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1.
J Nurs Care Qual ; 35(1): 83-87, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31219899

RESUMO

BACKGROUND: Research has shown that catheter-associated urinary tract infections (CAUTIs) are highly preventable and have significant impact on patient morbidity and mortality as well as financial consequences for the health care system. LOCAL: CAUTI rates were documented to be higher in the general internal medicine units when compared with the overall hospital rates. METHODS: A comparative analysis was undertaken. INTERVENTION: An interprofessional working group developed and implemented a quality improvement initiative bundled approach to reducing CAUTIs. RESULTS: There was a 79% reduction in average CAUTI rates following the bundle implementation along with reduced variability in rates. CONCLUSIONS: Implementation of a standardized bundle of practices aimed at reducing CAUTIs resulted in decreased CAUTI rates. Organizations can use the design and implementation approach to reduce and minimize CAUTI rates, which can positively impact cost, care experience, and outcomes.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecções Urinárias/prevenção & controle , Infecções Relacionadas a Cateter/enfermagem , Comportamento Cooperativo , Humanos , Melhoria de Qualidade , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/enfermagem
3.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289168

RESUMO

Some patients with neurological bladder dysfunction rely on suprapubic catheters (SPCs) for the management of their urinary symptoms. These catheters are usually changed without incident. However, problems can, and do, arise. We present the case of a 56-year-old woman who had a SPC change which was complicated by the catheter perforating the bladder and inflating in the vagina.


Assuntos
Cateteres de Demora/efeitos adversos , Doença Iatrogênica/prevenção & controle , Doenças da Bexiga Urinária/terapia , Bexiga Urinária/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Doenças da Bexiga Urinária/patologia , Cateterismo Urinário/instrumentação , Vagina/fisiopatologia
4.
Ren Fail ; 41(1): 497-506, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31215300

RESUMO

Objectives: To improve the mouse model of relief for unilateral ureteral obstruction (RUUO) and explore the pathological process of renal fibrosis after the obstruction was relieved. Methods: C57BL/6 mice in model group were randomly divided into RUUO group, improved RUUO group, and UUO group. After leaving Unilateral Ureteral Obstruction (UUO) for 3 days, the obstruction was released by reimplantation way in RUUO group and in reimplantation + catheter way in improved RUUO group. C57BL/6 mice in observation group were randomly divided into 1d RUUO group, 3d RUUO group, 7d RUUO group, and 14d RUUO group. Three days after UUO, the obstruction was released by reimplantation + catheter in four groups. We detected the renal volume, H&E, Masson staining, and immunohistochemistry of kidney pathology on the seventh day after RUUO in model group and on the 1st, 3rd, 7th, and 14th day after RUUO in observation group. Results: Comparing with mice in RUUO group, mice in improved RUUO group had lower renal volume, tubular damage score, and collagen area percentage. After the obstruction was relieved, the renal volume decreased gradually within 2 weeks. The tubular damage score in 7d RUUO group was lower than that in 1d RUUO and 3d RUUO group. However, the tubular damage score in 14d RUUO group was higher than that in 7d RUUO group. The tendency of collagen area percentage and α-SMA IOD value were consistent with the tubular damage score. Conclusions: Using the method of reimplantation + catheter, a reliable mice model of RUUO can be got. After RUUO, the de-obstructed kidneys are still in damage and fibrosis state.


Assuntos
Modelos Animais de Doenças , Rim/patologia , Obstrução Ureteral/complicações , Cateterismo Urinário/métodos , Animais , Fibrose , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Ureter/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/instrumentação , Cateteres Urinários
5.
J Vet Emerg Crit Care (San Antonio) ; 29(4): 366-372, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31215748

RESUMO

OBJECTIVE: To evaluate the effect of intra-abdominal pressure (IAP) on plasma exogenous creatinine clearance in both conscious and anesthetized dog models using a balloon technique to generate intra-abdominal hypertension. DESIGN: Prospective, cross-over, experimental study. SETTING: University-based small animal research facility. ANIMALS: Six healthy male Beagle dogs. INTERVENTIONS: A balloon device comprising a Foley urinary catheter and latex balloon was placed in the intra-abdominal cavity. Plasma exogenous creatinine clearance was compared after intravenous administration of exogenous creatinine solution at 80 mg/kg under 4 different treatment conditions as follows: control and IAP levels of 25 mm Hg in conscious dogs and control and IAP levels of 25 mm Hg in anesthetized dogs (CC, C25, AC, and A25, respectively). Samples were obtained before (T0) and 10, 20, 30, 60, 90, 120, 240, 360, 480, and 600 min after administration of creatinine in all treatment groups. MEASUREMENTS AND MAIN RESULTS: There were no significant differences in plasma creatinine concentration for CC, AC, and C25 during the treatment period. However, in the A25 treatment condition, the plasma creatinine concentration increased significantly at 10, 20, 30, 60, 90, and 120 min after administration of creatinine (P < 0.05). Plasma creatinine clearances were 5.0 ± 0.5, 4.7 ± 1.2, 5.5 ± 0.9, and 2.5 ± 0.5 mL/kg/min for 600 min (CC, AC, C25, and A25, respectively). In the A25 treatment condition, the plasma exogenous creatinine clearance decreased significantly to 50%, 47%, and 55% of that under control conditions (CC, AC, and C25, respectively). After decompression of the abdomen, plasma creatinine concentrations declined rapidly and returned to basal concentrations. CONCLUSIONS: Intra-abdominal hypertension under general anesthesia could cause renal hypoperfusion. Timely decompression may improve the outcome of acutely increased IAP when surgery and/or general anesthesia is required in canine patients.


Assuntos
Creatinina/sangue , Cães/fisiologia , Hipertensão Intra-Abdominal/veterinária , Cateterismo Urinário/veterinária , Animais , Creatinina/metabolismo , Estudos Cross-Over , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/fisiopatologia , Masculino , Estudos Prospectivos , Cateterismo Urinário/instrumentação
6.
Int J Gynaecol Obstet ; 146(1): 25-28, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31055829

RESUMO

OBJECTIVE: Adequate obstetric care requires the availability of essential diagnostic and management equipment; however, for centers with budget restrictions, the acquisition and maintenance of these devices can pose major challenges. The purpose of the present paper is to disseminate knowledge about the availability of affordable and low-maintenance obstetric devices, which might help to save lives in low- and medium-resource countries. METHOD: Over the course of 2015-2018, the International Federation of Gynecology and Obstetrics (FIGO) Safe Motherhood and Newborn Health Committee acquired information from different clinical and commercial sources regarding the availability of affordable and low-maintenance essential obstetric devices. RESULTS: The Committee identified several devices that met the criteria of low cost and ease of maintenance: a winding handheld Doppler device for intermittent auscultation; a portable continuous fetal heart rate monitor; a validated semi-automated blood pressure monitor; the Foley catheter balloon for labor induction in women with an unfavorable cervix; reusable metal and plastic vacuum cups and manual pumps; an intrauterine tamponade balloon; and the non-pneumatic anti-shock garment. CONCLUSION: Several affordable and low-maintenance obstetric devices are currently available that offer the potential to save lives in resource-constrained settings.


Assuntos
Obstetrícia/instrumentação , Oclusão com Balão/instrumentação , Determinação da Pressão Arterial/instrumentação , Cardiotocografia/instrumentação , Feminino , Humanos , Recém-Nascido , Trabalho de Parto Induzido/instrumentação , Obstetrícia/economia , Gravidez , Ultrassonografia Doppler/instrumentação , Cateterismo Urinário/instrumentação , Vácuo-Extração/instrumentação
7.
Artigo em Alemão | MEDLINE | ID: mdl-30999351

RESUMO

The diagnosis of obstructive urolithiasis in small ruminants frequently results in a multitude of decisions that have to be made by the consulted practitioner. Factors that influence the decision for therapy (or euthanasia) are the type of the animal's use, economic aspects and specific options of the veterinarian practice as well as emotional aspects depending on the owners of small ruminants kept as companion animals. The present article aims to present the currently available methods of therapy to facilitate a decision by the practicing veterinarian based on the present state of the science. Naturally, the individual method of choice may differ from the scientific point of view depending on the practitioner's evaluation.


Assuntos
Doenças das Cabras/terapia , Doenças dos Ovinos/terapia , Urolitíase/veterinária , Amputação/veterinária , Animais , Cistotomia/veterinária , Cabras , Litotripsia/métodos , Litotripsia/veterinária , Litotripsia a Laser/veterinária , Masculino , Pênis/cirurgia , Ovinos , Cirurgia Plástica/veterinária , Uretra/cirurgia , Obstrução Uretral/etiologia , Obstrução Uretral/terapia , Obstrução Uretral/veterinária , Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Cateterismo Urinário/veterinária , Urolitíase/complicações , Urolitíase/terapia
8.
Clinics (Sao Paulo) ; 74: e435, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994702

RESUMO

OBJECTIVES: Minimally invasive paracentetic suprapubic cystostomy is a technique that should be learned by all surgical trainees and residents. This study aimed to develop a self-made training model for paracentetic suprapubic cystostomy and placement of the suprapubic catheter and then to evaluate its effectiveness in training fourth-year medical students. METHODS: Medical students were divided into an experimental group receiving comprehensive training involving literature, video, and model use and a control group receiving all the same training protocols as the experimental group except without hands-on practice using the model. Each student's performance was video-recorded, followed by subjective and objective evaluations by urology experts and statistical analysis. RESULTS: All students completed the surgical procedures successfully. The experimental group's performance scores were significantly higher than those of the control group (median final performance scores of 91.0 vs. 86.8, respectively). Excellent scores were achieved by more students in the experimental group than in the control group (55% vs. 20%), and fewer poor scores were observed in the experimental group than in the control group (5% vs. 30%). CONCLUSIONS: Based on its cost-effectiveness, reusability, and training effectiveness, this paracentetic suprapubic cystostomy training model is able to achieve goals in teaching practice quickly and easily. Use of the model should be encouraged for training senior medical students and resident physicians who may be expected to perform emergent suprapubic catheter insertion at some time.


Assuntos
Cistostomia/educação , Avaliação Educacional , Modelos Anatômicos , Desenvolvimento de Programas/métodos , Treinamento por Simulação/métodos , Análise Custo-Benefício , Cistostomia/instrumentação , Cistostomia/métodos , Educação de Graduação em Medicina/métodos , Feminino , Humanos , Masculino , Paracentese/educação , Paracentese/instrumentação , Paracentese/métodos , Estudos Prospectivos , Distribuição Aleatória , Cateterismo Urinário/instrumentação , Cateterismo Urinário/métodos , Gravação em Vídeo/métodos
9.
Int J Nurs Stud ; 95: 1-6, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30981953

RESUMO

BACKGROUND: In pre-continent children, collection bags are frequently used as a first-line option to obtain a urine specimen. This practice, acknowledged by several guidelines for the step of UTI screening, is driven by a perception of the technique as being more convenient and less painful. However, our own experience led us to consider bag removal as a painful experience. OBJECTIVE: Our aim was to determine whether the use of an oleo-calcareous liniment to aid bag removal reduced the acute pain expressed by young children. METHODS: This prospective, randomized, controlled, single blind study was carried out in two emergency pediatrics departments. Pre-continent children aged 0-36 months admitted with an indication for urine testing were eligible for the study. Urine for dipstick test screening was obtained using a collection bag. At micturition, the patients were randomized into bag removal with (intervention group) or without (control group) liniment. Bag removal was recorded on video in such a manner as to permit independent assessments of pain by two evaluators blinded to group allocation. Pain was assessed using the FLACC scale. FINDINGS: 135 patients were analyzed: 70 in the intervention group and 65 in the control group. The median FLACC scores [interquartile range] for the intervention and control groups, respectively 4.0 [2.0-7.0] and 4.0 [3.0-7.0], did not differ significantly (p = 0.5). A FLACC score ≥4 was obtained for 56% of the patients and a score ≥7 for 28%. CONCLUSION: Removal of urine collection bags caused moderate to severe pain in half of the children included. The use of an oleo-calcareous liniment did not reduce this induced pain.


Assuntos
Dor/etiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Coleta de Urina/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Método Simples-Cego
11.
Ont Health Technol Assess Ser ; 19(1): 1-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30847008

RESUMO

Background: People with chronic urinary retention typically require intermittent catheterization. This review evaluates the effectiveness, safety, patient preference, cost-effectiveness, and budget impact of different types of intermittent catheter (IC). Specifically, we compared prelubricated catheters (hydrophilic, gel reservoir) and noncoated catheters, as well as their single use versus reuse (multiple use). Methods: We performed a systematic literature search and included randomized controlled trials, cohort, and case-control studies that examined any type of single-use versus multiple-use IC, hydrophilic single-use versus noncoated single-use, or gel reservoir single-use versus noncoated single-use. The outcomes of interest were symptomatic urinary tract infection (UTI), hematuria, other serious adverse events, and patient satisfaction. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also completed an economic evaluation, using the perspective of the Ontario Ministry of Health and Long-Term Care, to determine the cost-effectiveness of various intermittent catheters used in Ontario. We determined the budget impact of fully and partially funding various intermittent catheters for outpatients with chronic urinary retention. To understand patient experiences with intermittent catheterization, we interviewed 34 adults and parents of children affected by chronic urinary retention. Results: We found 14 randomized controlled trials that met the inclusion criteria. When comparing any type of single-use or multiple-use IC, we found no difference in UTI (RR = 0.98, 95% CI 0.70-1.39), hematuria, or serious adverse events, and inconclusive evidence on patient satisfaction.Our meta-analysis of studies on people living in the community showed that hydrophilic ICs may result in fewer UTIs than single-use noncoated ICs, but given the nature of the studies, we were uncertain about this conclusion.The nature of the available evidence also did not allow us to make definitive conclusions regarding whether one type of catheter was likely to result in less hematuria, fewer serious adverse events, or greater patient satisfaction.Our economic evaluation found that owing to small differences in quality-adjusted life-years and moderate to large incremental cost differences, the lowest-cost ICs-noncoated multiple-use (using one catheter per week or one catheter per day)-have the highest probability of being cost-effective. In a subpopulation of those clinically advised not to reuse ICs, single-use noncoated ICs have the highest probability of being cost-effective. As current funding is limited in the outpatient setting, publicly funding noncoated multiple-use catheters (one per day) would result in a total additional cost of $93 million over the first 5 years. People who use ICs reported that the high ongoing cost of purchasing catheters was a financial burden. Almost all said they would prefer not to reuse catheters sold as "single use" but could not afford to do so. Conclusions: Given the overall low quality of evidence in available studies, we are uncertain whether any specific type of IC (coated or noncoated, single- or multiple-use) significantly reduces symptomatic UTI, hematuria, or other serious adverse clinical events, or whether a specific type improves patient satisfaction. Therefore, the lowest-cost IC is likely the most cost-effective.


Assuntos
Cateteres , Cateterismo Urinário/métodos , Retenção Urinária/terapia , Assistência Ambulatorial/economia , Cateteres/efeitos adversos , Cateteres/economia , Doença Crônica , Materiais Revestidos Biocompatíveis/uso terapêutico , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
13.
Med. intensiva (Madr., Ed. impr.) ; 43(supl.1): 48-52, mar. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-188597

RESUMO

La infección del tracto urinario asociada al catéter es muy común tanto en el entorno hospitalario comunitario como en el de agudos, especialmente en el ámbito de cuidados intensivos. Para minimizar este problema es esencial realizar un abordaje correcto desde la inserción del catéter urinario hasta la extracción del mismo y aplicar siempre medidas antisépticas adecuadas. Hay demasiada información sobre las medidas antisépticas sin resultados consistentes. Este artículo tiene como objetivo revisar la evidencia científica existente sobre el tema y hacer recomendaciones basadas en la evidencia, a fin de optimizar los resultados. Todo el proceso se complementa con algunas consideraciones para lograr un manejo adecuado del catéter urinario del paciente


Catheter-related urinary tract infections are very common both in the community and in the acute hospital care setting, particularly in the critical care environment. In order to minimize this problem, it is essential to adopt a correct approach from insertion to withdrawal of the urinary catheter, and always perform proper antisepsis. There is too much information on antisepsis measures with no consistent results. The present article reviews the existing scientific evidence on the subject and establishes recommendations based on the evidence, in order to optimize outcomes. The entire process is complemented with considerations on how to secure proper management of the indwelling urinary catheter


Assuntos
Humanos , Antissepsia/métodos , Cateteres Urinários/normas , Cateterismo Urinário/instrumentação , Prática Clínica Baseada em Evidências/métodos , Bacteriúria/prevenção & controle , Infecções Urinárias/prevenção & controle , Cateteres/classificação , Higiene das Mãos/métodos , Antissepsia/normas
14.
Pediatr Int ; 61(7): 706-711, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30779413

RESUMO

BACKGROUND: Overnight catheter drainage (OCD) is introduced to avoid overdistention of the bladder at night-time when clean intermittent catheterization proves ineffective for daytime management of neurogenic bladder. We adopted OCD using disposable silicone no-balloon (DSnB) catheters, with the distal end outside the body opening into diapers. OCD using DSnB catheter, however, had risks of retrograde bacterial contamination. Therefore, in this study, the validity of equipping DSnB catheters with check valves to prevent retrograde bacterial contamination was examined. METHODS: For the in vitro study, excised saline-filled swine bladders were drained using DSnB catheters with or without check valves, and the time required for intravesical pressure to reach 5 cmH2 O was measured. For the in vivo study, in cross-over experiments comparing DSnB catheters with and without check valves, OCD using DSnB catheters for 10 h was performed in rabbits under analgesia. Bacterial growth from urine samples before and after OCD and residual urine volume were examined. RESULTS: For the in vitro experiment, the median drainage time was 368.2 s (range, 88-1,085 s) and 344.7 s (range, 28-840 s) with and without check valves, respectively (n = 6), which was not significantly different. For the in vivo experiment, in cross-over experiments (n = 8) new bacterial growth rates after OCD did not differ, and median residual urine volume was 17.1 mL (range, 0-75 mL) and 1.2 mL (range, 0-5 mL) with and without check valves, respectively (P = 0.055). CONCLUSIONS: Installing a check valve in the DSnB catheter did not decrease new bacterial growth, while tending to increase residual urine volume. DSnB catheters without check valves appear to be better for continuous drainage of urine from bladder.


Assuntos
Equipamentos Descartáveis , Drenagem/instrumentação , Bexiga Urinaria Neurogênica/terapia , Cateterismo Urinário/instrumentação , Cateteres Urinários , Animais , Estudos Cross-Over , Equipamentos Descartáveis/microbiologia , Drenagem/efeitos adversos , Drenagem/métodos , Técnicas In Vitro , Masculino , Coelhos , Distribuição Aleatória , Suínos , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/métodos , Cateteres Urinários/efeitos adversos , Cateteres Urinários/microbiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
15.
Trials ; 20(1): 133, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770766

RESUMO

BACKGROUND: Urinary catheter placement is essential before laparoscopic anterior resection for rectal cancer. Whether early removal of the catheter increases the incidence of urinary retention and urinary tract infection (UTI) is not clear. This study aims to determine the optimal time for removal of the urinary catheter after laparoscopic anterior resection of the rectum. METHODS/DESIGN: A total of 220 participants meeting the inclusion criteria will be randomly assigned to an experimental group or a control group. The experimental group will have their urethral catheters removed on postoperative day 2 and the control group will have their urethral catheters removed on postoperative day 7. In both groups, catheter removal will be performed when the bladder is full. The incidence of urinary retention and UTI in the two groups will be compared to determine the optimal catheter removal time. DISCUSSION: This is a prospective, single-center, randomized controlled trial to determine whether early removal of the urinary catheter after laparoscopic anterior resection of the rectum will help to decrease the incidence of postoperative acute urinary retention and UTI. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03065855 . Registered on 23 February 2017.


Assuntos
Cateteres de Demora , Remoção de Dispositivo/métodos , Laparoscopia , Neoplasias Retais/cirurgia , Reto/cirurgia , Tempo para o Tratamento , Cateterismo Urinário/instrumentação , Cateteres Urinários , Adolescente , Adulto , Idoso , Pequim , Infecções Relacionadas a Cateter/etiologia , Remoção de Dispositivo/efeitos adversos , Desenho de Equipamento , Estudos de Equivalência como Asunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Neoplasias Retais/patologia , Reto/patologia , Fatores de Tempo , Resultado do Tratamento , Retenção Urinária/etiologia , Infecções Urinárias/etiologia , Adulto Jovem
16.
BMC Musculoskelet Disord ; 20(1): 11, 2019 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-30611266

RESUMO

BACKGROUND: The purpose of this study was to investigate whether patients undergoing total joint arthroplasty (TJA) require catheterization. METHODS: PubMed, EMBASE, Web of Science, Cochrane Library and China National Knowledge Infrastructure were systematically searched. All randomized controlled trials (RCTs) receiving either a urinary catheterization or no urinary catheterization were included. Meta-analysis results were assessed by RevMan 5.3 software. RESULTS: Seven independent RCTs were included, with a total sample size of 1533 patients, including 750 patients in the indwelling catheter group and 783 patients in the none-indwelling catheter group. Our pooled data analysis indicated that patients in the indwelling catheter group had a higher risk of urinary tract infection than patients in the none-indwelling catheter group (RR, 3.21; P = 0.0003). However, the meta-analysis indicated that there was no significant difference between the two groups in terms of urinary retention (RR, 0.67; P = 0.13), duration of the surgery (MD, - 0.37; P = 0.55), and length of hospital stay (MD, 0.15; P = 0.38). CONCLUSION: Based on the current evidence, this meta-analysis showed that urinary catheterization during TJA can increase the postoperative urinary tract infection, and it may not routinely be required for the patients undergoing TJA. LEVEL OF EVIDENCE: Level I, therapeutic study.


Assuntos
Artroplastia de Substituição , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/efeitos adversos , Procedimentos Desnecessários , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateteres Urinários/efeitos adversos , Infecções Urinárias/microbiologia , Idoso , Infecções Relacionadas a Cateter/diagnóstico , Desenho de Equipamento , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Resultado do Tratamento , Retenção Urinária/etiologia , Infecções Urinárias/diagnóstico
17.
Int Braz J Urol ; 45(3): 617-620, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676306

RESUMO

OBJECTIVE: Pyeloplasty is considered the gold standard treatment for ureteropelvic junction obstruction (UPJO). However, the failure rate of pyeloplasty is as high as 10% and repeat pyeloplasty is more difficult. This study aimed to evaluate the efficacy of balloon dilatation for failed pyeloplasty in children. MATERIALS AND METHODS: Between 2011 and 2017, 15 patients, aged 6 months to 14 years, were treated with balloon dilation for restenosis of UPJO after a failed pyeloplasty. Ultrasound and intravenous urography were used to evaluate the primary outcome. Success was defined as the relief of symptoms and improvement of hydronephrosis, which was identified by ultrasound at the last follow-up. RESULTS: All patients successfully completed the operation, 13 patients by retrograde approach and 2 patients by antegrade approach. Thirteen patients were followed for a median of 15 (4 to 57) months and 2 patients were lost to follow-up. Resolution of the hydronephrosis was observed in 5 cases. The anteroposterior diameter (APD) of the pelvis decreased by an average of 12.4 ± 14.4mm. Eight patients needed another surgery. The average postoperative hospital stay was 1.78 ± 1.4 days. Two patients experienced fever after balloon dilation. No other complications were found. CONCLUSIONS: Balloon dilatation surgery is safe for children, but it is not recommended for failed pyeloplasty in that group of patients, owing to the low success rate.


Assuntos
Pelve Renal/cirurgia , Obstrução Ureteral/cirurgia , Cateterismo Urinário/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Hidronefrose/cirurgia , Lactente , Pelve Renal/diagnóstico por imagem , Masculino , Reprodutibilidade dos Testes , Resultado do Tratamento , Ultrassonografia/métodos , Obstrução Ureteral/diagnóstico por imagem , Cateterismo Urinário/instrumentação , Urografia/métodos , Procedimentos Cirúrgicos Urológicos/instrumentação
18.
Investig Clin Urol ; 60(1): 35-39, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30637359

RESUMO

Purpose: To evaluate patients' tolerance to indwelling urinary catheters (IUCs) before and after reducing their balloon volumes. IUCs are a source of discomfort or pain. Materials and Methods: All consecutive patients hospitalized in our department with IUCs were included during the study period with some exclusion. Each patient was his/her own control before and two hours after reduction of the balloon volume (RBV) by half using two types of assessments, a visual analog scale for pain and a catheter-related bladder discomfort (CRBD) symptom questionnaire. Results: Forty-nine patients were included in our study that completed the assessments. The mean scores for pain before and after RBVs were 2.80 and 2.02, respectively. The difference was significant (p<0.05). The mean grades of the CRBD before and after RBVs were 1.02 and 0.75, respectively. The difference was significant (p<0.05). Conclusions: A 50% RBV has shown a significant amelioration in tolerating the catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Dor Pós-Operatória/etiologia , Doenças da Bexiga Urinária/etiologia , Cateteres Urinários/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor/métodos , Complicações Pós-Operatórias , Estudos Prospectivos , Índice de Gravidade de Doença , Ressecção Transuretral da Próstata/métodos , Neoplasias da Bexiga Urinária/cirurgia , Cateterismo Urinário/instrumentação , Incontinência Urinária de Urgência/etiologia , Adulto Jovem
19.
J Surg Res ; 233: 100-103, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502234

RESUMO

BACKGROUND: In some institutions, urinary catheters (UCs) have been placed in all patients receiving opioid patient-controlled analgesia (PCA) because of the increased incidence of urinary retention. Our institutional data demonstrated no UC replacements in 48 children who had PCA for perforated appendicitis who had their catheters removed before discontinuation of the PCA. As part of a quality improvement initiative, we discontinued the practice of requiring UC with PCA for perforated appendicitis. MATERIALS AND METHODS: A prospective list of patients with perforated appendicitis was maintained. Data were gathered regarding 60 consecutive patients. UC placement was allowed for specific indications including urinary retention and surgeon discretion. RESULTS: Sixteen patients (27%) received a UC with 14 of these being placed in the operating room (OR). Two UCs were placed outside the OR for urinary retention. Patients who underwent UC placement in the OR weighed significantly more than those who did not (33 versus 42 kg, P = 0.05). No patients required replacement of the catheter once removed. There were no postoperative urinary tract infections. Median PCA duration was 68 h (50, 98) for patients with UC placed in the OR compared with 60 h (47, 78) (P = 0.42). Median postoperative length of stay for patients with UC placed in the OR was 95 h (76, 140) compared with 90 h (70, 113) (P = 0.09). CONCLUSIONS: UC can be withheld from patients with perforated appendicitis who are placed on PCA with a very low placement rate. UC placement at time of operation did not lengthen time receiving PCA or length of stay.


Assuntos
Analgesia Controlada pelo Paciente/efeitos adversos , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Retenção Urinária/prevenção & controle , Adolescente , Analgésicos Opioides/administração & dosagem , Cateteres de Demora/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Dor Pós-Operatória/etiologia , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Cateterismo Urinário/normas , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia
20.
Int Urogynecol J ; 30(5): 779-787, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30145671

RESUMO

INTRODUCTION AND HYPOTHESIS: Catheter-associated urinary tract infections (UTI) are the most common health-care-related infections. We aimed to compare the UTI rate among women undergoing urogynecological procedures with a silver-alloy suprapubic catheter (SPC) and a standard SPC, and identify the risk factors predisposing patients to UTI. METHODS: Patients who were to undergo placement of an SPC as part of pelvic organ prolapse surgery were enrolled between 1 August 2011 and 30 August 2017, and randomized to either standard SPC or silver-alloy SPC. Follow-up was performed at a postoperative visit or via a phone call at 6 weeks. The primary outcome was UTI. RESULTS: Of the 288 patients who were randomized, 127 with standard SPC and 137 with silver-alloy SPC were included in the analysis. Twenty-nine out of 123 women with standard SPC (23.6%) and 24 out of 131 (18.3%) with silver-alloy SPC were diagnosed with UTI within 6 weeks postoperatively (p = 0.30). In univariate analysis, non-white race (odds ratio [OR] 5.36, 95% CI 1.16-24.73) and diabetes (OR 2.80, 95% CI 1.26-6.23) were associated with increased risk of UTI. On multivariate analysis, only diabetes remained an independent risk factor. Comparisons between groups were evaluated using two-sample t test for age, Chi-squared tests for diabetes, and Wilcoxon rank sum test for all other variables. CONCLUSION: There was only a 5% difference in 6-week UTI rates between those who received standard vs silver-alloy SPC; the study was not powered to detect such a small difference. Diabetes was identified as a risk factor for SPC-associated UTI in women undergoing pelvic reconstructive surgeries.


Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Cateterismo Urinário/instrumentação , Infecções Urinárias/epidemiologia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Fatores de Risco , Compostos de Prata/uso terapêutico , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários , Infecções Urinárias/etiologia
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