Search

Background: To compare the safety and efficacy of open simple prostatectomy (OSP) and robotic simple prostatectomy (RSP) for the treatment of large benign prostatic hyperplasia (BPH). Materials and methods: We retrospectively reviewed the medical records of 52 patients who underwent OSP (n = 23) and RSP (n = 29) between January 2005 and March 2019 at a single institution. The preoperative status of the patients, complications related to surgery, and the functional outcomes of the surgery were analyzed. Results: There were no significant differences in the preoperative total prostate volume, transitional volume, prostate-specific antigen value, and age between the two groups. Postoperative improvements in the International Prostate Symptom Score, maximum urinary flow rate, and postvoid residual were significant and similar for both groups. There were no significant differences between the two groups regarding surgery duration and resected prostate volume. The majority of patients in both groups had the urethral Foley catheter removed within the planned 10 day postoperative period, with the exception of two patients in the OSP group who had prolonged indwelling Foley catheter placement because of persistent hematuria. Postoperative hematocrit changes were significantly lower in the RSP group (RSP: 7.8 ± 4.1%, OSP: 14.2 ± 4.9%, P

Catheter associated infection is one of commonest infection which affects hospital admitted patients. Indwelling urethral catheters which are kept in place for 30 days or less are called short term. Whereas, when catheter placement exceeds 30 days, it is known as chronic or long term. Objectives: This study was intended to investigate the frequency of urinary tract infection caused by chronic indwelling urethral catheters. Study Design: Cross Sectional study. Setting: Department of Urology & Renal Transplantation, Allied Hospital, Faisalabad. Period: 6 months between 01-12-2015 to 31-05-2016. Material & Methods: Informed consent was taken from all the 100 patients which were selected for the research purpose. Under aseptic conditions, indwelling urethral catheter was replaced. The Foley catheter tip which we had taken out was cut and separated. It was delivered to the pathologist for culture and sensitivity in a secured axenic container. Diabetes was ruled out using blood sugar fasting levels. Data was recorded using a proforma. Results: In our study, out of 100 cases with chronic supra-pubic or urethral Foley catheter, 53% cases (n=53) were aged below 50 years while 47% (n=47) were aged above 50 years. Furthermore, 95% patients (n=95) were men and only 5% (n=5) were women. 18% participants of our study were recorded to have urinary infection associated with chronic catheterization. Conclusion: We found that urinary infection affects the patients having chronic indwelling urethral catheters significantly. Therefore, it is justified to assess every patient having urethral catheter for possible urinary infection.

Acute urinary retention (AUR) is a common symptom evaluated in the emergency department. It is generally due to an obstructive process such as benign prostatic hyperplasia (BPH) and can be treated simply with an indwelling foley catheter and urological follow up. Perirectal abscess is a relatively rare cause of urinary retention with no documented prevalence but when present is almost universally accompanied by perirectal pain. We present a 53-year-old male with a four-day history of urinary retention without perirectal pain or additional symptoms, who was found to have a perirectal abscess on digital rectal exam (DRE) and confirmed on computed tomography (CT) imaging.

Purpose Postoperative urinary retention (POUR) is a common complication after spinal surgery. However, no clear definition of POUR currently exists, and no studies have evaluated the management of POUR. We aimed to investigate the prognostic factors for eventual POUR-free status in spinal surgery patients. Methods The records of patients who received a urologic consultation for POUR from January 2015 to December 2016 were reviewed. POUR-free status was defined as a voiding volume (VV) >100 mL and a VV ratio >50%. Patients with an indwelling Foley catheter and those with any postoperative complications were excluded. The patients were divided into 2 groups according to the primary management method (Foley catheterization [FC] or intermittent catheterization [IC]). Results In total, 205 patients (median age, 70.6 years) were evaluated. Significant prognostic factors for eventual POUR-free status were intraoperative FC, previous spinal surgery, operative level (L3–5), lumbar fusion, and total volume (TV) at the time of POUR. Bladder training and medication did not reduce the time to POUR-free status. In patients who underwent FC, the duration of indwelling FC was a significant prognostic factor for POUR-free status. In a subanalysis, the TV (≥500 mL) and VV ratio at the time of POUR were significant prognostic factors for POUR-free status after primary management. Among the patients who achieved a POUR-free status, 8 (6.4%) experienced recurrent POUR. The VV ratio (

Longterm indwelling urethral catheter can cause several complications such as lower urinary tract infections, tissue damage, pain, hemorrhage and encrustation of catheter leading to blockage. A 55- year old male presented with suprapubic pain for three months owing to poorly draining Foley catheter. He had undergone surgery for bladder calculi two and half a years back. He had been discharged with Foley catheter. He did not show up at the hospital for two and half years. The catheter was never changed during this period. Plain X-ray abdomen revealed a large encrustation with radiopacity surrounding the foley's bulb. Open suprapubic cystostomy was performed. The intact Foley catheter with encrusted bulb was removed. His postoperative period was uneventful. Surgical removal is the only treatment of choice for unusual massive encrustations in long-term indwelling urethral catheter. Minimally invasive technique is getting popularity, however we performed open cystostomy and removal due to the lack of expertise and instruments in our hospital setting. Catheterization under aseptic condition, frequent catheter change, early treatment of urinary infection and proper patient education on catheter hygiene are few methods that can reduce the complications of longterm indwelling urinary catheter., Highlights • Massive encrustations over the of bulb of urinary catheter is very unusual consequence of long term indwelling urinary catheter. • We report a massive encrustations in mentally healthy adult patient who was unusually carrying a catheter for two and a half years. • Catheterization under aseptic condition, frequent catheter change, and patient education on catheter hygiene can be effective in minimizing complications.

Data on the experience that women who undergo urogynecologic surgery have with postoperative catheterization are severely limited. As the importance of our patients' perioperative experience becomes more valued, assessment of the burden of postoperative catheterization, which has not yet been performed, is increasingly needed.The aim of this study was to compare catheter burden in women who self-selected use of an indwelling Foley catheter vs clean intermittent self-catheterization for voiding dysfunction after reconstructive pelvic surgery.This is a nested study within a nonblinded randomized controlled trial of 2 different voiding trial protocols that was conducted from March to October 2017. Women who underwent pelvic organ prolapse and/or stress urinary incontinence surgery who were English speaking and ≥18 years old with a preoperative postvoid residual100 mL were included. Participants who did not pass their voiding trial were discharged with an indwelling Foley catheter or self-catheterization per participant preference. Our primary outcome was catheter burden at 1 week after surgery assessed by the Short-Term Catheter Burden Questionnaire, which is a validated 6-item survey comprised of 2 subscales: difficulty of use and embarrassment. Scores range from 3-15 with higher scores indicating greater difficulty and/or embarrassment, and the sum of the 2 subscale scores measures total catheter burden with a higher score indicating greater burden. Secondary outcomes included the rate of urinary tract infection, the number of postoperative clinic visits, and the number of postoperative phone calls.Of 150 participants, 77 women (51%) did not pass their voiding trial; of those, 47 women (61%) were discharged home with an indwelling catheter and 30 women (39%) with self-catheterization. Baseline demographics were similar, except that women who chose an indwelling Foley catheter were older (62±11 vs 55±11 years; P.01). There were no significant differences between indwelling Foley catheter and self-catheterization in total catheter burden score (18±5 vs 18±6; P=.77), difficulty of use subscale score (8±3 vs 9±3; P=.20), or embarrassment subscale score (10±4 vs 9±4; P=.12). For secondary outcomes, there were no significant differences in rate of urinary tract infection (23% indwelling vs 30% self-catheterization; P=.60). Consistent with study protocol, women who were discharged with an indwelling Foley catheter did have more postoperative clinic visits (2±1 vs 1±1 visits; P.01), and those women who were discharged with self-catheterization had more postoperative phone calls (2±3 vs 5±3 phone calls; P.01). Otherwise there was no significant difference in nonvoiding-related clinic visits (1±1 visits for indwelling and self-catheterization; P=.15) or postoperative phone calls (1±2 indwelling vs 2±3 self-catheterization calls; P=.31).In women who used either an indwelling Foley catheter or clean intermittent self-catheterization for management of postoperative voiding dysfunction after pelvic reconstructive surgery, there were no differences in difficulty of use, embarrassment, or overall catheter burden. There were also no differences in nonvoiding-related postoperative phone calls or clinic visits, with similar rates of urinary tract infection between the 2 groups.

Removing a foley catheter can sometimes be a challenge, especially when it is related to non-deflating balloons which represent most of the cases. In female patients, due to their urethral anatomy, several techniques have been proposed for balloon puncture when other maneuvers have failed. We present a simple technique for non-deflating balloon catheter removal in an old female patient with a permanent indwelling foley catheter which required no anesthesia. The balloon was effectively punctured with minimal patient's discomfort. In addition, this technique was tested in several ex-vivo model catheters and found to be safe and effective. Our technique can be used for non-deflating balloon puncture in female patients in an outpatient setting without anesthesia.

What's known on the subject? and What does the study add? A vast literature has been published on the prevalence, morbidity and microbiology of catheter-associated urinary tract infections. Research and development in recent years has focused on producing antibacterial coatings for the indwelling Foley catheter with insufficient attention to its design. This article provides a critical examination of the design of the indwelling Foley catheter. Design specifications are outlined for a urine collection device that should reduce the vulnerability of catheterised urinary tract to infection. The indwelling urinary catheter is the most common cause of infections in hospitals and other healthcare facilities [1]. As long ago as 1958, Paul Beeson [2] warned '… the decision to use this instrument should be made with the knowledge that it involves the risk of producing a serious disease which is often difficult to treat'. Since then, scientific studies have progressed revealing a greater understanding of the bladder's defence mechanisms against infection and how they are undermined by the Foley catheter [3-5]. In addition, the complications caused by the development of bacterial biofilms on catheters have been recognised and the ways in which these bacterial communities develop on catheters have become clear [5,6]. It is now obvious that fundamental problems with the basic design of the catheter, which has changed little since it was introduced into urological practice by Dr Fredricc Foley in 1937 [7], induce susceptibility to infection. These issues need to be addressed urgently if we are to produce a device suitable for use in the 21st century.

Benign prostatic hyperplasia (BPH) is the fourth most commonly diagnosed medical condition in older men. As a consequence, acute urinary retention can occur in patients with preoperative prostate cancer. Robot-assisted radical prostatectomy as a treatment modality for prostate cancer was designed to decrease operative morbidity and minimize long-term morbidity such as incontinence and erectile dysfunction. Three patients with prostate cancer coexisting with a BPH-related urinary retention managed with a clean intermittent catheterization (patient #1), and an indwelling Foley catheter (patients #2 and #3), were treated with a robot-assisted radical prostatectomy. After the procedure, the patients were able to void spontaneously, with good urine flow and reasonable bladder emptying.

Urinary urgency and fever developed in a 55-year-old, bedridden woman with multiple sclerosis, a long-term indwelling Foley catheter, and multiple prior urinary tract infections. The patient had recently been transferred from an assisted-living facility to a skilled-nursing facility because of progressive disability. The laboratory evaluation revealed pancytopenia.

A 40-year-old G3P3 woman with grade 3 cervical intraepithelial neoplasia underwent loop electrosurgical excision procedure complicated by a large vesicovaginal fistula. She was initially managed with an indwelling Foley catheter to allow for fistula maturation. During planned surgical repair it was discovered that the fistula had closed spontaneously.

Background: The use of urethral catheter is common in medical practice with up to 25% of hospitalized adults having an indwelling Foley catheter at some point during hospital stay. Its use however, is not without complications. We sought to find out the knowledge and practice patterns of physicians regarding urethral catheterization. Methodology: Self-administered questionnaires aimed at elucidating knowledge of the indications of urethral catheterization and precautionary measures effective against catheter-associated urinary tract infection (CAUTI) were distributed to physicians in a teaching hospital. Results: The majority of respondents correctly identified hemodynamic instability necessitating fluid administration (94.9%), lower urinary tract obstruction (92.1%), and assisting the healing of perineal wounds (84.3%) as appropriate indications for urethral catheter use. Incontinence (89.1%), preoperative use (88.3%), and epidural anesthesia (66.9%) were also identified as indications for catheterization. Early catheter removal (94.9%), use of condom catheter (91%), use of antibiotic coated Foley catheter (79.6%), intermittent catheterization (76.2%) and the use of automated reminders (67.6%) were correctly identified as measures that can prevent CAUTI by the majority of the respondents. Routine change of catheter was identified as an effective measure by 84% of the respondents. Conclusion: Physicians in a teaching hospital in Jos, Nigeria have adequate knowledge of indications for urethral catheter use and effective measures aimed at preventing CAUTI. More surgeons identified epidural anesthesia as an appropriate indication for urethral catheter use when compared to those of the medical specialties. Key Words Foley Catheter, Indications, Physicians, Urethral catheterization

Urinary retention is the inability to empty the bladder. It may be acute or chronic. Acute urinary retention is a medical emergency requiring prompt action such as insertion of a urethral catheter. The objective of this study is to determine the incidence of bladder retention necessitating maneuvers that will induce urination in patients with indwelling foley catheter for seven days or less in an intensive care unit setting. There were a total of 125 patients who were included and observed in this study. The primary inclusion criterion was seven days on indwelling catheter. Nine out of 125 patients or 7.2% experienced urinary retention. There was a significant association noted between age and urinary retention but no association noted between sex and urinary retention. There was a significant difference in the number of days with catheter on subjects with or without urinary retention. The study showed that out of 125 patients who were included in this study, only nine patients (7.2%) had urinary retention. The predictive factors for the occurrence of urinary retention in catheterized patients include: ages of > 80 y/o and > 4 days on indwelling catheter. The gender as well as the primary illness has no association with the occurrence of urinary retention.

Despite major technological improvements in catheter drainage systems, the indwelling Foley catheter remains the most common cause of nosocomial infection in medical practice. By approaching this common complicated urinary tract infection from the perspective of the biofilm strategy bacteria appear to use to overcome obstacles to produce bacteriuria, one appreciates a new understanding of these infections. An adherent biofilm of bacteria in their secretory products ascends the luminal and external surface of the catheter and drainage system from a contaminated drainage spigot or urethral meatus into the bladder. If the intraluminal route of bacterial ascent is delayed by strict sterile closed drainage or addition of internal modifications to the system, the extraluminal or urethral route assumes greater importance in the development of bacteriuria, but takes significantly longer. Bacterial growth within these thick coherent biofilms confers a large measure of relative resistance to antibiotics even though the individual bacterium remains sensitive, thus accounting for the failure of antibiotic therapy. With disruption of the protective mucous layer of the bladder by mechanical irritation, the bacteria colonizing the catheter can adhere to the bladder’s mucosal surface and cause infection. An appreciation of the role of bacterial biofilms in these infections should suggest future directions for research that may ultimately reduce the risk of catheter-associated infection.

The use ofthe intraurethral prostatic spiral metal catheter (Prostakath) is rapidly gaining its deserved place as an alternative to the indwelling Foley catheter in alleviating the distress of the obstructed elderly patient with benign prostatic hyperplasia. Our experience extends over a period of 6 months in 23 patients: 16 with indwelling catheters and 7 without but suffering obstruction from hyperplastic prostates. Good to excellent objective and subjective results were obtained in all 19 patients who had successful insertion of the device. In four cases, the attempted insertion failed because of technical difficulties. We propose several modifications in the mode of insertion, mainly concerning more vigilance in the introduction procedure. We advocate urethroscopy before and after successful insertion, in addition to the ultrasonic guidance suggested by the manufacturer. More clinical experience is still needed, but for the present, the device seems to be a good alternative to the traditional indwelli...

Urethral prolapse is rarely diagnosed. We describe the clinical findings in an 86-year-old woman. The treatment chosen was the excision of the urethral prolapse over an indwelling Foley catheter and suturing the mucosa edges to the vaginal skin. Etiology, differential diagnosis, and treatment modalities will be discussed.

A 4-month-old, male castrated Alpine White goat presented to the University of Guelph, Veterinary Teaching Hospital, with urolithiasis and a ruptured urethra. A tube cystostomy was performed using an indwelling Foley catheter. Postoperatively, the goat remained in good health, and was discharged with the cystostomy catheter in situ. Five weeks following surgery, the goat was noted to pass urine through its urethra. Seven weeks following surgery, the catheter became dislodged and the goat was observed to urinate normally. Six months following surgery, the goat was apparently healthy and urinating normally. Tube cystostomy may be a useful therapeutic option in the management of small ruminants with obstructive urolithiasis with concurrent rupture of the urethra, especially for cases in which treatment cost is a limiting factor.

If this article has presented all the facts/details about the resident’s case, then there is more than one quality improvement issue to be identified and corrected. The four criteria for the malpractice action to have merit include establishing the duty or obligation of the institution to perform a particular service and/or provide care, to establish a breach of that duty, to show injury to the resident, and to show proximate cause. Clearly there was a duty or obligation on the part of the institution to provide care for the resident. However, the facility failed to provide necessary care not only by failing to contact the physician in a timely manner but by failing to provide an ongoing assessment of the resident and failing to develop and implement a plan of care for his changing medical condition. The failure to notify the physician was just the last step in a chain of failures. If one assumes that the resident entered the facility in mid August, 2001, following surgery for a left hip fracture performed on August 1, 2001, the facility had an obligation under the Medicare regulations to perform a comprehensive initial assessment within the first 14 days of admission [F272, 438.20(b)(1)(2)] and to develop a plan of care within an additional 7 days based on the initial assessment [F279, 438.20(d)]. This initial assessment and plan of care should have identified the resident’s potential for developing a urinary tract infection based on the presence of an indwelling Foley catheter. F316 requires that the resident receive necessary care to prevent urinary tract infection. There is no evidence in the narrative, as presented, that staff at the facility identified the resident’s risk for development of a urinary tract infection and/or developed an appropriate plan of care for prevention. Regulations further require that the facility must provide each resident with sufficient fluid intake to maintain proper hydration and health [F327, 438.25(j)]. Nothing was presented in the narrative to indicate that this action was taken by facility staff. Nursing staff did not need a physician order to “push fluids.” Encouragement of adequate intake is part of nursing practice. Once an order was received from a physician to push fluids, there is nothing to indicate that facility staff recorded intake and output. There is nothing to indicate that facility staff assessed the urine output and the color, clarity, and status of the urine output. Assessment of the urine and measurement of intake and output is a nursing function and does not require a physician order. The physician’s order to send the resident to the hospital “if overall condition doesn’t improve” is unclear and should have been clarified by nursing staff. Apparently this was not done. There was no ongoing nursing assessment of the resident on September 6, 2001, even though he had a significant change in medical condition on the 5th and should have received intensified assessment. At 10:45 AM on September 7, the resident exhibited a return of shaking and had a rectal temperature of 102°F. Why wasn’t a physician notified at this time? Did nursing staff fail to consider that a return of shaking accompanied by fever might constitute a failure of the resident’s overall condition to improve? There was an additional 10 hour delay before the resident was sent to an acute hospital for evaluation and treatment. No mention is made of the apparent improper treatment received by the resident at the acute hospital. If the resident’s sodium was 159 MEQ/L, why would a physician use normal saline as a bolus infusion? This caused the sodium level to rise to 166, further placing the resident at risk. In my opinion, the primary failures by facility staff were the failure to provide comprehensive initial assessment and development and implementation of an appropriate plan of care for the prevention of urinary tract infection and the failure to provide comprehensive ongoing assessment when there was a significant change in the resident’s medical condition. In service education for the facility’s staff should not be limited to instruction in following the facility’s policy on when to call the physician but should be focused on the necessity of providing comprehensive and appropriate nursing assessments with nursing interventions as required by the assessments. Notification of the physician, then, would normally follow the assessments that would identify the failure of the resident to respond to treatment. I do not believe that it is incumbent on facility staff to recommend that a physician order a urine culture, blood count, or antibiotics. However, if a comprehensive assessment is performed by nursing staff, and the results of that assessment reported to the physician, the physician, in turn, will have the Medical Consultant, Health Facilities Division, Department of Health Services, Los Angeles County, California.

Complete eversion and transurethral prolapse of the urinary bladder is rare. We report a case of complete eversion and prolapse of bladder that occurred due to self pulling out of an indwelling Foley catheter in a 72-year-old woman. She presented with retention of urine concurrent with complete uterine procidentia. An indwelling Foley catheter was given to relieve the retention. The senile lady pulled out the catheter resulting in complete transurethral prolapse with bladder eversion. Under injection Midazolam sedation and with application of xylocain jelly the prolapsed bladder could be reduced manually back through the urethra. Definite corrective surgery was done later for the uterine prolapse.

BACKGROUND: In this 600-plus-bed teaching hospital with multiple services, catheter-associated urinary tract infections (CAUTIs) was measured in the ICU only. A hospital-wide algorithm has been in place to assist healthcare workers in discontinuing Foley catheters. The rate of CAUTI infection in other units was unknown at the time the study was initiated. The catheter in use was an uncoated latex Foley. The epidemiology department sought to determine the rate of CAUTI hospital-wide and to make interventions to lower the hospital-wide CAUTI rate by introducing an all-silicone silver Foley catheter. The economic impact was also measured. METHODS: A retrospective review was done of all adult inpatients with an indwelling Foley catheter and a positive urine culture >105 cfus collected at least 72 hours post catheterization. The Centers for Disease Control and Prevention (CDC) definitions for nosocomial UTI were used to determine infection. Data were collected during a baseline period of May–July 2003, and a trial period of June–October 2004. The average cost to treat CAUTI at the hospital was determined through a review of patient charges and estimated at $2200. The additional cost of the all-silicone silver Foley catheter was considered. RESULTS: During the baseline period, there were 39 CAUTIs in 23,738 risk-adjusted patient days (1.6 CAUTIs/1000 risk-adjusted patient days). During the trial period, the incidence of CAUTI was reduced to 13 CAUTIs in 37,933 risk-adjusted patient days (0.39 CAUTI/1000 risk-adjusted patient days). A 73.8% reduction in CAUTI incidence was evident. CONCLUSIONS: A 73.8% reduction in nosocomial CAUTI represents a significant improvement in patient safety. In addition, the economic savings of $229,000 in direct patient care costs is significant to the organization. Another added benefit is the replacement of a latex Foley catheter with the all-silicone Foley catheter, thereby reducing the potential of latex sensitivity in both patients and staff. Further study and evaluation of the Foley catheter at the hospital is warranted.

To estimate the early operative results and learning curve of extraperitoneal laparoscopic radical prostatectomy in 103 patients. Between March 2006 and January 2009, 103 patients with clinically organ-confined prostate cancer who underwent laparoscopic radical prostatectomy were enrolled in this study. Surgical morbidity and the oncologic and functional results of the groups were compared to evaluate the learning curve. The patients' mean age was 63.3±8.1 years, and their mean serum PSA was 14.1±7.6 ng/ml. The mean operating time and hospital stay were 265±83 minutes and 10.6±3.6 days, respectively. The mean postoperative period of an indwelling Foley catheter was 13.8±2.7 days. The positive surgical margin rate was 26.2%. After a mean follow-up of 15.5±9.4 months, a PSA relapse was observed in 3 (8.6%) patients in the first period. Continence and sufficient erection rates were about 80% and 45% after 6 months, respectively. Analysis of the learning curve revealed differences in the operating time, estimated blood loss, and complication rate but showed no influence on hospital days, indwelling Foley catheter days, or positive surgical margin rate. Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, morbidity is low and the oncologic continence results were promising. Extraperitoneal laparoscopic radical prostatectomy could be considered as the first safe treatment for patients with organ-confined prostate cancer. The learning curve for extraperitoneal laparoscopic radical prostatectomy seemed to show no complete plateau in this study. It depended not only on technical skills, but also on self-perceived skills. Standardized expectations and operative outcomes could help to define the true learning curve for extraperitoneal laparoscopic radical prostatectomy.

Summary— A new self-retaining intraurethral catheter, designed as an alternative to an indwelling catheter, has been used in 14 patients. It was left in place for 2 to 18 weeks; 11 of the 14 patients were able to void freely, were continent and had neither residual urine nor urinary tract infection. This device may be used instead of an indwelling Foley catheter in patients with retention due to infravesical obstruction and may be an alternative to prostatectomy in patients who are at high risk for surgery.

The urologist is frequently called upon to remove a nondeflating Foley catheter. The basic strategies to accomplish removal involve relieving obstruction of the blocked balloon port channel, dissolving the rubber balloon chemically or rupturing the balloon percutaneously. A less invasive technique of balloon rupture in the female patient, using a pen-catheter urethral route, is described. Foley catheters are widely used for short-term or long-term bladder drainage. Potential factors predisposing to nondeflating balloons include faulty catheter balloon valves, the use of inflating fluids, such as saline or blood contaminated water that may crystallize and allow debris to block the balloon channel, and a long duration of catheterization. Initial attempts to dislodge debris blocking the balloon port should be made once the catheter has been cut proximal to the balloon valve. Techniques using guide wires or stylets have been cited.'.2 When this is unsuccessful, balloon rupture has been used to remove a nondeflating catheter. Balloons can be ruptured by over distention or by chemical means, most commonly using ether or mineral Alternatively, balloon needle puncture has been re~ommended.~ Routes for percutaneous needle puncture have been transabdominal, transperineal and transvaginal. We report a less invasive option in female patients for balloon needle puncture using a pen-catheter urethral approach. MATERIALS AND METHODS Two female patients with chronic neurological conditions and detrusor dysfunction treated by an indwelling Foley catheter presented with a nondeflating balloon at the time of scheduled catheter change. The catheter was transected above the valve mechanisms with no spontaneous balloon deflation. Fine guide wires, passed along the balloon channel, also failed. In each patient the catheter then was removed using our technique. With the patient in the lithotomy position the bladder was partially filled with water. Gentle traction was placed on the Foley catheter to ensure that the balloon was brought to rest against the bladder neck. A 20 gauge 2-inch long angiographic catheter was selected and lubricated. The sheath of the angiographic catheter was advanced over the inner needle to hide the needle tip. The angiographic catheter was then gently advanced urethrally alongside the Foley catheter until the tip reached resistance in contact with the balloon. The inner needle was then advanced slightly, allowing the needle to puncture the balloon. Both catheters were closely inspected for missing balloon rubber and were intact. The procedures were well tolerated with no discomfort or adverse effect. DISCUSSION

Two case reports are presented of patients who utilized long-term intermittent urethral catheterization as a primary management of diabetic neurogenic bladder. The results indicate fewer complications than with a continuous indwelling Foley catheter. Further, only two urinary tract infections occurred during 39 months of patients utilization. No renal or vesical lithiasis occurred. One patient had a remission and went on drug therapy alone. The other patient may use this technique indefinitely.

Four patients in our Medical Center underwent placement of a Small-Carrion penie prosthesis for the primary purpose of maintaining an exdwelling condom catheter. The major benefits of being able to carry on daily activities, while maintaining satisfactory perineal hygiene, without the need for an indwelling Foley catheter is a most significant factor in the consideration of prosthetic surgery.

A study was made of 73 elderly patients receiving methenamine and ascorbic acid concurrently. Each patient had an indwelling Foley catheter. Urinary pH was assessed in relation to the dosage of ascorbic acid, duration of therapy, formulation, and dosing intervals for ascorbic acid and methenamine. Statistical analysis revealed a significant increase in urinary pH when the dosage of ascorbic acid was increased. No significant relationships were found between urinary pH and the dosage forms of ascorbic acid, the salt of methenamine used, or the duration of methenamine therapy. Changes in urinary pH at different dosing intervals for ascorbic acid were found to be significant, at the 10 percent level only, for the three-times-daily dose schedule. These data raise a question as to the value of ascorbic acid for acidifying the urine of catheterized patients receiving methenamine therapy.

Operative correction of urinary incontinence is, of necessity, accompanied by varying periods of postoperative bladder drainage. Present methods of most effectively accomplishing drainage are by the indwelling Foley catheter or, more recently, the suprapubic tube. A comparative study of 195 patients drained by a Foley catheter and 107 patients drained by a suprapubic tube is presented. The operative techniques in both groups were the same. Both groups are compared with respect to the incidence of postoperative bacteriuria, morbidity, establishment of satisfactory voiding patterns, and the length of hospitalization. The results indicate a comparable amount of bacteriuria, morbidity, and the time at onset of voiding. A greater degree of patient comfort and the requirement for less nursing care are the advantages of the suprapubic tube.

Catheter-induced bladder perforation is a rare and serious complication. Only three cases have hitherto been reported in some detail. Two additional cases are described and the pathogenetic mechanism is discussed.

Four homosexual men and one heterosexual woman presented with acute urinary retention secondary to intense anal intercourse. All had normal urologic histories. Their residual urine volumes ranged from 475 ml to 1,400 ml. Urinalyses and urine cultures were negative. All were treated with an indwelling Foley catheter and then with bethanechol and dibenzyline. Normal micturition was restored. To evaluate the influence of anal dilatation on detrusor function, five control patients with urge incontinence were studied. A cystometrogram (CMG) displayed a hyperreflexic bladder pattern in all five patients. Average bladder capacity was 86 ml. Calibrated anal dilatation increased bladder capacity to the average value of 406 ml on CMG. The diameter of anal dilatation ranged from 3.5 cm to 5 cm. Intense anal intercourse producing severe anal dilatation triggers reflex bladder inhibition leading to acute urinary retention. The sensory input travels from the dilated anus to the sacral spinal micturition center, which sends inhibitory stimuli to the urinary bladder.

Six spinal cord injury patients with chronic prostatitis were reviewed, all of whom had been treated with an indwelling Foley catheter during the phase of spinal shock. The 3 glass urine specimen test, the bladder wash-out test, a study of antibody coated bacteria and urethrography had limited diagnostic value. A specific diagnostic 5 glass specimen test proved to be useful and reliable. Longterm antibiotic treatment was successful in only one patient. Injection of antibiotics into the prostate gland was ineffective in the five patients in whom it was carried out. During a follow up from 1 to 5 years urological complications were rare in all five patients who remained infected.

We present a case of intraperitoneal rupture of the bladder discovered during exploratory laparotomy for abdominal free air associated with an indwelling Foley catheter found in the peritoneal cavity. This report emphasizes the need for systematic and thorough evaluation of the genitourinary tract in the patient with multiple trauma.

A method is presented that permits prolonged urethral stenting following an internal urethrotomy without the need of an indwelling Foley catheter. During this technique a 22F silicone catheter is inserted into the distended bladder, the balloon is left deflated and the catheter is advanced until the drainage hole is beyond the sphincter and no fluid drains through the catheter. At this point the catheter is cut flush with and sutured to the urethral meatus using 2 nylon sutures. The patient then is continent, able to void through the catheter lumen and has the advantage of a urethral stent without requiring catheter drainage. Of 21 patients 19 had good to excellent results 1 to 4 years after internal urethrotomy. Patient acceptance uniformly has been excellent and enthusiastic.

The use of an indwelling Foley catheter for catheter drainage is a common practice following pelvic operations. The reasons for catheterisation generally focus on operative needs and the inability of patients to empty in the immediate post-operative period. Roughly 80% of patients undergoing a gynaecological procedure will require postoperative catheter drainage. However, most of these patients will have short-term needs for a catheter. Rarely, if ever, will the results of pelvic surgery, other than for removal of the rectum, lead to permanent paralysis of the bladder. Still, a number of patients will require catheter drainage for a varying time. Fortunately, for these patients, suprapubic drainage now rivals the transurethral approach; the former is safe and for the most part preferred. The purpose of this chapter is to review some of the subtleties of catheterisation, both advantageous and disadvantageous, and to provide some guidelines for the practising clinician.

Penile necrosis is a rare entity but it may be brought about more readily if certain risk factors are present. Such factors are discussed in this paper and the reader is forewarned about this problem.

A rare case of perforation of the urinary bladder induced by an indwelling Foley catheter is reported. The pathogenic mechanism and preventive measures are discussed.

Acute urinary retention secondary to anal intercourse was found in 4 homosexuals. All four were treated initially with an indwelling Foley catheter and then with bethanechol and phenoxybenzamine (Dibenzyline). Normal micturition was restored in all 4 patients. Anal dilatation can produce reflex bladder inhibition resulting in acute retention.