Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: A propensity score-matched analysis / 亚洲男科学杂志(英文版)

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Unusual Foreign Body in Urinary Bladder: A Case Report.

In the urinary tract, foreign body is most commonly found in the urinary bladder. It is commonly self-inflicted but can rarely be introduced by other person. Various types of foreign bodies have been reported, which includes infusion set, aluminum rod, gold chain, pearl, fish, pencil etc. Here we report a case of a 28-year young man who gave the history of forceful introduction of a long wire of mobile charger into the bladder by another person. It could not be removed by himself and by the local doctors. Then he was referred to Enam Medical College & Hospital and subsequently was removed by suprapubic cystostomy.

Long Term Follow up of Suprapubic Cystostomy

PURPOSE: We assessed the clinical significance of suprapubic cystostomy in the treatments of patients with voiding difficulty and analyzed the complications of it and their courses. Also we compared the results with our previous study. PATIENTS AND Methods: We reviewed 30 patients managed with suprapubic cystostomy. The changes in serum Cr, urinary pH and white blood cell values after suprapubic cystostomy were evaluated. We investigated complications of these patient. The stone-free rate after suprapubic catheter insertion was estimated by the Kaplan-Meier method. RESULTS: The original diseases were spinal cord injury in 19 (63.3%), cerebrovascular accident in 3 (10%), inoperable benign prostatic hyperplasia in 2 (6.7%), diabetic cystopathy in 2 (6.7%), recurrent urethral stricture in 2 (6.7%) and prostatic cancer in 2 (6.7%). The most common complication was the formation of the bladder calculi in 8 cases (26.7%). There were no serious complications associated with the procedure and no deterioration of the renal function. The mean serum creatinine level changed from 1.15+/-0.06 mg/dl to 1.13+/-0.07 mg/dl without statistical significance. The stone-free rates 1 and 7 years after the procedure were 96.7% and 73.3%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSION: Suprapubic cystostomy is an alternative method for patients of voiding dysfunction in cases of severe urethral damage or limited activity of upper extremities. In spite of advantage of suprapubic cystostomy, we must make an effort on preventing bladder stone, urinary tract infection in patients with suprapubic catheter.

Clinical Significance of Suprapubic Cystostomy in the Treatments of Patients with Voiding Difficulty / 대한비뇨기과학회지

PURPOSE: We assessed the clinical significance of a suprapubic cystostomy for the treatment of patients with voiding difficulties, and analyzed the related courses and complications. PATIENTS AND METHODS: A review of 55 patients managed with suprapubic cystostomy was undertaken. The changes in the serum Cr, urinary pH and white blood cell values, after a suprapubic cystostomy, were analyzed. The stone-free rate after insertion of a suprapubic catheter was estimated by the Kaplan-Meier method. RESULTS: The original diseases included: spinal cord injury in 20 (36.3%), inoperable benign prostatic hyperplasia in 12 (21.8%), cerebrovascular accident in 10 (18.2%), diabetic cystopathy in 4 (7.3%), recurrent urethral stricture in 3 (5.5%), spinal stenosis in 2 (3.6%), prostatic cancer in 2 (3.6%) and 1 (1.18%) each of Parkinson's disease and multiple sclerosis. The indications for the need for a cystostomy were: poor hand function in 35 (64%), patient request in 8, worsening of the original disease in 6, vesicoureteral reflux in 3, severe urethral damage in 2 and a recurrent urinary tract infection in 1. The most common complication was the formation of bladder calculi, which occurred in 9 (16%). There were no serious complications associated with the procedure. The mean serum creatinine levels changed from 1.01+/-0.09mg/ml to 0.90 +/-0.09mg/ml, but with no statistical significance. The stone-free rates at 1 and 5 years after the procedure were 91.9 and 61.6%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSIONS: Although continuous cystostomy drainage is not considered an ideal management for bladder emptying, the long-term uses of suprapubic catheters are well tolerated by patients, despite the frequent catheter-related complications. Therefore, a suprapubic cystostomy, as a management, may be indicated in some patients with severe urethral damage and limited activity of the upper extremities.

Efficacy of the Preliminary Ultrasonographic Examination before Suprapubic Cystostomy by Trocar / 대한비뇨기과학회지

Suprapubic cystostomy by trocar is a simple, safe and useful method for urinary diversion in acute urinary retention. But rarely, severe complications occur during or after suprapubic cystostomy such as bowel perforation, through and through perforation of the bladder, rectal injury and severe hematuria. We studied the complications of suprapubic cystostomy retrospectively and compared 19 patients who performed ultrasonographic examination with 30 patients without ultrasonographic examination. The complications in 30 patients without preliminary ultrasonographic examination were initial failure in 4 cases (13.3%), extravesical Foley indwelling in 2 cases (6.7%), puncture site closed to the pubic bone in 2 cases (6.7%), spontaneous bladder rupture in 1 case (3.3%) and bowel injury in 1 case (3.3%). But, the complication in 19 patients with preliminary ultrasonographic examination was only 1 retried case (5.3%) because of extravesical Foley indwelling. As above results, the brief preliminary ultrasonographic examination of the bladder is a very useful method with minimal risk during suprapubic cystostomy by trocar.

Clinical Results of Transurethral Resection for the Benign Prostatic Hypertrophy -Significance of Suprapubic Cystostomy before Transurethral Resection- / 대한비뇨기과학회지

A clinical observation was made on 96 cases of transurethral resection for the benign prostatic hypertrophy, admitted during the period of 3 years from January 1984 to December 1986. Previous to the transurethral resection of prostate, the suprapubic cystostomy was accomplished in 38 cases among them and following advantageous results were obtained. 1. Suprapubic cystostomy before TURP provides better endoscopic vision by continuous flow of irrigating fluid to permit no interrupted resection. 2. By eliminating the time spent for evacuation of the bladder, eye accommodation and reestablishment of surgical land marks, it permits transurethral resection of larger gland, within recognized safety guidelines. 3. It tends to minimize and prevent absorptive complications by lessening intravesical pressure. 4. It decreases operative risk by lessening operative time and the volume of fluid absorbed. 5. It provides an alternative route of irrigation and drainage intraoperatively and postoperatively.

Clinicel Observetion of Urethroplasty after Suprapubic Cystostomy in 11 Cases Urethral Injuries / 대한비뇨기과학회지

A clinical observation was made on 11 patients of urethral injury who were performed immediately suprapubic cystostomy only and 12-l7 weeks later perineal urethroplasty in the Department of Urology. Capital Armed Forces General Hospital Seoul. Korea. The following results were obtained. 1.Most common cause of the urethral injury was traffic accident. 2. Normal micturation was in 2 cases who were performed suprapubic cystostomy only. 3. Duration from urethral injury to urethroplasty was 12-17 weeks. 4. Among the 11 cases of urethral injury. urethral stricture. impotence and incontience observed in all.

New Technique of Suprapubic Cystostomy with Newly Devised Metal Sound: Bladder Surgery / 대한비뇨기과학회지

A longer metal sound with larger curvature is devised for bladder surgery. This sound was applied in 19 cases of bladder surgery performed at Korea University Hospital for 17 months from November 1976 to March 1978 and the results were excellent in all these cases. This new 17 F. metal sound is easily inserted through the urethra just like an usual metal sound such as Van Buren or Benique type. When the tip of the sound is reached to the bladder wall this tip is readily felt under the skin of suprapubic area. The local anesthetic is injected by infiltration in the skin, subcutaneous tissues and muscle layers of the lower abdomen and bladder wall. While the tip of the sound is felt over thesestissues. A small midline incision is made over the area where the tip of the sound is felt, and this incision is carried through the skin, subcutaneous tissues and the fascia of the rectus muscle. The muscle itself easily devided by the tip of the sound. And the peritoneum is usually reflected by the sound. When the bladder wall reached, two hanging sutures are made on both sides of tented bladder wall by the tip of the sound. Then the incision into the bladder wall is carried out at the point of the tip. The bladder wall is rasped by two Allis forceps. As the hemostat enters the lumen, the entire thickness of the bladder wall is rasped with Allis forceps and the incision is enlarged to provide the desired exposure of the interior of the bladder. Closure is done with ordinary way depends upon whether cystostomy is desired. The advantages of this technique are as follows 1. The peritoneum is usually reflected spontaneously by the sound. 2. The rectus muscle is easily devided by the tip of the sound. 3. In bladder surgery, the mucosa of the bladder is easily separated and pushed away from the bladder muscularies for a considerable distance, making it difficult to find the same separated bladder mucosa again. This problem is solved by this technique. 4. Shortening of operation time. 5. Local anesthesia performed with very small amount of anesthetics. 6. Less bleeding is noted because the tissues over the tip of sound become ischemic.