The incidence of early and recurrent urinary tract infections after midurethral sling operations.

OBJECTIVE: To define the incidence of early and recurrent urinary tract infections (RUTIs) in the 12-month postoperative period following midurethral sling (MUS) operations and evaluate for risk factors. METHODS: This retrospective chart review compiled all urine analyses and urine culture results within 12 months of MUS surgery on all patients in the years 2006-2012 for which data were available. All coincident risk factors were tabulated. Statistical analysis was performed using SAS v 9.2 (SAS Institute, Cary, North Carolina). RESULTS: 141 MUS procedures were performed in the 6-year time frame utilizing standard antibiotic prophylaxis regimens. 133 had adequate data for analysis. 10 patients (7.5% confidence intervals [CI] [3.7-12.4]) developed an acute UTI in the first 8 weeks postoperatively. 3 of 121 patients (2.3% CI [0.5-5.9]) developed RUTIs in the first year following surgery. Bivariate and multiple logistic regression analyses of the data did not reveal any risk factors for either isolated postoperative UTIs or RUTIs. CONCLUSIONS: This study documents a low incidence of both acute and RUTIs in the female population undergoing MUS operations. These results support the current recommendations for perioperative prophylactic antibiotics for anti-incontinence procedures.

Clinical evaluation of the Sorin Synthesis oxygenator with integrated arterial filter.

The use of arterial line filters has long been a standard of practice in the field of cardiopulmonary bypass. Sorin Biomedica has designed an adult hollow-fiber oxygenator that not only incorporates their Mimesys biomimicry coating technology but also has a 40-micron arterial filter as an integrated component of this unique membrane oxygenator. We did a prospective, randomized clinical trial of 54 Synthesis coated oxygenators and compared them with 54 uncoated Monolyth Pro oxygenators, the latter of which incorporated an external arterial line filter with a standard bypass loop There were few statistically significant differences found between the Synthesis group and the Monolyth group with regard to pressure differentials, hemodynamic resistance, and platelet drop. The Synthesis oxygenator did require less priming volume, but the amount was not significant. Platelet counts with the Phosphorylcholine coated Synthesis oxygenators, using crystalloid perfusates, was similar to our previously published data on platelet protection and Albumin perfusates. We conclude that the Sorin Synthesis oxygenator appears to have better flow characteristics than the Monolyth oxygenator, with the potential for lower priming volumes. The most clinically significant benefit comes from the elimination of the arterial filter bypass loop and the avoidance of inverting the arterial filter during priming.

Evaluation of Mimesys phosphorylcholine (PC)-coated oxygenators during cardiopulmonary bypass in adults.

A new generation of coating extracorporeal circuitry with biocompatible polymers has entered the North American perfusion market. This new biomimetic coating process uses synthetic phosphorylcholine (PC) containing polymers to bond covalently to the surface of the Sorin Monolyth oxygenator, under the brand name of Mimesys. In part one of a three-part investigation, 160 Mimesys-coated oxygenators were randomly evaluated against 36 uncoated oxygenators for blood flow, hemodynamic resistance, and pressure differentials. In part two, retrospective analysis of platelet data collected in this study was compared with platelet data collected from a previous investigation using uncoated Monolyth oxygenators with albumin and crystalloid perfusates. Part three examined the risk-adjusted clinical outcomes of 71 patients treated with Mimesys-coated oxygenators, compared with 71 case-matched patients treated with uncoated oxygenators. There was no difference found in the Mimesys-coated group, when compared to the control group, with regard to pressure differentials or hemodynamic resistance. However, we conclude that platelet protection with PC-coated Monolyth's using crystalloid perfusates, was similar to platelet protection with albumin perfusates, and significantly better than uncoated Monolyths using crystalloid perfusates.