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Purpose: We aimed to assess long-term use of continent catheterizable urinary channels (CCCs) and explore potential risk factors of disuse. Materials and Methods: People undergoing appendicovesicostomy and Monti procedures at our institution were retrospectively reviewed (1991-2023). The main outcome was CCC disuse (not intermittently catheterizing channels as the primary method of bladder emptying). Cox regression was used. Results: Five hundred sixty-one people (46% male, 57% shunted, 72% spina bifida) met inclusion criteria (244 appendicovesicostomy, 317 Monti; 69% right lower quadrant [RLQ]). Channels were created at a median age of 8 years (median follow-up: 11 years, 78% self-catheterized). Overall, 76 people disused their channels. The most common reasons for disuse were nonmechanical (64%). After disuse, 46% underwent incontinent diversion. After correcting for differential follow-up, 89% of people still used their channels at 10 years and 81% at 20 years. When analyzing all disused channels in patients reaching adulthood on multivariable analysis, channels catheterized by others had 3.78 times the risk of disuse compared with self-catheterized channels (P <.001); RLQ channels were 1.06 times more likely to be disused than umbilical channels (P =.02). For channels disused for nonmechanical reasons, catheterization by others, not attending transition clinic, and RLQ stoma were independently associated with disuse (P ≤.04). No variables were associated with disuse for mechanical reasons (P ≥.22). Conclusions: Most people with CCCs use them on long-term follow-up. One percent stopped using them annually. People who never self-catheterized, never attended transition clinic, or never had RLQ stomas were at higher risk of channel disuse, particularly because of nonmechanical reasons. [ABSTRACT FROM AUTHOR]

This study aims to establish a profile of the urethral stricture disease in the studied population, in addition to evaluating the correlation between the etiology of urethral stricture, age and findings evidenced in the retrograde and voiding urethrocystography (RVUC) examination. This observational study was conducted at a single institution and included 135 men with urethral stricture. Patient's age and the etiology of stricture were determined. RVUC findings such as length, number, location, and degree of urethral lumen obstruction of urethral stricture, as well as other associated pathological urological findings, were also analyzed. The correlation between demographic parameters, including age and etiology, and RVUC findings was then statistically analyzed. Median age of the patients was 64 years (range: 18–89 years). The most frequent etiologies were iatrogenic (51.9%), idiopathic (20.0%), inflammatory (15.6%) and external traumatic (12.6%). The subgroup of patients over 45 years of age had higher percentages of urethral stricture regardless of the etiology. In the comparative analysis between the four etiology categories, age group and location were the two variables with a statistically significant association (p = 0.001 and < 0.001, respectively). The penile urethral segment represented almost half of the cases of stricture of inflammatory etiology (47.6%). In the membranous urethral segment, almost all cases of stricture were of iatrogenic etiology, representing 24.3% of all cases of iatrogenic etiology in the study. Comparative statistical analysis between the traumatic and non-traumatic etiology categories found that location and length were the only variables with a statistically significant association (p < 0.001 and = 0.005, respectively). In the penile urethral segment, stricture of non-traumatic etiology was the most frequent (33.3% versus 11.5%). In this study, strictures were only of traumatic etiology in the membranous (20.7%) and prostatic (6.9%) urethral segments. Strictures of non-traumatic etiology were the longest. In another supplementary analysis, a statistically significant association was evidenced between age group and the specific cause of urethral stricture (p < 0.001). Prostatectomy was the main specific cause of urethral stricture considering all age groups, representing 20.7% of all cases in the study and 25.2% of patients aged over 45 years. The idiopathic and urethral catheterization were more frequent causes proportionally in the subgroup of patients aged 45 years or less than in the subgroup aged over 45 years (41.7% versus 15.3%, 29.2% versus 6.3%, respectively). A more severe disease profile of urethral stricture was evidenced, with 83% of cases causing obstruction in more than 2/3 of the urethral lumen. In our study, there was a significant statistical association between the etiology and patient's age, and also between the etiology and stricture's location and length as demonstrated by the RVUC exam. [ABSTRACT FROM AUTHOR]

OBJECTIVE To document differences in the microbiota of healthy cats versus cats with urethral obstruction (UO); compare the urinary microbiota with the oral, preputial, and rectal microbiota; and demonstrate that 16S rRNA gene sequencing will reveal rich and diverse urinary microbiota. METHODS 15 client-owned cats with UO and 15 age-matched healthy cats were included from July 2020 through April 2021. Exclusion criteria were evidence of urinary tract infection, urolithiasis, antimicrobial administration, urinary catheterization in the past 30 days, or a comorbidity. This study was a prospective, observational study. Both groups had a baseline CBC, chemistry panel, urinalysis, urine culture, and focal bladder ultrasound. Swabs of the cystocentesis site, buccal mucosa, rectum, prepuce, and urinary samples were collected, and 16S rRNA gene sequencing was used to compare the groups and sites. RESULTS Differences in the microbiota richness and diversity were found in the urine of cats with UO (n = 15) compared to healthy cats (15), along with differences in the preputial and oral samples, supporting the presence of a urinary dysbiosis in cats with UO. CONCLUSIONS Our preliminary data demonstrates a dramatic change in the urinary microbiota of cats with UO along with changes in microbiota in other sites compared to healthy cats. CLINICAL RELEVANCE A urinary dysbiosis in cats with UO has been minimally supported in prior studies using 16S rRNA gene sequencing. Although these are preliminary results, documenting this dysbiosis in cats with UO provides a potential avenue for novel therapeutics. [ABSTRACT FROM AUTHOR]

Background: Urethral strictures and bladder neck contractures (BNCs) can be significantly morbid for patients and may require intervention for effective urinary drainage. We hypothesized patients with abnormal scarring disorders, such as keloids or hypertrophic scars, are at elevated risks of urethroplasty failure as well as postprocedural urethral strictures and BNCs. Methods: We queried the TriNetX database to determine the risk of urethroplasty failure for patients with abnormal scarring disorders compared to controls. We also investigated the risk of developing urethral strictures and BNCs for patients undergoing various endourology procedures. Results are reported in terms of risk ratio (RR) with 95% confidence interval (CI). Statistical significance was considered when the CI did not include 1.0. Propensity score matching was performed to limit confounding. Notably, TriNetX rounds values < 10 to 10 for patient anonymity (denoted by *). Results: Urethroplasty patients with scarring pathology needed a second procedure more than twice as often (36.2% vs. <17.2%*, RR = 2.1, 95%CI 1.1–4.1). Following cystoscopy, there was no difference in urethral stricture rates for patients with scarring disorders (2.7% vs. 2.6%, RR = 1.1, 95%CI 0.85–1.3). These patients also showed similar rates of BNCs (7.5% vs. 5.3%, RR = 1.4, 95%CI 0.84–2.3) and urethral strictures (5.9% vs. 5.3%, RR = 1.1, 95%CI 0.68–1.8) after transurethral bladder outlet procedures. Conclusions: Patients with scarring disorders showed much higher urethroplasty failure rates. They experienced similar rates of urethral strictures and BNC formation after endoscopic procedures. These novel findings underscore the importance of recognizing abnormal scarring conditions during preoperative assessments, guiding clinicians in counseling patients and tailoring operative interventions. [ABSTRACT FROM AUTHOR]

Background: Horseshoe kidney is the most common renal fusion anomaly, occurring in approximately 1 in 500 individuals worldwide. It is characterized by abnormalities in kidney position, rotation, and vascular supply. While often asymptomatic, horseshoe kidneys can lead to urological complications, primarily due to ureteric obstruction and impaired urinary drainage.Although ureteropelvic junction obstruction (UPJO) is uncommon in horseshoe kidneys, its occurrence presents unique diagnostic and management challenges. This case explores the etiology, clinical presentation, and surgical management of UPJO in a patient with a horseshoe kidney, highlighting the critical role of urologists in addressing these anatomical and functional complexities. Case presentation: We report the case of a 3-month-old African male infant who presented with a two-month history of excessive crying and symmetrical abdominal distension. Radiological evaluation revealed a horseshoe kidney with decreased parenchymal thickness in the left kidney and marked hydronephrosis of the pelvis and calyces, with abrupt cessation at the left ureteropelvic junction. Surgical correction of the obstruction was performed successfully. The patient was followed for six months, during which he remained symptom-free with normal renal function tests. Conclusion: Ureteropelvic junction obstruction in a horseshoe kidney presents unique anatomical challenges. Symptomatic cases require thorough imaging for diagnosis and surgical planning. Pyeloplasty is the typical surgical intervention, meticulously planned to address these complexities. This ensures effective relief of obstructions and proper urinary drainage. [ABSTRACT FROM AUTHOR]

Semen collection in cats in the clinic setting can be difficult. However, semen analysis is vital when evaluating breeding soundness of a male. Electroejaculation (EEJ) is currently the most reliable semen collection method but requires specialized equipment and training of the operator. Chemical ejaculation followed by urethral catheterization (UC) is a technique that allows semen collection without special equipment: a catheter is placed into the urethra of a sedated tom and semen is collected passively into the catheter. Earlier studies used the sedative medetomidine at high doses for this procedure. However, medetomidine has been replaced with dexmedetomidine in some countries. This study sought to compare the results of EEJ and UC for semen collection in the domestic cat using dexmedetomidine, a potent α2-adrenoceptor agonist (α2A), as a substitute for medetomidine at the equivalent dose to that used in earlier studies. Twelve domestic cats were collected thrice at weekly intervals. All cats received intramuscular ketamine (5 mg/kg) and intramuscular dexmedetomidine (30 μg/kg) for initial cleanout via EEJ, then randomly underwent either EEJ or UC one week apart. The EEJ was performed under the same anesthetic protocol as the initial cleanout. The UC was performed using intramuscular dexmedetomidine at a dose of 60 μg/kg. Success of collection, total sperm number, sperm morphology, and motility characteristics were analyzed. Sperm was collected successfully from all 12 cats via EEJ and from 11/12 via UC. There were no significant differences in the percentage of total motile, progressively motile, or morphologically normal sperm between ejaculate types when averaged across all cats or individual cats. Although UC yielded a lower volume and higher concentration ejaculate, it consistently produced a lower total sperm number than ejaculates retrieved via EEJ (17.91 x 106 total sperm for UC versus 46.51 x 106 total sperm for EEJ). These results indicated that dexmedetomidine is a very effective sedative and performed satisfactorily in both procedures at the doses used in this study. It was also safe with no adverse effects on healthy toms. EEJ remained the most reliable in terms of assessing semen quality and retrieving semen with adequate number of sperm for breeding purposes. However, UC with dexmedetomidine at this dose demonstrated a 92 % success rate, presenting itself as a remarkably consistent alternative. • 50 mcg/kg dexmedetomidine produces a representative sperm sample in cats. • Chemical and electroejaculation yield comparable ejaculate concentration in cats. • Chemical and electroejaculation motilities and morphology are comparable in cats. • Electroejaculation yields higher volume and sperm number than chemical ejaculation. • Nucleocounter and hemocytometer concentration measurements are equivalent. [ABSTRACT FROM AUTHOR]

Aim: To compare the results of retrograde ureteral stent (RUS) and percutaneous nephrostomy (PCN) procedures for decompression in patients with acute obstructive pyelonephritis. Patients and Methods: Medical records of patients undergoing PCN or RUS for emergency urinary diversion because of obstructive pyelonephritis were evaluated retrospectively. Patients with urinary tract obstruction and concurrent fever (≥38°C), pyuria, and costovertebral angle tenderness were included and divided into two groups based on the type of emergency urinary drainage applied (PCN in Group 1) and (RUS in Group 2). Apart from the demographic data and Charlson Comorbidity Index, laboratory and radiologic examination outcomes were well evaluated. Results: A total of 155 patients including 73 patients (47.1%) undergoing PCN (Group 1) and 82 patients (52.9%) undergoing RUS (Group 2). Although no significant difference was found regarding the demographic characteristics, the operation time, as well as fluoroscopy time, was significantly shorter in Group 1 cases when compared with those in Group 2 (p < 0.0001). The success rate was similar between the two groups, and there was also a significant difference regarding the complication rates in both groups of cases (5.5% vs 7.3%). Conclusions: Our findings showed that despite similar efficacy and success rates noted between PCN and RUS applications in the emergency drainage of cases presenting with obstructive pyelonephritis, PCN application was found to be advantageous because of shorter operation and fluoroscopy durations. More importantly, this approach was associated with a significantly less need for intensive care during the postoperative period. [ABSTRACT FROM AUTHOR]

Background: Approximately 25% of hospitalised adults require an indwelling urinary catheter (IDC) during their hospital stay. IDCs expose patients to risks of infectious and non-infectious complications. Aims: To identify IDC prevalence, assess adherence to clinical practice guidelines and patient-reported involvement in IDC care for adult hospital inpatients. Methods: This point prevalence study was conducted in 22 wards in a single quaternary hospital. Data was collected by clinical and research nurses working in pairs on a single day. Study outcomes were reported descriptively as frequencies and percentages. Results: Of 502 patients included, 77 (15.3%) had an IDC (median duration 99.6 h). The median age of patients with an IDC was 64 years (interquartile range 22–88 years), 54 (70%) were male and one-quarter (n = 19; 25%) of IDCs were inserted at another hospital. More than half (n = 44; 57%) of the 77 IDCs had no documented removal plan. Three patients were unavailable for review for observed clinical practices, and it was found 43% (n = 32/74) lacked a securement device. Of 77 people with IDCs, there were 44 patient responses, and 27 (61.4%) patients did not know the reason for their catheter. Discussion: Areas for improvement included securement device use, timely removal plans and patient education for the reason for the device. Regular point prevalence studies to assess use and adherence to clinical practical guidelines can improve safety outcomes for patients requiring IDCs. [ABSTRACT FROM AUTHOR]

Aim(s): To evaluate the incidence of skin‐related complications attributable to incontinence‐associated dermatitis (IAD) using an external female urinary catheter device strategy for urinary incontinent (UI) patients in acute care. Design: Multicenter quality improvement study. Methods: Randomized allocation of two commercially available external female urinary catheter devices was used in hospitalized UI female patients. Daily nursing skin assessments were documented in the electronic health record before, during and after external catheter device application. Methods and results were reported following SQUIRE guidelines. Results: Three hundred and eighty‐one patients from 57 inpatient care units were included in the analysis. Both catheter devices were associated with an overall low risk (5 %) of new or worsening skin breakdown. Conclusion: The overall benefit of external catheters is most persuasive for skin integrity, rather than infection prevention. Impact: Significant negative outcomes are associated with UI patients. External female urinary catheters are a non‐invasive alternative strategy to reduce exposure of regional skin to urine contamination and IAD‐related skin complications. Use of external female urinary catheters in hospitalized UI female patients offers low risk (5%) of new or worsening overall skin breakdown. Patient Contribution: Hospitalized UI female patients were screened for external catheter device eligibility by the bedside nurse. The quality improvement review committee waved consent because the intervention was considered standard care. [ABSTRACT FROM AUTHOR]

Objective: To assess the satisfaction level of final year medical students with urinary catheterization workshop and the factors affecting it. Study Design: Cross-sectional study. Setting: Wah Medical College, Wah Cantonment. Period: October 15th, 2023 to January 15th, 2024. Methods: Satisfaction level and factors for its improvement were assessed by using a questionnaire after conducting a mandatory workshop on the skill of urinary catheterization. All the 90 final-year MBBS students present on the day of the workshop were included in the study using purposive sampling technique. The data was analyzed by using SPSS version 25. Fisher's exact test was applied to assess the association of gender with satisfaction level of students considering a p-value lesser than 0.05 as significant. For the open-ended questions, quantitative content analysis was performed. Results: The mean age of the students was 23.6+1.1 years. 82.2% of the participants had a very high satisfaction level with the workshop. Difference was observed when the satisfaction level of the students was assessed across gender (p-value=0.02). 45.6% of the students rated the workshop as good in all domains. The identified factors that can improve satisfaction with the workshop include the provision of refreshments, making smaller batches for teaching, providing feedback after skill performance and giving more time for practice. Conclusion: The majority of the students were highly satisfied with the workshop. Around half of the participants regarded the workshop as good in all domains but the students identified some factors for the improvement of satisfaction level with the workshop. [ABSTRACT FROM AUTHOR]

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Saúde Coletiva is the property of MPM Comunicacao and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Catheter-associated urinary tract infections (CAUTIs) are common health care–associated infections linked to indwelling urinary catheters. Nurse-driven protocols (NDPs) empower nurses to direct care without physician orders, potentially enhancing patient outcomes and reducing infection rates. Purpose: This systematic review and meta-analysis aimed to evaluate the effectiveness of NDPs for preventing CAUTIs and reducing catheter utilization rates. Methods: Databases searched included Cochrane Library, PubMed, Embase, and others. Ten studies involving 27, 965 NDP-treated patients and 30, 230 controls were reviewed, examining catheter utilization rates and CAUTI incidence. Results: Use of NDPs significantly lowered catheter utilization rates (34.84% vs 49.40%) and CAUTI incidence (2.867% vs 6.503%). Risk ratio analysis revealed a 29.48% decrease in catheter utilization and a 55.91% reduced CAUTI risk with NDP implementation. Conclusions: Using NDPs demonstrate superior efficacy in reducing catheter use and CAUTI occurrence compared to traditional methods. Further research is warranted to solidify evidence-based nursing practices in this area. [ABSTRACT FROM AUTHOR]

Background: Cronobacter sakazakii is an opportunistic pathogen that mostly affects neonates, infants, and elderly people with weakened immune systems. No study has reported the frequency and antibiotic susceptibility patterns of C. sakazakii from Oman, and thus this study was conducted to fill this gap in the literature. Materials and Methods: This single-center retrospective study included C. sakazakii isolates identified from different clinical samples of patients treated at Sohar Hospital, Oman, between January 2017 and December 2023. Bacterial identification and antibiotic susceptibility testing were done using the VITEK II automated microbiological system in accordance with the Clinical Laboratory Standards Institute (CLSI) guidelines. Results: A total of 185 C. sakazakii isolates were included, most commonly from patients aged >60 years (42.7%) and <1 year (11.4%). C. sakazakii strains had high susceptibility (>80%) to most of the tested antibiotics; however, for beta-lactam antibiotics, it ranged from 0% to 50%. Approximately 26.5% of the strains were multidrug resistant. Independent risk factors for increased frequency of multidrug-resistant strains were urinary catheterization (P = 0.002), surgery (P = 0.021), previous antibiotic therapy (P = 0.047), and critical care unit admission (P = 0.048). About one-fifth of the patients experienced life-threatening C. sakazakii infections such as septicemia (15%) and pneumonia (4.7%). All deaths due to septicemia occurred in the >60 years (n = 12) and <1 year (n = 4) age groups. Conclusions: Cronobacter sakazakii isolates from the North Batinah region of Oman were most frequently isolated from elderly and infant patients and had high antibiotic susceptibility; however, the significant resistance against beta-lactams suggests their low effectiveness. The high number of multidrug-resistant strains coupled with the independent risk factors suggests the need for following stricter antibiotic stewardship protocols and infection control practices. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to explore whether continuous infusion causing lubrication can effectively alleviate pain during male urethral catheterization. Methods: This prospective, multicenter, double-blinded study included 190 male patients scheduled for urethral catheterization. Patients were randomly allocated into four groups: Group A: the catheter was lubricated with paraffin; Group B: the catheter was lubricated with compound lidocaine gel; Group C: the pump continuously infusing with sterilized water; Group D: the pump continuously infusing with 2% lidocaine. The primary outcome was the visual analogue scale (VAS) scores. Statistical analysis system (SAS) (version 9.4) was used to perform all the statistical analyses. Significance for all results was set at P < 0.05. Results: The VAS of Group D was the lowest (18.90 ± 11.44), followed by the Group C (33.00 ± 11.07), and the VAS of Group A was the highest (53.98 ± 14.76). There were significant differences in VAS in Group D compared to Group A(P < 0.0001), Group B(P < 0.0001) and Group C (P < 0.0001), Group C compared to Group A (P < 0.0001) and Group B(P < 0.0001), Group B compared to Group A (P < 0.0001), indicating that patients treated with lidocaine infusion (Group D) experienced significantly less pain than did those in the other three groups. Conclusions: Continuous infusion with sterilized water during catheterization is an efficient method for lubricating the urethral mucosa; furthermore, infusion with 2% lidocaine provides better analgesia as well as lubrication. Trial registration: The study protocol was registered in the Chinese Clinical Trial Registry (ChiCTR2300070866) (https://www.chictr.org.cn/showproj.html?proj=194591) on Apr. 25th, 2023. [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) often leads to the loss of urinary sensation, making urination difficult. In a previous experiment involving six healthy participants, we measured heartbeat-induced acoustic pulse waves (HAPWs) at the mid-back, calculated time-series power spectra of heart rate gradients at three ultralow/very low frequencies, distinguished and formulated waveform characteristics (one characteristic for each power spectrum, nearly uniform across participants) at times of increased urine in the bladder and heightened urges to urinate, and developed an algorithm with five of these power spectra to identify when urination is needed by extracting the waveform portion (continuous timepoints) where all of the characteristics were consistent with the formulated characteristics. The objective of this study was to verify the validity of the algorithm fed with data from measured HAPW of participants with SCI and to adapt the algorithm for these individuals. Methods: In ten participants with SCI, we measured HAPWs continuously and urine volume intermittently, and obtained scores related to urinary sensation. A Boolean output at each data point was obtained by the algorithm fed with the calculated power spectra from each participant's HAPW. Notable times included when the output was positive or when the need to urinate (= (+)) was judged from the urine volume and urinary sensation scores. The outputs at these notable times were examined with the need to urinate and determined to be true/false. The accuracy of the algorithm was evaluated by the number of true/false-positive/negative points via the F-score with a binary classification model. We attempted to adapt the algorithm for participants with SCI. Results: The outputs at 13 notable times were examined, yielding seven true-positive, one false-positive, and five false-negative times, with an F-score of 0.70. The algorithm was modified by replacing three thresholds that determine the extraction condition for the slope in the power spectral waveform with new values that included all 12 true-positive points. Conclusions: Without changing the use of ultralow/very low frequencies or significantly modifying the extraction conditions, the modified algorithm did not miss any true urination times or identify false urination times in ten participants with SCI. [ABSTRACT FROM AUTHOR]

Purpose: Urethral instrumentation (UI) in patients with an artificial urinary sphincter (AUS) demands technical considerations and poses a risk of urethral erosion, leading to serious clinical and legal consequences. We conducted a national survey to evaluate the knowledge and experience of Brazilian urologists with UI in these patients. Methods: This study used an electronic survey distributed to members of the Brazilian Society of Urology. The survey included 19 multiple-choice questions assessing sociodemographic characteristics, practice patterns, AUS training, knowledge of AUS components and functionality, experience with UI in AUS patients, and interest in further training. Urologists were classified as 'competent' in AUS manipulation if they had prior experience and confidence in performing UI. Results: Among 536 participants (median age 47 years [39–55]), 72.8% reported involvement in urological emergencies, with 89.9% indicating inadequate AUS training during residency. Only 29.7% had occasional or regular involvement with AUS surgeries. Of the participants, 53.4% had performed UI in men with an AUS. Prior UI had been attempted by healthcare staff in 36.2% of cases. Only 46.8% reported knowledge of AUS components and 45.1% felt competent in deactivating it. Regarding urethral catheterization, 47.2% knew the safe catheter diameter, and 20.9% identified safe catheterization duration. Overall, 45.1% self-declared competence in UI, yet many gave incorrect answers on catheter size and duration. Competence strongly correlated with knowledge of AUS components, regular implant involvement, and prior experience. Most (89.3%) expressed interest in additional training for UI. Conclusion: This study highlights significant gaps in training and knowledge among Brazilian urologists regarding UI in AUS patients. These deficiencies underscore the potential for enhanced education to improve patient outcomes and reduce AUS-associated complications in Brazil and possibly broader international contexts. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the impact of different catheterization methods on transurethral resection of the prostate outcomes in patients with benign prostatic hyperplasia related acute urinary retention. Materials and Methods: Between 2019 and 2023, a retrospective examination was conducted on patients experiencing acute urinary retention secondary to benign prostatic hyperplasia. The study encompassed 89 patients who underwent transurethral resection of the prostate. The patients' demographic data, preoperative uroflowmetry results, pathology reports and the data obtained during their follow-up up to the 12th month were recorded. The patients' data were divided into two groups based on catheterization status: percutaneous cystostomy and Foley catheter, and compared. Results: The study included 76 patients with a transurethral Foley catheter and 13 with a percutaneous suprapubic cystostomy. No significant differences were observed in preoperative parameters or postoperative complications and pathology results between the groups. Uroflowmetry showed a significant decrease in postoperative postvoiding residual urine volume in the suprapubic catheter group but no significant difference in maximum flow rate. In the Foley catheter group both maximum flow rate and postvoiding residual urine volume showed significant changes postoperatively. However, when comparing uroflowmetry results between groups no significant differences were observed. Conclusions: Catheterization methods are utilized in the emergency management of acute urinary retention caused by benign prostate enlargement. Advantages and disadvantages should be carefully considered when selecting the appropriate method. Our study has shed light on this a spect. We believe that conducting more comprehensive prospective studies could yield more reliable results. [ABSTRACT FROM AUTHOR]

Background: Ureteral stents are one of the most used devices in Urology, allowing drainage of the upper urinary system, and can be used either in elective or emergency procedures. However, as a foreign body inside the urinary system, they are subject to encrustation. Encrustation is one of the burdens seen with double-J stents and, to date, there is no consensus about its best management. This study aims to prove that Endoscopic Combined Intra-Renal Surgery (ECIRS) is the best choice when there's an encrusted proximal loop of a ureteral stent. Methods: The authors conducted a retrospective cohort study of patients with an encrusted proximal loop of the ureteral stent who underwent surgery at a single center, comparing ECIRS with other procedures. Results: Between July 2011 and June of 2024, 33 patients (18 females and 15 males) were submitted to surgery. The median indwelling time of the stent was 11 (8-19) months and a stentfree rate of 100% was achieved. The authors demonstrated a significant stone-free rate of 61.1% following ECIRS compared to merely 20% with other procedures (p = 0.023). Notably, while the complication rate was low across all procedures, the ECIRS group exhibited fewer complications (5.6%) than those undergoing alternate techniques (13.3%), though this difference was not statistically significant (p = 0.439). Conclusions: Our study advocates for ECIRS as the preferred initial treatment for encrusted proximal ureteral stents, as it facilitates superior stone clearance, minimizes complications, and maintains comparable operative efficiency. This research contributes valuable insights into the management of challenging cases involving encrusted ureteral stents, calling for future studies to further validate these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: The objective of this study was to compare the accuracy of available tests for pyuria, including newer automated tests, and to examine the implications of requiring them for the diagnosis of urinary tract infections (UTIs). METHODS: We included children between 1 and 36 months of age undergoing bladder catheteri-zation for suspected UTIs who presented to 1 of 3 pediatric centers. Using a positive urine culture result as the reference standard, we compared the sensitivity of 5 modalities for assessing pyuria at the cutoffs most often used clinically for detecting children with a positive culture RESULT: leukocyte esterase on a dipstick, white blood cell (WBC) count on manual microscopy with and without using a hemocytometer, automated WBC enumeration using flow cytometry, and automated WBC enumeration using digital imaging with particle recognition. results: A total of 4188 children were included. Among febrile children, the sensitivity of the 2 most widely available modalities, the leukocyte esterase test and WBC enumeration using digital imaging, had sensitivity values of 84% (95% confidence interval, 0.80-0.87) and 75% (95% confidence interval, 0.66-0.83), respectively. CONCLUSIONS: Our findings suggest that for febrile children <36 months of age undergoing bladder catheterization for suspected UTI, pyuria will be absent in ^20% of children who are eventually shown to have pure growth of a pathogen on a culture. This raises questions about the appropriateness of requiring pyuria for the diagnosis of UTIs. [ABSTRACT FROM AUTHOR]

The article presents the case study of a 13-year-old boy diagnosed with metastatic embryonal rhabdomyosarcoma (RMS) of the prostate after presenting with urinary symptoms. Topics include the symptoms and initial findings, such as weakened urine stream, urinary frequency, and hematuria; the types and risk factors of RMS; and the age-related incidence pattern of RMS, which peaks in early childhood and adolescence.

Purpose: This study aims to examine the risk factors for catheter-associated urinary tract infection (CAUTI) following radical hysterectomy for cervical cancer (CC). Furthermore, the study seeks to develop a visual model that can effectively assist physicians in improving their proficiency in diagnosing, treating, and preventing CAUTIs. Patients and Methods: 48 subjects who developed CAUTI postoperatively were assigned to the infection group. There were 443 cases who did not develop CAUTI, and a 1:1 propensity score matching (PSM) method was employed to match 48 cases for the non-infection group. Univariate logistic and multivariate stepwise regression analyses were used to analyze the risk factors for CAUTI following radical hysterectomy for CC. Subsequently, a nomogram-based model was developed, and its effectiveness was comprehensively assessed. Results: The incidence rate of CAUTI in 491 patients who underwent radical hysterectomy for CC was 9.76% (48/491). Multivariate stepwise regression analysis revealed that the duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture were the independent risk factors for CAUTI after radical hysterectomy for CC (all β > 0, P < 0.05). A nomogram model incorporating these independent risk factors was constructed, and receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were generated. The ROC curve exhibited an area under the curve value of 0.9035, 95% CI of 0.8352– 0.9718, specificity of 0.8214, sensitivity of 0.8571, accuracy of 0.8429, positive predictive value of 0.8780, and negative predictive value of 0.7931. Conclusion: The duration of urinary catheterization, urinary leukocyte esterase, and positive urine culture are independent risk factors for CAUTI after radical hysterectomy for CC. This nomogram-based model exhibits numerous advantages, including simplicity, user-friendliness, high diagnostic accuracy, and significant clinical value, which can provide assistance in early clinical diagnosis decision-making. [ABSTRACT FROM AUTHOR]

Health care should aim to heal rather than harm. Sometimes traditional or routine practices which are not evidence-based can affect a person's health and wellbeing. They may experience minor issues such as the adverse effects of a medicine, major issues such as developing Clostridium difficile, or even death as a result of antimicrobial resistance (AMR). NHS hospital staff insert around two million urinary catheters each year (Shackley et al, 2017; NHS Digital, 2023). In some cases, antibiotic prophylaxis is given on insertion or removal of the catheter (Scarlato et al, 2017; Morris et al, 2023). Inappropriate urinary catheterisation and misuse of antibiotics expose individuals to a number of risks and increase the risk of antibiotic resistance. This paper examines the evidence base for antibiotic prophylaxis upon insertion and removal of urinary catheters. The author argues that a more holistic approach to care which reduces the routine use of indwelling catheters is required. [ABSTRACT FROM AUTHOR]

(1) Background: Urinary tract infections (UTIs) are caused by the proliferation of pathogenic microorganisms, and they are the second most common hospital-acquired infections, with catheter-associated UTIs (CAUTIs) accounting for about 40% of these nosocomial infections. This review aims to identify the impact of technology on preventing infections in patients with urinary catheters; (2) Methods: The search was conducted in April 2024 through the EBSCOhost platform, with access to the American Search Complete, CINHAL Ultimate, Medline databases, and through the Scopus database; (3) Results: In total were included eight articles in this review. Technology interventions can significantly reduce the incidence of CAUTIs, decrease the duration of catheter use, improve diagnosis, and enhance patient safety; (4) Conclusions: Technological advancements show significant benefits in reducing infection rates and improving patient outcomes, like shorter hospital stays and comfort. Multidisciplinary approaches and educational strategies are essential to maximize these benefits. [ABSTRACT FROM AUTHOR]

Aim: To assess the knowledge, attitude and practice (KAP) towards unnecessary urinary catheterisation among nurses in Taicang City, China. Design: Cross‐sectional study. Methods: This study included nurses from our hospital and was conducted between February 2023 and June 2023. Data Sources: A self‐administered questionnaire was designed to collect their demographic characteristics and KAP. Results: A total of 233 valid questionnaires were collected. The mean KAP scores were 13.44 ± 1.62 (possible range: 0–17), 45.28 ± 3.87 (possible range: 10–50) and 43.85 ± 5.98 (possible range: 10–50), which indicated moderate knowledge, positive attitude and proactive practice, respectively. The Pearson's correlation analysis showed positive correlations between knowledge and attitude (r = 0.253, p < 0.001), knowledge and practice (r = 0.279, p < 0.001), as well as attitude and practice (r = 0.441, p < 0.001). Partial correlation analysis adjusted for age, gender, department, working experience and experience in treating patients with catheter‐associated urinary tract infections also showed positive correlations among KAP. A structural equation modelling showed that both knowledge (β = 0.501, p = 0.047) and attitude (β = 0.691, p < 0.001) had direct effect on practice. Conclusion: This study found moderate knowledge, positive attitude and proactive practice among the participants. Both knowledge and attitude might affect their practice. Impact: We wanted to know the knowledge, attitude and behaviour of nurses in Taicang City towards unnecessary catheterisation. Moderate knowledge, positive attitude and proactive practice were found among the participants. The findings would provide evidence for policymakers to develop targeted educational intervention to improve nurses' practice and might improve the outcomes of patients. Reporting Method: This study was reported to be adhered to the STROBE guideline. Patient or Public Contribution: No patient or public contribution. Implications for the Profession and/or Patient Care: Targeted educational intervention was needed to improve nurses' practice. [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate the demographic, etiologic, and clinical characteristics, complicating factors, laboratory and radiodiagnostic evaluations, treatment practices, and follow-up processes of hospitalized patients diagnosed with acute pyelonephritis (APN). Materials and Methods: The files of 241 patients diagnosed with APN in the emergency department and admitted to clinics in our center between May 1, 2012, and May 1, 2016, were accessed through the automation information system of our hospital. Demographic characteristics, seasonal distribution, complaints, clinical findings, laboratory tests and imaging results, treatment, follow-up, and outcome status of the patients were retrospectively scanned and evaluated. Results: The mean age of the patients was 66.00±19.61 years. 54.4% were women. The most common presenting complaints were fever and flank pain; physical examination finding was suprapubic tenderness; predisposing factor was urinary catheterization; and comorbid diseases were chronic renal failure and DM. The most common causative agent was Escherichia coli The most common imaging findings were hydronephrosis and urolithiasis. The duration of hospitalization was 10.81±7.09 days; 1.2% of patients died. Conclusion: The most common predisposing factors for the development of APN were recent antibiotic use, particularly in the last two weeks, history of hospitalization in the last two weeks, chronic renal failure, and diabetes mellitus. APN may present as a spectrum ranging from mild to urosepsis. [ABSTRACT FROM AUTHOR]

Hyper-viscoelastic models have been used to characterize large strains coupled with viscosity. In this study, we aimed to model the urethral in-vivo biomechanics through a hyper-viscoelastic implementation. First, we used isotropic 2-parameter Demiray model for identification of urethral tube inflation after refining the values of quasistatic states. Attempting the approach by Holzapfel et. al., the average ratio of the elastic and dynamic modulus was computed to determine the stress contribution of the viscoelastic branches. The values of the parameters were determined after constraining a constant Energy dissipation (generalized maxwell) over range 1s to 100s. For the hyper-viscoelastic comparison implementation, it was observed that the goodness of fit criteria performs good for half of the samples (Adjusted R2>0.95). In some samples, the model is limited to fit 'S' shape curves but still performed well. The above identification technique and the hyper-viscoelastic in-silico approaches show that our approach fares sufficiently for the creep response characterization of the urethra. [ABSTRACT FROM AUTHOR]

At present， vascular intervention and surgery are the main methods for the treatment of pancreatic fistula with bleeding after pancreaticoduodenectomy， but these treatment methods have certain drawbacks， such as the complications of pancreatic fistula， bleeding， and abdominal infection after surgical treatment， and interventional treatment sometimes fails to identify the bleeding site. This article reports a case of complex pancreatic fistula with massive venous hemorrhage after pancreaticoduodenectomy treated with Foley catheter balloon compression through the drainage tube sinus. Bleeding was arrested and gastrointestinal fistula was cured after catheter balloon compression and effective drainage， with no complications such as pancreatic pseudocyst， intestinal ischemia， and portal hypertension. [ABSTRACT FROM AUTHOR]

Urinary tract infections caused by Aerococcus urinae have rarely been reported in children, and the clinical characteristics remain unclear. We reviewed medical records of children whose urine cultures grew A. urinae (≥104 CFU/mL) at a tertiary children's hospital in Tokyo, Japan. We found 17 pediatric patients in a review of 22,769 urine cultures between June 2006 and May 2022. The median age of 17 patients was 10.7 years (IQR 8–13 years), and males represented 76.5 % of the patients. Sixteen patients (94.1 %) had underlying urological conditions (neurogenic bladder, vesicoureteral reflux, urethral stenosis, bladder exstrophy, or urinary catheterization). The chief symptoms were fever (35.3 %), malodorous urine (23.5 %), nausea (11.8 %), and back pain (5.9 %). Ten patients were asymptomatic. Pyelonephritis was diagnosed in five male patients. All of them had underlying abnormal conditions of the bladder, and two had malodorous urine. All patients had favorable outcomes after 10–14 days of ampicillin/amoxicillin-based antimicrobial therapy. [ABSTRACT FROM AUTHOR]

Background: Delirium, which is prevalent in critical care settings, remains underexplored in acute coronary syndrome (ACS) patients in the cardiac intensive care unit (CICU). Aim: To investigate the prevalence and clinical significance of delirium in patients with ACS admitted to the CICU. Study Design: A prospective study (n = 106, mean age 74.2 ± 5.7 years) assessed delirium using the confusion assessment method‐intensive care unit (CAM‐ICU) tool in 21.7% of ACS patients during their CICU stay. Baseline characteristics, geriatric conditions and clinical procedures were compared between delirious and nondelirious patients. The outcomes included in‐hospital mortality, 30‐day and 6‐month mortality, acute adverse events and length of CICU stay and hospital stay (LOS). Results: Delirious patients who were older and had a higher incidence of coronary artery disease underwent more complex procedures (e.g., pacemaker placement). Multivariate analysis identified central venous catheter insertion, urinary catheterization and benzodiazepine use as independent predictors of delirium. Delirium was correlated with prolonged LOS (p <.001) and increased in‐hospital, 30‐day and 6‐month mortality (p <.001). Conclusions: Delirium in ACS patients in the CICU extends hospitalization and increases in‐hospital, 30‐day and 6‐month mortality. Early recognition and targeted interventions are crucial for mitigating adverse outcomes in this high‐risk population. Relevance to Clinical Practice: This study highlights the critical impact of delirium on outcomes in hospitalized patients with ACS in the CICU. Delirium, often overlooked in ACS management, significantly extends hospitalization and increases mortality rates. Nurses and physicians must be vigilant in identifying delirium early, particularly in older ACS patients or those with comorbidities. Recognizing independent predictors such as catheterization and benzodiazepine use allows for targeted interventions to reduce delirium incidence. Integrating routine delirium assessments and preventive strategies into ACS management protocols can improve outcomes, optimize resource utilization and enhance overall patient care in the CICU setting. [ABSTRACT FROM AUTHOR]

Purpose: It has been proposed that reusable catheters are more cost effective and environmentally sustainable than single‐use catheters intended for intermittent catheterization (IC). However, the aspect of individuals' well‐being and preference for catheter type is not considered. In this study, we investigated the impact on individuals' health‐related quality of life (HR‐QoL) when testing a reusable catheter. Materials and Methods: The study was an open‐labeled, single‐arm, multicenter investigation with a treatment period of 28 days. Forty subjects using single‐use hydrophilic catheters were accustomed to a reusable catheter for managing IC. HR‐QoL was evaluated by the Intermittent‐Self Catheterization Questionnaire (ISC‐Q). Additionally, satisfaction was evaluated by the Intermittent Catheterization Satisfaction Questionnaire (InCaSa‐Q). The difference in total score was analyzed using a mixed linear model. Furthermore, preference for IC (single‐use vs. reusable) was assessed and microbial evaluation of the catheters was performed. Results: The total ISC‐Q score measuring HR‐QoL decreased significantly by 28% (p < 0.001). Two of the four subdomains (ease‐of‐use and discreetness) also decreased significantly (p < 0.001). The total InCaSa‐score and all four subdomains evaluating satisfaction decreased significantly (p < 0.005). The primary study results were supported by the fact that 90.9% of subjects preferred to use a single‐use catheter for IC. Furthermore, 50% of reusable catheters were contaminated with bacteria. Conclusion: Switching from single‐use to reusable IC resulted in a significant decrease in HR‐QoL and satisfaction. Moreover, the vast majority preferred the single‐use catheter due to handling and convenience. The users' rights to their preferred bladder management method should be acknowledged. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between sacral underdevelopment, as defined by subnormal sacral ratio (SR) measurements, with increased maximum detrusor voiding pressure (P det. Max) in infants. Methods: In this 2007–2015 retrospective cohort study, the medical records of all infants who underwent a pyeloplasty due to congenital ureteropelvic junction obstruction were added. Their P det. Max was evaluated through the suprapubic catheter utilized for urinary drainage intraoperatively, without imposing any additional risk of urethral catheterization on the infant. SR was calculated via the plain kidney, ureter, and bladder (KUB) radiography film obtained during the voiding cystourethrogram (VCUG) evaluation before the surgery. Participants were categorized into SR < 0.74 or SR ≥ 0.74. P det. Max was subsequently compared between these two groups. Results: A total of 45 patients were included in our analysis. Twenty‐eight (62.2%) patients had a (SR < 0.74), while 17 (37.8%) had a (SR ≥ 0.74). P det. Max was shown to be significantly higher in the SR < 0.74 compared to the SR ≥ 0.74 group (167.5 ± 60.8 vs. 55.7 ± 17.9 cmH2O, p < 0.001). After adjusting for age and sex, SR remained a significant contributor to P det. Max (p < 0.001). Physiologic detrusor sphincter dyscoordination (PDSD) rate was significantly higher in the SR < 0.74 versus SR ≥ 0.74 group (100.0% vs. 70.6%, respectively; p = 0.005). Conclusion: Lumbosacral underdevelopment, as indicated by subnormal sacral ratios, is associated with sphincter‐detrusor dyscoordination, which causes PDSD and can ultimately result in higher P det. Max in infants. [ABSTRACT FROM AUTHOR]

Introduction: Cesarean section is the most common surgery performed on women. The enhanced recovery recommendations are early urinary catheter removal and early mobilization, as essential elements of post-operative care. This study aimed to analyze the association between these elements and whether limiting the catheter treatment duration affects the timing of post-operative mobilization. Methods: This retrospective case-control study compared the mobilization of healthy elective cesarean patients under different instructions on urinary catheter removal: cases with a preset catheter removal time (8–12 hours) and controls with catheter removal based on midwife considerations. Apart from the preset time of catheter removal, the routine post-operative care was given by the same personnel without any advice on patient mobilization. Data on patient demographics, surgery details, post-operative medication, first upright mobilization, the length of hospital stay, and patient satisfaction were analyzed. Results: The study comprised 52 cases and one control for each case (N=104). The mean duration of urinary catheterization was 20.15 ± 6.59 and 11.30 ± 4.20 hours in the control and intervention groups, respectively (p<0.001). A linear regression analysis showed a significant association between the catheter removal time and patient mobilization, when adjusted for maternal background parameters (age, BMI, fear of childbirth diagnosis, prior uterine scar), duration and timing of the surgery, bleeding and post-operative analgesic use (R2=0.444, p<0.001). No difference was detected in the length of hospital stay, or patient satisfaction. Conclusions: Limiting the duration of urinary catheter therapy is associated with shorter time to post-operative mobilization. A prospective randomized trial would provide more detailed information. [ABSTRACT FROM AUTHOR]

Purple urine bag syndrome (PUBS) is a rare and unusual event. It is related to symptomatic urinary infection and asymptomatic bacteriuria in patients with indwelling bladder catheters. The purple color of the urine is due to metabolic products of biochemical reactions formed by bacterial enzymes in the urine. Gastrointestinal tract flora breaks down the amino acid tryptophan into indole, which is subsequently absorbed into the portal circulation and converted into indoxyl sulfate. Indoxyl sulfate is then excreted into the urine, where it can be broken down into indoxyl if the appropriate alkaline environment and bacterial enzymes are present. The breakdown products, indigo, and indirubin appear blue and red. We reported on an elderly woman who was kept in a nursing home, had multiple comorbidities such as history of cerebrovascular accident (CVA), acute kidney injury (AKI) and she was hospitalized due to decreased consciousness, fever and kidney failure. On the third day of hospitalization, the patient developed PUBS while undergoing urinary catheterization in the hospital. She had no history of previous catheterization and chronic use of antibiotics, she was only using Tolterodine for a long time due to urinary urgency. Due to antibiotic resistance, the drugs were not changed and the purple color disappeared after changing the catheter and urinary bag. This was the first patient in this region to be reported with this manifestation. [ABSTRACT FROM AUTHOR]

Recent studies have identified a urinary microbiome, dispelling the myth of urine sterility. Intravesical bacillus Calmette–Guérin (BCG) therapy is the preferred treatment for intermediate to high-risk non-muscle-invasive bladder cancer (BCa), although resistance occurs in 30–50% of cases. Progression to muscle-invasive cancer necessitates radical cystectomy. Our research uses 16S rRNA gene sequencing to investigate how the urinary microbiome influences BCa and its response to BCG therapy. Urine samples were collected via urethral catheterization from patients with benign conditions and non-muscle-invasive BCa, all of whom underwent BCG therapy. We utilized 16S rRNA gene sequencing to analyze the bacterial profiles and metabolic pathways in these samples. These pathways were validated using a real metabolite dataset, and we developed predictive models for malignancy and BCG response. In this study, 87 patients participated, including 29 with benign diseases and 58 with BCa. We noted distinct bacterial compositions between benign and malignant samples, indicating the potential role of the toluene degradation pathway in mitigating BCa development. Responders to BCG had differing microbial compositions and higher quinolone synthesis than non-responders, with two Bifidobacterium species being prevalent among responders, associated with prolonged recurrence-free survival. Additionally, we developed highly accurate predictive models for malignancy and BCG response. Our study delved into the mechanisms behind malignancy and BCG responses by focusing on the urinary microbiome and metabolic pathways. We pinpointed specific beneficial microbes and developed clinical models to predict malignancy and BCG therapy outcomes. These models can track recurrence and facilitate early predictions of treatment responses. [ABSTRACT FROM AUTHOR]

Background: Extensively drug-resistant Acinetobacter baumannii (XDRAB) has become a significant pathogen in hospital environments, particularly in intensive care units (ICUs). XDRAB's resistance to conventional antimicrobial treatments and ability to survive on various surfaces pose a substantial threat to patient health, often resulting in severe infections such as ventilator-associated pneumonia (VAP) and bloodstream infections (BSI). Methods: We retrospectively analyzed clinical data from 559 patients with XDRAB infections admitted to Jinhua Central Hospital between January 2021 and December 2023. Patients were randomly divided into a training set (391 cases) and a testing set (168 cases). Variables were selected using Lasso regression and logistic regression analysis, and a predictive model was constructed and validated internally and externally. Model performance and clinical utility were evaluated using the Hosmer-Lemeshow test, C-index, ROC curve, decision curve analysis (DCA), and clinical impact curve (CIC). Results: Lasso regression analysis was used to screen 35 variables, selecting features through 10-fold cross-validation. We chose lambda.1se=0.03450 (log (lambda.1se)=-3.367), including 10 non-zero coefficient features. These features were then included in a multivariate logistic regression analysis, identifying 8 independent risk factors for XDRAB infection: ICU stay of 1-7 days (OR=3.970, 95%CI=1.586-9.937), ICU stay >7 days (OR=12.316, 95%CI=5.661-26.793), hypoproteinemia (OR=3.249, 95%CI=1.679-6.291), glucocorticoid use (OR=2.371, 95%CI=1.231-4.564), urinary catheterization (OR=2.148, 95% CI=1.120-4.120), mechanical ventilation (OR=2.737, 95%CI=1.367-5.482), diabetes mellitus (OR=2.435, 95%CI=1.050-5.646), carbapenem use (OR=6.649, 95%CI=2.321-19.048), and β-lactamase inhibitor use (OR=4.146, 95%CI=2.145-8.014). These 8 factors were used to construct a predictive model visualized through a nomogram. The model validation showed a Cindex of 0.932 for the training set and 0.929 for the testing set, with a Hosmer-Lemeshow test p-value of 0.47, indicating good calibration. Furthermore, the DCA curve demonstrated good clinical decision-making performance, and the CIC curve confirmed the model's reliable clinical impact. Conclusion: Regression analysis identified ICU stay duration, hypoproteinemia, glucocorticoid use, urinary catheterization, mechanical ventilation, diabetes mellitus, carbapenem use, and β-lactamase inhibitor use as independent risk factors for XDRAB infection. The corresponding predictive model demonstrated high accuracy and stability. [ABSTRACT FROM AUTHOR]

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation. [ABSTRACT FROM AUTHOR]

Background: Diabetes insipidus (DI) is a common complication following pituitary surgery, causing significant health issues if left untreated. As part of the diagnostic process, accurate urinary output monitoring via indwelling urinary catheters (IDUCs) is essential, despite risks such as urinary tract infections and hindered recovery. Research on IDUC removal after pituitary surgery remains scarce. Aim: To explore health professionals' perspectives on IDUC management following pituitary surgery. Methods: Employing a qualitative design, semistructured interviews were conducted with 15 professionals in the neurosurgical ward of a Dutch academic hospital. Findings: Four themes emerged: Concerns about missing identifying DI, patient–nurse dynamics, workload management, and lack of shared decision making. Conclusion: The findings underscore the need to balance clinical needs with patient care efficiency. There is a need for evidence-based guidelines and a multidisciplinary approach to optimise IDUC management, given the importance of patient-centred care and shared decision-making. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical, psychological, and economic impacts of the initial dressing change timing following peripherally inserted central catheter (PICC) placement in postoperative breast cancer patients. Methods We enrolled a total of 120 patients who underwent PICC placement following breast cancer surgery at a tertiary hospital in Guangzhou between April and October 2023 for this study. Based on predefined inclusion and exclusion criteria, the patients were divided into an observation group and a control group, with each group comprising 60 patients. In the observation group, the first dressing change was performed 48 hours after PICC placement, whereas in the control group it was done within 24 hours post-placement. The primary outcomes assessed included pain intensity at the puncture site during the initial dressing change, occurrence of bleeding at the puncture site within one week, psychological state evaluated using validated scales such as PHQ-9 depression scale and GAD-7 anxiety scale, as well as maintenance frequency and associated costs over a three-week period. Results There were no significant differences in baseline characteristics between the two groups. The observation group exhibited significantly lower pain levels at the puncture site during the initial dressing change, reduced bleeding at the puncture site within one week, and a shorter duration of bleeding compared to the control group (P < 0.001). Moreover, the observation group demonstrated statistically significant decreases in depression and anxiety scores, as well as maintenance frequency and costs within three weeks post-placement when compared to the control group (P < 0.001). Conclusions The implementation of an early dressing change within 48 hours after PICC catheterization in breast cancer patients undergoing surgery has been demonstrated to effectively ameliorate hemorrhage and discomfort at the puncture site, consequently mitigating patient distress and anxiety. Moreover, this intervention facilitates a decrease in dressing change frequency while reducing financial burdens on patients. [ABSTRACT FROM AUTHOR]

Objectives. The Mitrofanoff principle has been extensively evaluated in terms of associated morbidity and mortality. However, there is limited literature specifically addressing quality of life (QoL), particularly concerning the laparoscopic procedure. The aim of this study was to assess the impact of laparoscopic appendicovesicostomy (LA) on QoL by using a specific questionnaire targeted at patients and their families. Materials and methods. This observational and descriptive study involved patients who underwent LA between May 2018 and December 2023. A survey consisting of 29 questions, organized into three sections was used: satisfaction with the surgery, outcomes, and current continence status. Responses were graded according to the Likert scale (1-5) (1 = strongly disagree, 5 = strongly agree). Results. Of the 29 contacted families, 24 (82.8%) responded. The average age was 12.3 years (SD 4.4), with 75.9% being male. The primary indication for surgery was pain during urethral catheterization (69%). Mean postoperative follow-up was 36.5 months. Regarding satisfaction with surgery: overall satisfaction, hospitalization duration and pain control was rated with a score of 5 by 66.7%, 58.3% and 58.3%, respectively. In terms of outcomes: 54.2% rated aesthetic results with a score of 5, and 83.3% rated improvement in QoL with a score of 4 or 5. Concerning current continence status, 66.6% were very satisfied with the results and reported total absence of leakages or on a very specific occasion (score of 4 or 5). Conclusions. This study supports the improvement in perceived QoL among patients requiring an LA. Overall satisfaction with the procedure and outcomes related to continence were perceived as very good by both patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: Home healthcare (HHC) is an important care choice for ageing people with disabilities; however, the risk factors for emergency department (ED) visits, a poor outcome index, remain unclear. Therefore, we conducted this study to clarify it. Methods: We conducted a case-control study from a medical center in Taiwan by identifying HHC patients between Aug 1, 2019, and July 31, 2021. Age, sex, iatrogenesis, underlying comorbidities, and ED visit data were collected. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of ED visits. Results: We identified 240 patients, including 133 patients with and 107 patients without ED visits, for this study. The mean ages were 83.9 and 83.3 years and females accounted for 71% and 60.9% of patients without and with ED visits, respectively. Multivariable logistic regression analyses showed that urinary catheters (adjusted odds ratio [aOR]: 5.84; 95% confidence interval [CI]: 1.48-23.01, p = 0.012) and peptic ulcer disease (PUD)/gastroesophageal reflux disease (GERD) (aOR: 2.27; 95%CI: 1.12-4.61, p = 0.023) were independent predictors of ED visits. Stratified analyses according to sex and age showed that PUD/GERD and dyslipidemia were significant predictors of ED visits in female patients. Conclusions and clinical implications: This study identified independent predictors of ED visits in HHC patients. Our results provide an important reference for the early prevention, recognition, and adjustment of care plans for at-risk patients. Further studies recruiting more patients and external validation are warranted. [ABSTRACT FROM AUTHOR]

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Objectives: In this study, we evaluated the risk factors for urinary retention after freehand transrectal ultrasound (TRUS) guided transperineal prostate biopsy (TPB). Patients and Methods: Data from 102 cases of freehand TPB at a single institution were retrospectively collected and analyzed. All patients underwent magnetic resonance imaging (MRI)-TRUS cognitive fusion TPB using a transperineal needle guide, with systematic biopsies from 10 prostate sectors and additional MRI-guided targeted biopsies. Exclusions comprised patients with coagulation abnormalities, prior prostate surgeries including biopsy, active urinary tract infection, or a lack of pre-biopsy multiparametric MRI. Results: 14/102 (13.72%) had urinary retention and required urethral catheterization for voiding difficulty or discomfort along with a bladder volume of ≥500 ml. Patients with retention exhibited significantly larger prostate volumes (median 75 cc vs. 40 cc; P < 0.05). Receiver operating curve analysis revealed a prostate volume threshold of 57.5 cc and a core number cutoff of 23 for predicting post-TPB urinary retention, with sensitivities of 78.57% and 85.71%, specificities of 75% and 82.95%, positive predictive values of 33.33% and 44.44%, and negative predictive values of 95.75% and 97.33%, respectively, whereas the number of biopsy cores correlated positively with the development of urinary retention (median 25 vs. 22; P < 0.05). Urinary retention was independent of the patient's age, comorbidities, presenting prostate-specific antigen levels, prebiopsy severity of lower urinary tract symptoms, and use of alpha-blockers. Conclusion: Patients with larger prostates and higher number of biopsy cores are at a higher risk of postfreehand TPB urinary retention and should receive appropriate counselling. Targeted biopsies alone, rather than a full template, may help mitigate urinary retention in these high-risk groups. [ABSTRACT FROM AUTHOR]

An inguinal bladder hernia (IBH) is an abnormal protrusion of the bladder into the inguinal canal accompanied by a peritoneum sheath that creates the hernia sac. Clinical presentations vary greatly from lower urinary tract symptoms (LUTS) and reduction in scrotal size after voiding to being entirely asymptomatic. Since inguinal bladder hernias are uncommon and often accompanied by varied and nonspecific symptoms, it is challenging to diagnose and rarely included in differentials. Currently, computerized tomography (CT) imaging with contrast or voiding cystourethrography is recommended for diagnosis. There is no consensus on the best treatment for inguinal bladder hernias, with options ranging from laparoscopic repair to catheterization. In this study, we report the case of inguinal bladder hernia in an 86-year-old male presenting with symptoms of recurrent hematuria and two failed voiding trials after a Foley catheter placement from prostatomegaly resulting in bladder diverticula, and IBH. He was treated with prostate artery embolization (PAE) to address LUTS related to benign prostatic hyperplasia (BPH). The resultant decreased prostatic volume resolved his symptoms of IBH, hematuria, and urinary retention.