Assessing Health Care Utilization and Feasibility of Transurethral Catheter Self-Discontinuation.

OBJECTIVE: To compare the rates of health care utilization (office messages or calls, office visits, and emergency department [ED] visits) and postoperative complications within 30 days after surgery between patients with successful voiding trials on postoperative day 0 and those with unsuccessful voiding trials on postoperative day 0 and between patients with successful and unsuccessful voiding trials on postoperative day 1. Secondary objectives were to identify risk factors for unsuccessful voiding trials on postoperative days 0 and 1 and to explore the feasibility of catheter self-discontinuation by assessing for any complications associated with at-home catheter self-discontinuation on postoperative day 1. METHODS: This study was a prospective observational cohort study of women undergoing outpatient urogynecologic or minimally invasive gynecologic surgery for benign indications at one academic practice from August 2021 to January 2022. Enrolled patients with unsuccessful immediate postoperative voiding trials on postoperative day 0 performed catheter self-discontinuation by cutting their catheter tubing per instructions at 6 am on postoperative day 1 and recording their voided volumes over the subsequent 6 hours. Patients who voided less than 150 mL underwent a repeat voiding trial in the office. Demographics, medical history, perioperative outcomes, and number of postoperative office calls or visits and ED visits within 30 days were collected. RESULTS: Of the 140 patients who met inclusion criteria, 50 patients (35.7%) had unsuccessful voiding trials on postoperative day 0, and 48 of these 50 (96%) performed catheter self-discontinuation on postoperative day 1. Two patients did not perform catheter self-discontinuation on postoperative day 1: One had her catheter removed in the ED on postoperative day 0 during an ED visit for pain control, and the other performed catheter self-discontinuation off protocol at home on postoperative day 0. There were no adverse events associated with at-home postoperative day 1 catheter self-discontinuation. Of the 48 patients who performed catheter self-discontinuation on postoperative day 1, 81.3% (95% CI 68.1-89.8%) had successful postoperative day 1 at-home voiding trials, and 94.5% (95% CI 83.1-98.6%) of those with successful voiding trials did not require additional catheterization. Patients with unsuccessful postoperative day 0 voiding trials had more office calls and messages (3 vs 2, P <.001) and those with unsuccessful postoperative day 1 voiding trials attended more office visits (2 vs 1, P <.001) compared with those with successful postoperative day 0 or 1 voiding trials, respectively. There was no difference in ED visits or postoperative complications between patients with successful voiding trials on postoperative day 0 or 1 and those with unsuccessful voiding trials on postoperative day 0 or 1. Patients with unsuccessful postoperative day 0 voiding trials were older and more likely to have undergone vaginal hysterectomy or prolapse repair than those with successful postoperative day 0 voiding trials. Patients with unsuccessful postoperative day 1 voiding trials were older than those with successful postoperative day 1 voiding trials. CONCLUSION: Catheter self-discontinuation is a feasible alternative to in-office voiding trials on postoperative day 1 after advanced benign gynecologic and urogynecologic surgery, with low rates of subsequent retention and no adverse events seen in our pilot study.

Diagnosing a nocturnal eating disorder in an average-weight man.

A middle-aged man of average weight presented to the sleep medicine clinic for multiple episodes of nocturnal eating during night-time awakenings for the past several months. His symptoms were more characteristic of night eating syndrome rather than sleep-related eating disorder because of his recollection of the eating episodes and intake of edible substances during these episodes. He was treated with a low dose of sertraline with an initial improvement of symptoms followed by a relapse that was controlled with an increased dose. A year after initiation of therapy, his symptoms have resolved.

Desiccation tolerance in Anopheles coluzzii: the effects of spiracle size and cuticular hydrocarbons.

The African malaria mosquitoes Anopheles gambiae and Anopheles coluzzii range over forests and arid areas, where they withstand dry spells and months-long dry seasons, suggesting variation in their desiccation tolerance. We subjected a laboratory colony (G3) and wild Sahelian mosquitoes during the rainy and dry seasons to desiccation assays. The thoracic spiracles and amount and composition of cuticular hydrocarbons (CHCs) of individual mosquitoes were measured to determine the effects of these traits on desiccation tolerance. The relative humidity of the assay, body water available, rate of water loss and water content at death accounted for 88% of the variation in desiccation tolerance. Spiracle size did not affect the rate of water loss or desiccation tolerance of the colony mosquitoes, as was the case for the total CHCs. However, six CHCs accounted for 71% of the variation in desiccation tolerance and three accounted for 72% of the variation in the rate of water loss. Wild A. coluzzii exhibited elevated desiccation tolerance during the dry season. During that time, relative thorax and spiracle sizes were smaller than during the rainy season. A smaller spiracle size appeared to increase A. coluzzii's desiccation tolerance, but was not statistically significant. Seasonal changes in CHC composition were detected in Sahelian A. coluzzii Stepwise regression models suggested the effect of particular CHCs on desiccation tolerance. In conclusion, the combination of particular CHCs along with the total amount of CHCs is a primary mechanism conferring desiccation tolerance in A. coluzzii, while variation in spiracle size might be a secondary mechanism.