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Sarver J, Farley R, Daugherty S, Bilbrew J, Palka J. Improving outcomes in foley catheterization: A retrospective review with a proposed protocol. World J Nephrol 2025; 14:104207. [DOI: 10.5527/wjn.v14.i2.104207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 03/14/2025] [Accepted: 03/25/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Urologists are commonly consulted regarding difficult and traumatic urethral catheterizations. Complications surrounding Foley catheterizations represent a significant burden to the healthcare system.
AIM To assess the demographic and patient characteristics surrounding urological consultation for difficult and traumatic Foley catheterizations at our institution across multiple hospitals.
METHODS This is a single-institution, multi-hospital, 263 patient, retrospective chart review from Jan 2020–December 2023.
RESULTS The majority of consultations (80.2%) did not require heroic measures by the urology service. A Foley catheter placement was determined not difficult in the majority 191 (72.6%) of patients. Sub-group analysis of “difficult by urology” vs “not difficult by urology”, showed a significant difference between those with zero attempts, one attempt, and greater than one attempts (P = 0.004). Those patients specifically with greater than one attempts were more likely to be seen as a difficult insertion by urology assessment (60.6%) compared to not difficult (38.6%). Likewise, those patients with a history of difficult urethral catheter (DUC)/traumatic urethral catheterization (TUC) (25.8%) were more likely to be difficult compared to those without a history of DUC/TUC (14.2%) (P = 0.038).
CONCLUSION The study found that majority of consultations received did not require heroic measures by the urology service to place a catheter. Patients who had a history of DUC/TUC and those who had greater than one catheter attempts were statistically more likely to be a DUC based on urology assessment. At our institution we hope to propose a protocol in which nursing staff and non-urologic clinicians will utilize a troubleshooting checklist and an algorithm when difficult or traumatic urethral catheters are encountered in order to improve patient care and decrease healthcare costs. For example, this protocol would ideally address complications of multiple catheter attempts such as urethral trauma, development of urethral strictures, and infection risk. Additionally, future trainings and availability of additional resources will be provided and assessed with a goal of reducing healthcare cost surrounding these complications.
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Affiliation(s)
- Jordan Sarver
- Department of Urology, Detroit Medical Center, Detroit, MI 48201, United States
| | - Remington Farley
- Department of Urology, Detroit Medical Center, Detroit, MI 48201, United States
| | - Shane Daugherty
- Department of Urology, Detroit Medical Center, Detroit, MI 48201, United States
| | - Jordan Bilbrew
- Department of Urology, Detroit Medical Center, Detroit, MI 48201, United States
| | - Joshua Palka
- Department of Urology, Detroit Medical Center, Detroit, MI 48201, United States
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Calik G, Bahadır Z, Madendere B, Arikan O, Guzelburc V, Evci E, Cakir SS, Altay B, Laguna P, Kocak M, Albayrak S, Horuz R, Sabuncu K, Boz M, Erkurt B, Alrifaai MA, Al Chaabawi A, Alrais M, Ali IA, Ashour SMS, de la Rosette J. Knowledge and self-confidence of healthcare workers to perform transurethral catheterization: a matter deserving attention! World J Urol 2025; 43:311. [PMID: 40377708 DOI: 10.1007/s00345-025-05677-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/28/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Patients may suffer from the sequela of complicated transurethral catheterization (TUC) such as urethral injury, infection, and stricture formation. We assessed the self-confidence, knowledge, and experience of healthcare professionals performing TUC. METHODS A multi-center, prospective, cross-sectional questionnaire-based study was performed among healthcare workers from 5 university hospitals. Data was transferred to an online Data Management System and self-confidence, knowledge, and experience levels among different healthcare roles were compared. FINDINGS Of all 747 participants, 8% did not feel confident, had enough knowledge or preparation skills regarding TUC. 23% never asked for help while performing TUC whereas 42% always asked for assistance (p < 0.0001). Healthcare roles did not differ statistically in terms of TUC knowledge and understanding. However, healthcare workers in surgical specialties felt more confident in their knowledge (29% vs 21%). Confidence in male catheterization skills rated as 'well' and 'very well' were reported highest by paramedics (71%, 20%) followed by nurses (48%, 20%), physicians (53%, 30%) and residents (50%, 36%). In the event of difficult catheterizations, physicians mostly preferred the assistance of "urologists and urology residents" (64%) while nurses mostly reached out to other nurses (39%). Paramedics were the least likely to ask for assistance (40%) followed by nurses (26%), doctors (24%), and residents (13%) (p < 0.0001). CONCLUSION A significant proportion of healthcare workers do not have the necessary knowledge and understanding of TUC and do not feel confident in their catheterization and preparation skills when challenged by a difficult TUC, which requires the reassessment of the training programs pre- and post-graduation. This will facilitate and create a safer environment for both the patient and the healthcare professionals. TRIAL REGISTRY ClinicalTrials.gov NCT05334225.
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Affiliation(s)
- Gokhan Calik
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zeynep Bahadır
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Berk Madendere
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ozgur Arikan
- Department of Urology, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Vahit Guzelburc
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
| | - Engin Evci
- Istanbul Medipol University, Urology Clinic, Pendik Health Application and Research Center, Istanbul, Turkey
| | - Suleyman Sami Cakir
- Faculty of Medicine, Department of Urology, Istanbul Medipol University, Sefaköy Health Application and Research Center, Istanbul, Turkey
| | - Bulent Altay
- Faculty of Medicine, Department of Urology, Istanbul Medipol University, Kosuyolu Medipol Hospital, Istanbul, Turkey
| | - Pilar Laguna
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mehmet Kocak
- Multi-Omics Design and Analysis Studio (MODAS-SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Rahim Horuz
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Kubilay Sabuncu
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Boz
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Bulent Erkurt
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Faculty of Medicine, Department of Urology, Istanbul Medipol University, Kosuyolu Medipol Hospital, Istanbul, Turkey
| | | | | | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - Ibrahim Abdi Ali
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Shaban M S Ashour
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Jean de la Rosette
- Department of Urology, Faculty of Medicine, Medipol Mega University Hospital, Istanbul Medipol University, Istanbul, Turkey
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
- Bashkir State Medical University, Ufa, Russia
- Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
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3
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Campbell J, Broghammer JA. Urethral Stricture Disease and Urethroplasty in Older Men. Clin Geriatr Med 2025; 41:225-237. [PMID: 40345776 DOI: 10.1016/j.cger.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2025]
Abstract
Urethral stricture disease is scarring of the anterior urethra leading to urinary obstruction. The incidence of urethral stricture disease increases with age. Older men have an increased risk of coexisting medical conditions which may exacerbate urinary symptoms in the face of a urethral stricture. Initial management of urethral stricture disease uses minimally invasive methods. Urethral reconstruction should be reserved for patients with previous treatment failures and complex stricture disease. Urethral reconstruction can be safe and effective in older men, but fragility and comornidities should be considered when selecting surgical candidates.
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Affiliation(s)
- Jack Campbell
- Division of Urology, Department of Surgery, University of Missouri, MC305 McHaney Hall, One Hospital Drive, Columbia, MO 65212, USA
| | - Joshua A Broghammer
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3016, Kansas City, KS 66160, USA.
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Malde S, Lavin V, Perrouin-Verbe MA, Elterman D, Peyronnet B, Smits M, Shah S, Xavier K, Krlin R, Bukkapatnam R, Papi B, Champs M, Goudelocke C, Sahai A. Clinical Performance and Safety for the Rechargeable InterStim Micro System in Non-Obstructive Urinary Retention Subjects: 6-Month Results From the Global Post-Market ELITE Study. Urology 2025:S0090-4295(25)00311-5. [PMID: 40188967 DOI: 10.1016/j.urology.2025.03.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2024] [Revised: 02/17/2025] [Accepted: 03/31/2025] [Indexed: 04/19/2025]
Abstract
OBJECTIVE To confirm the clinical performance and safety of the rechargeable InterStim Micro sacral neuromodulation system, we report the first results from the global ELITE study for the non-obstructive urinary retention cohort through 6 months of follow-up. METHODS Subjects were enrolled following successful therapy evaluation and neurostimulator implant. The primary objective was improvement in the number of clean intermittent self-catheterizations (CISC) per day at 3-months post-implant compared to baseline. RESULTS The change in the number of CISC per day from baseline was -3.5 (95% CI: -4.77, -2.26; n = 23) at the 3-month follow-up, which was statistically significant (P <.001) and signifies that the primary objective was met. This change was sustained at 6-month follow-up, with a change of -3.5 (95% CI: -4.73, -2.29; n = 24). There was a reduction in post-void residual of 244 mL (95% CI: -334.6, -154; n = 22) at 3 months and 264 mL (95% CI: -366.43, -161.56; n = 21) at 6 months vs baseline. On the Patient Global Impression of Improvement, 88% and 79% of subjects reported that their bladder condition was better at 3 and 6 months, respectively, compared to before they were treated with InterStim Micro. Device-, procedure-, or therapy-related AEs included implant site pain (11.1%; 3/27), medical device site discomfort (7.4%; 2/27), and pain in extremity (7.4%; 2/27). CONCLUSION This study reports on the non-obstructive urinary retention population of the global ELITE study, demonstrating the efficacy and safety of the InterStim Micro system through 6 months of follow-up.
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Affiliation(s)
- Sachin Malde
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK.
| | - Victoria Lavin
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust - Freeman Hospital, Newcastle, UK
| | | | - Dean Elterman
- Division of Urology, University of Toronto, Toronto, Canada
| | - Benoît Peyronnet
- Department of Urology, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - Martijn Smits
- Maastricht Universitair Medisch Centrum, Maastricht, Netherlands
| | - Sagar Shah
- East Coast Institute for Research LLC, Jacksonville, FL
| | | | - Ryan Krlin
- Department of Urology, Louisiana State University Health Sciences Center, New Orleans, LA
| | | | | | | | | | - Arun Sahai
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
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Gupta A, Rainu SK, Kaur M, Meena M, Singh N, Jacob J. 1,4-Bis(2-hydroxyethyl)piperazine-derived water-dispersible and antibacterial polyurethane coatings for medical catheters. J Mater Chem B 2025; 13:3350-3364. [PMID: 39925157 DOI: 10.1039/d4tb02227k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Abstract
To prolong usage and mitigate infections associated with bacterial colonization on medical catheters, the development of water-dispersible polyurethane (PU) coatings with bactericidal properties is desirable. With this objective, we have formulated polyurethane coatings that exhibit both antibacterial activity and water dispersibility. A piperazine-based diol, 1,4-bis(2-hydroxyethyl)piperazine (HEPZ), was synthesized and used as a chain extender in PU synthesis. The PUs were prepared using hexamethylene diisocyanate (HDI), 4,4'-methylene diphenyl diisocyanate (MDI), polyethylene glycol (PEG600), and polypropylene glycol (PPG400), resulting in a series of polyurethanes (PU1-PU4). MDI-containing PUs showed superior tensile strength (3.2-3.6 MPa) and elongation (67-70%) attributable to their higher aromatic content. The PEG600-containing PUs (PU1 and PU3) were alkylated using methyl iodide (MeI) to varying degrees whereby a significant reduction in contact angle from ∼82° to ∼62° was observed, indicating enhanced hydrophilicity. MPU3-D with 72.5% methylation demonstrated the most stable water dispersion with a particle size of ∼190.8 nm and a zeta potential of +49.0 mV. In vitro cytocompatibility studies further revealed that methylated PU3 exhibited higher compatibility (80-90%) compared to methylated PU1 (30-40%). The hemolysis test showed the non-hemolytic behavior of MPU3-D films with a % hemolysis of 0.4 ± (0.2)% making it suitable for coating on medical devices. Additionally, MPU3-D films also demonstrated antibacterial activity against Gram-negative (E. coli) and Gram-positive (S. aureus) bacteria, with zones of inhibition measuring 7 mm and 8 mm, respectively. Also, water-dispersible MPU3-D-based coatings with a hardness of ∼75 A and a thickness of ∼17 μm (as observed through FESEM) showed strong adhesion to PVC catheters, exhibiting an adhesion strength of 4B rating. Our results suggest that water-dispersible polyurethane coatings with antibacterial properties are promising materials to reduce catheter-associated infections and enhance patient care.
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Affiliation(s)
- Anchal Gupta
- Department of Materials Science and Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India.
| | - Simran Kaur Rainu
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India
| | - Manleen Kaur
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India
| | - Mahipal Meena
- Department of Materials Science and Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India.
- Centre for Fire, Explosive and Environment Safety, DRDO, Delhi, 110054, India
| | - Neetu Singh
- Centre for Biomedical Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India
| | - Josemon Jacob
- Department of Materials Science and Engineering, Indian Institute of Technology, Delhi, New Delhi, 110016, India.
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Hosseini J, Parsapour R, Ganji M, Mirjalili SA, Baluch A. Unmet Needs, Pain, Shame, Regret, and Loss of Identity among Men with Urethral Injuries Resulting from Traffic Accidents; A Qualitative Study. Qual Life Res 2025; 34:843-856. [PMID: 39645541 DOI: 10.1007/s11136-024-03862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 12/09/2024]
Abstract
INTRODUCTION Urethral injuries are the most severe injuries caused by high-energy mechanisms such as traffic accidents, which have significant long-term serious consequences on the quality of life of the injured. OBJECTIVES Exploration of lived experiences of urethral injury in traffic accident victims is the main goal of this study. METHODS This is a phenomenological qualitative study among men suffering from urethral injuries due to traffic accidents and referred to hospitals for urethroplasty in Iran. Sixteen in-depth interviews were conducted with 15-59-year-old injured men from August 2022 to May 2023 using a semi-structured questionnaire at Shohada Hospital, considering maximum variation and achieving saturation. For data analysis, Colizzi's analysis method was implemented in MaxQDA2020. Lincoln's and Guba's criteria were assessed to achieve the trustworthiness of the study. RESULTS Five main themes emerged from the interviews: Urethral Injury resulting from traffic accidents as a Complex, Unknown Problem with a general lack of public awareness, Unpleasant Experience with Permanent Suffering from pain, shame, regret, isolation, Urethral Injury Causes Regret and Loss of Normalcy, Impact on Sexual and Social Identity, and its long-term consequences as neglected health and socio-economic issues are the unmet needs of the injured patients. CONCLUSION The majority of expressions related to low public awareness and poor infrastructure. There are needs neglected by public services, especially health care services. Alongside wresting with these issues, considering policies to support this vulnerable people, and their well-being, quality of life and prevent further damage in terms of physical, social and mental health is an axiom.
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Affiliation(s)
- Jalil Hosseini
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Roxana Parsapour
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Maryam Ganji
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Arash Baluch
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Miller D, Pelzman D, Bonfili J, Erpenbeck S, Orikogbo O, Risnear A, Pekala K, Maganty A, Jones R, Jackman S, Rusilko P. Implementation of a Standardized Process of Coude Catheter Insertion Decreases Traumatic Catheterizations. Urology 2024; 194:253-259. [PMID: 39395454 DOI: 10.1016/j.urology.2024.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 09/25/2024] [Accepted: 10/01/2024] [Indexed: 10/14/2024]
Abstract
OBJECTIVE To address the issue of traumatic foley catheterization, we developed and implemented a coude catheter education program for operating room nurses as well as standardize the usage of a coude catheter for male patients. Traumatic catheterization leads to patient morbidity and increased healthcare costs. METHODS A retrospective review was conducted to identify all traumatic catherizations over a 6-month period for several surgical services at our institution. A nursing education program was implemented that included basic urological anatomy, coude urethral catheter insertion techniques, and catheter safety. We conducted our trial over a period of 2 months with all catheterizations tracked. Following the trial, the process and outcomes were reviewed and then implemented for all male patients >18 years old requiring indwelling catheter placement in the operating room. RESULTS On retrospective review, there were 18 traumatic foley catheterizations of patients on the 3 surgical services out of a total 601 catheter placements (3% traumatic placement rate). The total cost of these traumatic catherizations was $27,793 when accounting for additional procedures, supplies, and additional OR time required for each traumatic catheterization. The average cost per patient was $1544. After full implementation of the process across all operating room services in June 2021, there have been 2038 catheterizations performed using a coude catheter kit with 4 traumatic foley placements through May 2022 (0.2% traumatic catheterization rate). CONCLUSION Implementation of the nursing education program and utilization of the coude catheter for all male catheterizations reduces costs, decreases iatrogenic urethral injury, and improves patient safety.
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8
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Madec FX, Marcelli F, Neuville P, Fourel M, Baudry A, Morel-Journel N, Karsenty G. Urethral strictures - General aspects: Definition, anatomy of the urethra and its clinical application in stenosis, epidemiology, etiology, and principles of urethral reconstruction. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102720. [PMID: 39586660 DOI: 10.1016/j.fjurol.2024.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/05/2024] [Accepted: 08/26/2024] [Indexed: 11/27/2024]
Abstract
BACKGROUND Urethral strictures are a common and persistent pathology in urology with significant clinical repercussions. Our aim is to provide an overview of the general aspects of this condition. METHODS A comprehensive review of the literature from PubMed was conducted covering the period from 2020 to 2023. This was complemented by a synthesis of the latest guidelines from the American, European, and French Urological Associations (AUA, EAU, AFU), as well as references from textbooks. RESULTS Urethral stricture is defined by a narrowing of less than 16 French. The urethra is divided into posterior and anterior parts. The prevalence of urethral stricture is approximately 0.9%. The most common location for strictures is the anterior urethra, particularly its bulbar portion in males. The main causes are idiopathic, iatrogenic, traumatic, inflammatory, and infectious. A better understanding of urethral anatomy and histopathology provides a key element. Urethral reconstruction is based on prior urethral rest, detailed analysis of the stricture characteristics, and the use of grafts and flaps. CONCLUSION Urethral strictures remain a broad pathology. Their definition and epidemiology have been clarified. They require a thorough understanding of the anatomy, etiologies, and principles of urethral reconstruction to optimize management.
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Affiliation(s)
- François-Xavier Madec
- Department of Urology, Foch Hospital, Suresnes, France; UMR1179 Inserm Faculty of Medecine, Versailles Saint-Quentin University, Paris Saclay, 78180 Montigny-le-Bretonneux, France.
| | - François Marcelli
- Department of Andrology, Urology and Renal Transplantation, University of Lille, Lille, France
| | - Paul Neuville
- Department of Urology, hospices civils de Lyon, hôpital Lyon Sud, France
| | - Mathieu Fourel
- Department of Andrology, Urology and Renal Transplantation, University of Lille, Lille, France
| | | | | | - Gilles Karsenty
- Department of Urology, La Conception Academic Hospital, Assistance publique-Hôpitaux de Marseille (AP-HM), Marseille, France
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Sitharthan D, Sved P. A rare case of fatal rectal perforation and sepsis following traumatic urinary catheterization. Urol Case Rep 2024; 54:102706. [PMID: 38827535 PMCID: PMC11143431 DOI: 10.1016/j.eucr.2024.102706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 06/04/2024] Open
Abstract
This case report details a fatal rectal perforation and sepsis in a comorbid 96-year-old male after traumatic urinary catheterization, highlighting the risks of IDC management in elderly patients with complex health backgrounds. Despite maximal medical therapy, including escalated antibiotics and ICU care, the patient died from septic shock linked to improper catheter insertion by a non-specialist nurse in the community. This case emphasizes the urgent need for better catheterization practices, specialized nursing education, and clear guidelines to prevent such outcomes.
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Affiliation(s)
- Darshan Sitharthan
- Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, NSW, 2200, Australia
- Discipline of Surgery, School of Health and Medicine, University of New South Wales, Kensington, NSW, 2052, Australia
| | - Paul Sved
- Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, NSW, 2200, Australia
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10
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Croghan SM, Voborsky M, Roche AF, Condron C, O'Keeffe DA, McGuire BB. Design and utilisation of a novel, high-fidelity, low-cost, hybrid-tissue simulation model to facilitate training in robot-assisted partial nephrectomy. J Robot Surg 2024; 18:103. [PMID: 38427102 PMCID: PMC10907476 DOI: 10.1007/s11701-024-01857-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024]
Abstract
Robot-assisted partial nephrectomy (RAPN) has rapidly evolved as the standard of care for appropriately selected renal tumours, offering key patient benefits over radical nephrectomy or open surgical approaches. Accordingly, RAPN is a key competency that urology trainees wishing to treat kidney cancer must master. Training in robotic surgery is subject to numerous challenges, and simulation has been established as valuable step in the robotic learning curve. However, simulation models are often both expensive and suboptimal in fidelity. This means that the number of practice repetitions for a trainee may limited by cost restraints, and that trainees may struggle to reconcile the skills obtained in the simulation laboratory with real-world practice in the operating room. We have developed a high-fidelity, low-cost, customizable model for RAPN simulation based on porcine tissue. The model has been utilised in teaching courses at our institution, confirming both feasibility of use and high user acceptability. We share the design of our model in this proof-of-concept report.
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Affiliation(s)
- Stefanie M Croghan
- Department of Urology and Transplantation, Beaumont Hospital, Dublin, Ireland.
- Strategic Academic Recruitment Programme, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Miroslav Voborsky
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Adam F Roche
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Claire Condron
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Dara A O'Keeffe
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barry B McGuire
- RCSI SIM Centre for Simulation Education and Research, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Urology, St. Vincent's University Hospital, Dublin, Ireland
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11
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Shi W, Whittington AR, Grant DC, Boreyko JB. Reduced Sliding Friction of Lubricant-Impregnated Catheters. ACS OMEGA 2024; 9:3635-3641. [PMID: 38284056 PMCID: PMC10809236 DOI: 10.1021/acsomega.3c07640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/30/2024]
Abstract
During urethral catheterization, sliding friction can cause discomfort and even hemorrhaging. In this report, we use a lubricant-impregnated polydimethylsiloxane coating to reduce the sliding friction of a catheter. Using a pig urethra attached to a microforce testing system, we found that a lubricant-impregnated catheter reduces the sliding friction during insertion by more than a factor of two. This suggests that slippery, lubricant-impregnated surfaces have the potential to enhance patient comfort and safety during catheterization.
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Affiliation(s)
- Weiwei Shi
- Department
of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia 24061, United States
- Division
of Natural and Applied Sciences, Duke Kunshan
University, Kunshan, Jiangsu 215316, China
| | - Abby R. Whittington
- Department
of Chemical Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
- Department
of Materials Science and Engineering, Virginia
Tech, Blacksburg, Virginia 24061, United States
| | - David C. Grant
- Department
of Small Animal Clinical Sciences, Virginia
Tech, Blacksburg, Virginia 24061, United States
| | - Jonathan B. Boreyko
- Department
of Mechanical Engineering, Virginia Tech, Blacksburg, Virginia 24061, United States
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Yeaman C, Lawton J, Smith C, Kamilova M, You W, Pilehvari A, Rapp DE. Urologic Consultations for Urethral Catheter Placement: A Cost Analysis. Urology 2024; 183:85-92. [PMID: 37984488 DOI: 10.1016/j.urology.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/08/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To comprehensively analyze the cumulative costs associated with Foley consultations throughout their event lifespan. Urologic consultation for Foley catheter (Foley) management is common. Such consultations are heterogeneous, with some requiring only simple catheter placement. Others (eg, traumatic Foley) necessitate more complex procedural intervention and may also result in downstream care and/or intervention needs. METHODS This study analyzed a retrospective database of consecutive urologic Foley consultations at a single academic institution (2017-2019), collecting comprehensive data on patient characteristics, related procedures/materials, and downstream care (eg, hospitalization, laboratory/radiology testing, evaluation and management services). A process map and related modeling were used to assess categorical and cumulative event costs. Allocated costs and charges were utilized for materials/institutional resources and for services rendered, respectively. Statistical analysis performed using SAS and statistical inferences were based on significance level of 10%. RESULTS A total of 244 patient encounters were included in the analysis. The mean overall cost of all care related to Foley consultation was $2389.23 (±$4045.89). A total of 62 (25.4%) patients required only consultation/Foley without additional intervention, with a total cost of $738.90 (±$94.10). The remaining 182 (75.6%) patients required additional intervention and related cost (total cost $3413.27 (±$4850.41)). Traumatic catheterization was associated with higher cost compared with atraumatic cases ($3201.50 (±$6158.4) vs $1926.40 (±$1776.20), respectively, P = .05). Downstream care comprised a significant portion of overall cost. In 61 (25%) cases no nurse attempt was performed prior to consultation. CONCLUSION Urologic Foley consultation is associated with significant health system cost. Quality initiatives to optimizing Foley placement and management are critical to improving quality of care and associated downstream costs.
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Affiliation(s)
- Clinton Yeaman
- University of Virginia School of Medicine, Charlottesville, VA
| | - Jack Lawton
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Caleigh Smith
- Department of Urology, University of Virginia, Charlottesville, VA
| | - Medina Kamilova
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Wen You
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - Asal Pilehvari
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA
| | - David E Rapp
- University of Virginia School of Medicine, Charlottesville, VA.
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13
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Croghan SM, Malcolm R, Flood HD, Mealing S, Avey B, Leonard G, Wright J, Davis NF, Walsh MT. Cost-effectiveness of a novel urethral catheter safety device in preventing catheterization injuries in the UK. J Med Econ 2024; 27:154-164. [PMID: 38126355 DOI: 10.1080/13696998.2023.2298121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
AIMS Intraurethral catheter balloon inflation is a substantial contributor to significant catheter-related urethral injury. A novel safety valve has been designed to prevent these balloon-inflation injuries. The purpose of this evaluation was to assess the cost-effectiveness of urethral catheterisation with the safety valve added to a Foley catheter versus the current standard of care (Foley catheter alone). MATERIALS AND METHODS The analysis was conducted from the UK public payer perspective on a hypothetical cohort of adults requiring transurethral catheterization. A decision tree was used to capture outcomes in the first 30 days following transurethral catheterization, followed by a Markov model to estimate outcomes over a person's remaining lifetime. Clinical outcomes included catheter balloon injuries [CBIs], associated short-term complications, urethral stricture disease, life years and QALYs. Health-economic outcomes included total costs, incremental cost-effectiveness ratio, net monetary benefit (NMB) and net health benefit. RESULTS Over a person's lifetime, the safety valve was predicted to reduce CBIs by 0.04 per person and CBI-related short-term complications by 0.03 per person, and nearly halve total costs. The safety valve was dominant, resulting in 0.02 QALYs gained and relative cost savings of £93.19 per person. Probabilistic sensitivity analysis indicated that the safety valve would be cost-saving in 97% of simulations run versus standard of care. CONCLUSIONS The addition of a novel safety valve aiming to prevent CBIs during transurethral catheterization to current standard of care was estimated to bring both clinical benefits and cost savings.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | | | | | - Brooke Avey
- York Health Economics Consortium, Heslington, UK
| | | | | | - Niall F Davis
- Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Michael T Walsh
- Bernal Institute and Health Research Institute, University of Limerick, Limerick, Ireland
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14
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Drake MJ, Anderson K, Gammie A, Morris N, Timlin T, Cotterill N, Duff J, Fader M, Taylor H, Holmes R, Havard J. Development and first-in-human testing of FLUME urinary catheter with protected tip and relocated drainage holes. CONTINENCE (AMSTERDAM, NETHERLANDS) 2023; 8:None. [PMID: 38107022 PMCID: PMC10719115 DOI: 10.1016/j.cont.2023.101054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Purpose Evaluation of a catheter design which protects its tip with the retaining balloon when inflated, and has eyeholes at the base of the balloon to improve drainage. Materials and methods Preclinical tests included assessment of retaining balloon performance, and microbiological blockage. Clinical testing evaluated short-term use and safety in hospital (stage 1) or the patient's usual residence (stage 2). Results The retaining balloon supported static loads of 0.7kg, with reduced trauma when modelling forced evulsion. In vitro time to blockage with P. Mirabilis was significantly slower for FLUME compared with latex Foley catheters, but not the silicone Foley. Stage 1 testing (10 patients) confirmed balloon inflation, drainage, retention and removal, with no serious adverse events caused by catheterisation; one balloon failed to inflate, one patient could not be catheterised. Of five patients at stage 2, one had the catheter for 28 days without complication, one experienced spontaneous balloon deflation (14th day) and three needed early removal (blood clot, bypassing, difficulty connecting the drainage bag). Bacterial profiles of two FLUME catheters retained at least 2 weeks matched the Foley catheters. Acquired catheter colouration (two FLUME, one Foley) was not associated with biochemical change in the material. Conclusion FLUME catheter performed well in preclinical blockage and balloon tests. Tests in 15 patients confirmed basic function and additional training was not needed for staff familiar with Foley catheterisation. Clinical issues commonly seen with catheters included failed catheterisation, clot blockage and bypassing. In addition, an unintended balloon deflation and a failure of bag connection occurred. Plain language summary This article describes a new catheter design which aims to improve patient comfort and safety, and maximise bladder drainage, by protecting the bladder from the exposed catheter tip and by locating the drainage holes better. Various tests were done to check the catheter retaining balloon was safe and how well the catheter did when exposed to bacteria that could block it. The catheter was also used in people for the first time, to check it could be put in safely and functioned as intended. The results showed the FLUME catheter did well in the balloon and blockage tests. Tests in 15 patients confirmed basic function and showed placement was easy for staff familiar with conventional catheters. There were some clinical issues typical of urinary catheters and some possible improvements were identified.
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Affiliation(s)
- Marcus J. Drake
- Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Andrew Gammie
- Bristol Urological Institute, North Bristol NHS trust, Bristol, UK
| | - Nicola Morris
- Bristol Urological Institute, North Bristol NHS trust, Bristol, UK
| | - Tony Timlin
- Research and Innovation, North Bristol NHS Trust, Bristol, UK
| | - Nikki Cotterill
- School for Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - John Duff
- Patient and Public Involvement, North Bristol NHS Trust, Bristol, UK
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15
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Ekici O, Keskin E, Kocoglu F, Bozkurt AS. Iatrogenic bladder neck rupture due to traumatic urethral catheterization: A case report. World J Clin Cases 2023; 11:7413-7417. [PMID: 37969443 PMCID: PMC10643055 DOI: 10.12998/wjcc.v11.i30.7413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/09/2023] [Accepted: 09/18/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In this article, we present a case of iatrogenic bladder neck rupture due to catheter insertion in a 94-year-old comorbid male patient. CASE SUMMARY The patient, who had a urethral catheter inserted in the palliative service 3 d ago, was consulted because the catheter did not work. Because the fluid given to the bladder could not be recovered, computed tomography was performed, which revealed that the catheter had passed the bladder neck first into the retrovesical area then into the intraabdominal area. The appearance of the anterior urethra and verumontanum was normal at cystoscopy. However, extremely severe stenosis of the bladder neck, and perforated posterior wall of the urethral segment between the prostatic urethra and the bladder neck were observed. Internal urethrotomy was applied to the bladder neck with a urethrotome. An urethral catheter was sent over the guide wire into the bladder. The patient was followed in the palliative care service and the catheter was removed 7 d later. No extravasation was observed in the control urethrography. CONCLUSION Although catheter insertion is a simple and frequently performed procedure in hospitalized patients, it is necessary to avoid unnecessary extra-indication catheter insertion.
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Affiliation(s)
- Ozgur Ekici
- Department of Urology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24000, Turkey
| | - Ercüment Keskin
- Department of Urology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24000, Turkey
| | - Fatih Kocoglu
- Department of Urology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24000, Turkey
| | - Ali Seydi Bozkurt
- Department of Urology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan 24000, Turkey
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16
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Cunnane EM, Cunnane CV, Allardyce JM, Croghan SM, Walsh MT, Davis NF, Flood HD, Mulvihill JJE. Mechanical and morphological characterisation of porcine urethras for the assessment of paediatric urinary catheter safety. J Mech Behav Biomed Mater 2023; 143:105923. [PMID: 37270901 DOI: 10.1016/j.jmbbm.2023.105923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/06/2023]
Abstract
Paediatric urinary catheters are often necessary in critical care settings or to address congenital anomalies affecting the urogenital system. Iatrogenic injuries can occur during the placement of such catheters, highlighting the need for a safety device that can function in paediatric settings. Despite successful efforts to develop devices that improve the safety of adult urinary catheters, no such devices are available for use with paediatric catheters. This study investigates the potential for utilising a pressure-controlled safety mechanism to limit the trauma experienced by paediatric patients during inadvertent inflation of a urinary catheter anchoring balloon in the urethra. Firstly, we establish a paediatric model of the human urethra using porcine tissue by characterising the mechanical and morphological properties of porcine tissue at increasing postnatal timepoints (8, 12, 16 and 30 weeks). We identified that porcine urethras harvested from pigs at postnatal week 8 and 12 exhibit morphological properties (diameter and thickness) that are statistically distinct from adult porcine urethras (postnatal week 30). We therefore utilise urethra tissue from postnatal week 8 and 12 pigs as a model to evaluate a pressure-controlled approach to paediatric urinary catheter balloon inflation intended to limit tissue trauma during inadvertent inflation in the urethra. Our results show that limiting catheter system pressure to 150 kPa avoided trauma in all tissue samples. Conversely, all of the tissue samples that underwent traditional uncontrolled urinary catheter inflation experienced complete rupture. The findings of this study pave the way for the development of a safety device for use with paediatric catheters, thereby alleviating the burden of catastrophic trauma and life changing injuries in children due to a preventable iatrogenic urogenital event.
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Affiliation(s)
- Eoghan M Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland.
| | - Connor V Cunnane
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland
| | - Joanna M Allardyce
- School of Allied Health, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Michael T Walsh
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland; Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland; Department of Surgery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Hugh D Flood
- Class Medical Limited, Unit 1 D, Annacotty Business Park, Co, Limerick, Ireland
| | - John J E Mulvihill
- Biomaterials Cluster, Bernal Institute, University of Limerick, Limerick, Ireland; School of Engineering, Faculty of Science and Engineering, University of Limerick, Limerick, Ireland; Health Research Institute, University of Limerick, Limerick, Ireland.
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17
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Takanashi M, Ito H, Fukazawa T, Shinoki R, Tabei T, Kawahara T, Kobayashi K. Predictive factors for the success of trial catheter removal for women with urinary retention. Low Urin Tract Symptoms 2023; 15:4-10. [PMID: 36252953 DOI: 10.1111/luts.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 09/17/2022] [Accepted: 10/03/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention. METHODS Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases. RESULTS Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598). Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively. Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1-9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9-25.0). CONCLUSIONS This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.
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Affiliation(s)
- Masato Takanashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Hiroki Ito
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeshi Fukazawa
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Risa Shinoki
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tadashi Tabei
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Takashi Kawahara
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
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18
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Croghan SM, Hayes L, O'Connor EM, Rochester M, Finch W, Carrie A, Considine SW, D'Arcy F, Riogh ANA, Mahmalji W, Elhadi M, Thursby H, Pearce I, Modgil V, Noweir H, MacCraith E, Madden A, Manecksha R, Browne E, Giri SK, Cunnane CV, Mulvihill J, Walsh MT, Davis NF, Flood HD. A Prospective Multi-Institutional Evaluation of Iatrogenic Urethral Catheterization Injuries. J INVEST SURG 2022; 35:1761-1766. [PMID: 35948441 DOI: 10.1080/08941939.2022.2109226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVES To perform a multi-institutional investigation of incidence and outcomes of urethral trauma sustained during attempted catheterization. PATIENTS & METHODS A prospective, multi-center study was conducted over a designated 3-4 month period, incorporating seven academic hospitals across the UK and Ireland. Cases of urethral trauma arising from attempted catheterization were recorded. Variables included sites of injury, management strategies and short-term clinical outcomes. The catheterization injury rate was calculated based on the estimated total number of catheterizations occurring in each center per month. Anonymised data were collated, evaluated and described. RESULTS Sixty-six urethral catheterization injuries were identified (7 centers; mean 3.43 months). The mean injury rate was 6.2 ± 3.8 per 1000 catheterizations (3.18-14.42/1000). All injured patients were male, mean age 76.1 ± 13.1 years. Urethral catheterization injuries occurred in multiple hospital/community settings, most commonly Emergency Departments (36%) and medical/surgical wards (30%). Urological intervention was required in 94.7% (54/57), with suprapubic catheterization required in 12.3% (n = 7). More than half of patients (55.56%) were discharged with an urethral catheter, fully or partially attributable to the urethral catheter injury. At least one further healthcare encounter on account of the injury was required for 90% of patients post-discharge. CONCLUSIONS This is the largest study of its kind and confirms that iatrogenic urethral trauma is a recurring medical error seen universally across institutions, healthcare systems and countries. In addition, urethral catheter injury results in significant patient morbidity with a substantial financial burden to healthcare services. Future innovation to improve the safety of urinary catheterization is warranted.
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Affiliation(s)
- Stefanie M Croghan
- Department of Surgery, Royal College of Surgeons, Dublin, Ireland.,Department of Urology, Blackrock Clinic, Dublin, Ireland
| | - Leah Hayes
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | | | - Mark Rochester
- Department of Urology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - William Finch
- Department of Urology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Anne Carrie
- Department of Urology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | | | - Frank D'Arcy
- Department of Urology, Galway University Hospital, Galway, Ireland
| | | | - Wasim Mahmalji
- Department of Urology, Wye Valley NHS Trust, Hereford, United Kingdom
| | - Mohammed Elhadi
- Department of Urology, Wye Valley NHS Trust, Hereford, United Kingdom
| | - Helen Thursby
- Department of Urology, Wye Valley NHS Trust, Hereford, United Kingdom
| | - Ian Pearce
- Department of Urology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Vaibhav Modgil
- Department of Urology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Hosam Noweir
- Department of Urology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Eoin MacCraith
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Aideen Madden
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Rustom Manecksha
- Department of Urology, Tallaght University Hospital, Dublin, Ireland
| | - Eva Browne
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Subhasis K Giri
- Department of Urology, University Hospital Limerick, Limerick, Ireland
| | - Connor V Cunnane
- School of Engineering, Bernal Institute, University of Limerick, Limerick, Ireland.,The Health Research Institute, University of Limerick, Limerick, Ireland
| | - John Mulvihill
- School of Engineering, Bernal Institute, University of Limerick, Limerick, Ireland.,The Health Research Institute, University of Limerick, Limerick, Ireland
| | - Michael T Walsh
- School of Engineering, Bernal Institute, University of Limerick, Limerick, Ireland.,The Health Research Institute, University of Limerick, Limerick, Ireland
| | - Niall F Davis
- Department of Urology, Beaumont Hospital, Dublin, Ireland
| | - Hugh D Flood
- Department of Urology, University Hospital Limerick, Limerick, Ireland
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19
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Ofuji Y, Nomoto H, Miya A, Kameda H, Cho KY, Nakamura A, Miyoshi H, Atsumi T. Urethral injury related to peri-urethral abscess as a complication of self-catheterization in an older patient with type 2 diabetes. Geriatr Gerontol Int 2022; 22:894-895. [PMID: 36017885 DOI: 10.1111/ggi.14470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/29/2022] [Accepted: 08/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Yuri Ofuji
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Nomoto
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Aika Miya
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiraku Kameda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kyu Yong Cho
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.,Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Akinobu Nakamura
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hideaki Miyoshi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tatsuya Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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20
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Lee KH, Min C, Kim HO, Kim YB, Park Y, Son JT, Lee SR, Jung KU, Kim H. Validation of a scoring system to predict bladder dysfunction after laparoscopic rectal cancer surgery. Langenbecks Arch Surg 2022; 407:2929-2935. [PMID: 35748955 DOI: 10.1007/s00423-022-02582-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/03/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE A recent trend in urinary catheter management in patients who underwent laparoscopic rectal cancer surgery is early removal. However, some patients develop bladder dysfunction and require urinary re-catheterization. In 2016, a scoring system to predict bladder dysfunction after laparoscopic rectal cancer surgery was developed in our institution. The aim of this study was to demonstrate the validity of this scoring system and to determine the suitability of patients for early removal of urinary catheter. METHODS A single-center, retrospective study from a prospective database was conducted on 234 patients who underwent elective laparoscopic rectal cancer surgery between January 2016 and December 2019. According to bladder dysfunction predictive score, the urinary catheter was removed on the first postoperative day (low-risk group) and fifth postoperative day (high-risk group). After catheter removal, all patients were managed using in-house protocols. RESULTS Of 234 patients, 130 (55.6%) were classified as a low-risk group. The overall incidence of bladder dysfunction was 8.5% (11/130) in the low-risk group and 13.5% (14/104) in the high-risk group. CONCLUSION The scoring system developed to predict bladder dysfunction showed good overall performance for discriminating between patients suitable or not for early removal of urinary catheter after laparoscopic rectal cancer surgery.
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Affiliation(s)
- Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Chungki Min
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Yong Bog Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea.,Department of Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Yongjun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jung Tak Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Hungdai Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 03181, Republic of Korea
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21
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Clark C, Haslam C, Malde S, Panicker JN. Urinary catheter management: what neurologists need to know. Pract Neurol 2021; 21:504-514. [PMID: 34753810 DOI: 10.1136/practneurol-2020-002772] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/22/2022]
Abstract
Patients with neurological disorders often have lower urinary tract dysfunction, manifesting as urinary retention or urinary incontinence, and so commonly use catheters. Neurologists should therefore be aware of the different types of catheters and appliances and their risks, benefits and complications. Clean intermittent self-catheterisation is preferable to an indwelling catheter; however, if this is not possible, then a suprapubic indwelling catheter is preferable to a urethral catheter for long-term management. We review the decision-making process when selecting catheters for neurological patients, the evidence base regarding the different options and how neurologists can recognise and address complications. We also discuss alternatives to catheterisation, such as non-invasive containment products and surgical treatments, and the indications for urological referral.
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Affiliation(s)
- Calum Clark
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Collette Haslam
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK .,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
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Pina IM, Khattak AS, Omar AM, Floyd MS. Letter to the Editor re Gration, 'From indwelling Foley to fail safe voiding: Proposed changes in design and thinking', Journal of Clinical Urology, 4 November 2020. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/20514158211032833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ines M Pina
- Department of Reconstructive Urology, St Helens and Knowsley Hospital NHS Trust, Prescot, UK
| | - Ahmed S Khattak
- Department of Reconstructive Urology, St Helens and Knowsley Hospital NHS Trust, Prescot, UK
| | - Ahmad M Omar
- Department of Reconstructive Urology, St Helens and Knowsley Hospital NHS Trust, Prescot, UK
| | - Michael S Floyd
- Department of Reconstructive Urology, St Helens and Knowsley Hospital NHS Trust, Prescot, UK
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Komiya A, Kitamura H, Wakasugi M, Okudera H. Efficacy of an educational program for medical staff in preventing incidents related to Foley catheter insertion and maintenance: A single-institution retrospective study. Int J Urol 2021; 28:645-649. [PMID: 33626596 DOI: 10.1111/iju.14528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze incidents related to Foley catheter insertion and maintenance, and to compare the rate of incidents before and after a medical staff education program. METHODS Data regarding Foley catheter insertion incidents and maintenance were collected at Toyama University Hospital, Toyama, Japan. The degree of harm for each incident was assessed. In the middle of the study period, a medical staff education program by urologists was implemented to help understand basic urological anatomy, urethral catheter insertion techniques and catheter safety. The incidents before and after the intervention were then compared. RESULTS During the study period, Foley catheter insertion was carried out in 12 476 patients. Related incidents were reported in 66 (0.53%), including 22 (0.18%) occurring during catheter insertion and 44 (0.35%) occurring during catheter maintenance. A total of 13 (0.10%) cases of urethral injury were reported. The degree of harm associated with catheter insertion incidents was moderate in 13. Nine of these incidents occurred before the education program (9/6799, 0.13%), and four were reported after the end of the program (4/5677, 0.07%, P = 0.4303). Transient suprapubic cystostomy was required in two due to urethral injury reported before the program. Among 44 incidents occurring during catheter maintenance, 37 catheters were removed or cut by the patient. Such incidents occurred regardless of the education program. CONCLUSIONS The rate of incidents related to Foley catheter use at our institution is low. A specific medical staff education program might prevent iatrogenic catheter-related urethral injury requiring cystostomy.
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Affiliation(s)
- Akira Komiya
- Departments of, Department of, Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan.,Department of, Crisis Medicine and Patient Safety, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Hiroshi Kitamura
- Departments of, Department of, Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Masahiro Wakasugi
- Department of, Crisis Medicine and Patient Safety, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
| | - Hiroshi Okudera
- Department of, Crisis Medicine and Patient Safety, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama, Japan
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Gration JCD. From indwelling Foley to fail-safe voiding: Proposed changes in design and thinking. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820970400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The Foley indwelling urethral catheter (IDC) has been an effective part of the clinician’s armoury for more than 80 years. It meets wide clinical needs, such as overcoming urinary retention for men and perioperative management, but its use risks the major iatrogenic conditions of catheter-associated urinary tract infection and urethral injury (CAUI) – the latter mainly in men. This article focuses on CAUI, examines some factors contributing to these risks, makes suggestions for design solutions which may help tackle them and invites collaboration to develop more effective and fail-safe IDC or voiding solutions.
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Wang Z, Li Q, Wang P, Yang M. Biodegradable drug-eluting urethral stent in limiting urethral stricture formation after urethral injury: An experimental study in rabbit. J BIOACT COMPAT POL 2020. [DOI: 10.1177/0883911520940002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
In this study, a reproducible urethral injury animal model was developed and the role of the biodegradable drug-eluting urethral stent in limiting urethral stricture formation after urethral injury was evaluated. A total of 22 rabbits were used, and 20 rabbits were randomly chosen to develop urethral injury animal model. Bulbar urethral injury was made by a self-designed explosion device in the 20 rabbits. The urethral injury animal model was then randomly assigned to 2 groups of 10 each, which received a treatment of biodegradable paclitaxel-eluting urethral stent or only end-to-end anastomosis. Other two rabbits served as normal control group. Stents were surgically implanted into the injured urethras of rabbits under direct vision. Reparative effects, including stent degradation, were evaluated by urethroscopy, retrograde urethrography, and histology at different intervals at weeks 4, 8, and 12. In stent-free group, 8 of 10 rabbits developed obvious urethral stricture which was demonstrated by urethroscopy and retrograde urethrography, while in biodegradable paclitaxel-eluting stent group, urethral stricture was absent in all animals (p < 0.05). Histological follow-up indicated that the drug-eluting stents can also minimize the inflammatory reactions and fibrosis formation compared with the stent-free groups. Scanning electron microscope demonstrated that the biodegradable drug-eluting stent can gradually degrade in 12 weeks. The biodegradable paclitaxel-eluting urethral stent is effective in limiting urethral stricture formation after urethral injury.
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Affiliation(s)
- Zhongxin Wang
- Department of Traditional Chinese Medicine, The First Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China
- Department of Urology, Hainan Hospital of Chinese PLA (People’s Liberation Army) General Hospital, Sanya, People’s Republic of China
| | - Qiongqiong Li
- Department of Nursing and Preschool Education, Shougang Technician College, Beijing, People’s Republic of China
| | - Pengchao Wang
- Department of Urology, Hainan Hospital of Chinese PLA (People’s Liberation Army) General Hospital, Sanya, People’s Republic of China
| | - Minghui Yang
- Department of Traditional Chinese Medicine, The First Medical Centre, Chinese PLA (People’s Liberation Army) General Hospital, Military Postgraduate Medical College, Beijing, People’s Republic of China
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Dragova M, Bamfo A, Holmes K, Attard K, Frost A, Mundy A. Managing difficult catheterisation in nurse‐led catheterisation services: Does guidewire‐assisted urethral catheterisation make a difference? INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2020. [DOI: 10.1111/ijun.12228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Culenova M, Bakos D, Ziaran S, Bodnarova S, Varga I, Danisovic L. Bioengineered Scaffolds as Substitutes for Grafts for Urethra Reconstruction. MATERIALS (BASEL, SWITZERLAND) 2019; 12:3449. [PMID: 31652498 PMCID: PMC6829564 DOI: 10.3390/ma12203449] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 12/25/2022]
Abstract
Urethral defects originating from congenital malformations, trauma, inflammation or carcinoma still pose a great challenge to modern urology. Recent therapies have failed many times and have not provided the expected results. This negatively affects patients' quality of life. By combining cells, bioactive molecules, and biomaterials, tissue engineering can provide promising treatment options. This review focused on scaffold systems for urethra reconstruction. We also discussed different technologies, such as electrospinning and 3D bioprinting which provide great possibility for the preparation of a hollow structure with well-defined architecture.
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Affiliation(s)
- Martina Culenova
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia.
| | - Dusan Bakos
- International Centre for Applied Research and Sustainable Technology, Jamnickeho 19, 841 04 Bratislava, Slovakia.
| | - Stanislav Ziaran
- Department of Urology, Faculty of Medicine, Comenius University, Limbova 5, 833 05 Bratislava, Slovakia.
| | - Simona Bodnarova
- Department of Biomedical Engineering and Measurement, Faculty of Mechanical Engineering, Technical University of Kosice, Letna 9, 042 00 Kosice, Slovakia.
| | - Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia.
| | - Lubos Danisovic
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University, Sasinkova 4, 811 08 Bratislava, Slovakia.
- Regenmed Ltd., Medena 29, 811 01 Bratislava, Slovakia.
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