ABSTRACT
This article, the fourth in a series of articles relating to clinical skills in nursing, outlines the procedure of urethral meatal cleansing. This involves cleansing the area around the urethra and is usually undertaken before insertion of a urinary catheter.
Subject(s)
Baths/methods , Infection Control/methods , Urethra , Urinary Catheterization/methods , Baths/nursing , Catheters, Indwelling , Clinical Nursing Research , Evidence-Based Medicine , Humans , Practice Guidelines as Topic , Urinary Catheterization/adverse effects , Urinary Catheterization/nursing , Urinary Tract Infections/etiology , Urinary Tract Infections/prevention & controlABSTRACT
OBJECTIVE: To evaluate the effect of pregnancy on renal function, and the effect of congenital urinary tract abnormality and reconstruction on pregnancy and delivery. PATIENTS AND METHODS: The case notes were reviewed of 20 women (median age 32.5 years) who had had 29 live babies. Data collected included patient demographics, congenital urological abnormality, urological reconstructive procedure(s) and any subsequent urological complications. Pregnancy details, including urological and obstetric complications, presentation and mode of delivery, were obtained via a postal questionnaire from the relevant obstetrician. RESULTS: Seven patients had exstrophy-epispadias, seven spinal dysraphism, two sacral agenesis, and one each cerebral palsy, epispadias, imperforate anus and small bladder with vesico-ureteric reflux and congenital incontinence. They had had a mean (range) of 5.7 (1-12) urological reconstructive procedures each. Patients with exstrophy-epispadias had significantly more operations (mean 7.8) than those with spinal dysraphism (mean 4.14) or other diagnoses (mean 2.6) (P < 0.01). At the last follow-up 13 patients had an enterocystoplasty, six a neobladder and one an ileal conduit. Pregnancy-related urological complications were urinary tract infection in 15, upper tract obstruction requiring nephrostomy and stent in three, Mitrofanoff difficulties in two and pyelonephritis in one. There was no significant deterioration in glomerular filtration rate or serum creatinine after pregnancy. Only 10 of the births were normal or assisted vaginal deliveries. Seven patients had emergency and 12 had elective Caesarean sections for obstetric indications, including four breech births in the seven patients with vesical exstrophy. CONCLUSIONS: Pregnancy has no long-term effect on renal function and does not compromise reconstruction. Although there is a substantial complication rate and an increased need for Caesarean section, pregnancy in women with lower urinary tract reconstruction for congenital urological abnormalities is ultimately safe for both mother and baby. Interdisciplinary co-operation is desirable for a successful outcome.
Subject(s)
Pregnancy Complications/etiology , Urinary Tract/abnormalities , Urologic Diseases/etiology , Adult , Cesarean Section/statistics & numerical data , Creatinine/blood , Delivery, Obstetric/statistics & numerical data , Female , Glomerular Filtration Rate/physiology , Humans , Kidney Diseases/etiology , Kidney Diseases/physiopathology , Male , Middle Aged , Pregnancy , Pregnancy Complications/physiopathology , Plastic Surgery Procedures/adverse effects , Urinary Reservoirs, Continent/physiology , Urologic Diseases/physiopathology , Urologic Surgical Procedures/adverse effectsABSTRACT
1. Continent urinary diversions are an alternative diversion to urostomies. 2. Nurses must be aware of the intense preparation, high level nursing and continuous support needed by patients. 3. Patients and carers need to be made aware of the high complication rate of these operations. 4. Commitment to care of the diversion by the patient and a strict follow-up regimen are essential to ensure complications are avoided or dealt with early.