cateter vesical de demora e poderá contribuir na detecção da retenção urinária.

Inguinal Bladder Hernia Indirectly Treated With Prostate Artery Embolization.

An inguinal bladder hernia (IBH) is an abnormal protrusion of the bladder into the inguinal canal accompanied by a peritoneum sheath that creates the hernia sac. Clinical presentations vary greatly from lower urinary tract symptoms (LUTS) and reduction in scrotal size after voiding to being entirely asymptomatic. Since inguinal bladder hernias are uncommon and often accompanied by varied and nonspecific symptoms, it is challenging to diagnose and rarely included in differentials. Currently, computerized tomography (CT) imaging with contrast or voiding cystourethrography is recommended for diagnosis. There is no consensus on the best treatment for inguinal bladder hernias, with options ranging from laparoscopic repair to catheterization. In this study, we report the case of inguinal bladder hernia in an 86-year-old male presenting with symptoms of recurrent hematuria and two failed voiding trials after a Foley catheter placement from prostatomegaly resulting in bladder diverticula, and IBH. He was treated with prostate artery embolization (PAE) to address LUTS related to benign prostatic hyperplasia (BPH). The resultant decreased prostatic volume resolved his symptoms of IBH, hematuria, and urinary retention.

Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center.

Background: Purple urine bag syndrome (PUBS) is an unusual condition in which a purple discoloration of urine and bag occurs in people with urinary catheters. People with purple urine usually do not complain of any symptoms. The purple discoloration of the urine bag is often the only finding, frequently noted by caregivers. Materials and methods: This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020. A total of 46 patients with PUBS were included in this study. The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested. Results: The mean age of PUBS patients was 67.4years and 67.4% were males. Most patients of PUBS (60.9%) had a urethral catheter, while there was percutaneous nephrostomy in 26.1% patients and 13% patients had a percutaneous suprapubic cystostomy catheter. Among the patients, 69.65% were bedridden or in an institutionalized situation, 73.9% were suffering from chronic constipation, 21.7% were associated with dementia, and 47.8% were cerebrovascular accidents with hemiparesis patients. In addition, 93.5% of patients presented with alkaline urine and 3 patients with acidic urine. The most common bacteria isolated in urine culture were E coli and Pseudomonas. Conclusions: Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females, but our study showed that it is more common in males. The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method. In addition, no correlation was found between the microorganisms isolated from the environment and patients' urine.

Purple Urine Bag Syndrome in Urinary Tract Infection.

Purple urine bag syndrome (PUBS) is an unusual manifestation of urinary tract infection, characterized by purple discoloration of urine. Due to its rarity, it can be challenging for some physicians to manage it properly. In addition, its striking appearance can cause concern to some patients. This condition usually occurs in the debilitated geriatric population with prolonged use of an indwelling urinary catheter. However, our case highlights the development of PUBS in a young adult with a relatively short period of urinary catheterization.

Can antibiotics for enteritis or for urinary tract infection disrupt the urinary microbiota in rats?

Background: To establish antibiotic preregimes and administration routes for studies on urinary microbiota. Methods and materials: Antibiotics for enteritis (Abx-enteritis) and UTIs (Abx-UTI) were administered via gavage and/or urinary catheterisation (UC) for 1 and/or 2 weeks. The effects of these Abx on the urinary microbiota of rats were examined via 16S rRNA sequencing and urine culture, including anaerobic and aerobic culture. Additionally, the safety of the Abx was examined. Results: Abx-enteritis/Abx-UTI (0.5 g/L and 1 g/L) administered via gavage did not alter the microbial community and bacterial diversity in the urine of rats (FDR > 0.05); however, Abx-UTI (1 g/L) administered via UC for 1 and 2 weeks altered the urinary microbial community (FDR < 0.05). Rats administered Abx-UTI (1 g/L) via UC for 1 week demonstrated a distinct urinary microbiota in culture. Abx-enteritis/Abx-UTI administered via gavage disrupted the microbial community and reduced bacterial diversity in the faeces of rats (FDR < 0.05), and Abx-UTI administered via UC for 2 weeks (FDR < 0.05) altered the fecal microbiota. Abx-UTI (1 g/L) administered via UC did not alter safety considerations. In addition, we noticed that UC did not induce infections and injuries to the bladder and kidney tissues. Conclusions: Administration of Abx-UTI via UC for 1 week can be considered a pre-treatment option while investigating the urinary microbiota.

Urinary tract infection is associated with 2.4-fold increased risk of surgical site infection in hip fracture surgery: systematic review and meta-analysis.

BACKGROUND: There is no consensus regarding whether urinary tract infection (UTI) should be screened for or treated in hip fracture patients. AIM: To assess the relationship between perioperative UTI and surgical site infection (SSI) in hip fracture patients, and the relationship between urinary catheterization and SSI in these patients. METHODS: PubMed, Embase, CINAHL and Cochrane Library were searched to identify studies that evaluated the relationship between perioperative UTI and SSI and/or between urinary catheterization and SSI. Articles were included if they used the term UTI or specified UTI as symptomatic bacteriuria. FINDINGS: A total of 4139 records were identified, with eight studies included. Meta-analysis of seven studies which evaluated perioperative UTI and SSI showed an SSI rate of 7.1% (95% confidence interval (CI): 3.8-13.2) among 1217 patients with UTI vs 2.4% (95% CI: 1.0-5.7) in 36,514 patients without UTI (OR: 2.41; 95% CI: 1.67-3.46; P < 0.001). In three studies which specifically defined UTI as symptomatic bacteriuria, the SSI rate among UTI patients was 5.7% (95% CI: 4.0-8.1) vs 1.1% (95% CI: 0.2-5.2) in those without UTI (OR: 3.00; 95% CI: 0.55-16.26; P = 0.20). One study evaluated urinary catheterization and SSI. CONCLUSION: Perioperative UTI is associated with a higher risk of SSI among hip fracture patients but the evidence is limited by the heterogeneity in the definition of UTI. We recommend considering the possibility of perioperative UTI in hip fracture patients, with treatment administered as necessary to reduce SSI rates.

Síndrome de la bolsa de orina púrpura

Introducción: El síndrome de la bolsa orina púrpura es una condición llamativa, que rara vez se presenta en la práctica clínica. Aparece en el contexto de infecciones urinarias en ancianos, pluripatológicos, con sonda vesical y factores de riesgo asociados. Se produce por una reacción química entre la orina, el material plástico de la bolsa colectora y enzimas sulfatasas/fosfatasas de bacterias que generan el color violáceo característico. Objetivo: Reportar un caso con síndrome de la bolsa orina púrpura, como forma de presentación inusual de infección urinaria. Caso Clínico: Paciente femenina, de 76 años de edad, con antecedentes de constipación habitual, acudió a urgencias por pérdida del conocimiento y hemiparesia derecha. Se realizó tomografía axial computarizada de cráneo y se diagnosticó una enfermedad cerebrovascular. Como parte de la conducta se indicó sonda vesical y 14 días después apareció orina de color violeta en la bolsa colectora. Se diagnosticó infección urinaria por Escherichia coli y se trató con ceftriaxona. Se normalizó el color de la orina al tercer día de tratamiento, la paciente evolucionó de forma favorable. Conclusiones: Aunque se puede identificar con facilidad, sin requerir exámenes costosos, constituye un reto para los médicos que atienden a pacientes geriátricos. Conocer este trastorno es fundamental, porque, aunque es infrecuente, puede ser la única manifestación de infección urinaria en pacientes con cateterismo uretral.

Introduction: Purple urine bag syndrome is a striking condition that rarely occurs in clinical practice. It appears in the context of urinary infections in the elderly, with multiple pathologies, with a bladder catheter and associated risk factors. It is produced by a chemical reaction between urine, the plastic material of the collection bag and sulfatase/phosphatase enzymes from bacteria that generate the characteristic purple color. Objective: To report a case with purple urine bag syndrome as an unusual presentation of urinary tract infection. Clinical Case: Female patient, 76 years old, health history, usual constipation, attended at Emergency due to loss of consciousness and right hemiparesis. Computed axial tomography of the skull was performed and a cerebrovascular disease was diagnosed. As part of the conduct, a bladder catheter was indicated and after 14 days, purple urine appeared in the collection bag. Urinary infection due to Escherichia coli was diagnosed and treated with ceftriaxone, normalizing the color of the urine on the third day of treatment, with patient favorable evolution. Conclusions: Although it can be easily identified and without requiring costly tests, it is a challenge for physicians who care for geriatric patients. Knowing this disorder is essential because, although rare, it may be the only manifestation of urinary infection in patients with urethral catheterization.

Diagnóstico y tratamiento de pacientes con vejiga neurogénica en la Unidad Técnica de Cirugía Pediátrica / Diagnosis and treatment of patients with Neurogenic bladder in the Surgery Technical Unit Pediatric

El presente trabajo toma como base el documento: "Manejo Urológico del Mielomeningocele" de las Guías de Atención Pediátrica, del Hospital De Pediatría "Juan P. Garrahan" de la ciudad de Buenos Aires - Argentina; de los autores: Dra. Carol Burek y Dra. Liliana Campmany. En la Unidad Técnica de Cirugía Pediátrica del Hospital de Especialidades Carlos Andrade Marín, se atienden por mes unos 50 a 70 pacientes afectos de vejiga neurogénica desde el nacimiento hasta la adolescencia. Es una enfermedad crónica que requiere un diagnóstico correcto con estudios de imagen y función de la vía urinaria además de un posterior manejo diario por parte de los padres con la guía del médico especialista.

This work is based on the document: "Urological Management of Myelomeningocele" from the Pediatric Care Guidelines of the Hospital De Pediatría "Juan P. Garrahan" of the city of Buenos Aires - Argentina; by the authors: Dr. Carol Burek and Dr. Liliana Campmany. In the Pediatric Surgery Technical Unit of the Carlos Andrade Marín Specialties Hospital, 50 to 70 patients affected by neurogenic bladder from birth to adolescence are treated every month. It is a chronic disease that requires a correct diagnosis with imaging and urinary tract function studies, as well as subsequent daily management by the parents under the guidance of the specialist.

Efficacy of IM dexmedetomidine in alleviating catheter related bladder discomfort and postoperative inflammatory response following percutaneous nephrolithotomy. A prospective randomized controlled study.

Background and Aims: Catheter-related bladder discomfort (CRBD) causes significant distress to the patient and requires great attention to analgesia and increases morbidity in the postoperative period. This study evaluated the efficacy of intramuscular dexmedetomidine in alleviating CRBD following percutaneous nephrolithotomy (PCNL) and postoperative inflammatory response. Material and Methods: A prospective randomized double-blind study was conducted in a tertiary care hospital from December 2019- March 2020. Sixty seven of ASA I and II patients scheduled for elective PCNL were randomized and group I received 1 µg/kg dexmedetomidine intramuscularly and group II normal saline as control 30 minutes before induction of anesthesia. Standard anesthesia protocol was followed and patients were catheterized with 16 Fr Foleys after induction of anesthesia. Rescue analgesia was paracetamol if the score was moderate. Postoperatively CRBD score and inflammatory markers; total white cell count, erythrocyte sedimentation rate and temperature were noted for 3 days. Results: There was a significant low CRBD score in group I. Ramsay sedation score was 2 in group I with p 0.00 and rescue analgesia required was very low with p 0.00. Statistical Package for social Sciences software version 20 was used for analysis. Student ttest, analysis of variance, and Chisquare test were applied for quantitative and qualitative analysis respectively. Conclusion: Single dose intramuscular dexmedetomidine is effective, simple and safe in preventing the CRBD and the inflammatory response remained uninfluenced except ESR, the reason remains largely unknown.

Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures.

BACKGROUND/AIM: This study aimed to describe the voiding patterns of patients after surgical treatment of pelvic fractures and determine the predictive factors of lower urinary tract injuries (LUTIs) and spontaneous voiding failure among patients with surgically treated pelvic fractures at a tertiary trauma center in Japan. PATIENTS AND METHODS: We retrospectively assessed patients with surgically treated pelvic fractures in our tertiary trauma center during May 2009-April 2021. We excluded patients who died during hospitalization and who had indwelling catheter prior to the injury. Patients' LUTIs and spontaneous voiding failure at discharge were recorded. Multivariate analysis was performed to assess the predictive factors of LUTIs and spontaneous voiding failure at discharge. RESULTS: In total, 334 eligible patients were identified. Among them, 301 patients (90%) voided spontaneously with or without diapers at discharge. Thirty-three patients required some form of catheterization for bladder drainage. LUTIs were found to be associated with chronological age [odds ratio (OR)=0.96; 95% confidence interval (CI)=0.92-0.99; p=0.024] and pelvic ring fracture (OR=12.0; 95%CI=1.39-255.2; p=0.024). Spontaneous voiding failure was associated with intensive care unit admission (OR=7.17; 95%CI=1.49-34.4; p=0.004). CONCLUSION: Overall, 10% of patients with surgically treated pelvic fractures were not able to void spontaneously at discharge. Spontaneous voiding failure after pelvic fractures was related to injury severity.

A Prospective Multi-institutional Study Using a Novel Safety Valve for the Prevention of Catheter Balloon Inflation Injury of the Urethra.

PURPOSE: We prospectively assessed the ability of a novel transurethral catheterization safety valve to prevent urethral catheter balloon injury in a multi-institutional clinical setting. MATERIALS AND METHODS: A prospective, multi-institution study was conducted. The safety valve was introduced for urinary catheterization in 6 hospital groups (4 in Ireland; 2 in the UK). The safety valve allows fluid in the catheter system to vent through a pressure relief valve if attempted intraurethral inflation of the catheter's anchoring balloon occurs. Device usage was studied over a 12-month period, with data recorded using a 7-item data sticker containing a scannable QR code. "Venting" through the safety valve during catheterization was indicative of prevention of a urethral injury. An embedded 3-month study was conducted in 3 centers, with any catheter balloon injuries occurring during catheterization without safety valve use referred to the on-call urology team recorded. Health economic analyses were also performed. RESULTS: During the overall 12-month device study phase, 994 urethral catheterizations were performed across study sites. Twenty-two (2.2%) episodes of safety valve venting were recorded. No urethral injuries occurred in these patients. In the embedded 3-month study, 18 catheter balloon injuries were recorded in association with catheterizations performed without the safety valve. Based on confirmed and device-prevented urethral injuries, the injury rate for urethral catheterization without safety valve use was calculated to be 5.5/1,000 catheterizations. CONCLUSIONS: The safety valve has the potential to eliminate catheter balloon injury if widely adopted. It represents a simple, effective, and innovative solution to this recurring problem applicable to all patient cohorts.