Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 231
Filtrar
1.
Urologiia ; (5): 156-160, 2019 Dec.
Artigo em Russo | MEDLINE | ID: mdl-31808653

RESUMO

In the treatment of lower urinary tract in combination with benign prostatic hyperplasia, alpha-blockers are most often prescribed, but in certain cases, the appointment of 5-reductase inhibitors is justified. This article analyzes relevant studies of recent years regarding the validity of the use of dutasteride (Gardium) 0.5 mg per day. Dutasteride can effectively reduce the total score of IPSS to 30%. It increases a volumetric urine flow rate 2-3 ml/sec, significantly reduces the chance of acute urinary retention in 70-88% in various studies, and reduces the frequency of hospitalization by 66%. Dutasteride also increases the likelihood of timely diagnosis of prostate cancer by 23%. Erectile dysfunction is a common side effect, serving as a reason for refusal of therapy is erectile dysfunction, which occurs in 16% of cases, and the probability of which is the highest in the first months during conservative therapy.


Assuntos
Inibidores de 5-alfa Redutase/administração & dosagem , Dutasterida/administração & dosagem , Sintomas do Trato Urinário Inferior/tratamento farmacológico , Hiperplasia Prostática/complicações , Inibidores de 5-alfa Redutase/uso terapêutico , Dutasterida/uso terapêutico , Humanos , Sintomas do Trato Urinário Inferior/diagnóstico , Sintomas do Trato Urinário Inferior/microbiologia , Masculino , Resultado do Tratamento , Retenção Urinária/prevenção & controle
2.
J Orthop Surg Res ; 14(1): 315, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533760

RESUMO

BACKGROUND: This study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR. MATERIALS AND METHODS: From January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: POUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0-7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR. CONCLUSIONS: The significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients.


Assuntos
Cateteres de Demora , Remoção de Dispositivo/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cateteres Urinários , Retenção Urinária/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Cateterismo Urinário , Retenção Urinária/etiologia , Retenção Urinária/terapia
3.
Medicine (Baltimore) ; 98(23): e15958, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169723

RESUMO

BACKGROUND: Thoracic epidural analgesia is associated with a high rate of postoperative urine retention (POUR). Auriculotherapy can reduce visceral dysfunction and can be helpful in anesthesiology and pain control. The aim of this study was to test the efficacy of preoperative auriculotherapy to decrease the occurrence of POUR. METHODS: This single-center, double-blinded, 2-arm randomized study was performed between January 2015 and May 2016 in a tertiary care university hospital. Male patients scheduled for an elective lung surgical procedure under combined general anesthesia and thoracic epidural analgesia were included. Auriculotherapy (A group) was performed once the patient was under general anesthesia with 5 semi-permanent needles inserted in both ears at the "Shen Men" "bladder", "pelvic parasympathetic", "anterior hypothalamus", and "frontal lobe" points. Five small round patches of adhesive pads were positioned bilaterally at the same points in the control group (C group). The main outcome measure was the requirement for bladder catheterization during the day and the first night following surgery. RESULTS: Fifty-three patients were randomized and 25 analyzed in each group. Requirement for bladder catheterization was different between groups: 24 C group patients (96%) and 18 A group patients (72%) (P = .049, Fisher exact test; Odds Ratio = 0.11 [0.01-0.95]. The number of patients needed to treat with auriculotherapy to avoid 1 case of bladder catheterization was 4. No adverse effect was observed due to auriculotherapy. CONCLUSION: This study demonstrates that auriculotherapy is a safe and useful technique reducing POUR in thoracotomy patients benefiting from thoracic epidural analgesia. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT02290054 (November 13, 2014).


Assuntos
Analgesia Epidural/efeitos adversos , Auriculoterapia/métodos , Complicações Pós-Operatórias/prevenção & controle , Toracotomia/efeitos adversos , Retenção Urinária/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Vértebras Torácicas , Toracotomia/métodos , Resultado do Tratamento , Bexiga Urinária/fisiopatologia , Bexiga Urinária/cirurgia , Cateterismo Urinário/estatística & dados numéricos , Retenção Urinária/etiologia , Retenção Urinária/terapia , Adulto Jovem
4.
Obstet Gynecol ; 133(5): 879-887, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30969209

RESUMO

OBJECTIVE: To determine whether backfilling the bladder postoperatively will reduce time to discharge in patients undergoing outpatient laparoscopic hysterectomy. METHODS: In a single-blind, randomized, controlled trial among women undergoing outpatient laparoscopic hysterectomy, patients were randomly assigned to a backfill-assisted void trial or a trial of spontaneous voiding. The primary outcome was time to discharge assessed by length of time spent in the postanesthesia care unit. Secondary outcomes included time to first spontaneous void, urinary retention rates, and postoperative complications within 8 weeks. We estimated that 152 patients (76/group) would provide greater than 80% power to identify a 30-minute difference in the primary outcome with a SD of 56 minutes and a two-sided α of 0.05. RESULTS: Between June 2017 to May 2018, 202 women were screened, 162 women were randomized, and results were analyzed for 153 women. Seventy-five patients (group A) who had a backfill-assisted voiding trial and 78 patients (group B) who had a spontaneous voiding trial were included in the analysis. The mean time to discharge was 273.4 minutes for group A vs 283.2 minutes for group B, which was not found to be significant (P=.45). The mean time to first spontaneous void was 181.1 minutes in group A vs 206.0 minutes in group B. There was a statistically significant reduction of 24.9 minutes in time to first spontaneous void with patients randomized to the backfill group (P=.04). Five of 75 patients (6.7%) in group A and 10 of 78 patients (12.8%) in group B developed urinary retention postoperatively and required recatheterization before discharge, which was also not significant (P=.20). CONCLUSION: Bladder filling before removing the Foley catheter is a simple procedure shown to reduce time to first spontaneous void, but not time to discharge in patients undergoing outpatient laparoscopic hysterectomy. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03126162.


Assuntos
Histerectomia Vaginal , Alta do Paciente , Solução Salina/administração & dosagem , Bexiga Urinária/fisiopatologia , Retenção Urinária/etiologia , Adulto , Feminino , Humanos , Laparoscopia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Fatores de Tempo , Resultado do Tratamento , Cateterismo Urinário , Retenção Urinária/prevenção & controle
5.
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
6.
J Arthroplasty ; 34(1): 136-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30268444

RESUMO

BACKGROUND: Postoperative urinary retention (POUR) remains a common complication after total joint arthroplasty (TJA). The objective of this study was to determine the incidence and risk factors for POUR in fast-track TJA emphasizing rapid mobilization, multimodal analgesia, and shorter hospital stay. METHODS: Our institutional joint registry was queried for patients who underwent primary TJA between January 2016 and November 2017. The primary outcome was the development of POUR. A panel of demographic, intraoperative, and postoperative variables was investigated. Multivariable regression analyses were performed to control for possible confounding factors. RESULTS: One hundred eighty-seven patients who underwent total hip arthroplasty (THA) and 191 patients who underwent total knee arthroplasty (TKA) were included in the study. Forty percent of TKA and 36% of THA patients developed POUR requiring bladder catheterization. Among THA patients, POUR was significantly associated with age >60 years, intraoperative fluid volume >1350 mL, and intraoperative placement of an indwelling bladder catheter (P = .016, P = .035, and P < .001, respectively). Among TKA patients, POUR was only significantly associated with intraoperative indwelling bladder catheter placement (P < .001). CONCLUSION: The most significant risk factors for POUR in modern-day fast-track TJA are iatrogenic. Routine intraoperative placement of an indwelling bladder catheter and fluid administration exceeding 1350 mL, especially in patients older than 60 years, are discouraged.


Assuntos
Artroplastia de Substituição/efeitos adversos , Hidratação/efeitos adversos , Artropatias/cirurgia , Cateterismo Urinário/efeitos adversos , Retenção Urinária/etiologia , Fatores Etários , Idoso , Protocolos Clínicos , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Cuidados Intraoperatórios/efeitos adversos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/efeitos adversos , Assistência Perioperatória/normas , Sistema de Registros , Fatores de Risco , Fatores de Tempo , Retenção Urinária/prevenção & controle , Retenção Urinária/terapia
7.
Dig Surg ; 36(3): 261-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29945140

RESUMO

BACKGROUND/AIMS: Postoperative urinary retention (POUR) is one of the most frequent complications of epidural anesthesia. This study aims to clarify risk factors of POUR and to estimate the appropriate timing of urethral catheter removal. METHODS: Between September and December 2014, a retrospective cohort study was conducted on 120 patients who underwent epidural anesthesia and major abdominal surgery. To observe trends in incidence of POUR, we analyzed the order and interval of removal of epidural and urethral catheters using Cochran-Armitage trend test. RESULTS: In this study, 40 patients were diagnosed with POUR (33.3%). Median removal of epidural catheters was 4 postoperative days in the POUR group and 3.5 postoperative days in the non-POUR group (p = 0.04). When the urethral catheter was removed before epidural catheter, incidence of POUR was comparatively greater (p < 0.001). There were no statistical differences in surgical fields, operation approach, epidural catheter levels, or epidural opioid use. No patients had urinary tract infections. CONCLUSION: We demonstrated that removal of urethral catheter before epidural catheter contributed to increasing trends in incidence of POUR. The optimal order and interval of removal of epidural and urethral catheters should be considered to avoid POUR after abdominal surgery.


Assuntos
Analgesia Epidural/efeitos adversos , Cateterismo/efeitos adversos , Remoção de Dispositivo , Laparotomia/efeitos adversos , Cateteres Urinários/efeitos adversos , Retenção Urinária/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Analgesia Epidural/instrumentação , Cateterismo/instrumentação , Protocolos Clínicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/instrumentação , Retenção Urinária/etiologia
8.
J Pediatr Surg ; 53(10): 2032-2035, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29983187

RESUMO

BACKGROUND: Patient-controlled analgesia (PCA) is often used in children with perforated appendicitis. To prevent urinary retention, some providers also routinely place Foley catheters. This study examines the necessity of this practice. METHODS: We retrospectively reviewed all children (≤18 years old) with perforated appendicitis and postoperative PCA from 7/2015 to 6/2016 at two academic children's hospitals. Urinary retention was defined as the inability to spontaneously void requiring straight catheterization or placement of a Foley catheter. RESULTS: Of 313 patients who underwent appendectomy for perforated appendicitis (Hospital 1: 175, Hospital 2: 138), 129 patients received an intraoperative Foley (Hospital 1: 22 [13%], Hospital 2: 107 [78%], p < 0.001). Age, gender, and BMI were similar between those with an intraoperative Foley and those without. There were no urinary tract infections in either group. Urinary retention rate in patients with an intraoperative Foley following removal on the inpatient unit (n = 3, 2%) and patients without an intraoperative Foley (n = 10, 5%) did not reach significance (p = 0.25). On univariate analysis, demographics, intraoperative findings, PCA specifics, postoperative abscess formation, and postoperative length of stay, were not significant risk factors for urinary retention. CONCLUSIONS: The risk of urinary retention in this population is low despite the use of PCA. Children with perforated appendicitis do not require routine Foley catheter placement to prevent urinary retention. LEVEL OF EVIDENCE: II.


Assuntos
Analgesia Controlada pelo Paciente , Apendicite , Complicações Pós-Operatórias/epidemiologia , Cateterismo Urinário/estatística & dados numéricos , Apendicectomia/efeitos adversos , Apendicite/epidemiologia , Apendicite/cirurgia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Retenção Urinária/prevenção & controle
9.
J Urol ; 200(6): 1235-1240, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29940251

RESUMO

PURPOSE: Transperineal template prostate mapping biopsy is an increasingly used method of procuring tissue from men with suspected prostate cancer. We report patient related outcome measures and adverse events in men in the PICTURE trial (ClinicalTrials.gov NCT01492270) who underwent this diagnostic test. MATERIALS AND METHODS: A total of 249 men underwent multiparametric magnetic resonance imaging followed by transperineal template prostate mapping biopsy as a validation study. Functional outcomes before and after transperineal template prostate mapping were prospectively collected and recorded with questionnaires, including the I-PSS (International Prostate Symptom Score), the I-PSS-QoL (Quality of Life), the IIEF-15 (International Index of Erectile Function-15) and the EPIC (Expanded Prostate Cancer Index Composite) urinary function. RESULTS: Mean age was 62 years, median prostate specific antigen was 6.8 ng/ml and median gland size was 37 ml. At transperineal template prostate mapping biopsy a median of 49 cores (IQR 40-55) were taken. Mean time to complete the post-procedure patient related outcome measure questionnaires was 46 days. Adverse events included post-procedure acute urinary retention in 24% of patients, rectal pain in 26% and perineal pain in 41%. Transperineal template prostate mapping biopsy resulted in a statistically significant increase in scores on the I-PSS from 10.9 to 11.8 (p = 0.024) and the I-PSS-QoL from 1.57 to 1.76 (p = 0.03). The IIEF-15 erectile function score decreased by 23.2% from 47.7 to 38.7 (p <0.001). Significant deterioration was noted in all 5 of IIEF-15 functional domains, including erectile and orgasmic function, sexual desire, and intercourse and overall satisfaction (p <0.001). EPIC urinary scores showed no overall change from baseline. CONCLUSIONS: Transperineal template prostate mapping biopsy causes a high urinary retention rate and a detrimental impact on genitourinary functional outcomes, including deterioration in urinary flow and sexual function. Our findings can be used to ensure adequate counseling about transperineal template prostate mapping biopsies. The results point to a need for strategies such as multiparametric magnetic resonance imaging and targeted biopsies to minimize the harms of transperineal template prostate mapping biopsy.


Assuntos
Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/métodos , Disfunção Erétil/epidemiologia , Disfunção Erétil/etiologia , Disfunção Erétil/prevenção & controle , Humanos , Processamento de Imagem Assistida por Computador/métodos , Biópsia Guiada por Imagem/métodos , Imagem por Ressonância Magnética Intervencionista/métodos , Masculino , Pessoa de Meia-Idade , Dor Processual/epidemiologia , Dor Processual/etiologia , Dor Processual/prevenção & controle , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Qualidade de Vida , Ultrassonografia de Intervenção/métodos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Retenção Urinária/prevenção & controle
10.
Hernia ; 22(5): 871-879, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29909567

RESUMO

PURPOSE: Inguinal hernia repair and general anesthesia (GA) are known risk factors for urinary retention. Paravertebral blocks (PVBs) have been utilized to facilitate enhanced recovery after surgery. We evaluate the benefit of incorporating PVBs into our anesthetic technique in a large cohort of ambulatory patients undergoing inguinal hernia repair. METHODS: Records of 619 adults scheduled for ambulatory inguinal hernia repair between 2010 and 2015 were reviewed and categorized based on anesthetic and surgical approach [GA and open (GAO), GA and laparoscopic (GAL), PVB and open (PVBO), and GA/PVB and open (GA/PVBO)]. Patients were excluded for missing data, self-catheterization, chronic opioid tolerance, and additional surgical procedures coinciding with hernia repair. Risk factors associated with the primary outcome of urinary retention were examined using logistic regression. RESULTS: PVBO (n = 136) had significantly lower odds than GAO of experiencing urinary retention (odds ratio 0.16; 95% CI 0.05-0.51); overall (P < .01), with 4.4% (n = 6) of the patients in the PVBO group having urinary retention versus 22.6% (n = 7) with GAO. Expressed as intravenous morphine equivalences, the PVBO group had the lowest median opioid use (5 mg), followed by GA, PVB, and open (7.5 mg); GAO 25 mg; and GAL 25 mg. Also, 30% (n = 41) of the PVBO group required no opioid analgesia in the postanesthesia care unit. CONCLUSIONS: PVBs as the primary anesthetic or an adjunct to GA is the preferred anesthetic technique for open inguinal hernia repair as it facilitates enhanced recovery after surgery by decreasing risk of urinary retention, opioid requirements, and length of stay.


Assuntos
Hérnia Inguinal/cirurgia , Bloqueio Nervoso , Complicações Pós-Operatórias , Retenção Urinária/etiologia , Retenção Urinária/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Analgésicos Opioides/uso terapêutico , Anestesia Geral , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Laparoscopia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/prevenção & controle
11.
J Clin Monit Comput ; 32(6): 1117-1126, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29516310

RESUMO

Ultrasound scanning of bladder volume is used for prevention of postoperative urinary retention (POUR). Accurate assessment of bladder volume is needed to allow clinical decision-making regarding the need for postoperative catheterization. Two commonly used ultrasound devices, the BladderScan® BVI 9400 and the newly released Prime® (Verathon Medical®, Bothell, WA, USA), with or without the 'pre-scan' option, have not been validated in clinical practice. The aim of this study was to assess the performance of these devices in daily clinical practice. Between June and September 2016 a prospective observational study was conducted in 318 surgical patients (18 years or older) who needed a urinary catheter perioperatively for clinical reasons. For acceptable performance, we required that the volume as estimated by the BladderScan® differs by no more than 5% from the actual urine volume after catheterization. The Schuirmann's two one-sided test was performed to assess equivalence between the BladderScan® estimate and catheterization. The BVI 9400® overestimated the actual bladder volume by + 17.5% (95% CI + 8.8 to + 26.3%). The Prime® without pre-scan underestimated by - 4.1% (95% CI - 8.8 to + 0.5%) and the Prime® with pre-scan underestimated by - 6.3% (95% CI - 11.6 to - 1.1%). This study shows that while both ultrasound devices were able to approximate current bladder volume, both BVI 9400® and Prime®-with and without pre-scan-were not able to measure the actual bladder volume within our predefined limit of ± 5%. Using the pre-scan feature of the Prime® did not further improve accuracy.


Assuntos
Complicações Pós-Operatórias/prevenção & controle , Ultrassonografia/instrumentação , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Estudos Prospectivos , Ultrassonografia/estatística & dados numéricos , Cateterismo Urinário
12.
Female Pelvic Med Reconstr Surg ; 24(2): 95-99, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29474280

RESUMO

OBJECTIVE: To determine the effect of preoperative oral phenazopyridine on postoperative voiding dysfunction in women undergoing a retropubic midurethral sling. METHODS: A single-institution randomized clinical trial was performed from September 2015 to March 2017, comparing 200 mg of oral phenazopyridine versus no phenazopyridine in patients undergoing a retropubic midurethral sling under general anesthesia with no concomitant procedures. A power calculation indicated that we required at least 40 subjects per arm. Preoperative demographics, intraoperative medications, blood loss, and complications were recorded. A standardized voiding trial was performed before discharge. Voiding dysfunction was determined by the proportion of subjects who failed a postoperative voiding trial. Pain scores were obtained before and 2 to 3 hours after the surgical procedure. Patient characteristics and surgical data were compared using χ, Fisher exact test, or Wilcoxon rank sum test. RESULTS: Ninety-two subjects were enrolled in the study. Three patients cancelled their surgery and 1 had an intraoperative urethral injury, leaving 88 patients for the final analysis (44 per arm). Patient demographics showed no differences between groups. Phenazopyridine did not reduce the proportion of patients who failed the voiding trial (27%) compared with subjects who did not receive the medication (21%) (P = 0.453). Postoperative visual analog pain scores were higher in those not receiving phenazopyridine (1.76 vs 1.21, P = 0.046), but after adjusting for the difference in preoperative and postoperative pain scores, the groups showed no difference (P = 0.087). CONCLUSIONS: Our prospective trial shows that phenazopyridine has no effect on short-term postoperative voiding dysfunction. This condition appears to be multifactorial, and further research is needed.


Assuntos
Anestésicos Locais/administração & dosagem , Fenazopiridina/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Slings Suburetrais , Retenção Urinária/prevenção & controle , Administração Oral , Anestesia Geral , Índice de Massa Corporal , Feminino , Humanos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Prospectivos , Resultado do Tratamento , Incontinência Urinária por Estresse/cirurgia , Retenção Urinária/etiologia
13.
Surgery ; 163(4): 854-856, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29397201

RESUMO

BACKGROUND: High narcotic requirements after minimally invasive repair of pectus excavatum (MIRPE) can increase the risk of urinary retention. Placement of intraoperative Foley catheters to minimize this risk is variable. This study determines the rate of urinary retention in this population to guide future practice. MATERIALS AND METHODS: We reviewed retrospectively all patients who underwent MIRPE from January 2012 to July 2016 at 2 academic children's hospitals. Data collected included demographics, BMI, severity of the pectus defect, postoperative pain management, and the incidence of urinary retention and urinary tract infection (UTI). RESULTS: Of 360 total patients who underwent MIRPE, 218 had an intraoperative Foley catheter. Patients with epidural pain control were more likely to receive a Foley catheter. The urinary retention rate was 34% for patients without an intraoperative Foley, and 1% in patients after removal of an intraoperatively placed Foley. Urinary retention was greater with an epidural compared with patient-controlled anesthesia (55% vs 26%, P = .002) in the no intraoperative Foley group. No urinary tract infections were identified. Epidural pain control was the only risk factor on multivariate analysis for retention in patients without an intraoperatively Foley catheter. CONCLUSION: Intraoperative Foley catheters obviate urinary retention without increasing the risk of urinary tract infection after MIRPE. These results will allow surgeons to better counsel patients regarding Foley placement.


Assuntos
Tórax em Funil/cirurgia , Cuidados Intraoperatórios/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Procedimentos Ortopédicos , Complicações Pós-Operatórias , Cateterismo Urinário , Retenção Urinária/etiologia , Adolescente , Criança , Feminino , Humanos , Incidência , Masculino , Dor Pós-Operatória/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Retenção Urinária/epidemiologia , Retenção Urinária/prevenção & controle , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/prevenção & controle
14.
Am J Surg ; 215(5): 973-979, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29397894

RESUMO

BACKGROUND: Alpha-1 adrenergic blockers used to treat postoperative urinary retention (POUR) may also have a preventative role. Here we assess the evidence behind their prophylactic use on POUR prevention. STUDY DESIGN: PRISMA guidelines were followed. All studies reviewed for eligibility, data extraction, and risk of bias assessment. Pooled risk ratios with 95% confidence intervals calculated using a random effects model. Heterogeneity assessed using Forest plots, I2 statistic and Chi-squared Cochran's Q-statistic. RESULTS: Fifteen RCTs (1732 patients) included. Prophylactic alpha-1 adrenergic blockers significantly reduced risk of POUR, 13.16% vs 30.24%, RR = 0.48 (95%CI: 0.33; 0.70, p-value = .001), without a statistically significant increase in adverse events. Substantial heterogeneity found between included studies (I2 = 65.49% [95%CI:48.49; 95.01] & Q-statistic 43.46 (p-value<.001)). Subgroup analysis revealed strong risk reduction and little heterogeneity in males (RR:0.33, 95%CI:0.23; 0.47, p-value<.001, I2:10.58) and patients receiving spinal anesthesia (RR:0.26, 95%CI:0.14; 0.46, p-value<.0001, I2 = 0%). CONCLUSION: Prophylactic alpha-1 adrenergic blockers reduce risk of POUR in males and after spinal anesthesia.


Assuntos
Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Retenção Urinária/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Female Pelvic Med Reconstr Surg ; 24(2): 188-192, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29300254

RESUMO

OBJECTIVE: The aim of this study was to evaluate practice preferences in catheter management after a failed inpatient voiding trial after pelvic reconstructive surgery. METHODS: This is a cross-sectional study of postoperative catheter management after pelvic reconstructive surgery after failed voiding trial. Physicians practicing at ACGME-accredited residencies and fellowships in Obstetrics and Gynecology (Ob/Gyn), Urology, and Female Pelvic Medicine and Reconstructive Surgery (FPMRS) within the United States completed a Web-based questionnaire in March 2017. Respondents were asked about voiding trial protocols, definitions of abnormal postvoid residual (PVR), type of catheterization used after failed voiding trials, and antibiotic use. Primary outcome was type of catheterization after failure of an inpatient voiding trial. Data were analyzed using χ statistical tests. RESULTS: One hundred five respondents had a mean age of 36.5 years (range, 36 years). A total of 45.9% of participants practiced in FPMRS, 36.5% in Ob/Gyn, and 17.6% in Urology. Catheters were discontinued most frequently by postoperative day 1 after all procedures. Distribution of catheterization by specialty differed. Clean-intermittent straight catheterization had the greatest prevalence in all specialties and was the highest, by percentage, in Urology (33% Ob/Gyn, 40.6% FPMRS, and 69% Urology); P = 0.026. Type of catheterization differed significantly between Ob/Gyn and FPMRS respondents (P = 0.045). A total of 77.7% measured PVR by ultrasound and 22.3% performed catheterization. This distribution was similar across the specialties (70% Ob/Gyn, 79% FPMRS, and 100% Urology; P = 0.092). Abnormal PVR was defined most frequently as 150 mL or greater (30.5%). A minority of respondents routinely administer antibiotics during catheterization (17.1%). Duration and time until repeat voiding trial varied from 1 day to 2 weeks. CONCLUSIONS: Practice variability in catheterization after pelvic reconstructive and incontinence surgery is high. Distribution of catheterization type by specialty varies significantly, with clean-intermittent straight catheterization most prevalent. Future studies are necessary to establish a consensus on optimal catheterization management technique for patients with acute postoperative voiding dysfunction.


Assuntos
Pelve/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Cateterismo Urinário/métodos , Retenção Urinária/prevenção & controle , Adulto , Antibacterianos/uso terapêutico , Cateteres de Demora , Estudos Transversais , Feminino , Humanos , Cuidados Pós-Operatórios
16.
Am J Surg ; 215(1): 23-27, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28400048

RESUMO

BACKGROUND: The Joint Commission's SCIP Inf-9 mandated early removal of indwelling urinary catheters (IUCs), but the impact of compliance on catheter-associated urinary tract infection (CAUTI) and postoperative urinary retention (POUR) are unknown. METHODS: Retrospective pre- and post-intervention study at a single tertiary academic medical center of all patients undergoing general surgery procedures with an IUC placed at the time of surgery who were admitted for at least two days before and after a Best Practice Advisory was put in place to improve compliance with SCIP Inf-9. RESULTS: A total of 1036 patients were included (468 pre-intervention; 568 post-intervention). POUR occurred in 13% of patients and CAUTI in 0.8%. There was no change in POUR, CAUTI, or catheter utilization after the Best Practice Advisory was initiated. Both POUR and CAUTI predicted longer lengths of stay. CONCLUSIONS: Near-perfect SCIP Inf-9 compliance had no effect on the CAUTI rate at our institution.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Complicações Pós-Operatórias/prevenção & controle , Cateterismo Urinário/estatística & dados numéricos , Retenção Urinária/prevenção & controle , Infecções Urinárias/prevenção & controle , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Assistência Perioperatória/normas , Assistência Perioperatória/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Guias de Prática Clínica como Assunto , Melhoria de Qualidade/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento , Cateterismo Urinário/instrumentação , Cateterismo Urinário/normas , Cateteres Urinários , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Infecções Urinárias/epidemiologia , Adulto Jovem
17.
Am J Surg ; 216(2): 337-341, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-28341140

RESUMO

BACKGROUND: Urinary retention following inguinal hernia surgery is common and is believed to be associated with adrenergic over-stimulation of the smooth muscle in the bladder neck and prostate. The efficacy of prophylactic alpha-blockade in the prevention of urinary retention following elective inguinal hernia repair in males is unknown. METHODS: A comprehensive literature search was performed adhering to PRISMA guidelines. Each study was reviewed and data were extracted. Random-effects models were used to combine data. RESULTS: Five randomized studies describing 456 patients were identified. General or spinal anaesthetic were used. Prophylactic alpha-blockade decreases the risk of urinary retention requiring catheterisation following elective unilateral inguinal hernia repair compared to control groups (OR:0.179, 95% CI:0.043-0.747, p:0.018). Rates of urinary retention between treatment and control groups are reduced by 20.6%. No serious complications relating to alpha blockade occurred. CONCLUSIONS: Prophylactic alpha-blockade reduces urinary retention following elective inguinal hernia surgery under general or spinal anaesthetic.


Assuntos
Antagonistas Adrenérgicos alfa/uso terapêutico , Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Retenção Urinária/prevenção & controle , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Retenção Urinária/etiologia
18.
Female Pelvic Med Reconstr Surg ; 24(1): 43-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28230566

RESUMO

OBJECTIVE: The aim of this study was to determine the effect of preoperative oral phenazopyridine on short-term voiding dysfunction in patients undergoing a retropubic midurethral sling. METHODS: We conducted a retrospective cohort study in subjects undergoing a retropubic midurethral sling comparing those who received preoperative oral phenazopyridine with those who did not. We included all women who underwent a retropubic midurethral sling without concomitant procedures under general anesthesia at our institution. Slings were placed by either suprapubic or transvaginal approach, per surgeon's preference. Demographics and intraoperative data on preoperative dose of phenazopyridine and medications linked to voiding dysfunction were captured. RESULTS: One hundred seventy-four subjects were identified. Twenty-five subjects failed to meet inclusion and exclusion criteria and were excluded, and 149 subjects comprised the final groups. Eighty-two subjects (55.03%) received phenazopyridine, and 67 (44.97%) did not. Most subjects received a 200-mg dose (97.6%). Except for surgical approach, both groups receiving and not receiving phenazopyridine had similar demographic characteristics. Eighty-eight percent of the subjects who received phenazopyridine passed the voiding trial versus 73.1% (odds ratio, 2.98; 95% confidence interval, 1.23-7.17). After adjusting for medications, estimated blood loss, number of trocar passages, or bladder perforation, the patients receiving phenazopyridine were still more likely to pass the postoperative voiding trials compared with those who did not (odds ratio, 2.97; 95% confidence interval, 1.10-7.98). CONCLUSIONS: Our findings suggest that the preoperative administration of phenazopyridine may improve postoperative voiding function after a retropubic midurethral sling. Additional prospective trials are needed to confirm this finding.


Assuntos
Anestésicos Locais/administração & dosagem , Fenazopiridina/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Slings Suburetrais , Retenção Urinária/prevenção & controle , Adulto , Estudos de Casos e Controles , Feminino , Procedimentos Cirúrgicos em Ginecologia/métodos , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Incontinência Urinária por Estresse/cirurgia
19.
Eur J Orthop Surg Traumatol ; 28(2): 283-289, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28900757

RESUMO

PURPOSE: Postoperative urinary retention (POUR), defined as the inability to empty the bladder voluntary after surgery, is a commonly reported complication. This study reports the incidence and possible risk factors for POUR after elective fast-track hip or knee arthroplasty when using a nurse-led bladder scan protocol. METHODS: This retrospective cohort study included data from 803 patients who underwent unilateral hip or knee arthroplasty. Patients' digital clinical records were reviewed for eligibility. Patients with incomplete data registration, preoperative bladder volume >250 ml, preexisting bladder catheterization, and/or patients following the outpatient pathway were excluded. Bladder volumes were assessed at different moments pre- and postoperatively. The outcome was the incidence of POUR, defined as the inability to void spontaneously with a bladder volume >600 ml, treated with indwelling catheterization. Further analysis between POUR and non-POUR patients was performed to detect possible risk factors for POUR. RESULTS: Six hundred and thirty-eight patients operated on primary unilateral hip or knee arthroplasty were analyzed. The incidence of POUR was 12.9% (n = 82, 95% CI 9.4-15.5). Gender, age, BMI, ASA classification, preoperative bladder volume, type of anesthesia, type of arthroplasty, and perioperative fluid administration were not significant different between POUR and non-POUR patients. Patients with a bladder volume of >200 ml at the recovery room were at higher risk (OR 5.049, 95% CI 2.815-9.054) for POUR. CONCLUSIONS: When using a nurse-led bladder scan protocol in fast-track hip and knee arthroplasty, the incidence of POUR was 12.9%, with a bladder volume of >200 ml at the recovery room as a risk factor for POUR. LEVEL OF EVIDENCE: A retrospective cohort study, Level III.


Assuntos
Complicações Pós-Operatórias/enfermagem , Padrões de Prática em Enfermagem , Retenção Urinária/enfermagem , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia , Bexiga Urinária/diagnóstico por imagem , Cateterismo Urinário , Retenção Urinária/diagnóstico por imagem , Retenção Urinária/etiologia , Retenção Urinária/prevenção & controle
20.
Respir Med ; 132: 195-202, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29229097
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA