Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 972
Filtrar
1.
Medicine (Baltimore) ; 100(15): e25490, 2021 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-33847659

RESUMO

BACKGROUND: The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA). METHODS: PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time. RESULTS: A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004). CONCLUSION: The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA. LEVEL OF EVIDENCE: Level I, therapeutic study.


Assuntos
Artroplastia do Joelho/efeitos adversos , Cateteres de Demora/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateterismo Urinário/instrumentação , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia , Idoso , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Retenção Urinária/etiologia
2.
J Am Vet Med Assoc ; 258(5): 483-492, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620246

RESUMO

OBJECTIVE: To investigate whether decompressive cystocentesis (DC) safely facilitates urethral catheterization (UC) in cats with urethral obstruction (UO). ANIMALS: 88 male cats with UO. PROCEDURES: Cats were randomly assigned to receive DC prior to UC (ie, DC group cats; n = 44) or UC only (ie, UC group cats; 44). Abdominal effusion was monitored by serial ultrasonographic examination of the urinary bladder before DC and UC or before UC (DC and UC group cats, respectively), immediately after UC, and 4 hours after UC. Total abdominal effusion score at each time point ranged from 0 (no effusion) to 16 (extensive effusion). Ease of UC (score, 0 [easy passage] to 4 [unable to pass]), time to place urinary catheter, and adverse events were recorded. RESULTS: No significant difference was found in median time to place the urinary catheter in UC group cats (132 seconds), compared with DC group cats (120 seconds). Median score for ease of UC was not significantly different between UC group cats (score, 1; range, 0 to 3) and DC group cats (score, 1; range, 0 to 4). Median change in total abdominal effusion score from before UC and DC to immediately after UC was 0 and nonsignificant in UC group cats (range, -5 to 12) and DC group cats (range, -4 to 8). Median change in effusion score from immediately after UC to 4 hours after UC was not significantly different between UC group cats (score, -1; range, -9 to 5) and DC group cats (score, -1; range, -7 to 5). CONCLUSIONS AND CLINICAL RELEVANCE: DC did not improve time to place the urinary catheter or ease of UC in cats with UO.


Assuntos
Doenças do Gato , Obstrução Uretral , Animais , Doenças do Gato/cirurgia , Gatos , Masculino , Obstrução Uretral/cirurgia , Obstrução Uretral/veterinária , Bexiga Urinária , Cateterismo Urinário/veterinária , Cateteres Urinários
3.
Medicine (Baltimore) ; 100(6): e24182, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578522

RESUMO

ABSTRACT: Cervical cancer is a common malignancy in women. The presence of hydronephrosis in patients with cervical cancer can be a challenging clinical problem. The appropriate management of these patients and the prediction of their outcomes are concerns among gynecologists, urologists, medical oncologists, radiation oncologists, and nephrologists. We enrolled a total of 2225 patients with cervical cancer over a 12-year period from the nationwide database of Taiwan's National Health Insurance Bureau. Among them, 445 patients had concomitant hydronephrosis. The remaining 1780 patients without hydronephrosis were randomly enrolled as a control group for the analysis of associated factors. The results indicated that the proportions of patients with hypertension, chronic kidney disease, and diabetes were significantly higher in the hydronephrosis group. The hydronephrosis group showed a higher all-cause mortality than the non-hydronephrosis group (adjusted hazard ratio 3.05, 95% confidence interval 2.24-4.15, P < .001). The rates of nephrectomy and stone disease were also significantly higher in the hydronephrosis group. A higher percentage of other cancers was also observed in the hydronephrosis group than in the non-hydronephrosis group (12.36% vs 8.99%, respectively). This study shows that cervical cancer with hydronephrosis may have a higher morbidity and mortality than cervical cancer without hydronephrosis. Other factors such as human papilloma virus vaccination, smoking, and cancer staging need to be further studied.


Assuntos
Hidronefrose/etiologia , Neoplasias do Colo do Útero/complicações , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Comorbidade , Gerenciamento de Dados , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Cálculos Renais/epidemiologia , Pessoa de Meia-Idade , Nefrectomia/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Insuficiência Renal Crônica/epidemiologia , Estudos Retrospectivos , Taiwan/epidemiologia , Cateteres Urinários/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle
4.
Int J Clin Pract ; 75(5): e13963, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33368991

RESUMO

PURPOSE: In the present study, the impact of penile nerve block (PNB) on postoperative pain and Catheter-Related Bladder Discomfort (CRBD) in the transurethral resection of prostate(TURP) patients were evaluated. METHODS: Participants of the present study were selected from patients who performed TURP under spinal anaesthesia for benign prostatic hyperplasia (BPH) between January 2018 and July 2020. The present study was planned as a single-centre, randomised-controlled prospective study in which the patients were divided into two groups. Group 1 was administered Control (n:40), and Group 2 ultrasonography(USG) guided PNB (n:40). The patients were included in the Groups, respectively. Visual analogue scale (VAS) scores were questioned and recorded in order to evaluate the postoperative pain complaints of the patients after the operation. In addition, in order to evaluate the CRBD, VAS scores were questioned and recorded as 0th, 0-1th hour, 1st-2nd hour, 2nd-4th hour, 4th-8th hour, 8th-12th hour, and 12th-24th hour. In addition, postoperative pain and need for analgesic drug were recorded. Tramadol was given to patients with moderate to severe CRBD. The findings were compared between the Groups. RESULTS: There was no statistical difference demographic and per-operative data between Group 1 and Group 2. The CRBD and pain-related VAS scores were significantly higher in Group 1 between the 0 and 8th hours. There was no difference between VAS scores in the postoperative 8-24th hours. In total 24 hours, Group 2's need for tramadol was significantly less than Group 1. On examining the factors affecting CRBD in the multivariate analysis, age, body mass index(BMI), prostate volume, operation time do not affect CRBD statistically, and only PNB reduces CRBD (P: .029). While less drug-related complications were observed in Group 2, no serious complications related to PNB were observed. CONCLUSION: Penile nerve block is an effective method for the decrease pain and CRBD after urological surgery. It will also reduce the need for analgesics, and provide painless patients in the postoperative period.


Assuntos
Nervo Pudendo , Ressecção Transuretral da Próstata , Humanos , Masculino , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Ressecção Transuretral da Próstata/efeitos adversos , Bexiga Urinária , Cateteres Urinários
5.
Carbohydr Polym ; 252: 117192, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33183634

RESUMO

Microorganisms which adhere to the surfaces of indwelling medical implants develop into a sessile microbial community to form monomicrobial or polymicrobial biofilms. Staphylococcus epidermidis and Candida albicans are the most common pathogens co-isolated from device mediated infections. Hence development of catheters coated with anti-fouling substances is of great interest. In this current study, chitosan, extracted from the shells of marine crab Portunus sanguinolentus was coated over the surface of the urinary catheters and checked for its efficacy to inhibit the adherence of both mono and mixed species biofilms. The Extracted Chitosan (EC) coated catheters showed profound activity in reducing the preformed biofilms and the other virulence factors of the pathogens like slime production in S. epidermidis and yeast to hyphal swtich in C. albicans. Furthermore, qPCR analysis showed that EC could downregulate the virulence genes in both the pathogens when grown as monospecies and mixed species biofilms.


Assuntos
Anti-Infecciosos/farmacologia , Biofilmes/efeitos dos fármacos , Candida albicans/efeitos dos fármacos , Quitosana/farmacologia , Staphylococcus epidermidis/efeitos dos fármacos , Cateteres Urinários/microbiologia , Animais , Braquiúros/química
6.
Rev. chil. infectol ; 37(5): 509-514, nov. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1144244

RESUMO

Resumen La infección del tracto urinario asociada al catéter urinario permanente (ITU/CUP) es un problema relevante en los centros de salud por su alta frecuencia. Objetivo: Identificar factores de riesgo de ITU en pacientes adultos con CUP. Material y Método: Estudio caso control efectuado entre los años 2010-2016 en el Hospital Militar de Santiago. Se realizó un análisis estadístico univariado y multivariado por medio del modelo de regresión logística binaria, con variables como edad, duración e indicación del dispositivo, algunas comorbilidades y la instalación del dispositivo luego de 15 días hospitalización. Resultado: Se obtuvo un total de 63 casos y 123 controles. Fueron variables predictoras de ITU/CUP la duración del CUP desde el séptimo día en adelante (OR 2,6 IC 1,4-4,9, p = 0,004) y la instalación del CUP con una estadía de hospitalización previa de 15 días y más (OR 7,8 IC 2,920,9 p = 0,000). No se encontró asociación con la edad mayor de 80 años, comorbilidades como diabetes y vejiga neurogénica e indicación de instalación. Conclusiones: Los resultados permiten focalizar las intervenciones, evaluando la necesidad real de indicación de CUP en pacientes con estadía hospitalaria previa de dos semanas y fomentar el retiro de CUP antes del séptimo día de uso.


Abstract Catheter-associated urinary tract infection (CAUTI) is a relevant problem in health centers because of its high frequency. Objective: To identify UTI risk factors in adult patients with urinary catheter. Material and Method: Control case study carried out between the years 2010-2016 at the Military Hospital of Santiago, Chile. Univariate and multivariate statistical analysis were performed using the binary logistic regression model, variables such as age, duration and indication of the device, some comorbidities and the installation of the device after 15 days of hospitalization. Result: A total of 63 cases and 123 controls were obtained. Predictive variables of CAUTI for the duration of the urinary catheter from the 7th day onwards (OR 2.6 IC 1.4-4.9, p = 0.004) and the installation of the urinary catheter with a previous hospital stay of 15 days and more (OR 7.8 CI 2.9-20.9 p = 0.000). No association was found in age over 80 years, comorbidities such as diabetes and neurogenic bladder and indication. Conclusions: The results permitted to focus the interventions, evaluating the real need for indication of CUP in patients with previous hospital statistics of 2 weeks and encouraging the withdrawal of CUP before the 7th day of use.


Assuntos
Humanos , Adulto , Idoso de 80 Anos ou mais , Infecções Urinárias/etiologia , Infecções Urinárias/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateteres Urinários/efeitos adversos , Cateterismo Urinário/efeitos adversos , Chile/epidemiologia , Infecção Hospitalar/epidemiologia , Fatores de Risco
7.
Actas urol. esp ; 44(8): 549-553, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-197146

RESUMO

OBJETIVOS: Desarrollar un modelo de formación sobre el catéter suprapúbico (CSP), ya que no existe un modelo realista específico para replicar el recambio de CSP. MATERIALES Y MÉTODOS: Describimos un modelo animal de simulación, anatómicamente realista, para su uso en la formación del manejo del CSP, el cual fue probado por residentes de urología y validado por urólogos expertos. Usando una pared abdominal porcina, se creó una reproducción a escala de la pared abdominal. Un segmento del intestino delgado fue cosido alrededor de un catéter de Foley de tamaño 16F para formar el tubo. Se crea una apertura cilíndrica en la pared abdominal, realizando un canal para introducir el tracto del intestino delgado; este fue suturado en la parte anterior, produciendo una sonda de CSP de apariencia realista. En la parte inferior la sonda fue anastomosada a una vejiga urinaria porcina. La validez de contenido del modelo fue evaluada por 10 urólogos expertos, con una escala de calificación de 8 ítems y 5 puntos, utilizada para evaluar las distintas áreas relevantes del simulador. RESULTADOS: Estas áreas fueron puntuadas de 1 a 5 por 10 urólogos expertos, siendo 1 «totalmente en desacuerdo» y 5 «totalmente de acuerdo». El promedio de la calificación de los expertos fue calculado y tabulado al finalizar la formación. La calificación global del modelo fue de 4,2/5, con un promedio de utilidad para la formación de 4,6/5. CONCLUSIÓN: La respuesta (informal) obtenida por parte de expertos y alumnos fue altamente positiva. En promedio, nuestros expertos reportaron una experiencia satisfactoria con el uso de este simulador como herramienta de formación


OBJECTIVES: To develop a suprapubic catheter (SPC) training model as no specific realistic training model exists to replicate SPC exchange where a catheter tract is present. MATERIALS AND METHODS: We describe a novel, anatomically realistic, animal simulator model for use in SPC training, which was trialed at a national urology simulation boot camp by new urology trainees and validated by expert urologists. A scale reproduction of an abdominal wall was created using a porcine abdominal wall. A segment of small bowel was stitched around a size 16F Foley catheter to form a tract. Abdominal wall tissue was excised cylindrically to create an opening, and the small bowel tract was passed through the abdominal wall and sutured anteriorly, producing a realistic SPC tract: inferiorly, the tract was anastomosed to a porcine urinary bladder. This model was evaluated by 10 expert urologists for content validity with an 8-item 5-point rating scale used to evaluate domains relevant to the simulator. RESULTS: The domains were scored between 1 and 5 by 10 expert urologists, 1 being «strongly disagree» and 5 being «strongly agree». The average expert ratings of the domains were then calculated and tabulated following the training course. There was an average global rating of 4.2/5 for the model, with an average usefulness for training score of 4.6/5. CONCLUSION: The feedback from experts and trainees (informal) was overwhelmingly positive. On average, our experts reported high satisfaction with their experience using this simulator as a training tool


Assuntos
Animais , Cateterismo Urinário/métodos , Cateteres Urinários , Simulação/métodos , Suínos , Cateterismo Urinário/instrumentação , Urologia/educação , Fatores de Tempo , Reprodutibilidade dos Testes , Urologistas/educação , Modelos Animais
9.
Hu Li Za Zhi ; 67(4): 89-97, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32748383

RESUMO

BACKGROUND & PROBLEMS: According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. PURPOSE: The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. RESOLUTIONS: This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. RESULTS: We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. CONCLUSIONS: This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Cateteres Urinários/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Cateterismo Urinário/enfermagem
11.
PLoS One ; 15(6): e0233215, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32520937

RESUMO

OBJECTIVE: To evaluate the efficacy of noble-metal coated catheters in reducing catheter-associated urinary tract infections (CAUTI) in adult patients requiring short term catheterization. METHODS: An electronic literature search of PubMed, BioMed Central, Embase, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar was carried out from inception to 10th October 2019. Any prospective study or randomized controlled trial (RCT) on adult patients comparing noble-metal coated urinary catheters with any standard catheter and evaluating the incidence of CAUTI or bacteriuria was included. RESULTS: A total of 13 studies were included in the systematic review. 12 were RCTs and one was a prospective cross-over trial. Catheters employed in the study group were grouped into two sub-groups: Silver alloy coated or Noble metal alloy-coated (Gold, Silver, and Palladium) catheters. Bacteriuria was the most commonly studied outcome variable across trials. Meta-analysis indicated that silver alloy-coated catheters (RR 0.63, 95%CI 0.44-0.90, P = 0.01; I2 = 72%) and noble metal alloy catheters (RR 0.58, 95%CI 0.41-0.81, P = 0.001; I2 = 0%) significantly reduce the risk of bacteriuria. Sub-group analysis based on the duration of catheterization demonstrated that silver alloy catheters reduce the risk of bacteriuria with >1week of catheterization (RR 0.46, 95%CI 0.26-0.81, P = 0.007; I2 = 63%). Symptomatic CAUTI was evaluated only in four studies with variable results. The quality of the included studies was not high. CONCLUSIONS: Our review indicates that bacteriuria may be reduced with the use of noble metal-coated catheters during short-term catheterization of adults, however, the quality of evidence is not high. It is not clear if these catheters reduce the risk of symptomatic CAUTI. Further homogenous RCTs are needed to provide clarity.


Assuntos
Metais/uso terapêutico , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Bacteriúria/complicações , Bacteriúria/etiologia , Infecções Relacionadas a Cateter/etiologia , Ouro , Humanos , Paládio , Prata , Cateteres Urinários/tendências , Infecções Urinárias/epidemiologia
12.
J Clin Neurosci ; 78: 135-138, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32536507

RESUMO

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.


Assuntos
Ligas/normas , Melhoria de Qualidade/normas , Silicones/normas , Prata/normas , Traumatismos da Medula Espinal/terapia , Cateteres Urinários/normas , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres de Demora/efeitos adversos , Cateteres de Demora/normas , Cateteres de Demora/tendências , Medula Cervical/lesões , Desenho de Equipamento/normas , Feminino , Humanos , Masculino , Estudos Prospectivos , Melhoria de Qualidade/tendências , Traumatismos da Medula Espinal/epidemiologia , Resultado do Tratamento , Cateteres Urinários/efeitos adversos , Cateteres Urinários/tendências , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle
13.
Saudi Med J ; 41(6): 640-644, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518932

RESUMO

OBJECTIVES: To investigate whether preoperative oral gabapentin could reduce postoperative pain, analgesic consumption and the occurrence of catheter-related bladder discomfort (CRBD). Methods: In this study, participants randomly received either 600 mg gabapentin or placebo orally 2 h prior to transurethral prostate resection. Visual analogue scale and Ramsay sedation scale was utilized to assess pain intensity and sedation status after surgery. Intravenous 1.5 mg.kg-1 tramadol was used for postoperative analgesia. Pain intensity, sedation status, CRBD, tramadol consumption, side effects and the overall satisfaction degree were assessed and recorded for 48 h after tracheal extubation.  Results: Ninety participants given gabapentin and 91 participants given placebo completed the study. Lower visual analogue scale scores, less tramadol consumption, longer time to the first analgesic requirement, lower incidence of CRBD and nausea and higher satisfaction degree were detected in the patients receiving gabapentin compared with the patients receiving placebo.  Conclusion: Preoperative oral gabapentin reduced postoperative visual analogue scale scores, tramadol consumption and the occurrence rate of CRBD and nausea, and consequently, increased the degree of patients' satisfaction after transurethral prostate resection.


Assuntos
Anestesia Geral , Gabapentina/administração & dosagem , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Ressecção Transuretral da Próstata , Administração Oral , Idoso , Método Duplo-Cego , Uso de Medicamentos , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/prevenção & controle , Cuidados Pré-Operatórios , Tramadol , Resultado do Tratamento , Bexiga Urinária , Cateteres Urinários/efeitos adversos
14.
Curr Urol Rep ; 21(8): 30, 2020 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-32506179

RESUMO

PURPOSE OF REVIEW: To review the evidence regarding the usage of suprapubic tube (SPT) versus indwelling urethral catheter (IUC) after robot-assisted radical prostatectomy (RARP). RECENT FINDINGS: Available data on the use of SPT for urinary drainage after RARP is somewhat limited mostly because of the variations of study designs and non-standardized outcomes. Although it may provide some mild benefit in terms of catheter-related pain and discomfort, the benefit seems not to be clinically significant. The evidence in the literature so far does not support routine usage of SPT as the primary urinary drainage method after RARP. Further higher-quality studies that can show clinically significant advantages over IUC are still needed to justify its usage.


Assuntos
Drenagem/métodos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cateterismo Urinário/métodos , Humanos , Masculino , Complicações Pós-Operatórias , Prostatectomia/efeitos adversos , Uretra , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos
15.
Am J Obstet Gynecol ; 223(2): 260.e1-260.e9, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32502559

RESUMO

BACKGROUND: Rates of postoperative incomplete bladder emptying vary significantly after pelvic reconstructive surgery. With enhanced recovery protocols the paradigm is shifting towards same-day discharge and the rates of incomplete bladder emptying are expected to increase. The optimal length of time for postoperative catheter drainage has not been clearly established. There are no current studies that assess the optimal timing of a repeat voiding trial in women who have unsuccessful same day voiding trials. OBJECTIVE: This study aimed to compare the outcomes of a second voiding trial performed 2-4 days (earlier group) vs 7 days (later group) postoperatively in women with incomplete bladder emptying after vaginal prolapse surgery. Secondary aims included postoperative urinary tract infection rates, total days with a catheter, and patient-reported catheter bother between groups. STUDY DESIGN: Across 2 sites, women undergoing multicompartment vaginal repair were enrolled. Within 6 hours postoperatively, subjects had an active retrograde voiding trial. Those who passed this voiding trial exited the study; those who had persistent incomplete bladder emptying (postvoid residual >100 mL) had a transurethral indwelling catheter placed and were randomized to return for an earlier (postoperative day 2-4) vs later (postoperative day 7) follow-up office voiding trial. Subjects were followed for 6 weeks after surgery. The primary outcome was the rate of unsuccessful repeat office voiding trial. Secondary outcomes included rates of urinary tract infection, total days with a catheter, and subjective catheter bother. A power calculation based on a projected 31% difference, a power of 0.8, and an alpha of 0.05 revealed that 30 subjects were needed in each group. RESULTS: A total of 102 subjects were enrolled; 38 exited on postoperative day 0, leaving 64 subjects for randomization (4 of whom withdrew after randomization). A comparison of data revealed that randomization was effective, with no differences between the earlier and later groups in terms of demographic data or surgical procedures. Using an intention-to-treat analysis, women in the earlier group were more likely to be unsuccessful in their follow-up office voiding trial (23.3%) than the later group (3.3%), with a risk difference of 20% (95% confidence interval, 3.56-36.44) and a relative risk of 7.00 (95% confidence interval, 0.92-53.47; P=.02). A number-needed-to-treat calculation found that for every 5 patients using a catheter for 7 days postoperatively, 1 case of persistent postoperative incomplete bladder emptying was prevented. Rates of catheter bother did not differ between groups at the time of the follow-up office voiding trial or at 6 weeks (P=.09 and P=.20, respectively). Urinary tract infection rates were higher in the earlier group but did not reach statistical significance (23% vs 7%, P=.07). Regression analysis revealed that subjects who required additional pain medication refills were 9.6 times (95% confidence interval, 1.24-73.77) more likely to have persistent incomplete bladder emptying after the follow-up office voiding trial. CONCLUSION: Women with incomplete bladder emptying after multicompartment prolapse repair had a 7-fold higher risk of an unsuccessful repeat office voiding trial if performed within 4 days of surgery than when performed within 7 days of surgery. In addition, requiring additional prescriptions for analgesia increased the risk of an unsuccessful follow-up office voiding trial.


Assuntos
Procedimentos Cirúrgicos em Ginecologia , Prolapso de Órgão Pélvico/cirurgia , Complicações Pós-Operatórias/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Cateterismo Urinário , Retenção Urinária/fisiopatologia , Vagina/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Slings Suburetrais , Fatores de Tempo , Cateteres Urinários , Retenção Urinária/diagnóstico , Infecções Urinárias/epidemiologia
16.
J Clin Nurs ; 29(15-16): 3042-3053, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32441867

RESUMO

BACKGROUND: It is essential to evaluate the ways in which practice changes are implemented and received in and across contexts, identifying barriers and enablers, and mechanisms for enhancing success. AIM: To provide insights into the experiences of clinicians in implementing a multifaceted bundled urinary catheter care intervention in four acute care hospitals in New South Wales, Australia. METHODS: The catheter care bundle was implemented using a pre- and postintervention study design. The intervention was implemented in all adult inpatient wards, emergency departments and operating theatres of four hospitals. The bundle consisted of an integrated set of evidence-based practices to assist clinicians in making better informed decisions related to catheter insertion, care and removal practices. Focus groups at each participating hospital evaluated the implementation processes from the clinicians' perspective, identifying barriers and enablers to successful implementation. RESULTS: Eight focus groups were held with 35 participants. Four key inter-related themes were identified: early and sustained engagement with key stakeholders; good planning but remaining flexible; managing the burden of practice change; and adopting and sustaining practice change. These themes capture and highlight the complexity and the challenges associated with implementation of the practice change across contexts and the project timeline. CONCLUSION: It is imperative to understand the challenges associated with complex practice change and ways in which implementation can be optimised. This study identified barriers and enablers experienced by staff implementing the bundled intervention. The themes encapsulate factors central to success of practice change within the complex, multilayered healthcare environment. RELEVANCE TO CLINICAL PRACTICE: Key challenges highlight the need for forward planning, strategic engagement of key players, continuing monitoring and feedback together with adequate resourcing tailored to result in sustainable normalisation of the intervention over time. The COREQ checklist for qualitative studies has been used in reporting this study.


Assuntos
Cateteres de Demora/efeitos adversos , Pacotes de Assistência ao Paciente/enfermagem , Cateterismo Urinário/enfermagem , Cateteres Urinários/efeitos adversos , Adulto , Tomada de Decisão Clínica/métodos , Prática Clínica Baseada em Evidências , Grupos Focais , Humanos , New South Wales , Desenvolvimento de Programas , Pesquisa Qualitativa , Cateterismo Urinário/métodos
17.
Medicina (B Aires) ; 80(3): 241-247, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442938

RESUMO

The second part of the Inter-Society Argentine Consensus on Urinary Tract Infection (UTI) includes the analysis of special situations. In patients with urinary catheter, urine culture should be requested only in the presence of UTI symptomatology, before instrumentation of the urinary tract, or as a post-transplant control. The antibiotics recommended for empirical treatment in patients without risk factors are third-generation cephalosporins or aminoglycosides. UTIs associated with stones are always considered complicated. In case of obstruction with urosepsis, an emergency drainage should be performed via a percutaneous nefrostomy or ureteral stenting. In patients with stents or ureteral prostheses, such as double J catheters, empirical treatment should be based on epidemiology, prior antibiotics, and clinical status. Before the extracorporeal lithotripsy procedure, bacteriuria should be investigated and antibiotic prophylaxis should be administered in case of positive result, according to the antibiogram. First generation cephalosporins or aminoglycosides are valid alternatives. The use of antibiotic prophylaxis with first-generation cephalosporins or aminoglycosides before percutaneous nephrolithotomy is recommended. Transrectal prostatic biopsy can be associated with infectious complications, such as UTI or acute prostatitis, mainly due to Escherichia coli or other enterobacteria. In patients without risk factors for multiresistant bacteria and negative urine culture, prophylaxis with intravenous amikacin or ceftriaxone is recommended. In patients with positive urine culture, prophylaxis will be performed according to the antibiogram, from 24 hours before to 24 hours post-procedure. For the targeted treatment of post-transrectal biopsy prostatitis, carbapenems for 3-4 weeks are the treatment of choice.


Assuntos
Anti-Infecciosos Urinários/uso terapêutico , Consenso , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Argentina , Feminino , Humanos , Litotripsia/efeitos adversos , Masculino , Nefrolitíase/complicações , Nefrolitotomia Percutânea/efeitos adversos , Prostatite/tratamento farmacológico , Prostatite/etiologia , Fatores de Risco , Stents/efeitos adversos , Cateteres Urinários/efeitos adversos
19.
Biofouling ; 36(3): 351-367, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32401555

RESUMO

Pseudomonas aeruginosa and Serratia marcescens are prominent members belonging to the group of ESKAPE pathogens responsible for Urinary Tract Infections (UTI) and nosocomial infections. Both the pathogens regulate several virulence factors, including biofilm formation through quorum sensing (QS), an intercellular communication mechanism. The present study describes the anti-biofilm and QS quenching effect of thiazolinyl-picolinamide based palladium(II) complexes against P. aeruginosa and S. marcescens. Palladium(II) complexes showed quorum sensing inhibitory potential in inhibiting swarming motility behaviour, pyocyanin production and other QS mediated virulence factors in both P. aeruginosa and S. marcescens. In addition, the establishment of biofilms was prevented on palladium (II) coated catheters. Overall, the present study demonstrates that thiazolinyl-picolinamide based palladium (II) complexes will be a promising strategy to combat device-mediated UTI infections.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Complexos de Coordenação/farmacologia , Paládio/farmacologia , Ácidos Picolínicos/química , Tiazóis/química , Cateteres Urinários/microbiologia , Antibacterianos/química , Antibacterianos/toxicidade , Biofilmes/crescimento & desenvolvimento , Sobrevivência Celular/efeitos dos fármacos , Complexos de Coordenação/química , Complexos de Coordenação/toxicidade , Infecção Hospitalar/prevenção & controle , Humanos , Células MCF-7 , Paládio/química , Paládio/toxicidade , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/metabolismo , Piocianina/metabolismo , Percepção de Quorum/efeitos dos fármacos , Serratia marcescens/efeitos dos fármacos , Serratia marcescens/metabolismo , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controle , Virulência , Fatores de Virulência/metabolismo
20.
Am J Physiol Renal Physiol ; 319(1): F29-F32, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32463724

RESUMO

The male mouse is underrepresented in research of the urinary tract due to the difficulty of transurethral catheterization. As a result, there is a lack of analysis of sex differences in urinary tract research. Here, we present a novel catheter design and technique that enables urethral catheterization of male mice for bladder inoculation. Our catheterization technique uses the resistance met at the level of the external urinary sphincter and prostate to guide the retraction, positioning, and advancement of the catheter into the urinary bladder. We have shown that this method can be used to reproducibly catheterize 12 male mice with minimal urogenital trauma but cannot be used as a cystometric technique. This method will facilitate the expansion of research into sex differences in various genitourinary conditions that require transurethral catheterization of mice.


Assuntos
Desenho de Equipamento , Cateterismo Urinário/instrumentação , Cateteres Urinários , Animais , Masculino , Camundongos , Bexiga Urinária
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...