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RATIONALE AND KEY POINTS: This article provides a step-by-step guide explaining how to prepare for and perform male urinary catheterisation in a safe, effective and supportive manner. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. ⢠Urethral catheterisation is an invasive procedure and carries a risk of infection. It should only be undertaken after thorough clinical assessment and when other alternatives have been considered. ⢠The procedure can be anxiety-provoking for the patient, so the nurse should explain what is involved and proceed carefully, while keeping the patient informed throughout. ⢠Due to the risk of catheter-associated urinary tract infection, it is important to regularly review the patient's need to be catheterised and the catheter should be removed as soon as practically possible. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: ⢠How this article might improve your practice when planning and undertaking male urinary catheterisation. ⢠How you could use this information to educate nursing students or your colleagues on the procedure for male urinary catheterisation.
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Catheter-associated urinary tract infections represent a major share of nosocomial infections, and are associated with longer periods of hospitalization and a huge financial burden. Currently, there are only a handful of commercial materials that reduce biofilm formation on urinary catheters, mostly relying on silver alloys. Therefore, we combined silver-phenolated lignin nanoparticles with poly(carboxybetaine) zwitterions to build a composite antibiotic-free coating with bactericidal and antifouling properties. Importantly, the versatile lignin chemistry enabled the formation of the coating in situ, enabling both the nanoparticle grafting and the radical polymerization by using only the oxidative activity of laccase. The resulting surface efficiently prevented nonspecific protein adsorption and reduced the bacterial viability on the catheter surface by more than 2 logs under hydrodynamic flow, without exhibiting any apparent signs of cytotoxicity. Moreover, the said functionality was maintained over a week both in vitro and in vivo, whereby the animal models showed excellent biocompatibility.
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Lacasa , Catéteres Urinarios , Catéteres Urinarios/microbiología , Animales , Lacasa/química , Plata/química , Plata/farmacología , Materiales Biocompatibles Revestidos/química , Materiales Biocompatibles Revestidos/farmacología , Antibacterianos/química , Antibacterianos/farmacología , Lignina/química , Ratones , Humanos , Biopelículas/efectos de los fármacos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Escherichia coli/efectos de los fármacos , Nanopartículas/química , Staphylococcus aureus/efectos de los fármacosRESUMEN
INTRODUCTION: There are many alternatives available regarding postoperative care in hypospadias surgery. The objective of this study was to assess the current care situation in our environment and to review the evidence available for pediatric surgeons who conduct this procedure. MATERIALS AND METHODS: A survey regarding the main aspects of hypospadias postoperative care was created and distributed to pediatric surgeons. In addition, the evidence currently published in this field was reviewed. RESULTS: A total of 46 replies were achieved. 100% of the surgeons leave in place a probe or stent, and more than 80% remove it after 5 or 7 days. 87.8% of the respondents use a double diaper, but only 65.2% discharge patients early in the postoperative period. 60.9% prescribe antibiotic prophylaxis for as long as the probe remains in place, and 34.8% use full-dose antibiotic therapy. DISCUSSION: There was a general consensus regarding urethroplasty guiding and the use of compression dressings among the pediatric surgeons surveyed. However, more discrepancies were found in the use of antibiotic therapy and early discharge. The currently available evidence and international practice suggest using a probe with double diaper and early discharge, with postoperative antibiotics being limited. In the absence of clear evidence for a specific care type, the patient's experience could be used to choose the best postoperative protocol on an individual basis.
INTRODUCCION: Existen numerosas alternativas en lo que respecta a los cuidados postoperatorios en la cirugía de hipospadias. El objetivo de este estudio es evaluar la situación actual de estos cuidados en nuestro medio y revisar la evidencia existente al respecto para cirujanos pediátricos que realizan este tipo de intervenciones. MATERIAL Y METODOS: Hemos elaborado y distribuido una encuesta que recoge los principales puntos en el cuidado postoperatorio del hipospadias dirigida a cirujanos pediátricos. Se ha realizado revisión de la evidencia actual publicada al respecto en la especialidad. RESULTADOS: Hemos obtenido un total de 46 respuestas. El 100% de los cirujanos dejan algún tipo de sonda o stent y más del 80% están de acuerdo en retirarlo tras 5 o 7 días. El 87,8% de los encuestados utiliza el doble pañal, pero solo el 65,2% da alta precoz en el postoperatorio. Un 60,9% pauta profilaxis antibiótica mientras dure el sondaje y un 34,8% antibioterapia a dosis plenas. DISCUSION: Existe consenso general respecto a la tutorización de la uretroplastia y el uso de apósito compresivo entre los cirujanos pediátricos encuestados. Se detectan más discrepancias en el uso de antibioterapia y el alta precoz. La evidencia actual y la práctica a nivel internacional apunta hacia el uso de la sonda a doble pañal con alta precoz y la limitación del uso de antibióticos postoperatorios. En ausencia de clara evidencia que favorezca un tipo de cuidado u otro, la experiencia del paciente podría ser utilizada para elegir el mejor protocolo postoperatorio individualizado.
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Hipospadias , Masculino , Niño , Humanos , Hipospadias/cirugía , Cuidados Posoperatorios , Profilaxis Antibiótica , Antibacterianos/uso terapéutico , Uretra/cirugíaRESUMEN
This narrative review explores the use of external urinary catheters. These devices are available in various types and materials for male and female patients. The indications for the use of external urinary catheters include managing incontinence linked to overactive bladder and neurogenic lower urinary tract dysfunction. Contraindications to the use of external urinary catheters include urinary obstruction. Proper skin care and proactive infection control measures are necessary to prevent complications. The collection of a urine specimen for culture requires a standardized technique to prevent contamination. Clinician-led patient education on catheter management plays a important role in ensuring patient comfort and safety.
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Infecciones Relacionadas con Catéteres , Catéteres Urinarios , Infecciones Urinarias , Humanos , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/terapia , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/métodos , Cateterismo Urinario/instrumentación , Masculino , Femenino , Control de Infecciones/métodosRESUMEN
Background: Foley catheters have been subject to limited development in the last few decades. They fulfil their basic function of draining urine from the bladder but cause other associated problems. T-Control is a new silicone Foley catheter with an integrated fluid control valve whose design aims to reduce the risks associated with bladder catheterization by a multifactorial approach. The general purpose of this study is to determine the effectiveness, comfort, and experience of the patient catheterized with T-Control® compared with patients with a conventional Foley catheter. Study Design: This trial is a mixed-method study comprising a two-arm, pilot comparative study with random allocation to T-Control catheter or traditional Foley catheter in patients with long-term catheterization and a study with qualitative methodology, through discussion groups. Endpoints: The comfort and acceptability of the T-Control® device (qualitative) and the quality of life related to self-perceived health (quantitative) will be analysed as primary endpoints. As secondary endpoints, the following will be analysed: magnitude and rate of infections (symptomatic and asymptomatic); days free of infection; indication of associated antibiotic treatments; determination of biofilm; number of catheter-related adverse events; use of each type of catheterization's healthcare resources; and level of satisfaction and workload of health professionals. Patients and Methods: Eligible patients are male and female adults aged ≥18 years, who require a change of long-term bladder catheter. The estimated sample size is 50 patients. Patient follow-up includes both the time of catheter insertion and its removal or change 4 weeks later, plus the time until the discussion groups take place.
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BACKGROUND: Improper urethral catheterization may lead to complications such as urethral injury, catheter entanglement and urinary tract infection. Most of the related literature has focused on aseptic surgical technique, but there are no guidelines on the optimal insertion length for neonatal urinary catheterization. OBJECTIVE: To explore the external anatomical landmarks for urethral catheter positioning in male newborns. METHODS: This research is based on an observational study in Beijing Children's Hospital, China. Hospitalized male neonates who required Foley balloon catheters were prospectively enrolled in this study. The actual insertion length of the urethral catheter for male neonates and the anticipated insertion length based on anatomical landmarks were measured and compared. RESULTS: A total of 67 male neonates were enrolled. The mean body length was 50.66⯱â¯2.93â¯cm, and the mean body weight was 3.33⯱â¯0.70â¯kg. The mean actual insertion length of catheter was 8.77⯱â¯0.94â¯cm, while the anticipated length was 10.89⯱â¯0.95â¯cm. All the anticipated lengths exceeded the actual insertion length by 0.5-4.6â¯cm, which was deemed suitable for the procedure. CONCLUSIONS: Estimating the insertion length of urethral catheters based on external anatomical landmarks is clinically feasible. Selecting an anatomical landmark is a safe method for nurses or doctors to ensure the correct positioning of a urethral catheter. TWEETABLE ABSTRACT: The data of 67 male neonates shows that external anatomical landmarks for urethral catheter positioning in male newborns are possible.
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Cateterismo Urinario , Catéteres Urinarios , Humanos , Masculino , Recién Nacido , Estudios Prospectivos , Cateterismo Urinario/métodos , Uretra/anatomía & histología , Puntos Anatómicos de ReferenciaRESUMEN
More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.
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Bacteriuria , Infecciones Urinarias , Humanos , Catéteres Urinarios/efectos adversos , Infecciones Urinarias/prevención & control , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Antibacterianos/uso terapéutico , Bacteriuria/complicaciones , Bacteriuria/tratamiento farmacológico , Bacteriuria/prevención & control , Vejiga Urinaria , Cateterismo UrinarioRESUMEN
There has been concern over whether to use sodium-glucose-cotransporter-2 (SGLT-2) inhibitors in patients that use catheters due to the concern for increased urinary tract infections (UTIs). The concern is that patients who use catheters are already at an increased risk for UTIs and that SGLT-2-inhibitors may promote bacterial growth due their mechanism of action, ie. increasing glycosuria. The objective of this study was to evaluate whether using empagliflozin, a SGLT-2-inhibitor, in patients who also use catheters, increases their risks for UTIs. A retrospective chart review of electronic health records at a single-center was completed of all Veterans who received an empagliflozin prescription and were also using catheters between October 1, 2015 and September 30, 2022. Veterans were included if they were using catheters for at least 2 months prior to starting empagliflozin and were on both therapies for at least 2 months concurrently. The primary outcome for this study is the number of UTIs occurring prior to and after beginning empagliflozin treatment. Additional secondary outcomes included change in A1c, change in body mass index (BMI), UTI-hospitalizations, and fungal infections. Of the 91 patients with concurrent empagliflozin and catheter-use, only 25 Veterans were included. There was an occurrence of .09 UTIs/month pre-empagliflozin compared to .07 post-empagliflozin (P = .61). There was an observed trend in Veterans with Type 2 Diabetes having an increased rate of UTIs. There was no statistically significant difference found in UTI rates when comparing catheters alone to concurrent catheter and empagliflozin-use.
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Urinary catheters and other medical devices associated with the urinary tract such as stents are major contributors to nosocomial urinary tract infections (UTIs) as they provide an access path for pathogens to enter the bladder. Considering that catheter-associated urinary tract infections (CAUTIs) account for approximately 75% of UTIs and that UTIs represent the most common type of healthcare-associated infections, novel anti-infective device technologies are urgently required. The rapid rise of antimicrobial resistance in the context of CAUTIs further highlights the importance of such preventative strategies. In this review, the risk factors for pathogen colonization in the urinary tract are dissected, taking into account the nature and mechanistics of this unique environment. Moreover, the most promising next-generation preventative strategies are critically assessed, focusing in particular on anti-infective surface coatings. Finally, emerging approaches in this field and their likely clinical impact are examined.
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Antiinfecciosos , Infecciones Relacionadas con Catéteres , Infecciones Urinarias , Humanos , Cateterismo Urinario/efectos adversos , Catéteres de Permanencia/efectos adversos , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/prevención & control , Infecciones Relacionadas con Catéteres/etiología , Antiinfecciosos/farmacología , Antiinfecciosos/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & control , Catéteres Urinarios/efectos adversosRESUMEN
BACKGROUND: The effects of non-infectious urinary catheter-related complications such as measurements of indwelling urinary catheter overuse, catheter-related trauma, and urinary retention are not well understood. METHODS: This was a retrospective cohort study of 200 patients undergoing general surgery operations. Variables to measure urinary catheter use, trauma, and retention were developed, then surgical cases were abstracted. Inter- and intra-rater reliability were calculated for measure validation. RESULTS: 129 of 200 (65%) had an indwelling urinary catheter placed at the time of surgery. 32 patients (16%) had urinary retention, and variation was observed in the treatment of urinary retention. 12 patients (6%) had urinary trauma. Rater reliability was high (>90% agreement for all) for the dichotomous outcomes of urinary catheter use, urinary catheter-related trauma, and urinary retention. CONCLUSIONS: This study suggests a persistent high rate of catheter use, significant rates of urinary retention and trauma, and variation in the management of retention.
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Retención Urinaria , Infecciones Urinarias , Humanos , Retención Urinaria/etiología , Retención Urinaria/terapia , Catéteres Urinarios/efectos adversos , Cateterismo Urinario , Estudios Retrospectivos , Reproducibilidad de los Resultados , Catéteres de Permanencia/efectos adversos , Complicaciones Posoperatorias/etiología , Infecciones Urinarias/etiologíaRESUMEN
This study evaluates potential associations between the perioperative urinary catheter (UC) carriage and (Gram-negative) surgical site infections (SSIs) after spine surgery. It is a retrospective, single-center, case-control study stratifying group comparisons, case-mix adjustments using multivariate logistic regression analyses. Around half of the patients (2734/5485 surgeries) carried a UC for 1 day (median duration) (interquartile range, 1-1 days). Patients with perioperative UC carriage were compared to those without regarding SSI, in general, and Gram-negative, exclusively. The SSI rate was 1.2% (67/5485), yielding 67 revision surgeries. Gram-negative pathogens caused 16 SSIs. Seven Gram-negative episodes revealed the same pathogen concomitantly in the urine and the spine. In the multivariate analysis, the UC carriage duration was associated with SSI (OR 1.1, 95% confidence interval 1.1-1.1), albeit less than classical risk factors like diabetes (OR 2.2, 95%CI 1.1-4.2), smoking (OR 2.4, 95%CI 1.4-4.3), or higher ASA-Scores (OR 2.3, 95%CI 1.4-3.6). In the second multivariate analysis targeting Gram-negative SSIs, the female sex (OR 3.8, 95%CI 1.4-10.6) and a UC carriage > 1 day (OR 5.5, 95%CI 1.5-20.3) were associated with Gram-negative SSIs. Gram-negative SSIs after spine surgery seem associated with perioperative UC carriage, especially in women. Other SSI risk factors are diabetes, smoking, and higher ASA scores.
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Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.
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Background: Reconstructive urologists often place both a urethral and suprapubic catheter intraoperatively to prevent extravasation of undrained urine across anastomosis sutures. As no consensus exists on which catheter drains the bladder more completely, many surgeons leave one catheter to gravity drainage and cap the other postoperatively. We sought to identify differences in catheter urine outflow during dual bladder drainage with suprapubic and urethral catheters in postoperative urology patients. Methods: Urine output (UOP) from transgender men who underwent Stage II Phalloplasty with urethral lengthening was retrospectively reviewed. Both 16 French urethral and suprapubic catheters were placed to gravity drainage postoperatively. Urine output from each catheter was recorded separately, twice daily. Mixed model regression modeling tested for differences in urine output by time of day (day/night) and activity status (Bedrest: Postop Day 0-2, Ambulatory: Postop Day 3+). Results: The aggregate number of 12-hour shift urine output observations was 250 (125 for urethral and 125 for suprapubic catheters) across 14 inpatients. Suprapubic catheters had a mean 410 ml higher output than urethral catheters per 12-hour shift (p=0.002; 95% CI: 185, 636 ml). During daytime, Suprapubic catheters demonstrated higher UOP than urethral catheters per 12-hour shift (Estimated Difference: 464 ml; p=0.002; 95% CI: 211, 718 ml). During nighttime, a similar phenomenon was observed (Estimated Difference: 356 ml; p=0.009; 95% CI: 104, 606 ml). When comparing mean UOP from each catheter during the Bedrest Phase, suprapubic catheters averaged an estimated 295 ml higher UOP compared to urethral catheters per 12-hour shift with a trend toward statistical significance (p=0.052; 95% CI -3, 594 ml). During the Ambulatory Phase, mean suprapubic catheter UOP was an estimated 472 ml higher than urethral catheters per 12-hour shift (p=0.009; 95% CI 142, 802 ml). Conclusions: Simultaneous bladder drainage with urethral and suprapubic catheters shows greater drainage from the suprapubic catheter (35% vs 65%). When using two catheters, both can be placed to gravity to maximize bladder drainage as the suprapubic catheter can drain residual urine not adequately drained by the urethral catheter.
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Graphene has been broadly studied, particularly for the fabrication of biomedical devices, owing to its physicochemical and antimicrobial properties. In this study, the antibiofilm efficacy of graphene nanoplatelet (GNP)-based composites as coatings for urinary catheters (UCs) was investigated. GNPs were functionalized with nitrogen (N-GNP) and incorporated into a polydimethylsiloxane (PDMS) matrix. The resulting materials were characterized, and the N-GNP/PDMS composite was evaluated against single- and multi-species biofilms of Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Both biofilm cell composition and structure were analyzed. Furthermore, the antibacterial mechanisms of action of N-GNP were explored. The N-GNP/PDMS composite showed increased hydrophobicity and roughness compared to PDMS. In single-species biofilms, this composite significantly reduced the number of S. aureus, P. aeruginosa, and K. pneumoniae cells (by 64, 41, and 29%, respectively), and decreased S. aureus biofilm culturability (by 50%). In tri-species biofilms, a 41% reduction in total cells was observed. These results are aligned with the outcomes of the biofilm structure analysis. Moreover, N-GNP caused changes in membrane permeability and triggered reactive oxygen species (ROS) synthesis in S. aureus, whereas in Gram-negative bacteria, it only induced changes in cell metabolism. Overall, the N-GNP/PDMS composite inhibited biofilm development, showing the potential of these carbon materials as coatings for UCs.
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The use of a Foley catheter is one of the oldest known methods of labor induction. Therefore, protocols using different volumes of Foley catheter balloons have been developed and tested to accurately determine their effectiveness. In this study, it was decided to retrospectively evaluate two induction of labor (IOL) protocols. The last 300 eligible patients who met the criteria and underwent the low-volume balloon protocol (40-60 mL) IOL were selected. Then next, 300 patients who met the criteria and underwent high-volume balloon (80-100 mL) IOL were selected. Outcomes included time to delivery and parturition type, oxytocin augmentation, operative deliveries and application of intrapartum anesthesia. Overall, the majority of patients delivered within 24 h. Patients who received a high-volume Foley catheter had statistically significantly more vaginal deliveries. The mean-time to delivery in the high-volume catheter group was statistically significantly shorter than in the low-volume catheter group. Patients who received a high-volume Foley catheter required statistically significantly less oxytocin augmentation during induction of labor compared to patients with a low-volume Foley catheter. Regardless of the balloon volume used, the percentage of operative deliveries remained at a similar, low level (8.36% and 2.14%). Regardless of the catheter volume used, the majority of patients chose epidural over intravenous anesthesia. In conclusion, a high-volume balloon Foley catheter IOL is characterized by an increased percentage of vaginal deliveries, shortened time to delivery regardless of the type of delivery, and lower need for oxytocin augmentation.
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BACKGROUND: This systematic review examines the prevalence of indwelling urinary catheters in nursing home residents. METHODS: MEDLINE via PubMed, CINAHL, and EMBASE were searched from inception to 9 August 2022. Cross-sectional studies and longitudinal studies with cross-sectional analyses reporting catheter prevalence in nursing home residents were identified and summarized descriptively. Study quality was assessed using the Joanna Briggs Institute's tool. RESULTS: Sixty-seven studies (92.5â¯% cross-sectional) were included. The reported number of included residents ranged from 73 to 110,656. The median catheter prevalence was 7.3â¯% (interquartile range 4.3-10.1â¯%; nâ¯=â¯65 studies). It was higher in Germany (10.2â¯% [9.7-12.8â¯%]; nâ¯=â¯15) than in the United States of America (9.3â¯% [6.3-11.9â¯%]; nâ¯=â¯9), United Kingdom (6.9â¯% [4.8-8.5â¯%]; nâ¯=â¯7), and Sweden (7.3â¯% [6.4-7.9â¯%]; nâ¯=â¯6). Furthermore, it was higher among men (17.0â¯% [16.0-26.0â¯%]) than among women (5.3â¯% [4.0-9.5â¯%]) (nâ¯=â¯9). Only one study investigated differences by age. The prevalence was higher for transurethral (5.7â¯% [5.6-7.2â¯%]; nâ¯=â¯12) than for suprapubic (1.2â¯% [0.6-2.5â¯%]; nâ¯=â¯13) catheters. Most catheterized residents were long-term catheterized (nâ¯=â¯6) and had their catheter changed within 3â¯months (nâ¯=â¯2). Symptomatic urinary tract infections were more common among catheterized than among non-catheterized residents (nâ¯=â¯4). DISCUSSION: Catheter prevalence in nursing home residents varies between studies and countries. Prevalence differences by sex, age, and catheter type as well as duration of catheterization, catheter change intervals, and catheter-associated urinary tract infections are rarely reported because most studies do not primarily focus on catheters. Future studies should focus on the circumstances of urinary catheter use and care in nursing home residents. REGISTRATION AND FUNDING: PROSPERO (29 August 2022; CRD42022354358); no funding.
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Catéteres de Permanencia , Infecciones Urinarias , Masculino , Humanos , Femenino , Estados Unidos , Catéteres de Permanencia/efectos adversos , Catéteres Urinarios/efectos adversos , Cateterismo Urinario/efectos adversos , Prevalencia , Estudios Transversales , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Casas de SaludRESUMEN
Biofouling is a major problem in all natural and artificial settings where solid surfaces meet liquids in the presence of living microorganisms. Microbes attach to the surface and form a multidimensional slime that protects them from unfavorable environments. These structures, known as biofilms, are detrimental and very hard to remove. Here, we used SMART magnetic fluids [ferrofluids (FFs), magnetorheological fluids (MRFs), and ferrogels (FGs) containing iron oxide nano/microparticles] and magnetic fields to remove bacterial biofilms from culture tubes, glass slides, multiwell plates, flow cells, and catheters. We compared the ability of different SMART fluids to remove biofilms and found that commercially available, as well as homemade, FFs, MRFs, and FGs can successfully remove biofilm more efficiently than traditional mechanical methods, especially from textured surfaces. In tested conditions, SMARTFs reduced bacterial biofilms by five orders of magnitude. The ability to remove biofilm increased with the amount of magnetic particles; therefore, MRFs, FG, and homemade FFs with high amounts of iron oxide were the most efficient. We showed also that SMART fluid deposition can protect a surface from bacterial attachment and biofilm formation. Possible applications of these technologies are discussed.
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PURPOSE: Urodynamics is the standard method of diagnosing bladder dysfunction, but involves catheters and retrograde bladder filling. With these artificial conditions, urodynamics cannot always reproduce patient complaints. We have developed a wireless, catheter-free intravesical pressure sensor, the UroMonitor, which enables catheter-free telemetric ambulatory bladder monitoring. The purpose of this study was twofold: to evaluate accuracy of UroMonitor pressure data, and assess safety and feasibility of use in humans. MATERIALS AND METHODS: Eleven adult female patients undergoing urodynamics for overactive bladder symptoms were enrolled. After baseline urodynamics, the UroMonitor was transurethrally inserted into the bladder and position was confirmed cystoscopically. A second urodynamics was then performed with the UroMonitor simultaneously transmitting bladder pressure. Following removal of urodynamics catheters, the UroMonitor transmitted bladder pressure during ambulation and voiding in private. Visual analogue pain scales (0-5) were used to assess patient discomfort. RESULTS: The UroMonitor did not significantly alter capacity, sensation, or flow during urodynamics. The UroMonitor was also easily inserted and removed in all subjects. The UroMonitor reproduced bladder pressure, capturing 98% (85/87) of voiding and nonvoiding urodynamic events. All subjects voided with only the UroMonitor in place with low post-void residual volume. Median ambulatory pain score with the UroMonitor was rated 0 (0-2). There were no post-procedural infections or changes to voiding behavior. CONCLUSIONS: The UroMonitor is the first device to enable catheter-free telemetric ambulatory bladder pressure monitoring in humans. The UroMonitor appears safe and well tolerated, does not impede lower urinary tract function, and can reliably identify bladder events compared to urodynamics.
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Vejiga Urinaria , Micción , Adulto , Humanos , Femenino , Catéteres Urinarios/efectos adversos , Urodinámica , Sujetos de InvestigaciónRESUMEN
OBJECTIVES: Convective water vapor thermal therapy (CWVTT-Rezum) is a minimally invasive surgical therapy that is being increasingly utilized for bladder outlet obstruction. Most patients leave the site of care with a Foley catheter in place for a mean reported duration of 3-4 days. A minority of men will fail their trial without catheter (TWOC). We aim to identify the frequency of TWOC failure following CWVTT and its associated risk factors. METHODS: Patients who underwent CWVTT at a single institution from October 2018 to May 2021 were retrospectively identified and pertinent data extracted. The primary endpoint was TWOC failure. Descriptive statistics were performed, and rate of TWOC failure was determined. Potential risk factors for failed TWOC were assessed through univariate and multivariate logistic regression. RESULTS: A total of 119 patients were analyzed. Seventeen percent (20/119) had a failed TWOC on their first attempt. Of those, 60% (12/20) failed in a delayed fashion. In patients who failed, the median number of total TWOC attempts required for success was two (interquartile range [IQR] = 2-3). All patients eventually had a successful TWOC. The median preoperative postvoid residual for successful and failed TWOC was 56 mL (IQR = 15-125) and 87 mL (IQR = 25-367), respectively. Preoperative elevated postvoid residual (unadjusted odds ratio [OR] 1.02, 95% CI: 1.01-1.04; adjusted OR 1.02, 95% CI: 1.01-1.04) was associated with TWOC failure. CONCLUSIONS: Seventeen percent of patients failed their initial TWOC after CWVTT. Elevated postvoid residual was associated with TWOC failure.