Effect of Preoperative Double-J Ureteral Stenting before Flexible Ureterorenoscopy on Stone-free Rates and Complications.

The effect of preoperative Double-J (DJ) ureteral stenting before flexible ureterorenoscopy (FURS) in the treatment for urinary stones was evaluated. We retrospectively enrolled 306 consecutive patients who underwent FURS from Jan. 2014 to Dec. 2017. All the patients were classified into two groups according to whether they had DJ ureteral stenting before FURS. Baseline characteristics (age, sex, stone location, stone size, surgical success rate, operation time, stone-free rate of the first day after surgery, stone-free rate of the first month after surgery, total complication rate) were compared using Chi-square test for categorical variables and Kruskal-Wallis test for continuous variables. In total, 306 patients were included in this study. The group of DJ stenting before FURS included 203 (66.3%) patients, and non-DJ stenting before FURS was observed in 103 (33.7%) patients. The group of DJ stenting before FURS was significantly associated with a shorter operation time (53.8 vs. 59.3 min, P<0.001), a higher stone-free rate of the first day after surgery (69.0% vs. 51.5%, P=0.003). However, statistical significant differences were not found in the age, sex, stone location, stone size, surgical success rate, stone-free rate of the first month after surgery (89.2% vs. 81.6%, P=0.065) and total complication rate (5.4% vs. 9.7%, P=0.161) between the two groups. Preoperative DJ ureteral stenting before FURS could reduce the operation time and increase stone-free rate of the first day after surgery. However, it might not benefit the stone-free rate of the first month after surgery and reduce the complication rate. Preoperative DJ stenting should be not routinely performed.

Impact of an evidence-based intervention on urinary catheter utilization, associated process indicators, and infectious and non-infectious outcomes.

BACKGROUND: Multi-centre intervention studies tackling urinary catheterization and its infectious and non-infectious complications are lacking. AIM: To decrease urinary catheterization and, consequently, catheter-associated urinary tract infections (CAUTIs) and non-infectious complications. METHODS: Before/after non-randomized multi-centre intervention study in seven hospitals in Switzerland. Intervention bundle consisting of: (1) a concise list of indications for urinary catheterization; (2) daily evaluation of the need for ongoing catheterization; and (3) education on proper insertion and maintenance of urinary catheters. The primary outcome was urinary catheter utilization. Secondary outcomes were CAUTIs, non-infectious complications and process indicators (proportion of indicated catheters and frequency of catheter evaluation). FINDINGS: In total, 25,880 patients were included in this study [13,171 at baseline (August-October 2016) and 12,709 post intervention (August-October 2017)]. Catheter utilization decreased from 23.7% to 21.0% (P=0.001), and catheter-days per 100 patient-days decreased from 17.4 to 13.5 (P=0.167). CAUTIs remained stable at a low level with 0.02 infections per 100 patient-days (baseline) and 0.02 infections (post intervention) (P=0.98). Measuring infections per 1000 catheter-days, the rate was 1.02 (baseline) and 1.33 (post intervention) (P=0.60). Non-infectious complications decreased significantly, from 0.79 to 0.56 events per 100 patient-days (P<0.001), and from 39.4 to 35.4 events per 1000 catheter-days (P=0.23). Indicated catheters increased from 74.5% to 90.0% (P<0.001). Re-evaluations increased from 168 to 624 per 1000 catheter-days (P<0.001). CONCLUSION: A straightforward bundle of three evidence-based measures reduced catheter utilization and non-infectious complications, whereas the proportion of indicated urinary catheters and daily evaluations increased. The CAUTI rate remained unchanged, albeit at a very low level.

Effectiveness of silver alloy-coated silicone urinary catheters in patients with acute traumatic cervical spinal cord injury: Results of a quality improvement initiative.

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.

A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda.

BACKGROUND: Enhanced recovery after surgery (ERAS) expedites return to patient baseline and functional status by reducing surgical trauma, stress, and organ dysfunction. Despite the potential benefits of enhanced recovery protocols, limited research has been done in low-resource settings, where 95% of cesarean deliveries are emergent and could possibly benefit from the application of ERAS protocols. METHODS: In a prospective, randomized, single-blind, controlled trial, mothers delivering by emergency cesarean delivery were randomly assigned to either an ERAS or a standard of care (SOC) recovery arm. Patients in the ERAS arm were treated with a modified ERAS protocol that included modified counseling and education, prophylactic antibiotics, antiemetics, normothermia, restrictive fluid administration, and multimodal analgesia. They also received early initiation of mobilization, feeding, and urethral catheter removal. The primary end point was length of hospital stay. The secondary end points were complications and readmission rates. Mean length of stay in the intervention and control arms were compared using t tests. Statistical analyses were performed using STATA version 13 (College Station, TX). RESULTS: A total of 160 patients were enrolled in the study, with 80 randomized to each arm. There was a statistically significant shorter length of stay for the ERAS arm compared to SOC, with a difference of -18.5 hours (P < .001, 95% confidence interval [CI], -23.67, -13.34). The incidence of complications of severe pain and headache was lower in the ERAS arm compared to SOC (P = .001 for both complications). However, pruritus was more common in the ERAS arm compared to SOC (P = .023). CONCLUSIONS: Use of an ERAS protocol for women undergoing emergency cesarean delivery in a low-income setting is feasible and reduces length of hospital stay without generally increasing the complication rate.

Male External Catheter in Adults: a glance at nursing care practice.

OBJECTIVE: to describe the patients care in the use of the Male External Catheter in Adults in a clinical-surgical hospitalization unit. METHOD: a cross-sectional study. Evaluation of 30 patients hospitalized in clinical-surgical units to collect items related to the specific care provided. RESULTS: 100% had no reference to the use of external catheter in the evolution of the nurse; 43.3% of the assistants or technicians recorded; 36.6% presented skin lesions; 100% had a latex device attached with adhesive tape; 90% were not submitted to hair removal; 96.7% had daily genital hygiene; 70% received no guidance at all. CONCLUSION: no individualized evaluation was observed for the use of the device, nursing records did not include prescription and description of installation and care, latex device and micropore paper adhesive tape were predominant; skin lesions were prevalent, hygiene and exchange were adequate, few patients were advised regarding the use of the device.

Male External Catheter in Adults: a glance at nursing care practice / Cateter Urinario Externo Masculino: una mirada sobre la práctica asistencial de la Enfermería / Cateter Urinário Externo Masculino: um olhar sobre a prática assistencial da Enfermagem

ABSTRACT Objective: to describe the patients care in the use of the Male External Catheter in Adults in a clinical-surgical hospitalization unit. Method: a cross-sectional study. Evaluation of 30 patients hospitalized in clinical-surgical units to collect items related to the specific care provided. Results: 100% had no reference to the use of external catheter in the evolution of the nurse; 43.3% of the assistants or technicians recorded; 36.6% presented skin lesions; 100% had a latex device attached with adhesive tape; 90% were not submitted to hair removal; 96.7% had daily genital hygiene; 70% received no guidance at all. Conclusion: no individualized evaluation was observed for the use of the device, nursing records did not include prescription and description of installation and care, latex device and micropore paper adhesive tape were predominant; skin lesions were prevalent, hygiene and exchange were adequate, few patients were advised regarding the use of the device.

RESUMEN Objetivo: describir la asistencia a los pacientes en uso del Cateter Urinario Externo Masculino en una unidad de internación clínico-quirúrgica. Método: estudio transversal. Evaluación de 30 pacientes internados en unidades clínico-quirúrgicas para el levantamiento de ítems relacionados al cuidado específico prestado. Resultados: el 100% no tuvo referencia del uso de catéter externo en la evolución del enfermero; el 43,3% de los auxiliares o técnicos realizaron anotaciones; el 36,6% presentó lesión de la piel; el 100% estaba con dispositivo de látex fijado con cinta adhesiva; el 90% no fue sometido a la remoción de los pelos; el 96,7% realizó higiene genital diariamente; el 70% no recibió ningún tipo de orientación. Conclusión: no se observó una evaluación individualizada para el uso del dispositivo, los registros de Enfermería no contemplaron prescripción y descripción de instalación y cuidados; el dispositivo de látex y la cinta adhesiva microporosa fueron predominantes; las lesiones de la piel fueron prevalentes, la higiene y el cambio fueron adecuados, y pocos pacientes fueron orientados en cuanto al uso del dispositivo.

RESUMO Objetivo: descrever a assistência aos pacientes em uso do Cateter Urinário Externo Masculino em unidade de internação clínico-cirúrgica. Método: estudo transversal. Avaliação de 30 pacientes internados em unidades clínico-cirúrgicas para levantamento de itens relacionados ao cuidado específico prestado. Resultados: 100% não teve referência do uso de cateter externo na evolução do enfermeiro; 43,3% dos auxiliares ou técnicos realizaram anotação; 36,6% apresentaram lesão de pele; 100% estava com dispositivo de látex fixado com fita adesiva; 90% não foram submetidos à remoção dos pelos; 96,7% tiveram higiene genital diariamente; 70% não receberam nenhum tipo de orientação. Conclusão: não se observou avaliação individualizada para uso do dispositivo, os registros de enfermagem não contemplaram prescrição e descrição de instalação e cuidados, dispositivo de látex e fita adesiva microporosa foram predominantes; lesões de pele foram prevalentes, higiene e troca foram adequadas, poucos pacientes foram orientados quanto ao uso do dispositivo.

Antisepsia en la manipulación de las conexiones de los accesos vasculares / Antisepsis in the handling of vascular access connections

Los conectores sin aguja proporcionan puntos de acceso fácil al sistema vascular para la administración de fluidos, evitando riesgos de punción accidental y aumentando la seguridad en la manipulación del acceso vascular. Una manipulación no aséptica puede favorecer su contaminación, convirtiéndolos en puerta de entrada de contaminantes endoluminales con capacidad de desencadenar complicaciones infecciosas de graves consecuencias para el paciente. ave y evitable, es necesario incluir en los programas de prevención aquellas medidas que eviten factores predisponentes como serían el aumento de la capacitación del personal, el diseño seguro de los dispositivos, la mejora del procedimiento de desinfección y el uso óptimo del antiséptico. Monitorizar la aplicación de prácticas seguras y difundir los resultados es importante para promover la comprensión de riesgos y beneficios que comporta la descontaminación de las conexiones y mejorar así la seguridad de los pacientes

Needleless connectors provide easy access points to the vascular system for the administration of fluids, avoiding the risk of accidental punctures and increasing safety in vascular access manipulation. Non-aseptic manipulation can favor contamination, turning connectors into the penetration route for endoluminal contaminants with the capacity of triggering infectious complications, with serious consequences for the patient. Considering catheter-related bacteremia as a serious and avoidable adverse effect, prevention programs should incorporate measures to combat predisposing factors, such as improved staff training, the safe design of devices, improved disinfection procedures, and optimized antiseptic use. Monitoring adherence to safe practices and reporting results are important to promote understanding of the risks and benefits of decontaminating connections and thus to improve patient safety

Antisepsia en el sondaje urinario y en el mantenimiento de la sonda vesical / Antiseptic urinary catheterization and maintenance of the bladder catheter

La infección del tracto urinario asociada al catéter es muy común tanto en el entorno hospitalario comunitario como en el de agudos, especialmente en el ámbito de cuidados intensivos. Para minimizar este problema es esencial realizar un abordaje correcto desde la inserción del catéter urinario hasta la extracción del mismo y aplicar siempre medidas antisépticas adecuadas. Hay demasiada información sobre las medidas antisépticas sin resultados consistentes. Este artículo tiene como objetivo revisar la evidencia científica existente sobre el tema y hacer recomendaciones basadas en la evidencia, a fin de optimizar los resultados. Todo el proceso se complementa con algunas consideraciones para lograr un manejo adecuado del catéter urinario del paciente

Catheter-related urinary tract infections are very common both in the community and in the acute hospital care setting, particularly in the critical care environment. In order to minimize this problem, it is essential to adopt a correct approach from insertion to withdrawal of the urinary catheter, and always perform proper antisepsis. There is too much information on antisepsis measures with no consistent results. The present article reviews the existing scientific evidence on the subject and establishes recommendations based on the evidence, in order to optimize outcomes. The entire process is complemented with considerations on how to secure proper management of the indwelling urinary catheter

Social Determinants of Health in the lives of urinary catheter users.

OBJECTIVE: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. METHOD: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. RESULTS: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. CONCLUSION: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

Social Determinants of Health in the lives of urinary catheter users / Determinantes Sociales de Salud en la vida de usuarios de cateterismo urinario / Determinantes Sociais de Saúde na vida de usuários de cateterismo urinário

ABSTRACT Objective: To identify the influence of social determinants of health on the life conditions of patients who use intermittent urinary catheters. Method: This was a descriptive study conducted in a rehabilitation center with 243 neurogenic bladder patients who used clear intermittent urinary catheters. The study was carried out between March 2012 and October 2015, using interviews based on semi-structured instruments, and data analysis using descriptive statistics. Results: Most of the patients were men, between 16 and 64 years old, single, with an elementary education level, and a monthly household income of 2 to 3 minimum wages. The results show that the social determinants of health were related to socioeconomic, demographic, and health factors. Conclusion: The findings indicate a complex relationship between social determinants of health and the life conditions of patients who use clean intermittent urinary catheters, presenting greater vulnerability related to some aspects of health conditions.

RESUMEN Objetivo: Identificar la influencia de factores de los determinantes sociales de salud en las condiciones de vida de pacientes usuarios de cateterismo urinario intermitente. Método: Investigación descriptiva realizada en centro de Rehabilitación. Participaron 243 pacientes con vejiga neurogénica, usuarios de cateterismo urinario intermitente limpio. Estudio realizado entre marzo de 2012 y octubre de 2015, aplicando entrevista apoyada por instrumento semiestructurado, y análisis por estadística descriptiva. Resultados: La mayoría de los pacientes era de sexo masculino, edad entre 16 y 64 años, solteros, con enseñanza primaria e ingresos familiares entre 2 y 3 salarios mínimos. Los determinantes sociales de salud encontrados estuvieron relacionados a aspectos socioeconómicos, demográficos y condiciones de salud. Conclusión: Los hallazgos señalan una compleja relación entre los determinantes sociales de salud y las condiciones de vida de estos pacientes usuarios de cateterismo urinario intermitente limpio, presentando vulnerabilidad en relación a algunos aspectos de las condiciones de salud.

RESUMO Objetivo: Identificar a influência de fatores dos determinantes sociais de saúde nas condições de vida de pacientes usuários de cateterismo urinário intermitente. Método: Pesquisa descritiva realizada em um Centro de Reabilitação com 243 pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo. O período do estudo foi de março/2012 a outubro/2015, utilizando-se entrevista com apoio de um instrumento semiestruturado e análise por estatística descritiva. Resultados: A maioria dos pacientes era do gênero masculino, idade entre 16 e 64 anos, solteiros, com ensino fundamental e renda familiar mensal de 2 a 3 salários mínimos. Os determinantes sociais de saúde encontrados foram relacionados aos aspectos socioeconômicos, demográficos e condições de saúde. Conclusão: Os achados assinalam para uma complexa relação entre os determinantes sociais de saúde e as condições de vida desses pacientes usuários de cateterismo urinário intermitente limpo, apresentando uma vulnerabilidade com relação a alguns aspectos das condições de saúde.

Ins and outs of urinary catheters

BACKGROUND: Inserting an indwelling catheter (IDC) is a common medical procedure that is often performed poorly and inappropriately, and can lead to significant morbidity. Although most catheterisations are performed by nursing staff, medical personnel need to be aware of the procedure, products and common IDC complications. OBJECTIVE: Current guidelines and literature were reviewed to outline catheterisation indications, catheter types and provide a general understanding of complications associated with IDCs for the general practitioner (GP). DISCUSSION: There is evidence that IDCs are often used when not indicated and improperly managed when inserted. IDCs can cause significant morbidity, prolong hospital stay and increase healthcare costs. Infection and traumatic insertion are common complications; advances in catheter design have helped to limit these complications. Most complications are avoidable, do not require specialist input and can be managed by community nurses or GPs. Reviewing indications, adopting proper technique for insertion and defining management strategies can limit complications.

Applying preventive measures leading to significant reduction of catheter-associated urinary tract infections in adult intensive care unit.

OBJECTIVES: To determine the impact of applying the best available clinical evidence on the preventive measures to reduce the rate of catheter-associated urinary tract infections (CAUTI) in adult intensive care units (ICU).     Methods:  Data were collected from adult ICUs (28 beds) from 2008 to 2016. The proper use of silicon catheter, aseptic insertion technique, emptying bag three-fourth via close circuit, the use of appropriate size catheter, securing the draining tube on the thigh to keep catheter bag below patient's bladder level and removal of the catheter as early as possible were ensured in all patients.   Results: Rate of UTI and urinary catheter utilization ratios were reviewed during the study period. There was a mean of 6,175 catheter days/year for ICU. Despite the overall rise in the urinary catheterization ratio over these years; we observed a significant reduction in the UTI rate per 1000 Urinary catheter days; from 2.3 in 2010 to 0.3 in 2011 and it was sustained through 2016.  Conclusion: The monthly rates of CAUTI significantly declined after the enforcement of agreed strategies and interventions to prevent CAUTI rates in adult ICU.

[Medical quality standards for selected urological aids and devices : Consensus for patients with neurogenic urinary bladder dysfunction]. / Medizinische Qualitätsstandards ausgewählter urologischer Hilfsmittel : Konsens für Patienten mit neurogenen Harnblasenfunktionsstörungen.

BACKGROUND: Using the CE mark of therapeutic appliances is, on its own, not sufficient enough for their appropriate and effective application. In order to treat the patient successfully, not jeopardizing the success of the treatment, medical quality criteria for therapeutic appliances care are necessary to acceptably compensate for a patient's disabilities. OBJECTIVES: Medical quality criteria are formulated for the most frequently used urological aids and devices, considering hygienic requirements, international literature and the practical experience of physicians and nurses with regard to the care of patients with neurogenic urinary bladder dysfunction. METHODS: An expert group of urologists, surgeons, rehabilitation physicians and nurses has developed medical quality criteria via a structured consensus procedure. Developing these criteria, the group has taken into account current jurisprudence, the current resource directory of neurourological relevant aids, data from international literature and hygiene requirements. RESULTS: Medical quality requirements are discussed and defined for selected groups of urological devices (single use catheters, indwelling catheters, external catheters, urine bags, templates and diapers as well as devices for the electrostimulation of nerves). CONCLUSION: The presented quality requirements offer the possibility to stabilize quality of care with neurourological relevant therapeutic appliances. The catalogue of therapeutic appliances must be urgently updated. Urinal catheters for single use must be classified as an individual product group. Devices for anterior root stimulation and neuromodulation must be included in the resource directory. The incontinence severity classification needs to be reviewed.

[Urinary catheter : comply with guidelines to avoid infections]. / Sonde urinaire : respecter les indications pour éviter les infections.

Catheter-associated urinary tract infection (CAUTI) is the most frequent hospital acquired infection, associated with significant morbidity, mortality and health care costs. Up to 50 % of urinary catheter use in hospital are for incontinence or convenience without proper indication. In addition, urinary catheters are not removed when no longer necessary, due to a lack of vigilance of the health care team. The duration of catheterization is the most important risk factor for the development of CAUTI. Simple measures to prevent CAUTI include appropriate use, maintaining awareness of catheters in place and use of different alternatives. These measures can reduce the number of CAUTI over 50 % along with positive impact on the quality of care and costs.

Les infections liées aux sondes urinaires sont les infections nosocomiales les plus fréquentes avec un impact majeur sur la morbi-mortalité et les coûts de la santé. Près de la moitié des patients sondés le sont sans indication formelle. De plus, les sondes urinaires sont laissées en place plus longtemps que nécessaire, souvent en raison d'un manque de vigilance des soignants. Or, le risque de développer une infection est étroitement lié à la durée du sondage. Des mesures simples pour améliorer la sécurité des patients consistent à respecter les indications, penser aux différentes alternatives et réévaluer quotidiennement la nécessité des sondes. Ces mesures permettent de diminuer le nombre d'infections urinaires liées aux sondes de plus de 50 % avec un impact positif sur la qualité de la prise en charge et une diminution des coûts.

Healthcare-associated infections: prevention and control in primary and community care

This guideline covers preventing and controlling healthcare-associated infections in children, young people and adults in primary and community care settings. It provides a blueprint for the infection prevention and control precautions that should be applied by everyone involved in delivering NHS care and treatment.mIn February 2017 a footnote was added to recommendation 1.1.4.2 linking to Health and Safety (Sharp Instruments in Healthcare) Regulations 2013. A footnote was also added to recommendations 1.4.3.1, 1.4.3.8, 1.4.4.1 and 1.4.4.11 linking to a safety alert on chlorhexidine. Other footnotes were updated with references to revised or replaced British Standards and other regulations.

Quantification of User and Manufacturer Variabilities in Urinary Catheter Anchoring Balloon Inflation and Mitigation of Variability by Flow Resistance.

OBJECTIVE: To quantify user variability and manufacturer variability in urinary catheter anchoring balloon inflation pressure and to mitigate any significant variance by incorporating flow resistance into the anchoring balloon inflation process. METHODS: Inflation of a urinary catheter anchoring balloon was performed at atmospheric pressure by different users (n = 8) to investigate user variability. A calibrated pressure transducer measured inflation pressures, and a video extensometer measured balloon inflation profiles. Manufacturer variability was investigated by applying constant forces to the plunger of conventional syringes to mimic "heavy-," "intermediate-," and "light"-handed users for 3 brands of catheter. Flow restrictors of variable reduced cross-sectional areas were introduced to the outflow of the inflation syringes to investigate the effect of flow resistance on anchoring balloon inflation profiles. RESULTS: Variations in maximum inflation pressures (range: 75-355 kPa) were observed among the different users. There were no significant differences in maximum inflation pressure between brands at any of the 3 simulated hand forces (P = .97). Increasing the flow resistance significantly reduces the applicable inflation pressure of all hand forces (P < .001). Specifically, the difference in inflation pressure between heavy- and light-handed forces is reduced from over 405 kPa to under 65 kPa. Introducing flow resistance does not result in a significant difference in inflation pressure between brands (P = .254). CONCLUSION: There is significant user variability in urinary catheter balloon inflation pressure. This variation can be significantly reduced by introducing flow resistance to the inflation technique.

Does Size Matter? Measured and Modeled Effects of Suprapubic Catheter Size on Urinary Flow.

OBJECTIVE: To quantify the effects of catheter size and urinary sediment on catheter drainage, and to determine the French size at which catheter upsizing yields a diminished marginal return in flow. MATERIALS AND METHODS: Latex Foley catheters (12-26 French [Fr]) were connected to a simulated bladder. Passive drainage times of 450 mL water were measured over 5 successive trials for each catheter size. The effect of sediment was modeled by adding 2g of infant rice cereal to the water. Measurements were repeated in half-length catheters to assess the effect of catheter length. A computational model of resistance was compared to measured data. Percent differences in catheter resistance based on measured catheter dimensions were determined. RESULTS: Catheter resistance significantly decreased (P < .001) with increasing catheter size. All catheter sizes had significantly faster (P < .001) drainage times after being shortened, except for the 16 Fr catheter. All catheter sizes exhibited significantly prolonged (P < .001) drainage times after the addition of sediment, except for the 16 Fr catheter. Beyond 18 Fr, larger catheter sizes provided diminishing marginal returns in flow; upsizing from 18 Fr to 20 Fr reduced measured resistance by 19%, which was the lowest improvement in resistance between 2 catheter sizes. The coefficient of determination (R2) between measured and modeled resistances was 0.9754, confirming that the model of catheter performance was accurate. CONCLUSION: Marginal improvement in urine flow occurs with catheter upsizing after 18 Fr; however, shortening catheter lengths may serve as another means of improving flow.

Urinary tract infections associated with ureteral stents: a review / Infecciones urinarias asociadas con catéteres ureterales: revisión

OBJECTIVES: We review the literature on infections associated with ureteral stents and new technologies aimed at preventing them. Ureteral stent placement is one of the most common urologic procedures, but carries a comparatively high morbidity. Infection is one of the most common stent-associated morbidities. Several new stent materials and coatings have been proposed and tested to reduce stent-associated infections. METHOD: We review the current methods of preventing bacterial infection, including antibiotic prophylaxis and minimising dwell time. We look at the science underlying infection and biofilm formation on stents. Several new stent materials and coatings are described, as well as the studies underlying their mechanism of action. RESULTS AND CONCLUSIONS: While many promising ideas for new stent coatings and materials have been tested, no significant improvement to current polyurethane stent technology is commonly available or used. The basic principles of antibiotic prophylaxis at time of insertion, avoiding contamination, and minimising dwell times remain the best methods to prevent stent-associated infections

OBJETIVOS: Revisamos la bibliografía sobre infecciones asociadas con catéteres ureterales y las nuevas tecnologías dirigidas a prevenirlas. La inserción de un catéter ureteral es uno de los procedimientos urológicos más frecuentes, pero conlleva comparativamente una alta morbilidad. La infección es una de las morbilidades más frecuentes asociadas al catéter. Para reducir las infecciones asociadas se han propuesto y probado varios nuevos materiales y recubrimientos para los catéteres. MÉTODOS: Revisamos los métodos actuales de prevenir la infección bacteriana, incluyendo la profilaxis antibiótica y la minimización del tiempo de permanencia. Miramos la base científica de la infección y de la formación de biofilms en los catéteres. Describimos nuevos materiales y coberturas de los catéteres, así cómo los estudios subyacentes a sus mecanismos de acción. RESULTADOS Y CONCLUSIONES: Aunque se han probado muchas ideas prometedoras de nuevos materiales y recubrimientos para catéteres, no se utiliza ni está disponible normalmente ninguna tecnología que mejore significativamente la del catéter de poliuretano. Los principios básicos de la profilaxis antibiótica en el momento de la inserción, evitando la contaminación y minimizando los tiempos de permanencia siguen siendo los mejores métodos para prevenir las infecciones asociadas con los catéteres

Catéteres urinarios en la edad pediátrica / Pediatric urinary tract catheters

Los catéteres urinarios son sondas huecas y flexibles que se usan para facilitar la salida de orina del aparato urinario o para conseguir un tránsito de orina a través del mismo. Podemos encontrar distintos tipos de catéteres en función del fin para el que han sido diseñados: sondas uretrales, de cistostomía y catéteres ureterales entre otros. Repasamos las indicaciones de colocación de estos catéteres, sus diseños, composición, materiales de cobertura, la técnica de inserción y las complicaciones derivadas de los mismos. Los catéteres en los niños van por detrás de lo que se fabrica para el adulto, por ello hacemos una revisión de la literatura sobre los catéteres urinarios en general haciendo énfasis en el paciente pediátrico

Urinary tract catheters are hollow and flexible tubes used to facilitate urine output or to achieve urine transit through them. We can find different types of catheters depending on the purpose they have been designed for: urethral, cystostomy and ureteral catheters among others. We review the indications for insertion of these catheters, their designs, composition, covering materials, insertion techniques and associated complications. Pediatric catheters are behind what is produced for adults, so we perform a bibliographic review about urinary catheters in general with emphasis on the pediatric patient