Persistent cloaca with fetal ascites: clinical features and perinatal management.

PURPOSE: Fetuses with persistent cloaca are known to develop urine or meconium backflow into the abdominal cavity caused by obstruction of the common channel, thus leading to fetal peritonitis with fetal ascites. We analyzed the impact of prenatal fetal ascites on postnatal clinical features and management. METHODS: This retrospective single-center cohort study was conducted to compare the perinatal parameters of patients with isolated persistent cloaca who were born and treated at our hospital between 1991 and 2021. The clinical features and management of those with and without fetal ascites were compared. RESULTS: Among the 17 eligible patients, fetal ascites were recognized in seven. The occurrence of fetal ascites was significantly related to preterm birth, higher birth weight z-score, birth via emergency cesarean delivery, low Apgar scores at 1 min and 5 min, higher C-reactive protein levels at birth, longer duration of oxygen administration, the need for a urinary drainage catheter at initial discharge, and shorter neonatal hospital stays. CONCLUSIONS: The postnatal management of patients with persistent cloaca with fetal ascites differed significantly from that of patients without fetal ascites. For patients with unexplained fetal ascites, magnetic resonance imaging may be helpful for determining the definite diagnosis of persistent cloaca.

Catheter squeeze technique to solve urinary catheter drainage problem.

Background: Urinary catheter insertion is one of the basic techniques used in patient care to drain the bladder. Around 30 million urinary catheters are inserted annually in the USA alone.2 Often, when inserting a urinary catheter, it is noticed that urine does not drain right away. Method: This article will discuss the 'urinary catheter squeeze' technique that can help healthcare providers resolve this problem. Results: We have a simple solution called the 'catheter squeeze technique' to address the problem of urine not draining. The clinician who inserts the catheter can assess the outcome of this technique immediately, as it provides immediate results. Conclusion: There are several theories regarding why urine may not properly drain into a catheter after it is inserted, and various methods are employed to address this issue. Our "catheter squeeze technique" is a simple approach that requires no tools or assistance, and its effectiveness can be observed immediately after insertion.

A case of traumatic urethral stricture complicated by periurethral abscess while awaiting delayed urethroplasty.

Introduction: We report a case of bulbar urethral injury complicated by periurethral abscess due to inappropriate suprapubic catheter management. Case presentation: A 58-year-old man with bulbar urethral injury due to perineal trauma was referred to our hospital, and a suprapubic catheter was inserted for initial management. Although he was instructed to connect the catheter to the urine collection bag, he connected a plug to the catheter. As a result, he developed periurethral abscesses due to extravasated urine from the injured urethra, requiring percutaneous drainage and prolonging the time to definitive urethroplasty for the urethral stricture. Conclusion: It is essential that the suprapubic catheter be connected to a urine collection bag rather than a plug to keep the bladder as empty as possible and to minimize extravasation of the urine from the injured urethra.

Quantitative assessment of renal obstruction in multi-phase CTU using automatic 3D segmentation of the renal parenchyma and renal pelvis: A proof of concept.

Purpose: Quantitative evaluation of renal obstruction is crucial for preventing renal atrophy. This study presents a novel method for diagnosing renal obstruction by automatically extracting objective indicators from routine multi-phase CT Urography (CTU). Material and methods: The study included multi-phase CTU examinations of 6 hydronephrotic kidneys and 24 non-hydronephrotic kidneys (23,164 slices). The developed algorithm segmented the renal parenchyma and the renal pelvis of each kidney in each CTU slice. Following a 3D reconstruction of the parenchyma and renal pelvis, the algorithm evaluated the amount of the contrast media in both components in each phase. Finally, the algorithm evaluated two indicators for assessing renal obstruction: the change in the total amount of contrast media in both components during the CTU phases, and the drainage time, "T1/2", from the renal parenchyma. Results: The algorithm segmented the parenchyma and renal pelvis with an average dice coefficient of 0.97 and 0.92 respectively. In all the hydronephrotic kidneys the total amount of contrast media did not decrease during the CTU examination and the T1/2 value was longer than 20 min. Both indicators yielded a statistically significant difference (p < 0.001) between hydronephrotic and normal kidneys, and combining both indicators yielded 100% accuracy. Conclusions: The novel algorithm enables accurate 3D segmentation of the renal parenchyma and pelvis and estimates the amount of contrast media in multi-phase CTU examinations. This serves as a proof-of-concept for the ability to extract from routine CTU indicators that alert to the presence of renal obstruction and estimate its severity.

A novel method for estimating the urine drainage time from the renal collecting system.

PURPOSE: Partial obstruction of the upper urinary tract is a common urological pathology that leads to progressive atrophy and dysfunction of the kidney. Most methods for evaluating the urine drainage rate, to assess the severity of partial obstruction, involve injection of markers into the blood stream and therefore the filtration rate from the blood effects the drainage rate. This study presents a novel method for assessing the drainage rate from the upper urinary tract by analyzing sequential fluoroscopic images from a routine nephrostogram, in which contrast material is introduced directly into the renal collecting system. METHODS: Fluoroscopic images from 36 nephrostograms, following percutaneous nephrolithotomy, were retrospectively evaluated, 19 with a dilated renal pelvis. A radiological model for calculating the radiopacity of the renal pelvis, which reflects the amount of contrast material in each sequential image, was developed. Using this model, an algorithm was designed for generating a drainage curve and calculating the "drainage time" t1/2 in which half of the contrast material has drained from the renal pelvis. RESULTS: Analysis of images of a step-wedge phantom made of an increasing number of contrast material layers showed that the calculated radiopacity of each step was proportional to the amount of contrast material, independent of the background attenuation. Analysis of the nephrostograms showed that the drainage curves highly fitted an exponential function (R = 0.961), with a significantly higher t1/2 for dilated cases. CONCLUSION: The developed method may be used for a quantitative and accurate estimation of the urine drainage rate.

Identifying safe practices for use of the urinary leg bag drainage system in the postacute and long-term care setting: An integrative review.

BACKGROUND: In the postacute and long-term care setting, the practice of changing the indwelling urinary catheter large sterile drainage bag to a small-size leg drainage bag is intended to maintain a person's mobility, dignity, and comfort. There is scant evidence that assesses the impact of intermittent use of a leg bag on frequency of urinary tract infection since this breaks the closed urinary drainage system. METHODS: We reviewed research published between 1993 and 2014 for the answers to 20 practice questions developed by experts and long-term care clinicians on the risks and benefits, cleaning, connection, and storage of reusable leg bags. RESULTS: Seventeen of the 26 publications and studies provided varying advice on the risk of breaking the closed system and on practices for changing, disinfecting, and storing leg bags between uses. Thirteen of 20 practice questions were answered by ≥1 publications, few of which were evidence based. CONCLUSIONS: We identified the existence of low-level evidence that leg bags pose no evident, disproportionate risk of infection compared with maintaining a closed system. The lack of uniformity in evidence in the literature suggests aseptic technique should guide practice. Available evidence suggests that aseptic technique should guide practice.